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Reporting LAHAN Alerts

Coronavirus Disease 2019

Isolation and Quarantine


Background

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.

Key Terms and Definitions

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*:

  1. An individual who was within 6 feet of the patient for a total of 15 minutes or more within a 24-hour period
  2. An individual who had unprotected contact with the patient’s body fluids and/or secretions, for example, being coughed or sneezed on, sharing utensils or saliva, or providing care without wearing appropriate protective equipment.

*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.

Presumed COVID-19

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).

Counseling for Compliance
for patients who need to isolate or quarantine

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:

  • Talking with your patients to identify potential challenges to complying with the orders and brainstorming solutions; consider using motivational interviewing.
  • Referral resources for food or other necessities such as the 24/7 County Information Line 2-1-1, 2-1-1 website 211la.org, and DPH resources web portal.
  • Mental health referrals.
  • Offering to provide a letter if they need one to telework or be excused from work.
  • Recommending that patients have adequate supplies of essential medicines and use medication delivery services.
  • Acknowledging how inconvenient and difficult home isolation or quarantine can be. For patients who do not understand the need for such strict measures, please explain the critical need to protect everyone in LA County during this time when there is very little immunity to this new infection, there is no vaccine and no cure, and that many people (including young healthy people) can get very sick and die.
Isolation - Presumed or Confirmed COVID-19 in Ambulatory Patients

Action Steps for Providers

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

  • Instruct the patient to immediately self-isolate and provide the patient with LAC DPH Health Officer Isolation Orders and instructions.
  • Review the home isolation instructions with their patient emphasizing the content of the following sections:
    • Seeking medical care-discuss what to do if symptoms worsen, when to seek medical care, and when to call 9-1-1.
    • Protecting others-they must stay isolated, except to get medical care, until the home isolation period ends.
    • Information for close contacts-they must inform all of their close contacts beginning 2 days before their symptoms began (or 2 days before the date of positive test if asymptomatic) that they need to be in quarantine. They should provide each close contact with a quarantine order plus quarantine instructions.
  • Make a plan to closely monitor patients at increased risk for severe disease, such as older adults and persons with underlying medical conditions (see CDC High-Risk Conditions). If these patients are living alone or are the only responsible adult in the home, discuss with them who could do virtual daily check ins. Consider contacting them frequently as there is potential for rapid clinical deterioration.

If testing a patient for SARS-CoV-2 virus

  • Confirm the patient’s current phone number(s) and address and include it in the laboratory requisition to facilitate prompt contact tracing.

If a patient tests positive for SARS-CoV-2 virus

  • If isolation orders and instructions were not already given, follow the action steps above.
  • Inform them that LA County Public Health will attempt to call them to interview them for contact tracing. Please encourage them to answer Public Health’s calls and to call them back if they receive a message.
  • Confirm the patient’s current phone number(s) and address and include it in the Medical Provider COVID-19 Report Form to facilitate prompt contact tracing.
  • Report the case within 1 day.

Ending Isolation and Return to Work/School

Persons with symptomatic COVID-19 can be released from isolation when the following criteria have been met:

  • At least 10 days have passed since symptoms first appeared and
  • At least 24 hours have passed since last fever without the use of fever-reducing medications and
  • Improvement in symptoms.

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

  • 10 days after the date of collection of their initial positive PCR test.

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.

Quarantine
Overview

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:

  • Screen the patient for new onset signs or symptoms compatible with COVID-19. If signs or symptoms are present, providers should have a low threshold for making a presumptive diagnosis of COVID-19 and providing isolation and quarantine orders as per above.
  • If the patient is asymptomatic, review the quarantine instructions emphasizing the content of the following sections:
    • Length of their quarantine period including how to calculate the end of their quarantine based on different exposure scenarios. Explain the importance of remaining in quarantine to protect others.
    • Testing for COVID-19 which includes different actions based on the results of their test. Please explain that a negative test will not release them from quarantine since it may be falsely negative in the early stages of the infection.
    • Monitoring their health - review symptoms of COVID-19 and advise them to contact your office if they develop any of these symptoms. Discuss when do seek medical care, and when to call 9-1-1
  • Test for SARS CoV-2 virus. See Testing of close contacts next.

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:
Positive SARS CoV-2 PCR test – the contact is now a case

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.

  • Explain that they could still have early COVID-19 infection.
  • Emphasize the importance of remaining in quarantine until 14 days after their last exposure to the case, monitor their health, and instruct them notify your office if they develop COVID-19-like illness.

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.

Special Considerations
When the presumed or confirmed case cannot inform their close contacts
  • If the patient is a minor or has a legal guardian, the parent/guardian should inform all close contacts and deliver health officer quarantine orders.
  • If the patient is severely ill or deceased, the diagnosing healthcare provider should inform the next of kin of the patient’s COVID-19 status and ask them to notify and deliver home isolation and quarantine instructions to the patient’s close contacts.

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.

Patients with a History of Recent Recovery from COVID-19

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:

Remain asymptomatic

  • They do not need to be re-tested for SARS-CoV-2 virus (nor re-isolated for a repeat positive result)
  • They do not need to quarantine if they have close contact with a COVID-19 case
  • They must continue to adhere to all other required protective measures, including, but not limited to, wearing face coverings and other job-specific personal protective equipment, maintaining their physical distance from non-household members, following hand hygiene, and staying home if sick, among other protective measures.

Develop new symptoms consistent with COVID-19 illness:

  • They may warrant re-testing, especially if there is no alternative diagnosis and/or the symptoms developed within 14 days after close contact to a case.
  • They should be instructed to self-isolate per Health Officer orders pending work-up and testing.

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.

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

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.

RESOURCES FOR PATIENTS

Instructions for patients - are available on webpages in English and Spanish and in PDFs in 13 languages– visit home isolation and home quarantine 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.

Home Cleaning Guidance
  • LAC DPH: Infographic on Preventing the Spread of Respiratory Illness in the Home
  • CDC: Recommendations for Cleaning and Disinfection for Households with Suspected or Confirmed COVID-19
  • LAC DPH: Guidance for Reporting and Clean-up when Death Occurs at Home

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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