Health Care Facilities COVID-19 Contact Tracing Frequently Asked Questions
The Test & Trace Corps is focused on breaking chains of COVID-19 transmission to save lives and so that New Yorkers can get back to school, work and leading their lives. This FAQ provides an overview to health care facilities in New York City on terminology and questions related to contact tracing. More detailed guidance on exposures and infection control related to health care facilities can be found from the Centers for Disease Control and Prevention (CDC), New York State Department of Health (NYS DOH) and New York City Department of Health and Mental Hygiene (NYC DOHMH).
What is COVID-19?
COVID-19 is caused by a virus called SARS-CoV-2. People with this infection may or may not have symptoms.
How is COVID-19 diagnosed?
COVID-19 is typically diagnosed through laboratory testing for the presence of SARS-CoV-2 genetic material. Someone who is a close contact of a person with COVID-19 and who develops symptoms within 14 days of exposure is typically considered to have COVID-19, even if they do not have a positive test result. Antibody (serology) tests do not diagnose current infection, nor does a positive test mean definitive protection from re-infection.
What is a “close contact” of a person with COVID-19?
People who have had “close contact” to a person with COVID-19 include those who:
lived with a person with COVID-19
provided services in the home of a person with COVID-19
kissed or had sex with a person with COVID-19
spent at least 10 minutes or more within six feet of a person with COVID-19 without appropriate personal protective equipment (PPE)
What is a COVID-19 exposure?
An exposure occurs when a person has direct contact with infectious respiratory secretions (such as through coughing or sneezing) or other excretions (such as urine, feces and sweat) from a person with COVID-19. Exposures may also occur when a person lives in the same home, provides services in that home, is an intimate partner of a person diagnosed with COVID-19, or spends at least 10 minutes or more within six feet of a person with COVID-19 without appropriate PPE.
What is contact tracing?
Contact tracing involves finding people with COVID-19 and asking them about their close contacts in order to identify persons exposed to the virus that causes COVID-19.
What is the infectious period?
The infectious period is the time that a person with COVID-19 can transmit the virus to others. During this time, a person with COVID-19 is considered “infectious” to other people. For symptomatic people, this typically starts 2 days before symptom onset and lasts for at least 10 days after illness onset. For people with asymptomatic infection, the infectious period is typically 2 days before through 10 days after the date of collection of the first specimen that was positive for COVID-19.
What is the incubation period?
The incubation period is the time between exposure to the virus that causes COVID-19 through start of the infectious period. For COVID-19, the incubation period can be up to 14 days.
What is isolation?
Isolation is the separation of people who are infectious with a contagious disease from the rest of the population. Isolation of persons with COVID-19 who are outpatients can be done in their own home, or if safe separation from others in the home is not possible, within a hotel room that is available through the Test & Trace Corps. In general, a person with COVID-19 is asked to isolate for 10 days from when the date their symptoms started (if symptomatic) or the date of collection of the first specimen that was positive for COVID-19 (if asymptomatic).
What is quarantine?
Quarantine is the separation of people who were exposed to a contagious disease from the rest of the population. Quarantine of COVID-19 close contacts can be done in their own home, or if safe separation from others in the home is not possible, within a hotel room that is available through the Test & Trace Corps. In general, a person with close contact with a person with COVID-19 is asked to quarantine for 14 days from when they were last exposed, because the incubation period for COVID-19 can be up to 14 days.
What defines a COVID-19 exposure for patients and visitors in health care facilities?
For patients and visitors within a health care facility, exposures occur when patients or visitors have had “close contact” (see definition above) with a person infectious with COVID-19.
What defines a COVID-19 exposure for health care personnel in health care facilities?
Health care personnel (staff and volunteers in a health care facility) are considered exposed in health care facilities if any of the following are true:
They were not wearing a face mask or respirator and spent 10 minutes or more within 6 feet of a person infectious with COVID-19, regardless of whether the infected person was wearing a face covering or face mask.
They were not wearing a mask and eye protection (goggles or face shield) and spent 10 or more minutes within 6 feet of a person infectious with COVID-19 who was not wearing a face covering or face mask.
