12/02/2020

The purpose of this Special General Memorandum (SGM) is to inform all Indian Health Service (IHS) Staff that, in accordance with IHS Circular No. 20-14, it has been determined that there is a Business Necessity to protect Staff from the COVID-19 pandemic and that COVID-19 poses a Direct Threat that requires screening of IHS Staff. Based on guidance of the Centers for Disease Control and Prevention (CDC) and public health authorities as of March 2020, the COVID-19 pandemic presents a hazard to Staff. The CDC and public health authorities have acknowledged the threat of community spread of COVID-19. They issued precautions to slow the spread, such as the identification and self-isolation of individuals who test positive or show symptoms of COVID-19. The CDC and the Equal Employment Opportunity Commission (EEOC) have provided COVID-19 specific guidance, including:

1. CDC, Coronavirus (COVID-19) Exit Disclaimer: You Are Leaving www.ihs.gov 
2. CDC, General Business Frequently Asked Questions Exit Disclaimer: You Are Leaving www.ihs.gov 
3. EEOC, What You Should Know About COVID-19 and the ADA, the Rehabilitation Act, and Other EEO Laws Exit Disclaimer: You Are Leaving www.ihs.gov 

In addition, HHS has issued guidance for Staff in the workplace. HHS Phased Return to Normal Operations – Implementation Guidance. Exit Disclaimer: You Are Leaving www.ihs.gov  [PDF]

Based on this and other COVID-19 guidance, the IHS has determined that screening staff for COVID-19 is a Business Necessity and that COVID-19 represents a widespread Direct Threat. IHS’s determination is based on: (1) the duration of the risk—the risk of COVID-19 continues several months after the declaration of the pandemic; (2) the nature and severity of the potential harm—some who are exposed will become extremely ill and may require hospitalization or even die; and (3) the likelihood and imminence of the potential harm—everyone who is exposed is at risk of getting COVID-19 (IHS Circular 20-14).

The threat of COVID-19 requires that the IHS implement screening policies and procedures for all Staff to reduce transmission among Staff and maintain healthy operations and a healthy environment. Consistent with the Business Necessity and the Direct Threat, as well as the HHS Phased Return to Normal Operations Implementation Guidance, all IHS Staff are required to:

1. Wear a personal face covering that complies with CDC guidelines when entering any IHS facility and at all times while in a healthcare facility, including in breakrooms or other spaces where they might encounter others. All IHS Staff working in locations other than a healthcare facility must wear a cloth face covering in any congregate settings (e.g., shared office spaces or cubicles) and in common areas (e.g., breakrooms) where social distancing is difficult to maintain.
2. If Staff become ill or symptomatic in the workplace, notify their supervisor and immediately leave the workplace (self-isolate); such Staff also are encouraged to contact their health care provider.
3. Stay home if they are feeling ill or have been in close contact¹ with someone who is sick.
4. Notify their supervisor as soon as possible if they test positive for COVID-19.

In addition to these requirements, facility-specific COVID-19 screening policies and procedures shall be established. At a minimum, the facility-specific COVID-19 screening policies and procedures must be consistent with the requirements listed above. In addition, depending on the local and situational considerations, additional COVID-19 screening policies and procedures may be required at particular IHS facilities, including but not limited to requiring Staff to:

1. Take a COVID-19 test before entering the workplace if the test is authorized for use by the Food and Drug Administration.
2. Answer pre-screen questions and take temperature screenings.
3. Adopt specific infection-control practices recommended by federal public health authorities and, to the extent applicable, state and local public health authorities.
4. Wear personal protective equipment (e.g., gloves and gowns) designed to reduce the transmission of COVID-19.
5. Provide a doctor’s note or other documentation certifying fitness to return to work after having symptoms or testing positive for COVID-19.

Effective Date

This SGM becomes effective on the date signed.

/Michael D. Weahkee/
RADM Michael D. Weahkee, MBA, MHSA
Assistant Surgeon General, U.S. Public Health Service
Director
Indian Health Service

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1 Close contact is defined as: a) being within six feet of a person with confirmed COVID-19; or b) having unprotected direct contact with infectious secretions or excretions of a person with confirmed COVID-19.