COVID-19 Alert for Healthcare Providers

COVID-19: Revised Quarantine Guidance - December 7, 2020

Posted December 7, 2020. Past health advisories and alerts are archived for historical purposes and are not maintained or updated.

Centers for Disease Control & Prevention (CDC) and Washington State Department of Health (DOH) have released revised options to reduce quarantine for contacts of persons with COVID-19 infection using symptom monitoring and diagnostic testing. The 14 days of quarantine is still recommended. The following options have been presented to shorten quarantine and are acceptable alternatives to balance personal burden against a small possibility of increasing the spread of the virus:

  • In some instances, quarantine can end after Day 10 without testing and if no symptoms have been reported during daily monitoring.
    • Additional criteria must be met:
      • No clinical evidence of COVID-19 has been elicited by daily symptom monitoring; and,
      • Daily symptom self-monitoring continues through quarantine Day 14; and,
      • Persons are counselled regarding the need to strictly adhere strictly to masking and physical distancing through quarantine Day 14. They should be advised that if any symptoms develop, they should immediately self-isolate. (Note: Education on symptoms to include headache, congestion, fatigue, and diarrhea is imperative.)
      • Testing on or around Day 10 is recommended.
  • The 14-day quarantine period is required in certain high-risk settings, including long term care, healthcare settings (particularly when the exposure in a healthcare worker is from a household member), correctional settings, inpatient substance use or behavioral health treatment settings, and homeless shelters.
  • Note: SRHD is not recommending the reduced quarantine option of seven days with a negative test due to very high incidence rates in the community. We will review guidance every two weeks to determine relevancy.

The purpose of quarantine is to reduce the risk that infected persons might unknowingly transmit infection to others. A 14-day quarantine can impose personal burdens that may affect physical and mental health as well as cause economic hardship that may reduce compliance. Implementing quarantines can also pose additional burdens on public health systems and communities, especially during periods when new infections, and consequently the number of contacts needing to quarantine, are rapidly rising. Lastly, the prospect of quarantine may dissuade recently diagnosed persons from naming contacts and may dissuade contacts from responding to contact tracer outreach if they perceive the length of quarantine as too onerous.

Reducing the length of quarantine will reduce these burdens and may increase community compliance. The CDC’s latest guidance document lays out evidence to support the above option to shorten the quarantine period. Shortening quarantine may increase willingness to adhere to public health recommendations but will require evaluation; not only in terms of compliance with quarantine and contact tracing activities, but also for any potential negative impacts such as post-quarantine transmission. Any option to shorten quarantine will be less effective at preventing transmission than the currently recommended 14-day quarantine. The variability of SARS-CoV-2 transmission observed to-date indicates that while a shorter quarantine substantially reduces secondary transmission risk, there may be settings (e.g., with high contact rates) where even a small risk of post-quarantine transmission could still result in substantial secondary clusters

A Review of Isolation and Quarantine Recommendations

Isolation

  • Patients must isolate while awaiting test results. If COVID-19 is highly suspected, the patient’s household members should be strongly advised to quarantine as well.
  • Patients with COVID must isolate for a full 10 days after their symptom onset or positive test result (returning to normal activities on the 11th day) and fever must be absent for 24 hours without the use of fever-reducing medications.
  • Severe illness requiring hospitalization or severely immunocompromised patients must isolate for a full 20 days after symptom onset.
  • Patients who are asymptomatic at the time of their positive test who later develop symptoms must isolate for 10 days after symptom onset, not the date of their positive test.
  • Repeat COVID-19 testing after someone has met initial isolation criteria should not occur.

Quarantine

  • UPDATED People with known exposure must quarantine for:
    • RECOMMENDED 14 days after exposure; or,
    • Ten days after exposure as long as no symptoms have developed and exposed person adheres to strict masking and distancing and continues symptom monitoring through Day 14.
  • Mask usage (by either the case or the exposed person) does not negate the need for quarantine in the exposed person, except in exposed healthcare workers wearing proper PPE.
  • UPDATED Household members of a COVID case must quarantine for 14 or 10 days (as explained above) beyond the day of last contact with the case while they were infectious. This can be as long as 20-24 days (10 days of infectiousness for case plus 10 or 14 days of standard quarantine after exposure). Note that this period starts over for uninfected household members as new cases are identified.
  • Household members of a single exposed person (such as a child exposed in school) do not need to quarantine with the exposed person unless the exposed person develops symptoms and/or tests positive.