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.
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*:
*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: with the exception of healthcare personnel, a person is still considered a close contact even if they and/or the case were wearing a cloth face covering or facemask at the time of exposure. See CDC Public Health Guidance for Community-Related Exposure.
Confirmed COVID-19 – A patient with a positive SARS-CoV-2 viral (molecular 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.
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:
If COVID-19 is laboratory confirmed or presumed, the diagnosing provider is asked to:
The CDC cites data that persons with mild to moderate COVID-19 are no longer infectious after 10 days have passed since symptom onset. Those with more severe illness or who are severely immunocompromised are no longer infectious by 15-20 days after symptom onset.
The CDC no longer recommends PCR testing to discontinue home isolation (except in some circumstances such as severe immunocompromise) because patients can shed non-infectious viral RNA for an extended period of time after COVID-19 infection.
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:
The patient must remain in isolation until either:
Note: Presumed COVID-19 patients who are close contacts to a confirmed case (i.e. under mandatory quarantine orders) must continue to follow quarantine orders even if they test negative for COVID-19 and/or have a clear alternate diagnosis, see Quarantine for more information. If they test positive for COVID-19, they are now a confirmed case and must isolate per the guidance for patients with confirmed COVID-19.
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.
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 continue to practice physical distancing (at least 6 feet away) and to wear a face covering when they are interacting with others who are not members of their household in public and private. Neither Public Health clearance nor a negative COVID-19 test is required for return to work/school.
On December 21, an LAHAN was issued to announce the revised quarantine period, provide the rationale and background for the changes, and outline additional instructions and special considerations for quarantine.
A mandatory quarantine after long distance travel is in effect for persons traveling/returning to LA County, effective 12-30-2020. See Mandatory Directive On Travel for more on the quarantine requirements and exemptions.
Close contacts of confirmed COVID-19 cases are required to self-quarantine, per the Los Angeles County Health Officer quarantine orders. They must stay in quarantine and monitor their health for 10 days from their last contact with the infectious person. If they remain asymptomatic, after Day 10 they are allowed to discontinue quarantine on the condition they follow these additional precautions:
From Day 11 through Day 14 they must both:
Special Quarantine Considerations
Refer to setting-specific guidelines or protocols for more information.
If a patient presents as a close contact, providers are asked to:
LAC DPH recommends diagnostic (viral) testing of asymptomatic 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. Testing cannot be used to release a close contact from quarantine early, with the exception of certain essential workers, see exception below.
*Note: viral testing is not recommended for asymptomatic persons who have recently recovered (within past 90 days) from laboratory confirmed COVID-19, including close contacts. See Patients with a History of Recent Recovery from COVID-19 for more information.
Exception: For critical staffing shortages, asymptomatic healthcare workers, first responders, and social service workers (who work face to face with clients in the child welfare system or in assisted living facilities) are permitted to return to work after Day 7 with a negative PCR test from a specimen collected after Day 5. When they are not doing their essential work, they must continue to follow quarantine orders and instructions.
When ordering diagnostic 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.Provider actions based on results:
Follow the guidance for cases above.Negative SARS CoV-2 viral (molecular or antigen) test
Because of the expected high false negative rate during incubation period, negative test results in these recently exposed patients cannot rule out infection.
The close contact must stay in quarantine for 10 days from the last date that they were in contact with the infectious person. After Day 10 has passed without any symptoms, they may return to regular activities including in-person work or school. They should strictly adhere to the daily prevention measures (e.g. wear a mask, stay at least 6 feet away from others, wash hands frequently, and avoid crowds) and monitor themselves for symptoms through Day 14.
Neither Public Health clearance nor a negative COVID-19 test is required for return to work and/or school.
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 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.