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When Should You Self-Isolate or Quarantine?

New CDC guidance for self-isolation and quarantine following COVID-19 exposure or positive test result explained

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CDC Covid quarantine for high risk exposure

As we approach the two-year mark of the COVID-19 pandemic, the Centers for Disease Control and Prevention (CDC) has updated the guidelines regarding quarantine and isolation if you have a high-risk exposure or test positive yourself.

In order to follow the CDC guidelines, it’s important to know the terminology.

Quarantine: separates and restricts the movements of those who were exposed to COVID-19 to see if they become sick.

Isolation: separates those who are sick with COVID-19 from those who do not have it to prevent the spread of the virus.

According to infectious diseases physician Timothy Friel, MD, Chair, Department of Medicine, Lehigh Valley Health Network (LVHN), it’s important for people to be aware of the updated CDC guidelines. “As we continue to live with COVID-19, it’s important to know what to do if you or someone you love tests positive for COVID-19 or has a high-risk exposure. This will help us reduce the spread of the virus and its impact on our community,” he says.

Timothy Friel, MD, Lehigh Valley Health Network Chair of Department of Medicine, Infectious Diseases, breaks down the latest guidance from the Centers for Disease Control and Prevention (CDC) regarding self-isolation and quarantine if you have a high-risk exposure to someone with COVID-19 or test positive yourself.

If you have a significant exposure to COVID-19

Friel explains a significant exposure to COVID-19 as contact within 6 feet for more than 15 minutes without the protection of personal protective equipment such as a mask. Asymptomatic individuals who had significant contact with someone with a confirmed COVID-19 diagnosis should quarantine following their exposure.

 

If you are unvaccinated or completed your vaccine series more than six months ago and have not received your booster:

  • Quarantine for at least five days following a high-risk exposure. The date of the last high-risk contact is considered day 0.
  • Testing is encouraged on day 5. Antigen (home) testing is preferred if available. If you continue to test positive, isolation should continue for 10 days.
  • Wear a well-fitting mask around others for 10 days following exposure.
  • Avoid people who are at high-risk of developing complications of COVID such as the elderly or immunocompromised.
  • Carefully monitor for any symptoms of COVID during the 10 days following exposure. If any symptoms appear, isolate immediately and seek testing.

If you completed your initial vaccine series within the last six months or received an mRNA booster six months after the completion of the initial vaccine series:

  • ​​​​​No quarantine is currently recommended. 
  • Testing is encouraged on day five. Antigen (home) testing is preferred if available. If you continue to test positive, isolation should continue for 10 days.  
  • Wear a well-fitting mask around others for 10 days following exposure.
  • If any symptoms appear, isolate immediately and seek testing.

If you have recovered from a documented COVID infection in the last 90 days:

  • No testing is recommended unless new symptoms develop.
  • Wear a well-fitting mask around others for 10 days following exposure.

If you test positive for COVID-19

If you test positive and have symptoms:

  • You should isolate for a minimum of five days from the start of symptoms AND after at least 24 hours of symptoms in the absence of fever-reducing medications and with improvement of other COVID-19 symptoms. The first day of symptoms is considered day 0.
  • Wear a well-fitting mask around others for a full 10 days following the onset of symptoms.
  • You should avoid others at high risk for COVID complications (for example, the elderly, nursing home residents, hospitalized patients or immunocompromised) for at least 10 days. In addition, you will want to avoid places where you are unable to wear a mask (such as restaurants) for 10 days.
  • Testing can be considered on day 5. Antigen (home) testing is preferred if available. If you continue to test positive, isolation should continue for 10 days.

Presumptive COVID-19 Diagnosis and Test Results Pending

If you go for a COVID-19 test and are presumed positive while your test results are pending:

  • You should remain in isolation until results of your COVID-19 test are available.
  • If your test results are significantly delayed, you can discontinue isolation five days from the start of symptoms and at least 24 hours fever-free in the absence of fever-reducing medications along with the improvement of other symptoms.
  • If you have worsening symptoms, you are encouraged to contact your provider via video visit, E-visit or in the event of respiratory distress, chest pain or dehydration, the emergency room.

Presumptive COVID-19 Diagnosis and No Testing Performed (for example, low risk, symptomatic family members of known positive case)

If you are presumed to have COVID-19 due to symptoms or a symptomatic COVID-19 family member you should do the following:

  • You can discontinue isolation after a minimum of five days from the start of symptoms AND after at least 24-hours of being fever-free (without fever-reducing medications) along with the improvement of other symptoms
  • You should wear a well-fitting mask around others for a full 10 days from the onset of symptoms.
  • Avoid others at high risk for COVID complications (for example, the elderly, nursing home residents, hospitalized patients or immunocompromised) for at least 10 days. In addition, you should avoid places where you are unable to wear a mask (such as restaurants) for 10 days.
  • Testing can be considered on day 5. Antigen (home) testing is preferred if available. If persistently positive, isolation should continue for 10 days.

If you are isolating at home and receive a negative COVID-19 test

If you had a known high-risk exposure to someone with COVID-19:

  • Quarantine is recommended if you are vaccinated but have not received a booster after completion of the initial vaccine series.

You receive another diagnosis like influenza:

  • If you are diagnosed with influenza, you should continue isolation until your fever has resolved for more than 24 hours without the use of fever-reducing medications or at least four to five days following the onset of symptoms. Influenza is most infectious during the first three days of symptoms (and the day before symptoms developed).

If you have continued symptoms without a definitive diagnosis:

  • If your symptoms are mild, you should remain isolated until symptoms improve. If symptoms persist without diagnosis, consider repeat testing for COVID-19 and influenza. If your symptoms worsen, have a reassessment. Options for reassessment include video visits, E-visits or in the event of symptoms such as increasing respiratory distress, chest pain, dehydration, etc., a visit to the emergency room.
Michelle Rojas, RN, Emergency Medicine, Lehigh Valley Hospital-Hazleton

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