COVID-19 Frequently Asked Questions

Generally, measuring an employee’s body temperature is a medical examination. Because the CDC and state/local health authorities have acknowledged community spread of COVID-19 and issued attendant precautions as of March 2020, employers may measure employees’ body temperature. As with all medical information, the fact that an employee had a fever or other symptoms would be subject to ADA confidentiality requirements.

Source: https://www.eeoc.gov/laws/guidance/pandemic-preparedness-workplace-and- americans-disabilities-act

No. These would not be disability-related inquiries. If the CDC or state or local public health officials recommend that people who visit specified locations remain at home for several days until it is clear they do not have pandemic influenza symptoms, an employer may ask whether employees are returning from these locations, even if the travel was personal.

Similarly, with respect to the current COVID-19 pandemic, employers may follow the advice of the CDC and state/local public health authorities regarding information needed to permit an employee’s return to the workplace after visiting a specified location, whether for business or personal reasons.

Source: https://www.eeoc.gov/laws/guidance/pandemic-preparedness-workplace-and- americans-disabilities-act

CDC provides guidance and work restrictions for healthcare workers potentially exposed to COVID-19 revised June 18, 2020. CDC defines “prolonged contact” as 15 or more minutes. However, any duration is considered prolonged if the exposure occurs during performance of an aerosol-generating procedure.

Source: https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html revised on June 18, 2020

First, please be sure to download and display the FMLA COVID-19 poster. This poster outlines paid leave. This applies to employers with fewer than 500 employees.

Employees may be paid up to two weeks (80 hours, or a part-time employee’s two-week equivalent) of paid sick leave based on the higher of their regular rate of pay or the applicable state or Federal minimum wage, providing they satisfy the qualifying reasons.

Qualifying reasons for leave related to COVID-19 include having been advised by healthcare provider to self-quarantine and experiencing symptoms of COVID-19 and seeking a diagnosis.

The cap is $511 per day and $5,110 total during the period April 1 through December 31, 2020.

If an employee is requesting such leave, certain documentation is necessary. This includes:

• The employee’s name;
• The date or dates for which leave is requested;
• A statement of the COVID-19 related reason the employee is requesting leave and written support for such reason; and
• A statement that the employee is unable to work, including by means of telework, for such reason.

In the case of a leave request based on a quarantine order or self-quarantine advice, the statement from the employee should include the name of the governmental entity ordering quarantine or the name of the healthcare professional advising self-quarantine, and, if the person subject to quarantine or advised to self-quarantine is not the employee, that person’s name and relation to the employee. This information is provided by the IRS.

Source:  https://www.dol.gov/sites/dolgov/files/WHD/posters/FFCRA_Poster_WH1422_Non-Federal.pdf

It is what it is. Employers qualify for tax credits. In order to apply for these credits, it is important to be able to distinguish the difference between regular wages and wages paid for sick leave. Maintain the following documentation:

• Documentation to show how the employer determined the amount of qualified sick and family leave wages paid to employees that are eligible for the credit, including records of work, telework, and qualified sick leave and qualified family leave.
• Documentation to show how the employer determined the amount of qualified health plan expenses that the employer allocated to wages.
• Copies of any completed Forms 7200, Advance of Employer Credits Due To COVID-19, that the employer submitted to the IRS.
• Copies of the completed Forms 941, Employer’s Quarterly Federal Tax Return, that the employer submitted to the IRS (or, for employers that use third party payers to meet their employment tax obligations, records of information provided to the third party payer regarding the employer’s entitlement to the credit claimed on Form 941).

Maintain documentation for four years.

Source: https://www.irs.gov/newsroom/covid-19-related-tax-credits-how-to-substantiate-eligibility-and-periods-of-time-for-which-credits-are-available-faqs#substantiate_eligibility

Maybe. If you have less than 50 employees you may elect to be exempt from providing paid leave for an employee to care for a son or daughter whose school or child care is closed due to COVID-19 only if providing such paid leave would jeopardize the viability of your practice. Factors to justify are whether such leave exceeds your available revenue and cause your practice to discontinue operating at minimal capacity and whether the absence of employees requesting such leave would create a substantial risk to your practice’s financial health or operational capabilities. Remember, you must be able to substantiate your reasons with documentation.

