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COVID-19

Provider Isolation and Quarantine Guidelines


Updates

11-21-22

  • Updated to align with revised CDPH Guidance for Isolation and Quarantine of the General Public. This includes a different definition of close contacts in large indoor spaces (>400,000 cubic feet) and removing the required work exclusion or quarantine for certain exposed persons in correctional facilities and homeless shelters.
Background

The LA County Health Officer orders require persons diagnosed with COVID-19 to isolate and their close contacts to follow Instructions for Close Contacts. See Quick Links to view Health Officer Orders and Instructions.

Healthcare providers who diagnose a patient with COVID-19 (confirmed or presumed) are asked to give their patient isolation orders and instructions and to provide their close contacts with instructions (available at ph.lacounty.gov/covidcontacts).

Providers are also asked to consider outpatient therapy for their patients with COVID-19 at higher risk for progressing to serious disease. Similarly, they are encouraged to proactively tell patients who are close contacts and are higher risk about how to access outpatient treatment quickly should they test positive and have symptoms. Learn more at ph.lacounty.gov/covidtherapeutics

Definitions

Close Contact refers to anyone who shared the same indoor airspace (e.g., home, clinic waiting room, airplane, etc.) with someone with COVID-19 for a cumulative total of 15 minutes or more over a 24-hour period while they were infectious*.

In large indoor spaces greater than 400,000 cubic feet per floor (such as open-floor-plan offices, warehouses, large retail stores, manufacturing, or food processing facilities), a close contact is anyone who was within 6 feet with someone with COVID-19 for a cumulative total of 15 minutes or more over a 24-hour period while they were infectious*.

*A patient with COVID-19 is considered to be infectious from 2 days before their symptoms started until their isolation period ends. Asymptomatic patients with a positive SARS-CoV-2 viral test are considered to be infectious from 2 days before their test was taken until their isolation period ends.

Note: A person is still considered a close contact even if they and/or the case were wearing facemask at the time of exposure. Exceptions to this are healthcare personnel wearing appropriate PPE and employees who were wearing a respirator as per Cal/OSHA regulations.

Please note that a different definition of close contact may be used for exposures occurring at the workplace, for children at educational settings, and for some residents and employees of certain high-risk settings.

Confirmed COVID-19 — A patient with a positive FDA authorized SARS-CoV-2 viral test (i.e., NAAT/molecular or antigen tests, including over the counter (OTC) self-tests).

Presumed COVID-19 – A patient with clinically compatible symptoms of COVID-19 and no clear alternate diagnosis with/without exposure history. This presumptive clinical diagnosis is used when the provider has a high index of suspicion that a patient has COVID-19 despite a negative COVID-19 test.

A person who had a positive viral COVID-19 test within the past 3 months (90 days) who has recovered from the previous infection. Recovered means they are no longer considered infectious (i.e., their isolation period has ended).

If the patient had symptoms with their most recent infection, the 90 days are from the onset of the initial COVID-19 symptoms. If they never had symptoms, then the 90 days are from the date of collection of the first positive viral COVID-19 test.

A COVID-19 test is any FDA-authorized SARS-CoV-2 viral test. This includes nucleic acid amplification tests (NAAT) such as PCR tests and antigen tests as well as over the counter self-tests (OTC).

Note: OTC tests may be used for Cal-OSHA testing requirements if certain criteria are met. See Cal-OSHA Testing FAQs.

Isolation - COVID-19 in Ambulatory Patients
Overview All persons diagnosed with confirmed or presumed COVID-19 must isolate regardless of vaccination status, previous infection, or lack of symptoms.
Action Steps for Providers

When COVID-19 is confirmed or presumed, the diagnosing provider is asked to:

  • Evaluate whether care at home is suitable for the patient. Most patients do not require hospitalization and can self-isolate at home. Considerations for the suitability of at-home care include:
    • If the person is stable enough to be at home
    • If needed, appropriate and competent caregivers are available at home
    • If the person and other household members have access to recommended PPE (mask and gloves) and can adhere to recommended precautions as part of home care or self-isolation (e.g., respiratory hygiene, cough etiquette, hand hygiene).
  • Unless the patient requires alternate provisions, instruct them to immediately self-isolate and provide the patient with LAC DPH Health Officer Isolation Orders and instructions. Isolation and Quarantine Housing is available for persons who are able to perform activities of daily living (ADLs) independently.
  • Inform them that LA County Public Health may contact them to answer any questions they may have regarding COVID-19 and steps to take to prevent exposing others and to interview them for contact tracing.
  • Review the home isolation instructions, including:
  • Make a plan to closely monitor patients at increased risk for severe disease and prescribe outpatient therapy for COVID-19, if clinically appropriate (see box).

