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. During the COVID-19 pandemic, when there are no effective pharmaceutical interventions (e.g. vaccination or treatment), isolation and quarantine are essential strategies to prevent outbreaks in the community.

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*:

1. An individual who was within 6 feet of the patient for more than 15 minutes
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).

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.

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.

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.

Instructions for patients is 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 to make it easier to direct patients to the quarantine and isolation webpages over the phone.

Contact tracing flyer

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.