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COVID-19

Isolation and Quarantine Guidelines


Updates
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, which for some people include quarantine. See Quick Links to view Health Officer Orders and Instructions).

LAC DPH is attempting to contact all laboratory confirmed COVID-19 cases to interview them, initiate contact tracing, and provide isolation instructions and orders. In addition, in order to improve disease control, we are asking healthcare providers who diagnose a patient with COVID-19 (confirmed or presumed) to give their patient isolation orders and instructions. Patients with laboratory confirmed COVID-19 infection should also be instructed to provide quarantine orders and instructions to all their close contacts. See Ambulatory Patients with COVID-19 for more details.

If a patient with COVID-19 is unable to inform their contacts of the need to quarantine (e.g., the patient is severely ill or deceased), this responsibility falls to the diagnosing healthcare provider. See When the 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 (presumed or laboratory confirmed) 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 close contacts of individuals with COVID-19 from others because they may be incubating virus and may become infectious at some point during their incubation period. 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 person with confirmed COVID-19 (“case”) while they were infectious*:

  1. A person who was within 6 feet of the case for a total of 15 minutes or more over a 24-hour period
  2. A person who had unprotected contact with the case’s body fluids and/or secretions, for example, were coughed or sneezed on, shared utensils or saliva, or provided care without wearing appropriate protective equipment.

*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 diagnostic (viral) test 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 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.

See CDC Public Health Guidance for Community-Related Exposure.


Confirmed COVID-19 – A patient with a positive SARS-CoV-2 viral (NAAT or antigen) test.

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. See COVID-19 Risk Assessment and Presumptive Clinical Diagnosis for guidance.

Fully vaccinated-A person is considered fully vaccinated >2 weeks following the receipt* of:

  • the second dose in a 2-dose series (Pfizer-BioNTech or Moderna)
  • one dose of a single-dose vaccine (Johnson and Johnson/Janssen)

*This guidance can also be applied to COVID-19 vaccines that have been listed for emergency use by the World Health Organization (e.g., AstraZeneca/Oxford). See CDC Clinical Considerations People vaccinated outside the Unites States footnote 2 for current WHO list.

Recently recovered from COVID-19 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.

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.
  • 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.
  • 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.
Isolation - COVID-19 in Ambulatory Patients
Action Steps for Providers

If COVID-19 is laboratory 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 appropriate and competent caregivers are available at home, if needed
    • If the person and other household members have access to recommended PPE and can adhere to recommended precautions
  • 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.
  • Inform them that LA County Public Health will attempt to call (if laboratory positive) to answer any questions they may have and to interview them for contact tracing. Please encourage them to answer or return Public Health’s calls.
  • Review the home isolation instructions emphasizing the content of the following sections:
  • Make a plan to closely monitor patients at increased risk for severe disease, such as unvaccinated older adults, unvaccinated persons with underlying medical conditions (see CDC High-Risk Conditions), and those with moderate to severe immunocompromising 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 regularly during isolation to assess for clinical worsening and other needs. Additional monitoring, such as oxygen saturation measurement or other assessments, can be considered, especially for those at higher risk of severe illness.
Duration of Isolation

Confirmed COVID-19

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
  • Symptoms have improved.

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 viral test.

Presumed COVID-19

The patient must remain in isolation until either:

  1. 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
    • Symptoms have improved
    --or
  2. a healthcare provider reassesses the initial diagnosis and concludes that the patient is not infected with SARS-CoV-2. In this situation, the patient can leave isolation after they have been fever-free for 24 hours and their symptoms have improved.

Note: Presumed COVID-19 patients who are close contacts to a confirmed case must continue to follow quarantine and other instructions for close contacts, even if they test negative for COVID-19 and/or have a clear alternate diagnosis. See Quarantine for more information.

Patients with Severe/Critical COVID-19 or Who Are Severely Immunocompromised

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.

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

After Isolation and Return to Work/School

When their isolation period ends, the patient is considered recovered and may resume their usual activities including return to in-person work and/or school. They should be reminded to follow COVID-19 precautions including masking, physical distancing, and hand hygiene. Neither Public Health clearance nor a negative COVID-19 test is required for return to work/school.

QUARANTINE
Quarantine Overview

Close contacts of laboratory-confirmed COVID-19 cases are required to self-quarantine (stay home and separate themselves from others), per the Los Angeles County Health Officer quarantine orders, unless they are exempt.

All close contacts are required to monitor for symptoms of COVID-19 and take extra precautions for 14 days after their last exposure with the infectious case.

The following close contacts in the general public are exempted from quarantine as long as they remain asymptomatic: 

  • They were fully vaccinated before the exposure, OR
  • They are within 3 months (90 days) of recovering from laboratory confirmed COVID-19.

To learn more about the public health recommendations for close contacts who are fully vaccinated or have recently recovered from COVID-19 please visit:

Duration of Quarantine

CDC recommends a quarantine period of 14 days based on estimates of the upper bounds of the COVID-19 incubation. The CDC has also provided acceptable shorter quarantine options.

The California Department of Public Health (CDPH) and LAC DPH support the CDC’s two options for shortening the recommended 14-day quarantine duration for the general public. Close contacts working and living in healthcare and high risk non-healthcare congregate settings have special quarantine considerations.