Antiviral Therapy for Ambulatory Patients

Early outpatient treatment of COVID-19 can avert serious, potentially life-threatening illness. Individuals should be considered for outpatient therapy for COVID-19 if they meet the criteria below:

Treatment should be initiated as soon as possible. See COVID-19 Monoclonal & Antiviral Therapy for Non-Hospitalized Patients at ph.lacounty.gov/covidtherapeutics for currently recommended treatments.

Duration of Isolation

Symptomatic COVID-19 Infection

Isolation can end after Day 5 ONLY if all of the following criteria are met:

  • They have a negative viral COVID-19 test collected on Day 5 or later (antigen test preferred) and
  • They have not had a fever for at least 24 hours and
  • Their symptoms are improving.

--or--

Isolation can end after Day 10 if fever-free for 24 hours without the use of fever-reducing medications. If fever is present, isolation should continue until 24 hours after fever resolves.

Note: Most outpatients with follow-up positive viral tests may end isolation after Day 10. This is because patients who have recovered from COVID-19 can continue to have positive COVID-19 viral tests when they are no longer infectious. CDC recommends extending isolation for patients who were severely ill or who are moderately to severely immunocompromised. See Severe/Critical COVID-19 or Immunocompromised.

Patients with an initial presumptive clinical diagnosis of COVID-19 who are ruled out—if the healthcare provider reassesses the initial diagnosis and concludes that the patient is not infected with SARS-CoV-2 (and they never tested positive), the patient can leave isolation after they have been fever-free for 24 hours. If they are close contacts they must continue to follow instructions for close contacts.

Asymptomatic COVID-19 Infection

Persons with COVID-19 who never developed symptoms may be released from isolation:

After Day 5 if they have a negative COVID-19 viral test result from a specimen collected on Day 5 or later (antigen test preferred).  

--or--

After Day 10 from the date of collection of the initial positive viral test. 

Note: Most outpatients with follow-up positive viral tests may end isolation after Day 10. This is because patients who have recovered from COVID-19 can continue to have positive COVID-19 tests in upper respiratory specimens for up to 3 months after initial illness. CDC recommends extending isolation for patients who were severely ill or are immunocompromised. See Patients Who Are Immunocompromised or Had Severe/Critical COVID-19 Illness next. 

Patients Who Are Immunocompromised or Had Severe/Critical COVID-19 Illness

For patients with severe to critical COVID-19 illness (e.g., required hospitalization, intensive care, or ventilation support) who are not immunocompromised, the CDC recommends extending the duration of isolation and precautions from 10 days to up to 20 days from illness onset. This is because they may produce replication-competent virus beyond 10 days.

For patients who are moderately to severely immunocompromised (regardless of symptoms or COVID-19 illness severity) the CDC recommends an isolation period of at least 20 days, ending isolation in conjunction with a test-based strategy and consultation with an infectious disease specialist to determine the appropriate duration of isolation and precautions. This is because moderately or severely immunocompromised patients may produce replication-competent virus beyond 20 days.

See CDC Interim Guidance on Ending Isolation and Precautions for Adults with COVID-19 for more details.

Return to Work or School

Generally, employers may determine if their employees/contractors with COVID-19 must complete the full 10 days of isolation before returning to work or if they may return to work after Day 5 if the criteria above are met. Employees/contractors are advised to obtain information from their employer.


Children may return to school when they have completed isolation. For more information, refer to ph.lacounty.gov/EducationToolkitTK12.  

Instructions for Close Contacts including Quarantine
Overview

Asymptomatic close contacts in the general public no longer are required to quarantine, regardless of vaccination status. Quarantine or work exclusion is required for some exposed residents and workers in specific high-risk settings (see Higher Risk Settings below).

Close Contacts (General Public)

Asymptomatic close contacts in the general public do not need to quarantine. They must follow all instructions at ph.lacounty.gov/covidcontacts.

All close contacts in the general public are required to:

  1. Wear a highly protective mask around others indoors through Day 10. This includes wearing it at home.
  2. Monitor their health through Day 10. If symptoms develop, they must stay home and test for COVID-19.
  3. Get tested 3-5 days* after their last exposure (unless they recently recovered from COVID-19).

