Individual risk assessment and fitness for duty for exposed healthcare workers should be determined with the support of COVID testing results, if available, and updated staff medical records. Updated CDC guidelines regarding healthcare workers can be found in the following resources list. In general, the following principles should be followed:

- All healthcare workers should engage in appropriate education, training and policies to comply with infection prevention and control.
- Any healthcare worker who develops fever or symptoms consistent with COVID-19 should immediately self-isolate and contact their established point of contact for testing.
- Per the CDC, “The utility of serologic testing to provide evidence of prior infection that would permit exclusion from quarantine has not been established and is not recommended for this purpose at this time.”
- Healthcare workers who are ill should not be involved in direct patient care.

Within the operational environment, health protection measures must be able to make allowances for mission-critical operational demands beyond the healthcare workers. Certain units, personnel, and functions are mission-critical and incapable of quarantining away from work for 14 days. To overcome this need, certain locations have established the concept of a “firewall” quarantine. While not an official CDC evolution, these firewall quarantines are designed to provide maximal protection from COVID-19 spread while allowing continued operations. It is modeled after the CDC’s recommendation for “Interim U.S. Guidance for Risk Assessment and Work Restrictions for Healthcare Personnel with Potential Exposure to SARS-CoV-2.”

Firewall quarantine is a self-sustaining group of individuals exposed to COVID-19 that must continue to work to sustain mission-critical capabilities. For 14 days, these individuals quarantine and self-monitor for symptoms of COVID-19. They are only allowed in their designated workstation or berthing unit and must wear N95s whenever outside of berthing. Firewalled individuals are required to have separate basic life support (bathrooms, showers) from others who are not firewalled. They also use separate workstations from those who are not quarantined. Meals are delivered, and they are prohibited from visiting the barber, gym, PX, DFAC, etc., until the firewall quarantine completes. Any violations of the firewall quarantine will cause a restart of the 14-day quarantine for the whole firewall cohort and may subject the offender to UCMJ disciplinary actions. Examples of units that have successfully implemented firewall quarantine include healthcare facilities, base defense units, and command and control elements.

RESOURCES:

CDC Return to Work for Healthcare Personnel with Confirmed or Suspected COVID-19

Interim U.S. Guidance for Risk Assessment and Work Restrictions for Healthcare Personnel with Potential Exposure to SARS-CoV-2

Strategies to Mitigate Healthcare Personnel Staffing Shortages

Additional Training, Resources, and Tools are listed at Appendix B