Note: CDPH updated its Guidance on Isolation and Quarantine for COVID-19 Contact Tracing on August 17, 2021. However, until Cal/OSHA changes the Return to Work criteria listed in its Emergency Temporary Standards (ETS), people with workplace exposures are required to continue following the close contact (quarantine) criteria listed in the ETS.

General public

Close contacts who remain asymptomatic may discontinue self-quarantine under the following conditions:

  • After Day 10 from the date of last exposure; OR
  • After Day 7 if they have a viral test COLLECTED after Day 5 and the result is negative.

To discontinue quarantine before 14 days, asymptomatic close contacts must:

  • Continue daily self-monitoring for symptoms through Day 14 from last known exposure; AND
  • Follow all recommended non-pharmaceutical interventions (e.g., wearing a mask when around others, hand washing, avoiding crowds, and staying at least 6 feet from others) through Day 14 from last known exposure.

If any symptoms develop during this 14-day period, the close contact should immediately self-isolate, get tested and contact their healthcare provider with any questions regarding their care.

If the close contact lives with someone who is immunosuppressed, at increased risk for severe disease, or unvaccinated, it is recommended that the close contact continue to wear a mask at home for the full 14 days.

Healthcare and High-Risk Non-Healthcare Congregate Settings-Special Quarantine Considerations

  • Those Living or Working in High-Risk Non-Healthcare Congregate Settings: Close contacts who live or work in high-risk congregate settings (e.g., prisons, jails, and shelters)
    •  Residents should remain in quarantine either for 14 days or for 10 days with a negative molecular test (specimen collected after Day 7).
    •  Staff should not return to in-person work until after 14 days or after 10 days with a negative molecular test (specimen collected after Day 7).
  • Inpatients and Residents in Healthcare Settings (e.g., Long-Term Care Facility Residents): Exposed inpatients and residents of SNFs and CCFs should continue to quarantine for 14 days (regardless of vaccination status).
  • Healthcare personnel and first responders should follow the COVID-19 exposure protocols as outlined in the relevant LAC DPH guidelines including: Healthcare Personnel Monitoring and EMS Monitoring Guidelines.

Refer to setting-specific guidelines or protocols for more information.

Patients Presenting as Close Contacts-Action Steps for Providers

If a patient presents as a close contact, providers are asked to:

  • Test for SARS CoV-2 virus (see Testing of Close Contacts below).
  • Assess the patient for new onset signs or symptoms compatible with COVID-19.
  • If symptomatic, manage as a presumptive case and follow isolation guidance above.
  • If asymptomatic, review the quarantine instructions emphasizing the content of the following sections:
    • Length of quarantine including how to calculate the end of their quarantine. Please explain the importance of remaining in quarantine for the required duration and to strictly adhere to COVID-19 prevention steps for at least 14 full days. They should consider wearing a mask at home for 14 days if they live with someone who is immunosuppressed, at risk for severe disease, or unvaccinated (including children <12 years of age).
    • Monitoring their health - review symptoms of COVID-19 and advise them to monitor their symptoms through Day 14. If they develop symptoms, please provide instructions to isolate at home, and to contact your office for an assessment and testing. Discuss when to seek urgent care, and when to go to the emergency department or call 9-1-1.
    • Testing for COVID-19 which includes different actions based on the results of their test.
Testing of Close Contacts

Post-exposure viral testing is recommended for close contacts, regardless of vaccination status.

Testing is not recommended for persons who had a positive COVID-19 test in the past 3 months. See Patients with a History of Recent Recovery from COVID-19 for more information.

Only FDA-approved viral COVID-19 tests that are collected and performed in a healthcare setting or certified testing site are acceptable documentation of infection status. Negative test results from home-test kits cannot be used to end quarantine early.

When ordering viral tests please make sure to confirm the patient’s current phone number(s) and address and include it in the laboratory requisition to facilitate prompt contact tracing if the result is positive. 

Timing of testing

If symptoms develop, diagnostic testing should be performed immediately. 

Unvaccinated close contacts - Testing is recommended 5-7 days after exposure. Negative viral test results on specimens collected after Day 5 can be used to end self-quarantine after Day 7 .  

Fully vaccinated close contacts - CDC and CDPH recommend testing asymptomatic fully vaccinated close contacts 3-5 days after exposure.  

Special Considerations
When the 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

This is defined as a person who had a positive viral COVID-19 test within the past 3 months (90 days) who has recovered from the previous infection (i.e. their isolation period has ended). If they 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:

  • 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; however, they must monitor their health for 14 days after their last contact with the infected person. Tell them to follow the Quarantine and Other Instructions for Close Contacts -- People who have recovered from COVID-9 in the past 3 months.
  • They must continue to adhere to all other protective measures, including, but not limited to, wearing a mask and other job-specific personal protective equipment, maintaining their physical distance from non-household members, following hand hygiene, avoiding crowds and poorly ventilated spaces, and staying home if sick. See Reducing Risk at ph.lacounty.gov/reducerisk.

Develops 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 pending clinical evaluation and SARS-COV-2, if indicated.

Healthcare providers should always use their clinical judgment and consider exceptions, particularly for patients who are severely immunocompromised.

Rationale - Per the CDC, reinfection is unlikely to occur within the first 3 months (90 days) after infection. 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 Interim Guidance on Ending 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
Thumbnail of Contact Tracing Infographic

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 quarantine and other 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.

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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