SARS-Coronaviruses and Highly Pathogenic Influenza Viruses

Section 6: Basis for "stand-down"

The Risk Assessment Group will re-assemble when assay results are available and when the rate of progression of symptoms in the staff member has been assessed. The decision to allow the employee to return to normal duties or to continue isolation will be made by the Risk Assessment Group based on all factors. Important supporting evidence would include an alternative diagnosis that explains the symptoms or negative PCR results for SARS Co-V and HPI virus and the resolution of symptoms. Laboratory workers may be asked to be seen by the Infectious Disease Medical Provider prior to return to work.

Section 7: Risk assessment

The Risk Assessment Group will consist of an infectious disease medical provider, a DOH epidemiologist, two Wadsworth Center scientists i.e., the individual's immediate supervisor plus another scientist with relevant BSL-3 laboratory experience and the Wadsworth Center Biosafety Officer. The Risk Assessment Group will be activated by Wadsworth Center senior administration in one of six situations.

1. An exposure event has occurred such that there may be a low or moderate to high risk of exposure of an individual or the environment to the pathogen.
2. An individual working in the BSL-3 laboratory within the last 14 days has developed symptoms consistent with the case definition of SARS or HPI (fever ≥ 100.4°F, lower respiratory symptoms [cough, shortness of breath], sore throat, rhinorrhea, chills, rigors, myalgia, and/or diarrheal illness).
3. An individual working with the pathogen within the last 14 days requests specimen testing.
4. When test results are available.
5. When the staff member's symptom progression indicates risk assessment is necessary.
6. Following resolution of symptoms in an ill worker, to evaluate clinical course, laboratory results and other diagnoses, to advise on removal of isolation practices, and to authorize return to work.

The Risk Assessment Group will take all information into account to determine whether there is high/moderate, low, or no risk of exposure and to determine what level of testing and isolation may be required.

Risk assessment criteria may include:

• Was there a documented exposure event?
• Is there evidence of compatible symptoms?
• Is there medical examination/laboratory data supporting a diagnosis of SARS, HPI or other illness?
• Did the individual work with an infectious agent within a time period prior to onset of symptoms that is compatible with the incubation period for SARS-CoV or HPI virus?
• Did the individual use a laboratory procedure likely to cause aerosols?
• Is there illness in other laboratory workers?
• Is there a high prevalence of respiratory disease in the community?