āāāāāIsolation and Quarantine Q&A
Updates as of March 13, 2023:
- Removes recommendation for the general public to test in order to leave isolation before Day 10, if the individual is well with no symptoms, or symptoms are mild or improving, and fever-free for 24 hours without the use of fever-reducing medication.
- After ending isolation, persons may remove their mask sooner than Day 10 after two sequential negative tests one day apart.ā
- Updates definition of infectious period to incorporate the above items.
Questions and Answers
Why has CDPH removed its recommendation to test in order to leave isolation before Day 10?
CDPH is aligning recommendations for the general public based on CDC COVID-19 isolation recommendations. Persons who have tested positive for COVID-19 can end isolation after Day 5 if:
- Syāmptoms are not present, or are mild and imāāāāproving; AND
- They have been fever-free for 24 hours (without the use of fever-reducing medication).
I have ended isolation before Day 10. When can I remove my mask? ā
Individuals ending isolation before Dāay 10 are still recommended to mask through Day 10. āāHowever, persons wāāho end isolation before Day 10 can remove their masks after two sequential negative tests at least one day apart.
Persons who meet the criteria for ending isolation before Day 10 may take their first test on the same day they leave isolation and their second test (if first test is negative) on the following day (or later). If the second test is negative, persons may remove their mask that same day. For example, if a person meets the criteria to leave isolation after Day 5, they may take the first test on Day 6, and the second test on Day 7. If both testsā are negative, persons may remove their mask on Day 7.
If there is a positive test result, ātesting should be started again at least one day later, with masking continued until two negative test results are achieved, without a positive test in between.
Employers must continue to ensure that workers comply with Cal/OSHA COVID-19 Non-Emergency Regulationsā or in some workplaces the Cal/OSHA Aerosol Transmissible Diseases (ATD) Standard and should consult those regulations for additional applicable requirements. Workers leaving isolation are required to continue wearing a face covering in the workplace until 10 days have passed since the date that COVID-19 symptoms began or, if the person did not have COVID-19 symptoms, from the date of their first positive COVID-19 test.
In certain healthcare situations or settings and other facilities, services and operations covered by the Cal/OSHA ATD Standard, surgical masks (or higher filtration masks) are required and are not affected by the March 13th guidance change.āā
What symptom(s) of COVID-19 are indicative of a person still being infectious? ā
Other than feveār, there are no specific symptoms of COVID-19 that indicate a person is still infectious, and symptoms can persist after a person is no longer infectious. ā
Additionally, if symptoms are not improving or are increasing, it is possible that the infected person is still infectious and should remain in isolation for the full 10 days, following recommendations for isolation in Table 1 of the guidance.
Does this updated guidance apply to all persons in a workplace setting?
Healthcare personnel (HCP) working in settings covered byāÆAFL 2ā1-08.9āÆ should continue to follow the guidance outlined in AFL 21-08.8. Healthcare personnel (HCP) working in settings not covered byāÆAFL 21-08.9āÆ may follow the guidance outlined in AFL 21-08.8.āÆ Skilled nursing facilities should follow the guidance for isolation of infected residents ināÆAFL 22-13.1.
Other healthcare settings not covered by AFL 21-08.8 include, for example, outpatient clinics, free-standing urgent care facilities, dental clinics, pharmacies, infusion centers, behavioral health clinics, and school clinics. ā
How should healthcare facilities respond to a potential exposure when usināg the close contact definition?
Healthcare facilities should continue to use theāÆCDC's risk assessment frameworkāÆto determine exposure risk for HCP with potential occupational exposure to patients, residents, and visitors with COVID-19 in healthcare settings.āÆCDC provides additional considerationsāÆfor assessing exposure risk for patients or residents exposed to HCP with COVID-19 in healthcare settings.
