On January 4, 2022 CDC updated their guidance on Isolation and Quarantine based on several factors.
Updated: January 10, 2022
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BACKGROUND
On January 4, 2022 CDC updated their guidance on
Isolation and Quarantine based on
several factors - the impact of COVID-19 infections due to the Omicron variant, when and for how long a person is maximally infectious with Omicron, the effectiveness of COVID-19 vaccines and booster doses against Omicron infection, and adherence to prevention interventions.
While the incubation period of SARS-CoV-2 is between 2-14 days, illness onset and infectivity most commonly occur at the beginning of this period. Reports suggest that compared with previous variants, Omicron has a shorter incubation period (2-4 days), defined as the time between becoming infected and symptom onset. COVID-19 vaccine booster shots have been shown to increase protection against SARS-CoV-2, including Omicron. Although many people have intentions to self-isolate, both isolation and quarantine are challenging; especially in the context that many infections are asymptomatic.
The shortened timeframes for isolation and quarantine focus on the period when a person is most infectious, followed by continued masking for an additional 5 days. Preliminary data suggest that the Omicron variant is up to three times more infectious than the Delta variant. With the recommended shorter isolation and quarantine periods, it is critical that people continue to wear well-fitting masks and take additional precautions for 5 days after leaving isolation or quarantine.
ISOLATION (APPLIES TO INFECTED PERSONS)
Isolation is used to separate people with confirmed or suspected COVID-19 from those without COVID-19. The majority of SARS-CoV-2 transmission occurs early in the course of illness, generally in the 1-2 days prior to onset of symptoms and the 2-3 days after.
Persons who have COVID-19
symptoms should be tested for COVID-19 with a
viral test. Everyone who tests positive for COVID-19 infection or who have symptoms of COVID-19 (including those waiting for test results or who haven’t been tested), regardless of vaccination status, should isolate for at least 5 full days and take additional precautions during and after isolation.
This document applies to most community settings, including workplaces and schools, high-risk congregate care settings, and the public (refer to section on Exceptions and Special Circumstances for additional considerations). This document does not apply to childcare settings.
Additional guidance for childcare will be forthcoming.
Guidance for healthcare facilities is available on the NJDOH COVID-19 website for healthcare professionals.
Persons who test positive for COVID-19 and are symptomatic or persons with COVID-19 symptoms who weren’t tested or who are waiting for test results
1
• Stay home and isolate from other people for at least 5 full days (day 0 is the first day of symptoms).
a. If symptoms resolve (fever-free for 24 hours and other symptoms improve
2), isolation can end after 5 full days (i.e., on day 6).
b. If symptoms persist (fever or if other symptoms have not improved), continue to isolate until fever-free for 24 hours and other symptoms have improved.
Persons who test positive for COVID-19 but have no symptoms
• Stay home and isolate from other people for at least 5 full days (day 0 is the day of the positive viral test
3).
a. If no symptoms develop, isolation can end after 5 full days (i.e., on day 6).
b. If symptoms develop within one week of the positive test, the 5-day isolation period starts over with day 0 being the first day of symptoms. Follow recommendations for ending isolation for persons who have COVID-19 symptoms.
Additional precautions during/after isolation (everyone)
• MASK: Continue to wear a well-fitted mask when around others at home and in public through day 10. For those ending isolation on day 5, this would be during days 6 through 10. Persons who are unable to wear a mask when around others should stay home and isolate from other people for a full 10 days.
• TRAVEL: Avoid travel until a full 10 days after your first day of symptoms or if asymptomatic, after the date of the positive test. If travel is necessary on days 6-10, wear a well-fitting mask when around others for the entire duration of travel. Persons unable to wear a mask should not travel during the 10 days.
• AVOID HIGH-RISK ACTIVITIES: Avoid people who are immunocompromised or at high risk for severe disease, including nursing homes and other high-risk settings; do not go to places where you are unable to wear a mask, such as restaurants and some gyms, and avoid eating around others at home and at work until a full 10 days.
