Close Contact, Quarantine and Isolation
The CDC has recently updated the definition of “close contact”, which impacts indications to quarantine. This post will begin with definitions, followed by additional resources.
Close Contact: The CDC has changed the definition of “close contact” to include the cumulative 24- hour exposure to a positive case. The current definition of “close contact” for purposes of quarantine or testing include: “Someone who was within 6 feet of an infected person for a cumulative total of 15 minutes or more over a 24-hour period starting from 2 days before illness onset (or, for asymptomatic patients, 2 days prior to test specimen collection) until the time the patient is isolated.” This better reflects cumulative exposure risk as opposed to the prior criteria that required a continuous 15- minute exposure.
Quarantine: This term is often used interchangeably with isolation, but the terms are quite different. Quarantine means that someone who has been or may have been exposed to COVID is being kept away from others. Quarantine is a method used to prevent the spread of disease that can occur before individuals know they have contracted an illness. A 14-day period of quarantine is recommended for suspected and known exposure to COVID-19.
Isolation: Individuals who test positive for COVID-19 are isolated from other individuals until they are no longer infectious even if they are living in the same household.
According to the CDC, individuals who have been in close contact with someone who has COVID-19—excluding people who have had COVID-19 within the past 3 months, must quarantine for 14-days. During this period, the individual should monitor for any signs and symptoms of COVID, such as cough, fever, and shortness of breath. They should also stay away from other individuals in their household as much as possible. The CDC also recommends that individuals who were in close contact to an individual infected with COVID-19 undergo COVID-19 testing. During this time, the individual should remain under quarantine. If the test is positive, the individual should seek medical attention right away. If the test is negative, that means that the individual is not likely infected with COVID-19 at the time the sample was collected. However, as the incubation time is 2-14 days, it does not mean that the individual will not develop COVID-19 in the coming days following the exposure and should continue quarantine for the full 14-days.
Close contacts should monitor their health as noted above; they should call their healthcare provider right away if they develop symptoms suggestive of COVID-19 (e.g., fever, cough, shortness of breath).
Apple has a website and an app that are CDC approved to help individuals determine what steps to take next. You can use your browser to access: https://www.apple.com/covid19. This works for both Apple and other users. There is also an app in the Apple app store for iOS (iPhone, iPad, iPod). Search the iOS app store for "Apple COVID-19" to locate the app.
If a patient tests positive for COVID-19, they must practice strict home isolation. If unable to care for themselves, a caregiver must monitor the patient’s symptoms. If the patient is getting sicker, call his or her healthcare provider and tell them that the patient has laboratory-confirmed COVID-19. This will help the healthcare provider’s office take steps to keep other people in the office or waiting room from getting infected. Ask the healthcare provider to call the local or state health department for additional guidance. If the patient has a medical emergency and you need to call 911, notify the dispatch personnel that the patient has, or is being evaluated for COVID-19. Additional precautions are noted below for patients on home isolation.
- Household members should stay in another room or be separated from the patient as much as possible. Household members should use a separate bedroom and bathroom, if available.
- Prohibit visitors who do not have an essential need to be in the home.
- Household members should care for any pets in the home. Do not handle pets or other animals while sick. For more information, see the COVID-19 and Animals section of the CDC COVID-19 Frequently Asked Questions Guide.
- Make sure that shared spaces in the home have good air flow, such as by an air conditioner or an opened window, weather permitting.
- Perform hand hygiene frequently. Wash your hands often with soap and water for at least 20 seconds or use an alcohol-based hand sanitizer that contains 60 to 95% alcohol, covering all surfaces of your hands and rubbing them together until they feel dry. Soap and water should be used preferentially if hands are visibly dirty.
- Avoid touching your eyes, nose, and mouth with unwashed hands.
- The patient should wear a facemask when around other people. If the patient is not able to wear a facemask (for example, because it causes trouble breathing), the caregiver, should wear a mask when in the same room as the patient. See here for more on the use of masks.
- Wear a disposable facemask and gloves when you touch or have contact with the patient’s blood, stool, or body fluids, such as saliva, sputum, nasal mucus, vomit, urine.
- Throw out disposable facemasks and gloves after using them. Do not reuse.
- When removing personal protective equipment, first remove and dispose of gloves. Then, immediately clean your hands with soap and water or alcohol-based hand sanitizer. Next, remove and dispose of facemask, and immediately clean your hands again with soap and water or alcohol-based hand sanitizer.
- Avoid sharing household items with the patient. You should not share dishes, drinking glasses, cups, eating utensils, towels, bedding, or other items. After the patient uses these items, you should wash them thoroughly (see below “Wash laundry thoroughly”).
- Clean all “high-touch” surfaces, such as counters, tabletops, doorknobs, bathroom fixtures, toilets, phones, keyboards, tablets, and bedside tables, every day. Also, clean any surfaces that may have blood, stool, or body fluids on them.
- Use a household cleaning spray or wipe, according to the label instructions. Labels contain instructions for safe and effective use of the cleaning product including precautions you should take when applying the product, such as wearing gloves and making sure you have good ventilation during use of the product.
- Wash laundry thoroughly.
- Wear disposable gloves while handling soiled items and keep soiled items away from your body. Clean your hands (with soap and water or an alcohol-based hand sanitizer) immediately after removing your gloves.
- Immediately remove and wash clothes or bedding that have blood, stool, or
- body fluids on them.
- Read and follow directions on labels of laundry or clothing items and detergent. In general, using a normal laundry detergent according to washing machine instructions and dry thoroughly using the warmest temperatures recommended on the clothing label.
- See here for information on when, and how, to properly use a mask.
- Place all used disposable gloves, facemasks, and other contaminated items in a lined container before disposing of them with other household waste. Clean your hands (with soap and water or an alcohol-based hand sanitizer) immediately after handling these items. Soap and water should be used preferentially if hands are visibly dirty.
Discuss any additional questions with your state or local health department or healthcare provider. Check available hours when contacting your local health department.
For more information, see the CDC Guide to Frequently Asked Questions on COVID-19 and its overall index of the virus.
Modified from The CDC Guidelines for Preventing the Spread of Coronavirus Disease 2019 in Homes and Residential Communities (modified October 20, 2020).