Updates as of July 21, 2022:
- Recommendations for healthcare facilities for using the updated close contact definition when responding to a potential exposure.
Why has CDPH updated its guidance to remove quarantine recommendations for exposures?
As the SARS-CoV-2 virus has evolved to have a shorter incubation period (e.g., average 2-3 days), usually by the time identified exposed persons are notified, their incubation period is over and the most relevant time period for restricting movement by quarantine has passed. In addition, we are now transitioning to a phase in the pandemic where many in our communities have been vaccinated against and/or previously infected with SARS-CoV-2, the virus causing COVID-19; and effective vaccines and treatment options are available to reduce the severity of disease and resulting hospitalizations, deaths, and stress on our infrastructure and healthcare systems. Additionally, the financial, social and societal burden of having exposed persons stay home is high, particularly for certain populations, including children and economically vulnerable communities.
CPDH updated recommendations for asymptomatic exposed persons in the general public, while maintaining quarantine recommendations for unvaccinated, incompletely vaccinated, or completed a primary series and booster-eligible but not boosted individuals in specified high-risk settings.
Recommendations related to isolation of individuals who have tested positive remain unchanged, along with the recommendation for individuals with COVID-19 symptoms to stay home until tested and receiving a negative result.
Does this updated guidance apply to all persons in a workplace setting?
In some workplaces, employers are subject to the Cal/OSHA COVID-19 Prevention Emergency Temporary Standards (ETS) and should consult those regulations for applicable requirements.
In some workplaces, employers are subject to the Cal/OSHA Aerosol Transmissible Diseases (ATD) Standard and should consult those regulations for additional applicable requirements.
In addition, in high-risk workplace settings (which includes other healthcare settings not covered by AFL-21-08.8), exposed employees without symptoms who are unvaccinated, incompletely vaccinated, or completed a primary series and booster-eligible but not boosted and have not had a previous infection within the prior 90 days should follow the recommendations in Table 3. Exposed employees in those settings without symptoms who have completed a primary series are not booster eligible and completed a primary series and boosted should follow Table 2 in the Isolation and Quarantine Guidance.
Other healthcare settings include, for example, outpatient clinics, free-standing urgent care facilities, dental clinics, pharmacies, infusion centers, behavioral health clinics, and school clinics.
Why does the CDPH definition of "close contact" differ from that of the CDC?
CDPH updated its definition of close contact to acknowledge that COVID-19 is an airborne disease (similar to measles and varicella), rather than one spread by respiratory droplets. Accordingly, CDPH has moved away from risk mitigation strategies that include physical distancing and physical barriers, and instead has adopted approaches that mitigate the risk of inhalation of infectious aerosols, including ventilation, air filtration, use of masks whenever indoors, and attention to mask fit and filtration.
How should non-healthcare entities respond to a potential exposure when using this updated definition?
Because COVID-19 is airborne, it can travel within indoor spaces, and large indoor spaces may create close contacts. When responding to a potential exposure, entities may prioritize the response by:
- Identifying close contacts who may be considered "high-risk contacts" based on their proximity to the case in the setting, the duration or intensity of their exposure, and/or their greater risk of severe illness or death from an exposure. Although SARS-CoV-2 is airborne, those closest to the infected person will be at greatest risk of exposure.
- Determining any smaller spaces within the larger indoor setting for the purposes of assessing potential exposure. For example, individual rooms, waiting areas, bathrooms, or break or eating areas within larger areas could be identified as the shared airspace area. When a larger indoor space cannot be easily divided into smaller discrete spaces, then close contacts may be determined based on proximity to the positive case, particularly in high-risk settings where close contacts might be considered for quarantine, cohorting, or work exclusion. Viral particles are less likely to concentrate in larger indoor spaces (e.g., department store or indoor shopping mall, or warehouse, gymnasium) so only those closer to the infectious person or in a more enclosed shared airspace would be considered at great enough risk of becoming infected to be called a close contact.
- Determining any transient exposures totaling <15 minutes, such as passing in a hallway. Those with transient exposures would not meet the definition of close contact.
Broad (or group) notification of possible exposures may be used based on the considerations above.
In all instances, all persons considered close contacts who have not been infected in the previous 90 days (regardless of vaccination status) should consider testing as soon as possible to determine infection status. CDPH also recommends testing within 3-5 days after last exposure. In addition, all close contacts, regardless of previous infection or vaccination status are strongly recommended to 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, and self-monitor for symptoms.