CDPH guidance for assessing community-related exposures should be applied to HCP with potential exposures outside of work (e.g. household). HPC exposed to each other while working in non-patient care areas (e.g. administrative offices), and for patients/residents exposed to other patients/residents or visitors in healthcare and non-patient care areas (e.g. waiting rooms, dining areas). Healthcare facilities should prioritize identifying and responding to such contacts based on their proximity to the case, duration or intensity of the exposure, as described above, and the contact's risk of severe illness or death from infectionā.
What is the definition of a "close contact"?āÆ
The definition of close contact depends on the size of the indoor space, the distance between the case and the contact, and the arrangement within the indoor environment. Specifically, a close contact is defined as follows:
- In indoor spaces of 400,000 or fewer cubic feet per floor (such as homes, clinic waiting rooms, airplanes, etc.), a close contact is defined as sharing the same indoor airspace for a cumulative total of 15 minutes or more over a 24-hour period (for example, three individual five-minute exposures for a total of 15 minutes) during a confirmed case's (confirmed by COVID-19 test or clinical diagnosis) infectious period.
- In large indoor spaces greater than 400,000 cubic feet per floor (such as open-floor-plan offices, warehouses, large retail stores, manufacturing, or food processing facilities), a close contact is defined as being within six feet of the confirmed case for a cumulative total of 15 minutes or more over a 24-hour period during the confirmed caseās infectious period.
Spaces that are separated by floor-to-ceiling walls (e.g., offices, suites, rooms, waiting areas, bathrooms, or break or eating areas that are separated by floor-to-ceiling walls) should be considered distinct indoor airspaces.
What is the difference between direct and indirect aerosol exposure? ā
Direct, short-range aerosol exposure occurs when someone inhales SARS-CoV-2 aerosols during face-to-face interactions with a person with COVID-19. The infected person generates and releases aerosols through breathing, speaking, coughing, and sneezing. The concentration of the aerosols containing SARS-CoV-2 is highest close to the infected person and decreases as the aerosols disperse through the air, especially in larger spaces where there is sufficient air volume to dilute the aerosols that may accumulate.
Indirect, long-range aerosol exposure occurs when someone inhales SARS-CoV-2 aerosols that have traveled away from a person with COVID-19 and accumulated in the air in an indoor space. The aerosols tend to mix evenly throughout a space because of dilution and air mixing.
Smaller spaces tend to have higher concentrations of accumulated aerosols than larger spaces, because there is less air to dilute the aerosols in a smaller space.
For both direct and indirect exposures, the risk of infection depends on the duration of exposure, whether the infected person has symptoms, the levels of ventilation and air filtration, and whether the infected and exposed persons were wearing a respirator or mask. The risk of infection from direct exposure also depends on the distance from the infected person, with the highest risk being within six feet. The risk of infection from indirect exposure also depends on the size (volume) of the room. Therefore, the risk of infection from indirect exposure is the about same for everyone in a smaller indoor space regardless of the distance from the infected personā. This is because they are all exposed to about the same aerosol concentration after it mixes throughout the room.āÆ In large indoor spaces, SARS-CoV-2 aerosols get diluted, and the risk of indirect exposures is low. ā
Should individuals in high-risk settings use the same isolation recommendations as the general public? ā
Non-healthcare high-risk settings (for example, Adult and Senior Care Facilities, correctional facilities, homeless and emergency shelters, and warming/cooling centers) may follow the isolation and exposure recommendations that are applicable to the general public, as detailed in Table 1 and Table 2 of theāÆCOVID-19 Isolation and Quarantine Guidance.
Healthcare personnel should follow recommendations as set forth ināÆāÆAFLāÆ21-08.9.āÆ Healthcare personnel working in settings not covered byāÆAFL 21-08.9āÆmay follow the guidance outlined in AFL 21-08.9.āÆ Skilled nursing facilities should follow the guidance for isolation of infected residents ināÆAFL 22-13.1. ā
What is the definition of Healthcare Settings?
