Table.

Advantages and disadvantages of HCW monitoring, evaluation, and management during the COVID-19 pandemic

	Advantages	Disadvantages
Monitoring HCW contacts
Risk assessment of HCW contacts	Can identify HCWs at considerable risk of acquiring SARS-CoV-2 in the health-care setting and focus resources on active monitoring or proactive laboratory testing; can support implementation of quarantine measures for a specific group of HCWs, minimising the effect on the workforce and maximising containment of SARS-CoV-2 within the health-care environment	Can reduce awareness that interactions with any patients with COVID-19 (known or unknown) carry some risk of nosocomial transmission to HCWs; can be confusing when understanding of the optimal PPE remains unclear; can undermine HCW engagement with key IPC measures other than PPE (eg, hand hygiene and physical distancing) in the erroneous belief that these are ineffective; might not be relevant in settings where some level of PPE is universally recommended (eg, wearing of surgical masks for all patient contacts) and there is high adherence to other IPC measures
Use of (self)quarantine after contact	Can maximise containment of SARS-CoV-2 within the health-care environment, especially in HCWs who may have no, few, or atypical symptoms; can reduce HCW anxiety about contracting SARS-CoV-2 in the workplace from colleagues with known exposure	Can rapidly deplete the workforce, particularly in cases of HCWs infected with SARS-CoV-2 exposing many colleagues or when there is uncontrolled community transmission, with HCWs exposed outside of the hospital; might not be relevant in settings where some level of PPE is universally recommended (eg, wearing surgical mask for all patient contacts) and there is high adherence to other IPC measures
Symptom monitoring of HCWs
Active (eg, at the start of shifts or through regular telephone or email reporting)	Can support the reliable reporting of signs and symptoms compatible with SARS-CoV-2 infection; can lead to earlier identification of symptomatic HCWs, and therefore support targeted timely testing to reduce exposure of colleagues and patients; can be an opportunity to interact with HCWs about their general psychological and physical wellbeing to provide wider support	Can present a considerable administrative and resource challenge, depending on the exact method of active monitoring and selection of HCWs who undergo active monitoring; can lead to a rapid depletion of staff if minor symptoms lead to (self)isolation without SARS-CoV-2 testing; might be a drain on resources, especially in cases of clusters involving multiple HCWs and in settings where large sections of a hospital are dedicated to the care of patients with COVID-19
Self-monitoring	Can reduce the barrier to HCW SARS-CoV-2 testing, if a simple algorithm is combined with clear advice on how to access testing; can involve the majority of HCWs in one facility, thereby detecting SARS-CoV-2 cases among personnel resulting from known and unknown exposures within and outside of the health-care setting; can be supported using digital tools, such as symptom monitoring apps	Can be unreliable if HCWs do not consider self-monitoring sufficiently important, or do not disclose symptoms when present, or when atypical or very mild symptoms are frequent among affected HCWs; can lead to a rapid depletion of staff if minor symptoms lead to (self)isolation without SARS-CoV-2 testing; might be ineffective unless clear contacts in occupational health or their delegates are defined and accessible to advise on required measures when symptoms are detected
SARS-CoV-2 testing of HCWs: identification of cases
Regular testing (screening)	Can detect asymptomatic or mildly symptomatic cases and can reduce the risk of nosocomial transmission to other staff and patients; can provide an opportunity to check in at regular intervals with occupational health or other public health authority delegates	Can have a major impact on testing capacity depending on volume and frequency of HCW testing, potentially with few cases detected; can provide insufficient information if done intermittently, because positive HCWs might have been infected for an unknown period of time before being sampled and negative HCWs could become positive in the time between tests; might increase the sense of insecurity among staff if large numbers of asymptomatic or mildly symptomatic positive HCWs are identified, when the relevance of this finding for onward transmission is unclear (especially in settings with universal PPE for all patient contacts and high adherence to other IPC measures); can engender a potentially misdirected sense of security to staff
Responsive testing (to symptoms)	Can support rapid identification of HCWs infected by SARS-CoV-2 to provide adequate clinical support and inform self-isolation; can provide a sense of security to staff working in close proximity with colleagues (eg, ICUs, operating theatres, emergency departments); can represent an efficient use of resources, especially if the threshold for accessing testing is low, sampling is carried out rapidly after onset of symptoms, and results are available in a timely fashion	Can lead to delays in identification of symptomatic SARS-CoV-2 positive HCWs by relying on (self-) identification of symptoms if pathways to accessing testing are unclear or cumbersome, or if HCWs feel uncomfortable with accessing testing because of fear or stigma; might not identify asymptomatic or oligosymptomatic SARS-CoV-2 positive HCWs who could theoretically represent a source of infection for other staff or patients
Management of SARS-CoV-2 infected HCWs
Application of standard isolation duration	Can prevent a difficult to justify disconnect between public health measures and special provisions for HCWs; could ensure that the risk of introduction of SARS-CoV-2 from the health-care setting to the community is minimised	Might result in staff shortages, especially if isolation is symptom-driven rather than limited to individuals who are confirmed to be SARS-CoV-2 positive
Repeat PCR testing	Can identify HCWs no longer shedding SARS-CoV-2 and therefore assumed to have a low risk of transmitting the virus to other staff and patients; can provide a sense of security to staff working in close proximity with colleagues (eg, ICUs, operating theatres, emergency departments); can provide reassurance of safety to return to work in areas with high-risk patients (eg, on haemato-oncology or transplant units)	Might worsen staff shortages, particularly when the link between SARS-CoV-2 detection and transmissibility is unclear for infected people who are no longer symptomatic
SARS-CoV-2 serology testing	Could identify HCWs after SARS-CoV-2 infection and who might have some protection; could support more directed deployment of HCWs after SARS-CoV-2 infection	Could falsely reassure HCWs of being immune to SARS-CoV-2 when the correlates and duration of protection are insufficiently understood; could produce misleading data owing to the current lack of validated, scalable tests

HCW=health-care worker. ICU=intensive care unit. IPC=infection prevention and control. PPE=personal protective equipment. SARS-CoV-2=severe acute respiratory coronavirus 2.