Workplaces covered under the Cal/OSHA ETS should consult those regulations for specific requirements regarding management of close contacts in the workplace. Indoor work settings may raise different considerations. Additionally, healthcare
facilities should reference the below question and answer to address response
to potential exposures in a healthcare setting.
Entities should also be aware that their local health department may have additional recommendations or requirements (especially in regard to high-risk settings or during an outbreak or surge).
How should healthcare facilities respond to a potential exposure when using this updated definition?
Healthcare facilities should continue to use the CDC's risk assessment framework to determine exposure risk for healthcare personnel (HCP) with potential occupational exposure to patients, residents, and visitors with COVID-19 in a health care setting. CDC provides additional considerations for assessing exposure risk for patients or residents exposed to HCP with COVID-19 in a health care setting. CDPH guidance for assessing community-related exposures should be applied to HCP with potential exposures outside of work (e.g., household), HCP 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 health care 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, and risk of severe illness or death from exposure, as described above.
Why do close contacts in high-risk settings have separate quarantine and work exclusion recommendations than close contacts in the general public?
A high-risk setting is one in which transmission risk is high (e.g., setting with a large number of persons in close proximity, particularly persons who may not receive full protection from vaccination due to co-existing medical conditions), or one that serves populations at risk of more serious COVID-19 disease consequences including hospitalization, severe illness, and death.
As such, CDPH is recommending work exclusion (for staff) and quarantine (for patients, residents and clients) if such persons are unvaccinated, incompletely vaccinated, or have completed a primary series and are booster-eligible but not boosted. This allows us to continue protecting our most vulnerable populations and the workforce that delivers critical services in these settings.
Additionally, CDPH recommends that for healthcare facilities that may serve more vulnerable populations at risk for severe disease or illness (for example, outpatient oncology settings, other long-term care facilities not specifically identified in AFL 21-08.8), facilities should consider current CDC healthcare infection control guidance for quarantine of HCP, patients and residents that exceed the recommendations included in this statewide guidance. Local correctional facilities may also consider current CDC recommendations for isolation and quarantine that exceed the recommendations included in this statewide guidance.
For specific requirements for staff and residents in Long-Term Care Settings & Adult and Senior Care Facilities licensed by the California Department of Social Services, entities must reference applicable Provider Information Notices.
Which high-risk Healthcare and Long-Term Care Settings are covered by this guidance?
This guidance applies to all staff and residents in all healthcare settings except for healthcare personnel in settings covered by AFL-21-08.8. It also does not apply to Emergency Medical Services personnel, who are permitted to follow the Guidance on Quarantine for Health Care Personnel in AFL-21-08.8.
Healthcare settings refer to places where healthcare is delivered and includes, but is not limited to, acute care facilities, long-term acute-care facilities, inpatient rehabilitation facilities, nursing homes, home healthcare, vehicles where healthcare is delivered (e.g., mobile clinics), and outpatient facilities, such as dialysis centers, physician offices, dental offices, and others.
CDPH recommends that exposed, asymptomatic healthcare personnel who are not excluded from work in high-risk settings test immediately upon notification of exposure, and at 3-5 days unless they have been infected within the prior 90 days.
Does this guidance apply to children?
- Children less than 18 years of age, who test positive for COVID-19, should follow the recommendations included in Table 1 of the Isolation and Quarantine Guidance. However, as per CDPH masking guidance, children under 2 years of age should not wear a mask during their isolation period.
- Children less 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 guidance. However, as per CDPH masking guidance, children under 2 years of age should not wear a mask.
Does this guidance apply to children in childcare and K-12 schools settings?
Childcare providers and programs should consult the Guidance for Child Care Providers and Programs and K-12 schools should consult the CDPH K-12 Schools Guidance.
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.
Workplaces covered under the Cal/OSHA ETS should also consult those regulations for applicable outbreak management requirements.
When is a person considered "incompletely vaccinated"?
"Incompletely vaccinated" means persons who have not received all recommended doses in the COVID-19 primary vaccination series, for example, someone who has received only one dose of a two-dose COVID-19 primary vaccine series.
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.
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 and whether they do or do not have symptoms, should follow CDPH recommendations for isolation.
What should persons do if they experience COVID-19 rebound after a Paxlovid treatment?
For COVID-19 rebound (characterized by a recurrence of symptoms or a new positive viral test after having tested negative) following Paxlovid treatment, persons should re-isolate for at least 5 days and follow the recommended actions in Table 1 above to prevent further transmission.
When is a person considered infectious?