No, unless your employee agrees. Paid sick leave under the EPSLA is in addition to your employee’s (including Federal Employees’) other leave entitlements. You may not require your employee to use provided or accrued paid vacation, personal, medical, or sick leave before the paid sick leave. You also may not require your employee to use such existing leave concurrently with the paid sick leave under the EPSLA. But if you and your employee agree, your employee may use preexisting leave entitlements to supplement the amount he or she receives from paid sick leave, up to the employee’s normal earnings. Note, however, that
you are not entitled to a tax credit for any paid sick leave that is not required to be paid or exceeds the limits set forth under the EPSLA. You are free to amend your own policies to the extent consistent with applicable law.

https://www.dol.gov/agencies/whd/pandemic/ffcra-questions#33

The Families First Coronavirus Response Act (FFCRA) requires employers with fewer than 500 employees to provide up to two weeks (80 hours) of paid sick leave for certain qualifying reasons due to COVID-19 and up to 12 weeks of family medical leave (10 weeks paid) for employees who cannot work (or work remotely) because their minor child’s school or child care service is closed due to COVID-19.

However, an employee working as a health care provider or an emergency responder can be excluded from the paid sick leave and expanded family and medical leave by his or her employer. Initially “health care provider” was interpreted to apply only to front-line workers, such as emergency responders, physicians, and nurses. Most leading authorities including contacts from the Department of Labor interpreted that dentists and their employees were not included in the “health care provider” exemption as defined by FFCRA.

On September 16, 2020, the Department of Labor issued updated guidance regarding the FFCRA exemption. It appears that this decision creates a situation where dentists and their licensed employees would be exempt as health care providers, but other support staff such as administrative employees would be eligible to receive the leave benefits under FFCRA.

Unfortunately, the lack of clarity could create legal consequences if this issue is interpreted incorrectly. Additionally, some states may take a different position than the federal government. Consult legal counsel. Keep in mind, that the FFCRA reimburses private employers who have fewer than 500 employees with tax credits for 100% of the wages paid when they provide the paid leave to eligible employees who are required to take the leave for qualifying reasons related to COVID-19.

Source: https://www.dol.gov/agencies/whd/pandemic/ffcra-questions#56

Local public health authorities determine and establish the quarantine options for their jurisdictions. CDC currently recommends a quarantine period of 14 days. However, based on local circumstances and resources, the following options to shorten quarantine are acceptable alternatives.

• The quarantine can end after Day 10 without testing and if no symptoms have been reported during daily monitoring.
  • With this strategy, residual post-quarantine transmission risk is estimated to be about 1% with an upper limit of about 10%.
• When diagnostic testing resources are sufficient and available (see bullet 3, below), then quarantine can end after Day 7 if a diagnostic specimen test negative and if no symptoms were reported during daily monitoring. The specimen may be collected and tested within 48 hours before the time of planned quarantine discontinuation (e.g., in anticipation of testing delays), but quarantine cannot be discontinued earlier than after Day 7.
  • With this strategy, the residual post-quarantine transmission risk is estimated to be about 5% with an upper limit of about 12%.

In both cases, additional criteria (e.g., continued symptom monitoring and masking through Day 14) must be met and are outlined in the full text.

SOURCE: CDC, https://www.cdc.gov/coronavirus/2019-ncov/more/scientific-brief-options-to-reduce-quarantine.html (December 2, 2020)

TDH recommends you quarantine through 14 days after your exposure (resuming normal activities on Day 15). There are two alternatives, but less effective, quarantine release options proposed by CDC:

• 10 Day Quarantine: If you do not develop symptoms consistent with COVID-19 or have an additional exposure, you may resume normal activities after Day 10.
• 7 Day Quarantine: If you do not have symptoms and if you test negative by PCR or antigen test after Day 5 you may resume normal activities after Day 7. You are responsible for securing verification of your negative test results if using this quarantine release option. You should continue to monitor yourself for COVID symptoms through Day 14.

Watch for fever, cough, and shortness of breath during the 14 days after the last day you were in close contact with the person with COVID-19. If you develop these symptoms within 14 days of the last contact with a person with COVID-19, you may have COVID-19.

If your symptoms are mild, stay home, and monitor your health. If you need medical assessment, call the health clinic or hospital before you arrive and tell the provider that you are a contact with a person who was diagnosed with COVID-19.

Mask wearing is especially important though Day 14, and should also continue beyond your quarantine period.

Source: TN Department of Health, https://www.tn.gov/content/dam/tn/health/documents/cedep/novel-coronavirus/CloseContactGuidance.pdf

The recommendation to wait 15 minutes after completion of clinical care and exit of each patient without suspected or confirmed COVID-19 to begin to clean and disinfect room surfaces has been removed as of June 17, 2020 to align with CDC’s Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 in Healthcare Settings. The American Dental Association continues to recommend the 15-minute wait time after aerosol-generating procedures as of June 19, 2020.

