Health Update
Delaware Updates Quarantine Guidance For Persons Exposed to COVID-19

The Delaware Division of Public Health (DPH) is issuing this health update to provide the health care community with updated information regarding options to reduce quarantine for contacts of persons with SARS-CoV-2 infection using symptom monitoring and diagnostic testing.

Summary

Consistent with recently-released guidance and data from the Centers for Disease Control (CDC), DPH is shortening the recommended quarantine period for the general public after exposure to an individual with COVID-19. In general, quarantine can be discontinued after Day 10 of quarantine without testing if no symptoms have been reported during daily monitoring, or after Day 7 of quarantine if a diagnostic specimen collected within 48 hours of the time of planned quarantine discontinuation tests negative and if no symptoms were reported during daily monitoring.

The updated guidance only applies to individuals who were exposed to someone who tested positive for COVID-19, and does not apply to persons who are symptomatic or tested positive for the virus.

Background

Quarantine is used to separate someone who might have been exposed to COVID-19 and may infect other people. Quarantine helps prevent spread of disease that can occur before a person knows he/she has the virus. CDC recently released updated guidance on options to reduce the duration of quarantine for individuals exposed to SARS-CoV-2, recognizing that any quarantine shorter than 14 days balances reduced burden against a small possibility of increasing the spread of the virus (https://www.cdc.gov/coronavirus/2019-ncov/more/scientific-brief-options-to-reduce-quarantine.html).

The previous recommendation for a 14-day quarantine was based on estimates of the upper bounds of the COVID-19 incubation period. Quarantine’s importance grew after it was evident that persons are able to transmit SARS-CoV-2 before symptoms develop, and that a substantial portion of infected persons (likely up to 40%) never develop symptomatic illness but can still transmit the virus. In this context, quarantine is a critical measure to control transmission.

Quarantine is intended to reduce the risk that infected persons might unknowingly transmit infection to others, however, a 14-day quarantine can impose personal burdens that may affect physical and mental health as well as cause economic hardship that may reduce compliance. Implementing quarantines can also pose additional burdens on public health systems and communities, especially during periods when new infections, and consequently the number of contacts needing to quarantine, are rapidly rising. Lastly, the prospect of quarantine may dissuade recently diagnosed persons from naming contacts and may dissuade contacts from responding to contact tracer outreach if they perceive the length of quarantine as burdensome.

Reducing the length of quarantine will reduce the burden and may increase community compliance and willingness to adhere to public health recommendations.

Recommendations

Within congregate settings where there is a high risk of sustained transmission of COVID-19, such as long-term care facilities and correctional facilities, DPH recommends a quarantine period of 14 days. For the general public, however, the following options to shorten quarantine are now recommended:

• Quarantine can end after Day 10 without testing if no symptoms have been reported during daily monitoring.
  • ​​​ With this strategy, residual post-quarantine transmission risk is estimated to be about 1% with an upper limit of about 10%.
• Quarantine can end after Day 7 if a diagnostic specimen tests negative and if no symptoms were reported during daily monitoring. The specimen may be collected and tested within 48 hours before the time of planned quarantine discontinuation (as early as Day 5 of quarantine)), but quarantine cannot be discontinued earlier than after Day 7.
  • DPH strongly recommends that if antigen testing is performed, the specimen be collected and tested no sooner than Day 7 of quarantine.
  • With this strategy, the residual post-quarantine transmission risk is estimated to be about 5% with an upper limit of about 12%.

• Persons can discontinue quarantine at these time points only if the following criteria are also met:
  • No clinical evidence of COVID-19 has been elicited by daily symptom monitoring† during the entirety of quarantine up to the time at which quarantine is discontinued; and,
  • Daily symptom monitoring continues through quarantine Day 14; and,
  • Persons are counseled regarding the need to adhere strictly through quarantine Day 14 to all recommended non-pharmaceutical interventions (NPIs, a.k.a. mitigation strategies), especially.
• ​ Testing for the purpose of earlier discontinuation of quarantine should be considered only if it will have no impact on community diagnostic testing. Testing of persons seeking evaluation for infection must be prioritized.

It is very important that exposed individuals who discontinue quarantine prior to 14 days continue monitoring their symptoms for the full 14 days after their last exposure to a COVID-positive person. If any symptoms develop, they should immediately self-isolate and contact their health care provider or DPH to report the change in symptom status. In addition, individuals should continue to strictly adhere to prevention recommendations – wear a face covering, wash hands frequently, social distance by staying 6 feet away from others, and avoid gatherings.

Additional Information

• State of Delaware COVID-19 website: https://coronavirus.delaware.gov/
• CDC –When to Quarantine: https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/quarantine.html