The COVID-19 infectious period used to determine exposure of contacts starts 2 days before symptom onset or 2 days before first positive specimen collection date (if asymptomatic) and may go through day 10 after symptom onset (or after positive specimen collection date if remaining asymptomatic), if the infected person does not test negative prior to day 10.
For the purposes of identifying close contacts and exposures, infected persons who test negative on or after day 5 and end isolation, in accordance with the guidance, 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. For calculating infectious period, day 0 is symptom onset/positive test date (see below).
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.
Can a person who tests positive on day 5 of isolation test again on subsequent days to see if they can discontinue isolation?
If a person tests positive on day 5 of isolation, they may continue to test again on day 6, 7, and so forth, and may discontinue isolation when any subsequent test comes back as negative as long as they meet other criteria for discontinuing isolation before 10 days. Persons do not have to wait until day 10 to retest and do not need a negative test in order to discontinue isolation after day 10.
What if I still test positive on day 10 of isolation?
Persons in the general public who test positive on day 10 may leave isolation after 10 days regardless of their test result. Healthcare personnel covered by AFL-21-08.8 should consult the AFL to determine any additional requirements or recommendations regarding additional precautions (including use of N95 respirators for source control and care for patients at high risk for severe disease).
Do persons still need to quarantine or be excluded from work even if they were recently infected with COVID-19?
Persons infected with COVID-19 within the last 90 days (meaning they tested positive using a viral test) do not need to be tested, quarantined, or excluded from work unless symptoms develop and should refrain from testing during the 90 days unless symptoms develop. They should also self-monitor for symptoms, continue masking for 10 days and follow all other recommendations in Table 2, as well as the additional precautionary measures indicated below.
Do persons who have completed a primary series and are boosted if eligible for a booster dose need to quarantine or be excluded from work after an exposure?
No, persons covered by this guidance who have completed a primary series and are boosted if eligible for a booster dose (see definitions above) do not need to quarantine or be excluded from work following an exposure.
CDPH recommends that exposed, asymptomatic workers who are not excluded from work in high-risk settings test immediately upon notification of exposure, and at 3-5 days unless they have been infected within the prior 90 days.
Unless they have been infected within the prior 90 days, all close contacts, whether quarantined or not, should consider testing as soon as possible to determine infection status and follow all isolation recommendations above if testing positive. Knowing one is infected early during quarantine enables (a) earlier access to treatment options, if indicated (especially for those that may be at risk for severe illness), and (b) notification of exposed persons (close contacts) who may also benefit by knowing if they are infected. If testing negative before day 3, retest at least a day later, during the 3-5 day window following exposure.
What should excluded or quarantined persons in high-risk settings do if they test positive (regardless of whether they have symptoms)? Is it different for those who don't have to be excluded or quarantine because they have completed a primary series and are boosted if eligible for a booster dose?
In both situations, if someone has a positive test, they have become an infected person and should follow the indicated isolation recommendations in the CDPH guidance, regardless of vaccination or boosted status.
What should excluded or quarantined persons in high-risk settings do if they develop symptoms but test negative? Is it different for those who don't have to be excluded or quarantine because they have completed a primary series and are boosted if eligible for a booster dose?
In both situations, symptomatic exposed persons who test negative on an antigen test within the first 1-2 days of symptoms should retest at least 24 hours later during the 3-5 day window following exposure with an antigen or PCR test. If the second test is also negative, the negative result can be accepted. Symptomatic persons who test negative on a PCR test do not need to be retested and the results can be accepted as negative.
Do persons who are exposed to an infected person in their home need to quarantine or be excluded from work?
Persons not living or working in a high-risk setting do not need 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 test every 3-5 days while the case is in isolation and 3-5 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 3-5 days after their last exposure to the case.
- Household contacts may consider testing more frequently if resources are available.
- Household contacts who tested positive for COVID-19 in the previous 90 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.
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, no fever and a negative COVID-19 test), the following additional precautionary measures are recommended through day 10:
- Avoid indoor public settings where you are unable to wear a mask, such as restaurants, bars, and indoor mega events where food and drink are served.
- Avoid people who are immunocompromised or at high risk for severe disease.
- Avoid nursing homes and other high-risk congregate settings.
- Avoid eating around others at home and at work.
- Avoid non-essential travel
What if a person needs to travel immediately after discontinuing isolation or quarantine?
Per CDC Guidance:
- Persons who have tested positive for COVID-19 should not travel until a full 10 days after symptom onset or 10 days after the date their positive test if they do not have symptoms.
- Persons who were exposed to someone with COVID-19 are discouraged from traveling until testing negative 5 days after exposure. 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.
- Please refer to CDC's travel guidance for more information.