Healthcare settings refer to places where healthcare is delivered and include, but are not limited to, acute care facilities, long-term acute care facilities, inpatient rehabilitation facilities, skilled nursing facilities, home healthcare, vehicles where healthcare is delivered (e.g., mobile clinics), and outpatient facilities, such as dialysis centers, physician offices, dental offices, and others. ā
Does this guidance apply to children? ā
- Children younger than 18 years of age who test positive for COVID-19 should isolate and follow the recommendations included in Table 1 of theāÆIsolation and Quarantine Guidance; however, as perāÆCDPH masking guidance, children younger than 2 years of age should not wear a mask.
- Children younger than 18 years of age, regardless of vaccination status, who have been exposed to someone with COVID-19 do not need to quarantine but should follow all recommendations in Table 2 of the Isolation and Quarantine Guidance; however, as perāÆCDPH masking guidance, children younger than 2 years of age should not wear a mask. ā
Does this guidance apply to children in K-12 school settings?
āYes, K-12 schools should refer to Table 1 and Table 2 in the Isolation and Quarantine Guidance and should also consult theāÆCDPH K-12 Schools Guidance for more information. ā
Does this guidance apply to outbreaks?
No, this guidance should not be used for outbreak management purposes. CDPH recommends consulting with the Local Health Jurisdiction for outbreak guidance.
When is a person considered to have "completed their primary series"?
For the definition of "Completed a primary series" please see CDPH Vaccine Records Guidelines and Standards.
When is a person considered "boosted?" Do they have to wait two weeks after receiving the booster dose?
Persons are considered boosted as soon as they receive their booster dose, as a booster dose typically refreshes protection more quickly than after the primary series. They do not need to wait two weeks after receiving their booster dose to be considered boosted.
Isolāation
If a person tests positive for COVID-19, does that person still need to isolate, even if they are boosted?
Yes, all persons who test positive for COVID-19, regardless of their vaccination status, whether they do or do not have symptoms, or had previous infection should isolate and follow CDPH recommendations for isolation in Table 1 of the guidance.
What should persons do if they experience COVID-19 rebound, whether it occurs with or without antiviral medicine treatment?
For COVID-19 rebound (characterized by a recurrence of symptoms or a new positive viral test after having tested negative), persons should re-isolate for at least 5 days and follow the recommended actions in Table 1 to prevent further transmission. ā
When is a person considered infectious?
CDPH has recently modified its infectious period definition to align with the updated isolation recommendations as set forth in the guidance. The COVID-19 infectious period starts:
- For symptomatic confirmed cases, 2 days before the confirmed case had any symptoms (symptom onset date is Day 0) through Days 5-10 after symptoms first appearedāÆANDāÆ24 hours have passed with no fever, without the use of fever-reducing medications, and symptoms have improved, OR
- For asymptomatic confirmed cases, 2 days before the positive specimen collection date (collection date is Day 0) through Day 5 after positive specimen collection dateāÆfor their first positive COVID-19 test.ā
For the purposes of identifying close contacts and exposures, symptomatic and asymptomaticāÆconfirmed cases who end isolation in accordance with the Isolation and Quarantine Guidance and are no longer considered to be within their infectious period. Such persons should continue to follow CDPH isolation recommendations, including wearing a well-fitting face mask through Day 10.
When does the clock start for isolation?
The five-day clock for the isolation period starts on the date of symptom onset (day 0) for people who test positive after symptoms develop, with day 1 being the first full day of isolation after symptom onset.
The five-day clock for people who are and remain asymptomatic begins the day of the first positive specimen collection (day 0). If an asymptomatic person who has tested positive subsequently develops symptoms, the five-day clock is restarted on the day of symptom onset, with the date of symptom onset being day 0. The isolation clock continues to day 10 if the infected person tests positive on day 5 or later or does not meet the other criteria for discontinuing isolation earlier.
Does someone need to be fever-free for a full 24-hours prior to leaving isolation (as had been stated in previous guidance)?