Source: https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html updated June 17, 2020, and https://www.ada.org/en/publications/ada-news/2020-archive/june/ada-responds-to- change-from-cdc-on-waiting-period-length updated June 19, 2020

The time period was changed from 10 days before obtaining the specimen that tested positive for COVID-19 to 2 days. You may find it helpful to utilize your appointment confirmation/messaging service to remind patients to notify you within the 2 days if they have symptoms or are diagnosed with COVID-19. The recommendation for the shorter contact elicitation window will help focus case investigation and contact tracing resources toward activities most likely to interrupt ongoing transmission.

Yes! Contact all patients prior to their dental visit by telephone to screen them for COVID- 19 symptoms. If the patient reports symptoms, avoid non-emergent care and, if possible, delay the dental care until the patient has recovered.

Notify your patient in advance not to bring unnecessary persons to accompany them during their visit. Both the patient and their guest will be requested to wear a cloth mask or facemask when entering the dental office and will undergo screening for fever and symptoms consistent with COVID-19.

Upon arrival, ask about the presence of symptoms of COVID-19 and actively take the patient’s temperature. If the patient is afebrile (temperature <100.4 degrees F) and without COVID-19 symptoms, dental care may be provided using appropriate engineering controls, administrative controls, work practices, and infection control considerations.

The patient should re-don their face covering at the completion of their dental treatment.

https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html updated on June 17, 2020

Yes. Display the cough etiquette poster or other visual alerts in the reception area.  Instructions should include wearing a cloth face covering or face mask. Provide supplies such as alcohol-based hand rub with 60–95% alcohol, tissues, and no touch waste receptacle.

Install physical barriers at the reception area such as plastic barrier to limit close contact.

Place chairs in the reception area at least six feet apart. Remove toys, magazines, and other frequently touched items. Minimize the number of persons in the reception area.  Patients may opt to wait in their vehicle or outside the building. Avoid overbooking the appointment schedule.

Keep in mind that administrative personnel should wear a cloth face covering for source control while in the dental office.

https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html updated on June 17, 2020

Space patients at least six feet apart. This will involve careful appointment book control.  Install physical barriers between patient chairs. Easy-to-clean floor-to-ceiling barriers will enhance the effectiveness of portable HEPA air filtration systems.

Treatment rooms should be oriented parallel to the direction of airflow if possible. Where feasible, consider patient orientation carefully, placing the patient’s head near the return air vents, away from pedestrian corridors, and toward the rear wall when using vestibule- type office layouts.

Build enough time into each patient appointment to allow for adequate time required to clean and disinfect the treatment rooms between patients.

Both CDC and Federal OSHA issued guidance on PPE. OSHA indicates to wear work clothing, such as scrubs, lab coat, and/or smock or a gown, gloves, eye protection (e.g., goggles, face shield), and face mask (e.g., surgical mask) for dental procedures not involving aerosol-generating procedures on well patients.

For dental procedures that may or are known to generate aerosols on well patients, CDC recommends gloves, gown, eye protection (e.g., goggles, face shield) and NIOSH-certified, disposable N95 filtering facepiece respirator or better.

CDC indicates that during aerosol-generating procedures conducted on patients assumed to be non-contagious, the dental worker should use an N95 respirator or a respirator that offers a higher level of protection such as other disposable filtering facepiece respirators, powered air purifying respirators (PAPRs), or elastomeric respirators, if available. If a respirator is not available for an aerosol-generating procedure, use both a surgical mask and a full-face shield. The mask should be FDA cleared as a surgical mask. If a surgical mask and a full-face shield are not available, do not perform any aerosol-generating procedures.

Source: https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html

updated on June 17, 2020 and https://www.osha.gov/SLTC/covid-19/dentistry.html

The employer must conduct a hazard assessment to determine what hazards are present in the workplace. According to OSHA, controlling exposures to occupational hazards is a fundamental way to protect personnel. Conventionally, a hierarchy has been used to achieve feasible and effective controls. Multiple control strategies can be implemented concurrently and or sequentially. This hierarchy can be represented as follows:

• Elimination
• Substitution
• Engineering controls
• Administrative controls
• Personal protective equipment (PPE)

The most effective means of abating a hazard is to physically remove the hazard. This is not always possible. We quickly learned that we could not remain shut down any longer and maintain viability as a business or a country.

We next evaluate engineering and administrative controls. This includes monitoring patients for COVID-19 symptoms and physically taking their temperature. It includes refraining from using ultrasonic scalers and high-speed handpieces, installing barriers, implementing HEPA filtration, and other engineering controls.