They were not wearing all recommended personal protective equipment (gloves, gown, respirator [e.g., N95 respirator], and either goggles or face shield) when a procedure was performed that can generate aerosols (e.g., intubation, suctioning, high-flow oxygen administration, nebulizer treatment) on a person infectious with COVID-19.
How can health care facilities protect employees, visitors, and patients from exposure to COVID-19 at health care facilities?
Reduce the risk of COVID-19 exposure at your facility by implementing the following:
Screen: All employees, patients, and visitors should be screened for COVID-19 signs and symptoms (such as temperature checks) prior to entering your facility.
Keep physical distance: Limit the number of people in waiting areas and keep people in waiting rooms 6 feet apart.
Support contact tracing investigations when cases are identified: Review medical and scheduling records of who was at your facility, in what capacity, and on what dates and times.
Implement source control measures: Ensure that all patients, visitors, and health care personnel at your facility wear face masks because people can be infectious without symptoms.
Use PPE: Ensure that health care personnel wear appropriate PPE as per CDC guidance.
Further information on how facilities can safely continue to operate can be found at https://www.cdc.gov/coronavirus/2019-ncov/hcp/ways-operate-effectively.html
What should health care facilities do when they identify a COVID-19 case?
When a person with COVID-19 is identified as being at your health care facility while infectious, a contact tracing investigation should be undertaken by the health care facility to identify individuals that may have had an exposure to the person with COVID-19 while at the health care facility using the criteria defined above. The contact tracing investigation should involve a review of in-person interactions the person with COVID-19 had at the health care facility during their infectious period. The health care facility should then notify the individuals who have been identified as close contacts and advise them to get tested for COVID-19 and to quarantine for 14 days after the exposure. The investigation will support contact tracing efforts by identifying exposed individuals who should be advised to get tested and quarantine for 14 days from the date of exposure. Additionally, contact tracing investigations can also help to identify opportunities for improvement in infection control protocols. Guidance on risk assessments for health care personnel, personal protective equipment use, and infection control support can be found from CDC, NYS DOH, and NYC DOHMH.
What if one of my employees has a positive antibody test or previous laboratory-confirmed COVID-19? Do they still need to quarantine after an exposure?
Do not use results of antibody tests or previous laboratory-confirmed COVID-19 results to decide whether a person is considered exposed or not. It is not yet known whether a positive antibody test means that someone is protected from getting COVID-19 or how long immunity lasts from a previous episode of COVID-19.
When can health care personnel exposed to the virus that causes COVID-19 return to work?
Health care personnel who were exposed to COVID-19 must quarantine for 14 days from the date of last exposure and monitor daily for symptoms unless furlough of staff would significantly impact facility operations (see NYS DOH Health Care Staff Guidance and additional guidance for Nursing Home Staff). During staffing shortages in which staff who were exposed to SARS-CoV-2 are required to work, exposed health care personnel must be screened for COVID-19 symptoms prior to start of shift and wear appropriate PPE while at work. (Health care personnel must be excluded from work immediately if symptoms develop.) Exposed staff who are permitted to work are required to quarantine while not at work. Before making decisions on return-to-work policies, heath care facilities should review the most up-to-date guidance which can be found here.
When can health care personnel diagnosed with COVID-19 return to work?
Health care personnel who test positive for SARS-CoV-2 with a viral RNA- or antigen-based test should not go to work. They should isolate themselves at home (or any other location where they can avoid contact with others) and monitor their health for at least 10 days from the date of symptom onset or the date of collection of the first specimen that was positive for COVID-19 (if asymptomatic) (see NYC Health Department Health Advisory# 14). If asymptomatic health care personnel remain symptom-free, they may return to work after the 10 day monitoring period. If asymptomatic health care personnel develop symptoms of COVID-19 during the 10 day monitoring period, they will need to isolate for 10 days from symptom onset and until they have been afebrile for at least 24 hours without antipyretics and their symptoms have improved before they return to work.
Of note, based on current New York State guidance, employees of long-term care facilities (e.g., nursing homes, adult care facilities) cannot return to work until they have a negative RNA-based test after a minimum of 14 days isolation (see also NYS Dear Administrator Letter).
Note: The information provided is subject to change as the COVID-19 public health emergency evolves. As we learn more about COVID-19, details will be updated and revised.