If they test positive at any time, they must follow isolation requirements at ph.lacounty.gov/covidisolation. See section above: Isolation-COVID-19 in Ambulatory Patients

*If the close contact is at increased risk for severe illness, testing is recommended as soon as possible and, if negative, again on Day 5. Identifying infection early after exposure enables earlier access to outpatient treatment options should symptoms be detected.

Providers are asked to tell their higher risk patients who are close contacts about outpatient treatments for COVID-19 should they test positive for COVID-19 and develop any symptoms. Please emphasize the importance of starting therapy soon after symptoms start and tell them how to contact your office for a prescription/referral if appropriate. See ph.lacounty.gov/covidtherapeutics

CLOSE CONTACTS WHO LIVE OR WORK IN CERTAIN HIGH-RISK SETTINGS

Some close contacts must quarantine or be excluded from work if they live or work in the following high-risk settings:

  • Healthcare settings
  • Long-term care centers
  • Adult and senior care facilities

See sector specific guidance for further information:

The following high-risk settings may require certain exposed persons to follow extra-precautions:

Patients with a History of Recent Recovery from COVID-19

A patient with a history of recent recovery from COVID-19 is defined as a person with a positive viral COVID-19 test within the past 3 months (90 days) who has recovered from the previous infection. Recovered means they are no longer considered infectious (i.e., their isolation period has ended).

If the patient had symptoms with their most recent infection, the 90 days are from the onset of the initial COVID-19 symptoms. If they never had symptoms, then the 90 days are from the date of collection of the first positive viral COVID-19 test.

If the recently recovered person

Is asymptomatic:

  • If they have close contact with a COVID-19 case, they are not required to test, quarantine, nor be restricted from work. They must follow the Instructions for Close Contacts including wearing a highly protective mask around others and monitor their health for 10 days.
  • If they have close contact with a COVID-19 case and their first positive test was:
    • ≤30 days prior-no viral testing is generally recommended
    • 31-90 days prior-antigen testing is recommended

Develops new symptoms consistent with COVID-19 illness:

  • Testing with antigen tests is recommended, especially if there is no alternative diagnosis and/or the symptoms developed within 10 days after close contact to a case.
  • They should be instructed to self-isolate pending clinical evaluation and the results of SARS-COV-2 testing, if performed.

Rationale:

Immunocompetent patients who have recovered from acute COVID-19 infection can continue to have detectable SARS-CoV-2 RNA in upper respiratory specimens for 3 months after illness onset and persistent positive antigen tests are possible for at least 24 days. Replication-competent virus has not been reliably recovered from such patients, and they are not likely infectious.  

Antigen testing of asymptomatic close contacts is recommended to identify a new infection if 31-90 days have passed since their first positive test. This is because persistent antigen positivity is unlikely after a month and because the probability of SARS-CoV-2 reinfection increases with time due to exposure to viral variants and waning immunity.

See CDC Key Findings from Transmission Literature for more information.

Isolation and Quarantine Housing
Isolation and Quarantine Housing is available for patients who have or who were exposed to COVID-19. The patient must be able to perform Activities of Daily Living (ADLs) independently. The Quarantine and Isolation Intake Call Center is open 7 days a week from 8am-8pm: 833-596-1009. Due to the health screening required to assess eligibility, the healthcare provider must make this referral for the patient. Self-referrals are not accepted.
CASE INTERVIEW AND CONTACT TRACING
Thumbnail of Contact Tracing Infographic

LAC DPH will attempt to contact patients with COVID-19 by phone or text. LA County Public Health staff will answer any questions the patient may have and share helpful resources.

This flyer explains to patients what to expect.

RESOURCES FOR PATIENTS

Resources for patients —the patient isolation and instructions for close contacts are available on webpages in English and Spanish and in PDFs in 13 languages. They also host resources including:

  • Information about Disability Insurance, Unemployment & Paid Family Leave for people who are unable to work because they, or a family member, need to isolate or quarantine.
  • Referral resources for food or other necessities such as the 24/7 County Information Line 2-1-1, the 211la.org website, and DPH resources web portal.
  • Patients experiencing homelessness or who are unable to safely isolate or quarantine at home can call the COVID Info line 833-540-0473, open daily 8:00am–8:30pm.
  • Information on mental health referrals.

Visit home isolation and instructions for close contacts to view these resources. 

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.

Additional information for providers in multiple languages is available on the LAC DPH Print materials webpage.


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Public Health has made reasonable efforts to provide accurate translation. However, no computerized translation is perfect and is not intended to replace traditional translation methods. If questions arise concerning the accuracy of the information, please refer to the English edition of the website, which is the official version.

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