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Reporting LAHAN Alerts

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 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: with the exception of healthcare personnel, a person is still considered a close contact even if they and/or the case were wearing 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.

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.
  • 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:

  • Instruct the patient 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 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:
    • 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-Patients with confirmed COVID-19 must inform all of their close contacts from 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 and 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.
Duration of Isolation

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 are no longer infectious by 20 days after symptom onset.

The CDC no longer recommends PCR testing to discontinue home isolation because patients can shed non-infectious viral RNA for an extended period of time after COVID-19 infection.

Severely immunocompromised patients (e.g., currently receiving chemotherapy for cancer, uncontrolled HIV infection with current CD4 <200, prednisone treatment >20mg/kg for more than 14 days) may produce replication-competent virus beyond 20 days and require additional testing and consultation with infectious diseases specialists and infection control experts.

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 (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.

See CDC Discontinuation of Home Isolation for Persons with COVID-19 (Interim Guidance)

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 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.

QUARANTINE
Fully Vaccinated Persons

The CDC has released recommendations for fully vaccinated persons in healthcare and non-healthcare settings.

Key points:

  • A person is considered fully vaccinated >2 weeks following the receipt of the second dose in a 2-dose series (Pfizer-BioNTech or Moderna) OR >2 weeks following the receipt of one dose of a single-dose vaccine (Johnson and Johnson/Janssen).
  • Quarantine of exposed asymptomatic fully vaccinated persons is no longer recommended, with exceptions for inpatients, residents in healthcare settings, and residents of high-risk residential congregate settings
  • Fully vaccinated asymptomatic workers in healthcare and non-healthcare settings do not need to be restricted from work after exposure.

See LAC DPH Interim Quarantine and Work Restriction Guidance for Fully Vaccinated Persons for more information.

Quarantine Overview

Close contacts of 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. 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:

  • Adhere to routine COVID-19 prevention interventions including, wearing a face covering whenever around other people, keeping a distance of at least 6 feet from others, and washing hands often, AND
  • Monitor daily for COVID-19 symptoms. If symptoms develop, they must isolate immediately and contact their healthcare provider, clinician advice line, or telemedicine provider for a medical assessment and arrange a test for COVID-19.

* See exceptions for fully vaccinated persons and persons who are within 3 months (90 days) of recovering from laboratory-confirmed COVID-19.

Quarantine Instructions
  • The mandatory quarantine period is 10 days with or without testing. A negative test is not required for discontinuation of quarantine after Day 10.
  • In settings where a 14-day quarantine is recommended (see Special Quarantine Considerations) a 10- day quarantine with a negative molecular test (collected after Day 7) may be used if testing supplies are adequate.
  • All healthcare personnel and first responders should follow COVID-19 exposure protocols as outlined in the relevant LAC DPH guidelines including: Healthcare Personnel Monitoring and EMS Monitoring Guidelines.

Special Quarantine Considerations

  • Those Living with Persons at High Risk: Close contacts who live with persons at high risk for severe COVID-19 especially severely immunosuppressed persons (e.g. bone marrow or solid organ transplants, chemotherapy) should continue to separate themselves from the high-risk individual for at least 14 days.
  • 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).
    • Unvaccinated/partially vaccinated 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 hospital residents of SNFs and CCFs should quarantine for 14 days.
  • Long-Term Care Facility Visitors: Visitors will continue to be restricted from entry to skilled nursing facilities (SNFs) and community care facilities (CCFs) for 14 days after their last exposure to the infected person.

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 full 10 days after their last exposure and to strictly adhere to COVID-19 prevention steps for at least 14 full days. If they live with persons at high risk for severe COVID-19, especially severely immunosuppressed persons (e.g. bone marrow or solid organ transplants, ongoing chemotherapy) they should continue to separate themselves from the high-risk individual for at least 14 days.
    • 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. 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. See exception below.
Testing of Close Contacts

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.

Testing exceptions for essential workers: For critical staffing shortages, unvaccinated/partially vaccinated 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:
Positive SARS CoV-2 viral (molecular or antigen) test – the contact is now a case

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.

  • Explain that they could still have early COVID-19 infection.
  • Emphasize the importance of monitoring their health through Day 14 and remaining in quarantine until after Day 10. If they are asymptomatic and stop quarantine after Day 10, from Day 11 through Day 14 they must monitor their health and strictly adhere to routine COVID-19 prevention. Instruct them to 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 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 need to monitor themselves for symptoms through Day 14 and 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).

Neither Public Health clearance nor a negative COVID-19 test is required for return to work and/or school.

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

Persons who have recently recovered from confirmed COVID-19, for 3 months (90 days) after the onset of the initial illness (or after the date of first positive viral test if they never had symptoms) who:

Are 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 should be instructed to monitor their health for 14 days after their last contact with the infected person.
  • 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.

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 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 - Reinfection is unlikely to occur within the first 3 months (90 days) 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.

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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