1 These timeframes do not apply to people with severe COVID-19 or with weakened immune systems (immunocompromised). See Exceptions and Special Circumstances section.
2 Loss of taste and smell may persist for weeks or months after recovery and need not delay the end of isolation.
3 The day of the positive test is the day tested, not the day the positive test result was received.
Testing during/after isolation
COVID-19 tests are best used early in the course of illness to diagnose COVID-19 and are not authorized by the U.S. Food and Drug Administration (FDA) to evaluate duration of infectiousness. Some people may remain positive by Nucleic Acid Amplification Tests (NAATs) (e.g., RT-PCR) long beyond the period of expected infectiousness. The significance of a positive or negative antigen test late in the course of illness is less clear; while a positive antigen test likely means a person has residual transmissible virus and can potentially infect others, a negative antigen test does not necessarily indicate the absence of transmissible virus. Regardless of the test result, wearing a well-fitting mask is still recommended.
Given the limitations of testing later in the course of illness, if an individual who is isolating has access to a test and wants to test, the best approach is to use an antigen test towards the end of the 5-day isolation period. Testing should be performed only if fever-free for 24 hours and other symptoms have improved (or if symptoms weren’t present). If the antigen test result is positive, continue to isolate until day 10. If the antigen test result is negative, isolation can end, but continue to wear a well-fitting mask around others at home and in public until day 10. In this scenario, negative antigen tests should be used twice over a three-day period with at least 24 hours and no more than 48 hours between tests.
QUARANTINE (APPLIES TO PERSONS EXPOSED TO SOMEONE WITH COVID-19)
Quarantine is a strategy used to prevent transmission of COVID-19 by keeping people who have been in close contact
4 with someone with COVID-19 apart from others. Persons having close contact with someone who is in their isolation period would be considered exposed, should be tested for COVID-19, and may need to quarantine, depending on vaccination status and if recently recovered. Persons having close contact with someone who has completed their isolation period but who is still taking additional precautions through day 10 is not considered exposed for the purpose of quarantine but should self-monitor for symptoms for 10 days and if concerned about possible exposure, get tested for COVID-19.
4 Someone who was less than 6 feet away from an infected person (laboratory-confirmed or a clinical diagnosis) for a cumulative total of 15 minutes or more over a 24-hour period.
Who does not need to quarantine?
Individuals in the following groups who had close contact with someone with COVID-19 do NOT need to quarantine but should wear a well-fitting mask around others for 10 days and get tested at least 5 days after the last close contact
5. If the test is positive or if COVID-19 symptoms develop, follow isolation recommendations.
• Adults ≥ 18 years old who completed a primary series of COVID-19 vaccine AND have received all recommended vaccine doses, including boosters
6 and additional primary shots for some immunocompromised people.
• Children and adolescents 5-17 years old who completed the primary series of COVID-19 vaccine.
• Persons who had confirmed COVID-19 within the last 90 days (positive viral test).
Who should quarantine?
Individuals in the following groups who had close contact with someone with COVID-19 DO need to quarantine and should take additional precautions during and after quarantine:
• Adults ≥ 18 years old who completed a primary series of COVID-19 vaccine but have NOT received a recommended booster shot when eligible.
• Persons who are not fully vaccinated (haven’t completed a primary vaccine series).
During quarantine
• Stay home and away from other people for at least 5 days (day 0 through day 5) after the last close contact with a person who has COVID-19. The date of the exposure is considered day 0.
• If COVID-19 symptoms develop, get tested and follow isolation recommendations.
• If asymptomatic, get tested at least 5 days after the last close contact 5.
If the test is positive, follow isolation recommendations.
If the test is negative, you can end quarantine after day 5.
If testing is not available, you can end quarantine after day 5 (as long as there were no COVID-19 symptoms throughout the 5-day period).
5 Exception: persons who recently recovered from COVID-19 (tested positive and recovered in the past 90 days) do not need to be tested.
