In order to help slow the spread of COVID-19, protect vulnerable individuals, and prevent the healthcare system in LA County from being overwhelmed, the LA County Health Officer issued orders requiring the self-isolation of persons diagnosed with or presumed to have COVID-19 and the self-quarantine of their close contacts.
LAC DPH is attempting to contact all laboratory confirmed COVID-19 cases to serve them with isolation orders and conduct contact tracing. In addition, in order to improve disease control, we are asking healthcare providers who diagnose a patient with either presumed or confirmed COVID-19 to give their patient isolation orders and instructions and tell their patient to provide quarantine orders and instructions to all their close contacts. See Presumed or Confirmed COVID-19- Ambulatory Patients for more details.
If a patient with COVID-19 is unable to inform their contacts of their exposure and need to quarantine (e.g. the patient is severely ill or deceased), this responsibility falls to the diagnosing healthcare provider. See When the Presumed/Confirmed Case Cannot Inform Contacts below for more details.
Isolation is used to separate people who are infectious with COVID-19 away from people who are not infected. Persons in isolation may be symptomatic (with or without laboratory confirmation) or asymptomatic with a positive viral test for COVID-19. Persons under isolation orders are released when they are no longer considered infectious, see Ending Isolation and Return to Work/School.
Quarantine is used to separate people who have been recently exposed to COVID-19 (close contacts) from others while they are potentially incubating virus and becoming infectious. Persons under quarantine orders are released when they are determined to no longer be at risk for spreading the virus, see Ending Quarantine and Return to Work/School.
Close Contact refers to any of the following people who were exposed to a patient with presumed or confirmed COVID-19 (“patient”) while they were infectious*:
*A patient with presumed or confirmed COVID-19 is considered to be infectious from 2 days before their symptoms started until their isolation period ends. Asymptomatic patients with laboratory-confirmed COVID-19 infection are considered to be infectious from 2 days before their test was taken until 10 days after their test was taken.
Note: a person is still considered a close contact if they and/or the case were wearing a cloth face covering or facemask at the time of exposure.
In the absence of a more likely diagnosis, patients with symptoms of an acute febrile respiratory illness (fever, cough, shortness of breath) should be presumed to have COVID-19.
Clinicians should use their clinical judgement to determine if patients presenting with other signs or symptoms are likely to have COVID-19 and should be isolated.
Confirmed COVID-19 – A patient with a positive SARS-CoV-2 test using a viral detection method (NAAT or antigen detection).
We are asking for your help to make sure that your patients understand that the isolation and quarantine orders are legal mandates that must be followed and why they are important. The following can be helpful:
Action Steps for Providers
If COVID-19 is presumed or confirmed, the diagnosing provider is asked to:
If testing a patient for SARS-CoV-2 virus
If a patient tests positive for SARS-CoV-2 virus
Ending Isolation and Return to Work/School
Persons with symptomatic COVID-19 can be released from isolation when the following criteria have been met:
Asymptomatic persons with COVID-19 who never developed symptoms may be released from isolation:
When their isolation period ends, they may resume their usual activities including return to work and/or school. They should be reminded to continue to practice physical distancing (stay 6 feet away from others) and to wear a cloth face covering when they are in public settings where other people are present. Neither Public Health clearance nor a negative COVID-19 test is required for return to work/school.
The CDC no longer recommends PCR testing to discontinue home isolation. Patients can shed non-infectious viral RNA for an extended period of time.
Special Considerations for Ending Home Isolation
For patients with severe to critical illness or who are severely immunocompromised, the CDC recommends extending the duration of isolation or precautions from 10 days to up to 20 days from illness onset.
A test-based strategy for discontinuing isolation could be considered for persons who are severely immunocompromised, however the CDC recommends this be done in consultation with infectious disease experts.
All close contacts of presumed and confirmed COVID-19 cases are required to self-quarantine, per the Los Angeles County Health Officer quarantine orders. They must stay in quarantine for 14 days from their last contact with the infectious person. If they remain asymptomatic, they are released from quarantine on day 15.
Patients Presenting as Close Contacts-Action Steps for Providers
If a patient presents as a close contact, providers are asked to:
Testing of close contacts
LAC DPH recommends testing of persons who are close contacts to a patient diagnosed with COVID-19. The rationale is to detect current asymptomatic or pre-symptomatic COVID-19 cases for contact tracing in order to decrease disease spread.
Patients receiving quarantine orders and instructions are told to seek testing for COVID-19. If a patient presents to your office requesting testing because they are a close contact, even if they do not have quarantine documents with them, please do not deny them SARS CoV-2 PCR testing.Provider actions based on results:
Follow the guidance for cases above.Negative SARS CoV-2 PCR test
Because of the expected high false negative rate during incubation period, negative test results in these recently exposed patients cannot rule out infection.
Ending Quarantine and Returning to School/Work
The close contact must stay in quarantine for 14 days from the last date that they were in contact with the infectious person. They may return to regular activities including work or school after the 14 days have passed.
Neither Public Health clearance nor a negative COVID-19 test is required for return to work and/or school. The patient should be reminded to continue to practice physical distancing (stay 6 feet away from others) and to wear a cloth face covering when they are in public settings where other people are present to reduce the risk of COVID-19 transmission or acquisition in the future.
Health and Human Services has issued a Limited Waiver of HIPAA Sanctions and Penalties During a Nationwide Public Health Emergency to cover these disclosures during the COVID-19 outbreak.
Persons who have recently recovered from confirmed COVID-19, for 90 days after the onset of the initial illness (or after the date of first positive viral test if they never had symptoms) who:
Develop new symptoms consistent with COVID-19 illness:
Healthcare providers should always use their clinical judgment and consider exceptions, particularly for patients who are severely immunocompromised.
Rationale - Reinfection is very unlikely to occur within the first 3 months after infection. Available data indicate that persons with mild to moderate COVID-19 remain infectious no longer than 10 days after symptom onset. Persons with more severe illness or severe immunocompromise likely remain infectious no longer than 20 days after symptom onset. Recovered persons, however, may continue to shed detectable but non-infectious SARS-COV-2 virus for up to 3 months.
For more detailed discussion of this evidence and CDC recommendations see, Duration of Isolation and Precautions for Adults with COVID-19.
LAC DPH will attempt to contact patients with laboratory confirmed COVID-19 by phone in order to interview them about possible exposures and to identify others who may have also been exposed to the infection (contact tracing). They will leave a call back number if necessary. If they cannot reach the patient by phone, they will send a letter. LA County Public Health will provide information to cases and contacts about how to protect themselves and others from COVID-19 and information about resources for delivery of essentials such as food and medicines if needed.
This flyer explains to patients what to expect.
Short URLs - are available at the top of this page to make it easier to direct patients to the quarantine and isolation webpages over the phone.
Information about symptoms - information from DPH (ph.lacounty.gov/covidcare) and the CDC for people who want to learn about symptoms, or who have symptoms of COVID-19 but have not been tested or sought medical advice.Home Cleaning Guidance
Additional information for providers in multiple languages is available on the LAC DPH Print materials webpage.