The least effective method of making the workplace safer is by providing PPE. In other words, it is the lowest rank on the Hierarchy of Controls.

One way to evaluate the selection of PPE is how would you justify your selection and provision of PPE if one of the employees contracted COVID-19 and positive COVID-19 patient(s) were traced to your practice? What were the engineering controls in place? Did you provide adequate PPE as set forth by CDC and Federal OSHA?

If you justify that your engineering and administrative controls warrant not using a respirator, then OSHA would require that you provide Appendix D of the Respiratory Standard and employees could use respirators voluntarily.

Source: https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html updated on June 17, 2020 and https://www.osha.gov/SLTC/covid-19/dentistry.html

There are isolation gowns and surgical gowns. Surgical gowns should be prioritized for surgical and other sterile procedures during periods of gown shortage.

One option is to wear cloth isolation gowns. Gowns made of polyester or polyester- cotton fabrics can be safely laundered using routine procedures.

Consider using expired gowns beyond manufacturer-designated shelf life for training so that you preserve gowns for patient care.

Use gowns or coveralls conforming to international standards.

Source: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/isolation- gowns.html

Yes. CDC indicates that we put on a clean gown or protective clothing that covers personal clothing and skin likely to be soiled with blood, saliva, or other potentially infectious materials. Remove the gown or protective clothing and discard the gown in a dedicated container for waste or linen. Discard disposable gowns after each use. Launder cloth gowns or protective clothing after each use.

Source for this section: https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental- settings.html updated on June 17, 2020

Use NIOSH-approved alternatives to N95 respirators where feasible. These include other classes of filtering facepiece respirators, elastomeric half-mask and full facepiece air purifying respirators, powered air purifying respirators (PAPRs). All of these alternatives will provide equivalent or higher protection than N95 respirators when properly worn. NIOSH maintains a searchable, online version of the certified equipment list identifying all NIOSH-approved respirators.

Every other NIOSH approved filtering facepiece respirator is at least as protective as the N95. These include N99, N100, P95, P99, P100, R95, R99, and R100. Many filtering facepiece respirators have exhalation valves and should not be used in surgical settings as unfiltered exhaled breath would compromise the sterile field. On March 2, 2020, FDA issued an Emergency Use Authorization (EUA) authorizing the use of certain NIOSH- approved respirator models in healthcare settings.

Elastomeric respirators are half-facepiece, tight-fitting respirators that are made of synthetic or rubber material permitting them to be repeatedly disinfected, cleaned, and reused. They are equipped with replaceable filter cartridges. Similar to N95 respirators, elastomeric respirators require annual fit testing. Elastomeric respirators should not be used in surgical settings due to concerns that air coming out of the exhalation valve may contaminate the sterile field.

PAPRs are reusable respirators that are typically loose-fitting hoods or helmets. These respirators are battery-powered with blower that pulls air through attached filters or cartridges. The filter is typically a high-efficiency particulate air (HEPA) filter. Loose-fitting PAPRs do not require fit-testing and can be worn by people with facial hair. However, PAPRs should not be used in surgical settings due to concerns that the blower exhaust and exhaled air may contaminate the sterile field.

Source: https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirators- strategy/index.html updated June 28, 2020

During the recent dental office shutdowns, more employees worked remotely. This is yet another avenue for cybercriminals to attack. Persons working from home may have outdated security systems that cybercriminals love to access.

Dental practices must be vigilant in working with IT professionals to prevent any vulnerabilities to their database and network. Develop work-from-home policies and ensure the same level of security is in place on home networks. Ensure that all devices use multi-factor authentication, endpoint protection on all notebook computers and mobile devices with encrypted VNP tools. Telecommuters should use work-issued devices and not personal devices. Likewise, do not use work-issued devices for personal use.

Yes, the HIPAA Privacy Rule permits a covered entity to disclose the protected health information (PHI) of an individual who has been infected with, or exposed to, COVID-19 with law enforcement, paramedics, other first responders, and public health authorities without the individual’s HIPAA authorization, in certain circumstances, including the following:

• When the disclosure is needed to provide treatment.
• When such notification is required by law. For example, HIPAA permits a covered entity, such as a hospital, to disclose PHI about an individual who tests positive for COVID-19 in accordance with a state law requiring the reporting of confirmed or suspected cases of infectious disease to public health officials.
• To notify a public health authority in order to prevent or control spread of disease. For example, HIPAA permits a covered entity to disclose PHI to a public health authority. Under HIPAA, “public health authority” means an agency or authority of the United States.

Source: https://www.hhs.gov/sites/default/files/covid-19-hipaa-and-first-responders- 508.pdf