Yes. Before discontinuing isolation, persons in isolation need to be fever-free for 24 hours without the use of fever-reducing medication. This is a good general guideline for other infections as well.
Quarantine
What should close contacts who develop symptoms but test negative do?
Close contacts who have COVID-19 symptoms and who test negative on an antigen test within the first 1ā2 days of symptoms should retest at least 24 hours later during the 3ā5 day window following exposure with an antigen or PCR test (PCR tests are not recommended if it has been less than 90 days since a prior infection). If the second test is also negative, the negative result can be accepted.
Symptomatic persons who initially test negative on a PCR test do not need to be retested and the results can be accepted as negative.āÆIn general, individuals with symptoms should still mask around others and minimize contact with others until symptoms have resolved to prevent spread of other infectious diseases.
Close contacts in Healthcare Settings should follow recommendations as indicated ināÆAFL 21-08.9.āÆ Healthcare settings not covered byāÆAFL 21-08.9āÆmay follow the guidance outlined in AFL 21-08.8 Skilled nursing facilities should follow the guidance for management of exposed residents ināÆAFL 22-13.1.ā
Do persons who are exposed to an infected person in their home need to quarantine or be excluded from work?
Close contacts who are asymptomatic regardless of vaccination status no longer have to quarantine or be excluded from work after exposure to an infected household member, but they are considered a high-risk contact with a much higher likelihood of infection and should more carefully follow all the recommended actions in Table 2, including getting tested and wearing a well-fitting mask around others and around the infected person while they are isolating at home.
What are the recommendations for households with an infected household member?
- Cases who cannot separate from others in the home should mask when in common areas and when around others for 10 days, AND
- Asymptomatic household contacts of cases should mask in the home when not separated from the isolated case.
What are the testing recommendations for asymptomatic household contacts?
- Household contacts who were likely to have been exposed at the same time as the case should test immediately to determine if they are already infected.
- Household contacts who cannot separate from the case in the home should testāÆevery 3ā5 days āÆwhile the case is in isolation and 3ā5 days after the case ends isolation (or 3-5 days after their last exposure to the case during case's isolation period).
- Household contacts who are able to separate from the case in the home should test 3ā5 daysāÆafter their last exposure to the case.
- Household contacts may consider testing more frequently if resources are available.
- Household contacts should wear a well-fitting mask around others for a total of 10 days, especially in indoor settings and when near those at higher risk for severe COVID-19 disease.
- Household contacts who tested positive for COVID-19 in the previous 30 days do not need to get tested if they have had no new symptoms; if they develop symptoms, they should get tested using an antigen test.
- Household contacts who develop symptoms should isolate and test immediately. If they test positive, they should follow isolation recommendations in Table 1 of the Isolation and Quarantine Guidance. If they test negative and symptoms continue, they should retest at least once in 1ā2 days.
Are there additional precautionary measures that should be followed if a person leaves isolation before day 10?
While persons may exit isolation after Day 5 (based on lack of symptoms or improved symptoms andāā no fever), the following additional precautionary measures are recommended through Day 10:
- Wear a high-quality mask when indoors around others at home or in public.
- Do not go to places where you are unable to wear a mask until you are able to discontinue masking.
- Avoid people who are immunocompromised or at high risk for severe disease.
- āAvoid nursing homes and other high-risk congregate settings.
- Avoid non-essential travel.
What if a person needs to travel immediately after discontinuing isolation?
- āPersons who have tested positive for COVID-19 should not travel until a full 10 days after symptom onset or 10 days after the positive test specimen collection date if they do not have symptoms.
- Travel is discouraged before the 10 days are completed, but if travel is unavoidable, persons should wear a well-fitting mask with good filtration when around others during travel for the entire 10 days.
- If ending isolation but still need to continue wearing a mask per Isolation and Quarantine Guidance, travel is discouraged on public transportation if the person is unable to wear a mask or respirator when around others for the full duration of the trip.
- Please refer toāÆCDC's travel guidanceāÆfor more information.
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