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Wednesday Oct 07, 2020

Sorry, Boss, I Can't Guarantee Your Worker Is COVID-free

I’ve always felt somewhat wary of doctors’ work notes. They can be used against employees, they don’t necessarily lead to the outcome a patient needs and the requirement of a note can often lead to unnecessary (and expensive) visits to the doctor.

[Woman writing on clipboard]

I, like many physicians, have had an influx of requests for notes to employers of late. Many of my patients are asking me to attest that their runny nose is just a symptom of allergies or that their small fever was an anomaly. They’re all asking me to attest that they don’t have COVID-19, and I really can’t do that in a timely, accurate fashion. So I gave up. Here’s my note. Employers, enjoy! We live in a world of impossible choices.

Dear Employer,

Your employee is a patient in my care and has had a recent illness about which I was consulted. I cannot be more explicit regarding his illness without a written release, but my patient did share that he needs a doctor’s note stating he’s “cleared” from COVID-19 and is able to return to work – per your direction. I am happy to oblige, but I question the utility of this note.

Let me explain: I am just as frustrated as everyone else with our lack of evidence-based guidance on how to best protect ourselves, our co-workers and those we serve with regard to SARS-CoV-2. Any recommendations based on symptoms seem quaint given that we know those without symptoms can spread COVID-19. Any recommendations based on timeframes and testing seem equally odd given the logistical breakdown with testing and lack of clear, coordinated initiatives in our community.

As such, we recommend that everyone do their best at washing or sanitizing hands frequently (gloves are only helpful if changed quite frequently and with each new person served), avoiding touching the face, staying home when sick, wearing a snug-fitting mask over the nose and mouth, and spending as little time as possible in close proximity to others.

For anyone with prolonged exposure (6 feet or less for 10 minutes or more) to someone with confirmed COVID-19, I recommend a full 14-day quarantine.

For those who have been sick with any COVID-19 symptoms (there are many) or with confirmed COVID-19, we recommend isolation from others for 10 days from the onset of symptoms and suggest coming out of isolation only after being more than 24 hours fever-free and experiencing improvement in symptoms.

Although we encourage COVID-19 testing for anyone with any concern of infection or close exposure, we also recognize the logistical and financial difficulty that going this route poses for many people. Employers requiring a negative test for an employee to return to work should be aware that there is a risk of false reassurance with a falsely negative test. Essentially, a negative testing strategy may not provide clear protection to you, your employees or your clients. That said, if you choose to follow a negative testing strategy, we encourage employers to reimburse employees for this expense because doing so fosters a culture of health-focused, appropriate incentives to return to work.

Being around others when ill propagates the spread of this illness, and without clear mechanisms to test and isolate those who are infected, we will deal with the constant uncertainty regarding spread of the disease for the foreseeable future. As such – and given the constraints of a clear and cohesive public health and governmental response to this pandemic – I cannot “clear” my patient – your employee – as free from COVID-19 and safe to return to work.

Thus, we defer to individuals and their employers regarding return-to-work policies after illness in these uncertain times.

Good luck,

Your local family physician

Allison Edwards, M.D., founded and cares for patients at Kansas City Direct Primary Care;(kansascitydirectprimarycare.com) provides locums coverage at rural hospitals in Missouri, Kansas and Colorado; and is volunteer faculty at the University of Colorado and the University of Kansas. You can follow her on Twitter @Dr_A_Edwards.(twitter.com)

Read other Fresh Perspectives posts by this blogger.

Posted at 06:00AM Oct 07, 2020 by Allison Edwards, M.D.

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