As more businesses reopen and the number of cases of COVID-19 climb in the community, organizations are having to navigate the challenges, twists and turns of managing a proper response to a known or suspected case. In this discussion we talk about the fundamentals of case response in non-healthcare settings and some of the lessons learned from the front line which can inform the development of an effective and efficient response protocol.

Case Response Fundamentals

A COVID-19 case response protocol can be broken down into five basic steps:

1. Identification & Reporting. What triggers a case response action? The short answer is when someone interfacing with your organization exhibits COVID-19 symptoms, a positive test, or has an exposure to a known or suspect case. This can rapidly become more complex when trying to sort out if symptoms are COVID-19 related or not, if testing is reliable, or if a “close contact” exposure has occurred. From a protocol standpoint, the critical piece is providing simple direction (erring on the side of caution) to encourage the reporting of potential cases and exposures. At the time of reporting, immediate actions should be taken to isolate suspected cases and potentially exposed persons pending a more in-depth assessment. In addition, potentially impacted areas should be closed to all personnel for at least 24 hours after the case was last present, and until proper cleaning and disinfection has occurred.
2. Incident Assessment. This step involves engaging an informed individual, typically a member of your COVID-19 response team or expert partner, to take a closer look at the reported incident. The assessment tackles three issues: 1) confirming that the subject person meets the criteria of being a known/suspected case or the criteria for a close-contact exposure, 2) identifying who has had a close contact exposure to the subject person, and 3) determining what areas/surfaces in the environment have been impacted.

3. Notification & Communication. This step involves informing the subject person and subsequent potentially exposed persons of the incident and the next steps to be taken. For employees, this includes how long they must remain out of the workplace, criteria for their return, and any support and benefits available. For third party customers and other stakeholders, this can be more complex. In the interest of slowing the spread of the virus and protecting people, informing potentially affected third parties is encouraged. When sharing case response information, it is also important that the privacy of individual medical information be preserved.

4. Cleaning & Disinfection. The next step is to clean and disinfect the impacted areas/surfaces identified in the incident assessment, or to ensure they are closed for a minimum of 7 days. Care should be taken to document that the proper areas/surfaces were addressed, that disinfectants approved by EPA for the SARS-CoV-2 virus were used, and that use was in accordance with label instructions. A period of enhanced routine cleaning/disinfection may also be prudent.

5. Monitoring & Closure. Communication with the subject case and exposed persons should be maintained during their isolation period (typically about 14 days) so that a proper determination can be made about when they can return. After the proper criteria have been met for ending isolation, the subject people can return, the case response protocol is concluded, and documentation is archived.

Lessons Learned

Experience in addressing case response activities has highlighted a few practice pointers to keep in mind:

1. Ensure employees and other stakeholders know what to report and to report it immediately. Delays in reporting symptoms, test results, and potential exposures can result in others being exposed and lead to further spread of the virus.
2. When addressing a case response incident, potentially exposed parties may experience significant concern over the events and their personal risk. Ensuring prompt action, thorough communication of information, and diligently addressing stakeholder concerns can help to minimize the disruption to people and the organization.
3. Be sure to continuously reinforce safe work practices. Properly developed and diligently implemented practices help to ensure that even when a COVID-19 case is present, risks of exposure and virus transmission are minimized.

Proper case response not only helps protect an organization’s people, resources, and reputation, but also plays a critical role in slowing the spread of the virus and helping the broader public health battle against COVID-19.

The team of environmental health experts at FACS stands ready to assist our client partners in implementing streamlined protocols for carrying-out and documenting case response actions.