CDC Reduces COVID-19 Quarantine Requirement

December 3, 2020

The CDC reduced the length of quarantine required for persons exposed to someone infected with SARS-CoV-2 from 14 days to 10 or to 7 with a negative test.

The US Centers for Disease Control and Prevention (CDC) on Wednesday announced 2 shorter quarantine options for people exposed to COVID-19: 10 days without appearance of symptoms and 7 days if a diagnostic test is negative.

The revised options are based on review of new research and on an "acceptable risk" of transmission. Citing a desire to reduce the significant personal, social, and economic burden of the 14-day requirement, the agency also hopes the options will increase overall compliance and improve observance of public health recommendations.

Highlights in this short slide show.

COVID-19 14-day Quarantine. Original recommendation: based on estimates of upper bounds of COVID-19 incubation period. Importance heightened with understanding that asymptomatic persons are able to transmit virus and that ~20%-40% of those infected never develop symptomatic illness.

*Quarantine is critical to control transmission.*

Benefit/Risk Balance. CDC: reduced quarantine length may reduce burden, increase community compliance & willingness to adhere to public health recommendations. Evaluation of impact will be required. Such as post-quarantine transmission (ie, in settings with high contact rates) where even as mall risk of post-quarantine transmission could lead to substantial secondary clusters.

1. Recommended Alternatives to 14-day Quarantine. Quarantine can end after Day 10 without testing and 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%.**

Alternatives to 14-day Quarantine (continued). When diagnostic testing resources are sufficient and available (slide 8 ) then quarantine can end after Day 7 if a diagnostic specimen tests negative and if no symptoms were reported during daily monitoring.

Alternatives to 14-day Quarantine (continued). Specimen to be tested may be collected/tested within 48h before the time of planned quarantine discontinuation (eg, to account for testing delays), but quarantine cannot be discontinued earlier than after Day 7. **With this strategy, the residual post-quarantine transmission risk is estimated to be about 5% with an upper limit of about 12%.**

2. Mandatory Criteria to Discontinue Quarantine. 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 (next slide).

† Monitoring can be conducted using any method acceptable to local public health authorities and could include self-monitoring using an approved checklist of signs and symptoms, direct contact daily by public health authorities or their designates, or automated communications systems (e.g., on-line or texting self-checkers).

2. Mandatory Criteria (continued). Persons are counseled regarding the need to adhere strictly through quarantine Day 14 to all recommended non-pharmaceutical interventions (ie, mitigation strategies), especially. Advise them that if any symptoms develop, they should immediately self-isolate and contact the local public health authority or their HCP to report the change in clinical status.

Mitigation strategies (aka, nonpharmaceutical interventions [NPI]) ± NPIs that can be practiced by individuals include the following: correct and consistent mask use, social distancing, hand and cough hygiene, environmental cleaning and disinfection, avoiding crowds, ensuring adequate indoor ventilation, and self-monitoring for symptoms of COVID-19 illness. These are also summarized here.

3. Testing for Earlier End to Quarantine. 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.

Completion of 14-day Quarantine. Persons can continue to
be quarantined for 14 days without testing per existing recommendations.

**This option maximally reduces risk of post-quarantine transmission risk and is the strategy with the greatest collective experience at present.**

Adding Testing at Entry to Quarantine. CDC found that adding testing at entry to quarantine provided little additional benefit
in terms of reduction in post-quarantine transmission risk.

However, testing may be useful to identify infected persons without symptoms for contact tracing efforts, if sufficient resources allow.