6 For the purpose of quarantine, someone is considered “boosted” upon receipt of the booster dose.
Additional precautions during and after quarantine
• MASK: Continue to wear a well-fitted mask when around others at home and in public through day 10. For those ending quarantine on day 5, this would be during days 6 through 10. Persons who are unable to wear a mask when around others should continue to quarantine for a full 10 days. In very limited circumstances when a 5-day quarantine is not feasible, it is imperative that a well-fitted mask be worn when around others at home and in public through day 10.
• MONITOR FOR SYMPTOMS: Watch for fever (100.4◦F or greater), cough, shortness of breath, or other COVID-19 symptoms for 10 days after last close contact. If symptoms develop, get tested and follow isolation recommendations.
• TRAVEL: Get tested at least 5 days after your last close contact and make sure the test result is negative and you remain without symptoms before traveling. If testing is not available, delay travel until a full 10 days after the last close contact. If travel is necessary before the 10 days are completed, wear a well-fitting mask around others for the entire duration of travel. Persons unable to wear a mask should not travel during the 10 days.
• AVOID HIGH-RISK ACTIVITIES: Avoid people who are immunocompromised or at high risk for severe disease, including nursing homes and other high-risk settings; do not go to places where you are unable to wear a mask, such as restaurants and some gyms, and avoid eating around others at home and at work until a full 10 days. If possible, stay away from people you live with, especially people who are at higher risk for getting very sick from COVID-19, as well as others outside your home throughout the full 10 days after your last close contact with someone with COVID-19.
EXCEPTIONS AND SPECIAL CIRCUMSTANCES
High-risk congregate settings
In certain congregate settings that have high risk of secondary transmission and where it is not feasible to cohort people (e.g., correctional and detention facilities, homeless shelters, cruise ships), a 10-day isolation and quarantine period is recommended for residents, regardless of vaccination and booster status. During periods of critical staffing shortages, facilities may consider shortening the isolation or quarantine period for staff to ensure continuity of operations. Decisions to shorten timeframes in these settings should be made in consultation with local public health officials and should take into consideration the context and characteristics of the facility. Refer to setting-specific guidance for additional information.
Household settings
Isolation and quarantine can be challenging in households, particularly when caregiving is involved. Persons with COVID-19 should stay home and isolate away from other people for at least 5 full days and wear a well-fitted mask around others in the home (and in public) for 5 additional days. Those who are unable to consistently wear a mask at home should isolate from household members for a full 10 days. Household contacts who can’t isolate away from the household member with COVID-19 should start their quarantine period on the day after the household member would have completed their 10-day isolation period, UNLESS the household member is able to consistently wear a well fitted mask in the household through day 10, in which case the quarantine period would start on the day after the household member completes their 5-day isolation period.
Persons not included in shorter isolation/quarantine timeframes
In addition to those listed above under “High-risk congregate settings,” the following individuals should not follow the shortened isolation/quarantine timeframes in this document:
• Children < 2 years of age, or other individuals who are unable to wear a mask should isolate (if infected) and quarantine (if exposed) for 10 days.
• People who have
moderate7 COVID-19 illness should isolate for 10 days.
• People who are
severely ill with COVID-19 (including those who were hospitalized or required intensive care or ventilation support) and people with compromised immune systems might need to isolate at home longer and should consult with their healthcare provider to determine the appropriate duration of isolation. CDC recommends an isolation period of at least 10 and up to 20 days for people who were severely ill with COVID-19 and for people with weakened immune systems. For guidance on moderately or severely immunocompromised people with COVID-19 in non-healthcare settings, please see
Ending Isolation and Precautions for People with COVID-19: Interim Guidance (cdc.gov).
REFERENCES
CDC:
Quarantine and Isolation
What We Know About Quarantine and Isolation
Clinical Spectrum of SARS-CoV-2 Infection
Stay Up to Date with Your Vaccines
7 Individuals who show evidence of lower respiratory disease during clinical assessment or imaging and who have an oxygen saturation (SpO2) ≥94% on room air at sea level.