Revised Guidance on the Quarantine of Close Contacts to Persons Diagnosed with COVID-19
December 9, 2020
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- Be aware that CDC has issued new guidance related to the quarantine of people who come into close contact to people diagnosed with COVID-19.
- Be aware isolation guidance has NOT changed: Clinicians should continue to advise people diagnosed with or suspected to have COVID-19 to isolate themselves for a minimum of 10 days following their first onset of symptoms AND until they have been afebrile for at least 24 hours without antipyretics AND their respiratory symptoms have improved. Asymptomatic people with COVID-19 should stay in isolation for 10 days following collection date of their specimen for testing.
- Be aware quarantine guidance HAS changed: Public Health and CDC continue to recommend that whenever possible, all close contacts to people with COVID-19 remain in quarantine for 14 days following their last exposure. In order to improve overall compliance with quarantine recommendations, we now allow for options that consider economic and psychosocial factors that may prevent people from completing the full 14 day quarantine. The three available quarantine options are:
- The 14-day quarantine: This remains the safest option for preventing SARS-CoV-2 transmission and clinicians should encourage exposed people to adhere to this period of quarantine.
- The 10-day option: People who cannot adhere to a 14-day quarantine may leave quarantine after 10 days as long as they remain asymptomatic.
- The 7-day option: Selected close contacts may leave quarantine after 7 full days from their last contact with an infected person if they remain asymptomatic AND have a negative test on a specimen obtained no sooner than 48 hours before ending quarantine (e.g., no sooner than day 5 for release after day 7). This option provides the lowest level of protection against post-quarantine transmission, and at this time Public Health does not recommend its routine use. However, this may be an option for certain close contacts who cannot stay in quarantine for at least 10 days, particularly if the exposure risk is deemed to be low and the person will not be in a high-risk setting through day 14.
- Ensure that people leaving quarantine after 10 days or 7 days continue to monitor themselves through day 14 for symptoms, avoid crowded settings, and consistently wear a mask when outside the home, and isolate and seek testing if symptoms develop.
- Be aware that for household contacts to a person infected with COVID-19, the quarantine period starts as soon as the infected person is diagnosed with COVID-19 and continues through 14 days (or shortened option as needed) after the last day of the infected person's period of isolation (so quarantines often last >14 days total).
- Be aware a 14-day quarantine is preferred in healthcare settings and other congregate or potentially high-risk transmission settings. Quarantine duration in these settings should be based on the feasibility of adherence to a 14-day quarantine, the increased risk for post-quarantine transmission of a shorter option, and other details of the specific setting and situation such as staffing needs to ensure maintenance of essential services.
- Clinicians should test or refer for testing all people who live with someone diagnosed with COVID-19, as well as other close contacts, even if they are asymptomatic, in order to diagnose and counsel unrecognized cases requiring isolation. To avoid false-negative results, exposed persons with discrete exposures should not be tested sooner than 48 hours after that exposure (testing on day 5 through 7 may be ideal). A negative test obtained before the 14-day incubation period has elapsed does not rule-out infection developing during the remainder of the incubation period.
- Be aware that testing is available through high-volume testing sites. These sites can test household and other contacts to COVID-19. No patient will be denied testing because of lack of insurance or ability to pay for the test. A list of these sites is available online.
- Clinicians should advise patients diagnosed with COVID-19 to immediately notify the people they live with & other close contacts, including those in their workplace, that they need to test for COVID-19 and should go into quarantine.
- Clinicians should also advise patients diagnosed with COVID-19 to notify their employer.
- Clinicians should provide patients with written guidance on isolation and quarantine (see Resources tab)
COVID-19 cases and hospitalizations in King County and Washington state are at high levels and rising. Controlling this increase and preventing recurring waves of COVID-19 transmission requires that people diagnosed with COVID-19 go into isolation, and that close contacts to a person infected with COVID-19 go into quarantine. Since near the outset of the COVID-19 pandemic, CDC and Public Health have recommended that people exposed to COVID-19 go into quarantine for 14 days. This 14-day quarantine corresponds to the SARS-CoV-2 incubation period, the time from infection to when the vast majority of cases develop symptoms. This period of quarantine can be onerous, and contacts’ success in adhering to quarantine guidance is ill-defined and thought to be highly variable. The new guidance attempts to balance the unintended economic hardship and other factors that may reduce compliance with a 14-day quarantine and the risk of people developing and transmitting COVID-19 after shortened quarantine. Several recent, as yet unpublished mathematical models (available on CDC website in the Resources tab) suggest that shorter periods of quarantine may be sufficient to eliminate most transmission. New CDC guidance allows for shorter periods of quarantine when the 14-day quarantine is not possible.
- Options to Reduce Quarantine for Contacts of Persons with SARS-CoV-2 Infection Using Symptom Monitoring and Diagnostic Testing, CDC
- Interim COVID-19 Testing Guidance for Healthcare Providers, WA State Dept. of Health
- Guidelines on isolation for patients with confirmed or suspected COVID-19, WA State Dept. of Health
- Guidelines for What to do if you were potentially exposed to someone with COVID, WA State Dept. of Health