LAC DPH COVID-19 Update: Revised Quarantine Period and Resources December 21, 2020 California, California Department of Public Health, Health Officer, Healthcare Personnel Monitoring, LA County, Long-Term Care Facility, Los Angeles County, Quarantine, Vaccination, Vaccine 1345 Key Message The quarantine period for close contacts to COVID-19 has been revised to align with California Department of Public Health (CDPH) quarantine guidelines. All asymptomatic close contacts may discontinue quarantine after Day 10 from the date of last exposure. Day 11 through Day 14 they must monitor daily for symptoms of COVID-19 and strictly adhere to routine COVID-19 prevention interventions. Health Officer Orders for Quarantine and Isolation have been revised accordingly. See LA County Quarantine Orders and Instructions below for more information. New/Updated Guidance from LAC DPH Post Vaccination Assessment of Symptomatic Healthcare Personnel New recommendations for the evaluation of healthcare personnel with systemic signs and symptoms following COVID-19 vaccination. See Post Vaccination Assessment Healthcare Personnel Monitoring Guidelines Revised These guidelines include a reduced quarantine period for healthcare personnel, updates for facilities experiencing staffing shortages, and considerations for personnel who develop symptoms post COVID-19 vaccination. See HCP Monitoring Guidelines Preventing & Managing COVID-19 in Outpatient Facilities FAQs Updated These FAQs address common questions related to the prevention and management of COVID-19 in outpatient facilities. See Outpatient FAQs Situation The CDC recently released a scientific brief with alternate options for shortening quarantine for local public health departments to consider based on local circumstances and resources. The rationale for this is because a 14-day quarantine can impose burdens that affect physical and mental health as well as cause economic hardship that may reduce compliance. In addition, the prospect of quarantine may also dissuade recently diagnosed persons from naming contacts and may dissuade contacts from responding to contact tracer outreach if they perceive quarantine as onerous. They reviewed modeling data to determine the residual post-quarantine transmission risk if quarantine were discontinued early and recommended two shorter alternate quarantine options. These options were presented with the recognition that any quarantine shorter than 14 days balances a reduced burden of quarantine and the potential for increased compliance against a small possibility of increasing the spread of the virus. In both options, additional criteria (e.g., continued symptom monitoring and use of face coverings through Day 14) must be met. CDC Modeling Estimates Last day of quarantine and the estimated residual post quarantine transmission risk with and without negative PCR collected within 48 hours prior to release CDPH guidance released on December 14 supports the discontinuation of quarantine for all asymptomatic close contacts after Day 10 with or without testing. In California, the shorter Day 7 quarantine plus a negative PCR test (when collected after Day 5) is to only be used for return to work for asymptomatic healthcare workers, emergency response workers, and social service workers (who work face to face with clients in the child welfare system or in assisted living facilities) during critical staffing shortages. Health care employers with staffing shortages and lacking the staff to provide safe patient care may use CDC Contingency Capacity Strategies. See CDPH Quarantine Guidance LA County Quarantine Orders and Instructions Revised LA County Quarantine Orders Close contacts of confirmed COVID-19 cases are required to self-quarantine for 10 days after 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 strictly adhere to all 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 continue to 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. Asymptomatic healthcare workers, first responders, and social workers (who work face to face with clients in the child welfare system or in assisted living facilities) are allowed to return to work if their employer is experiencing critical staffing shortages. They must follow job specific return-to-work protocols. When they are not doing their essential work, they must continue to follow quarantine orders and instructions. View Health Officer Orders for Isolation and Quarantine. View Patient Quarantine Instructions ph.lacounty.gov/covidquarantine View Provider Isolation and Quarantine Guidance. Quarantine Instructions and Special Considerations 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 Congregate Settings: Close contacts who live or work in high risk congregate settings (e.g., prisons, jails, and shelters) Residents should remain in quarantine for either 14 days or for 10 days with a negative molecular test (specimen collected after Day 7). 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). Long-Term Care Facility Visitors: Visitors will continue to be prevented entry to skilled nursing facilities (SNFs) and community care facilities (CCFs) for 14 days after their last exposure to the infected person. Long-Term Care Facility Residents: Exposed residents of SNFs and CCFs should quarantine for 14 days. Refer to setting-specific guidelines or protocols for more information. Visit our Provider COVID-19 Hub & Vaccine Hub for current resources and guidance This communication was sent by Dr. Sharon Balter, Director of Acute Communicable Disease Control Program, Los Angeles County Department of Public Health.