The following information is provided for Fire and EMS agencies following COVID immunization of personnel, regarding isolation of personnel for symptoms of COVID as opposed to side effects of COVID vaccinations. This document is intended to reduce the risks for disruptions in work resulting from:
- Unnecessarily excluding personnel with only post-vaccination signs and symptoms from work, and
- Inadvertently allowing personnel with COVID infection to work.
Considerations are based on the current information, including timing and duration, and may change as experience with the vaccine accumulates.
Overview
Systemic signs and symptoms such as fever, fatigue, headache, chills, muscle and joint aches can occur following COVID-19 vaccination. Preliminary information from COVID-19 vaccine trials indicates that most post-vaccination signs and symptoms are mild to moderate in severity, occur within the first three days of vaccination (the day of vaccination and following two days, with most occurring the day after vaccination), resolve within 1-2 days of onset, and are more frequent and severe following the second dose and among younger persons compared to those who are older (>55 years). Cough, shortness of breath, congestion/runny nose, sore throat, or loss of taste or smell are NOT consistent with post-vaccination symptoms, and instead may be symptoms of COVID-19 or another infection.
If EMS personnel with postvaccination signs and symptoms are restricted from work unnecessarily, this has negative consequences for the personnel, the agency, and the community. Note that vaccinated personnel should continue to follow all current infection prevention and control recommendations to protect themselves and others from COVID-19 infection.
Strategies to Reduce Lost Work Time due to Post Vaccination COVID Symptoms:
- Vaccinate personnel when they are not required to be at work for the next 1-2 days when feasible.
- Stagger delivery of vaccine so that not all personnel from a shift are vaccinated at the same time. Staggering vaccinations may be more important following the second dose of vaccine.
- Inform personnel about potential vaccine side effects, mitigation (e.g., nonsteroidal anti-inflammatory medications or acetaminophen), and agency polices.
Suggested Approaches to Evaluating and Managing Post-Vaccination Side Effects
The approaches below apply to personnel who have received the COVID-19 vaccination in the prior 3 days (including day of vaccination, which is considered day 1) and are not known to have had unprotected exposure to COVID-19 in the previous 14 days. Symptomatic personnel who are within 14 days of an unprotected exposure should be isolated.
Ultimately, clinical judgement should be used to determine the likelihood of infection versus post-vaccination symptoms and the indicated clinical approach.
NOTE: A positive (nucleic acid or antigen) COVID test should NOT be attributed to the COVID-19 vaccine. The vaccination does not influence the results of these tests.
The following signs and symptoms, alone, are not consistent with COVID-19 infection:
- Immediate hypersensitivity reactions (e.g., urticaria, anaphylaxis)
- Local symptoms (e.g., pain, swelling, or redness at injection site)
Signs and symptoms unlikely to be from COVID-19 vaccination:
Cough, shortness of breath, rhinorrhea (runny nose/congestion), sore throat, or loss of taste or smell) are not typical post-vaccination signs and symptoms. Agency policy for potential COVID infection should be applied for testing and isolation, including exclusion from work.
Signs and symptoms that may be from either COVID-19 vaccination or COVID-19 infection:
Systemic signs and symptoms (e.g., fever of 100.0 F or greater, fatigue, headache, chills, muscle and body aches) are consistent with post-vaccination signs and symptoms as well as with COVID-19.
Evaluate personnel who have the following criteria. They may be considered for return to work without viral testing for COVID-19:
- Feel well enough and are willing to work and
- Signs and symptoms are limited only to those observed following COVID-19 vaccination (i.e., do not have other signs and symptoms of COVID-19 including cough, shortness of breath, sore throat, or change in smell or taste).
- If personnel remain symptomatic for more than 2 days, agency policy should be followed for potential COVID infection, including isolation and exclusion from work.
- Ideally personnel with fever should be excluded from work pending further evaluation, including consideration for SARS-CoV-2 testing. If an infectious etiology is not suspected or confirmed as the source of their fever, they may return to work when they feel well enough.
- In agencies with critical staffing shortages, personnel with fever and systemic signs and symptoms limited only to those observed following vaccination could be considered for work if they feel well enough and are willing. They should be re-evaluated, and viral testing for SARS-CoV-2 considered, if fever does not resolve within 2 days.
Information derived from CDC Guidance. Full guidance is available here:
https://www.cdc.gov/coronavirus/2019-ncov/hcp/post-vaccine-considerations-healthcare-personnel.html