Order-of-the-State-Public-Health-Officer-Beyond-the-Blueprint-QA Public Health Order Questions & Answers: COVID-19 Disease Control and Prevention

Public Health Order Questions & Answers: COVID-19 Disease Control and Prevention

​​​​​​​​​​Why did California Department of Public Health (CDPH) update the infectious period definition for the purposes of isolation and exclusion?

The updated definition of the infectious period is intended for purposes of isolation and exclusion ​when an individual becomes a confirmed case.  We are now at a different point in time with reduced impacts from COVID-19 compared to prior years due to broad immunity from vaccination and/or natural infection, and readily available treatments for infected people. Our policies and priorities for intervention are now focused on protecting those most at risk for serious illness, while minimizing the disruptive impact of isolation in schools and workplaces​​​.

Does the change to the infectious period definition for purposes of isolation and exclusion apply to healthcare settings?​​​​

No, this change applies only to non-healthcare settings. Please refer to AFL 21​​​​-08.9 for healthcare setting guidance. ​

How does CDPH define close contact in large ​indoor non-healthcare spac​es​? 

"Close Contact" is defined as the following:

  •  In indoor spaces 400,000 or fewer cubic feet per floor (such as home, clinic waiting room, airplane 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 separate 5-minute exposures for a total of 15 minutes) during a confirmed case's 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 6 feet of the confirmed case for a cumulative total of 15 minutes or more over a 24-hour period during the confirmed case's 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) must be considered distinct indoor airspaces.

The above definition is used for several reasons. SARS-CoV-2 aerosols are generated and released by a person with COVID-19 through activities such as breathing, speaking, and coughing. These aerosols enter the air around the infected person and then spread out evenly throughout the air.

In indoor environments, exposure to SARS-CoV-2 aerosols can occur in two ways: 1) directly, through face-to-face interactions with a person with COVID-19 and 2) indirectly, by inhalation of aerosols that have spread out from the person with COVID-19 and accumulated in the air in a space.  Both types of exposures to SARS-CoV-2 aerosols can lead to infection and COVID-19.

The risk of infection from direct face-to-face interactions depends on the distance from the infected person, with the highest risk being within six feet. The risk of infection from exposure to aerosols that have accumulated in the air, however, depends on the size (volume) of the room and the levels of ventilation and air filtration as key factors amongst others.

In addition to the infection risk from face-to-face interactions in an indoor space, air quality models predict that spending 15 minutes anywhere in a 400,000 cubic ft indoor space or smaller with an infected person poses an infection risk from indirect exposure to aerosols that have accumulated in the air; the infection risk increases with duration of time spent in the space.

For larger indoor non-healthcare spaces greater than 400,000 cubic feet, the infection risk from exposure to aerosols that have accumulated in the air is expected to be less than ten percent even after 8 hours because of the large volume of air present. The infection risk in these large settings is thus mainly limited to direct, face-to-face exposure with the infected person.

What is the differe​​nce​​​ between direct and indirect exposure?

Direct, short-range 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 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 will 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, the amount of virus inhaled, the levels of ventilation and air filtration in the area, whether the infected person has symptoms, and whether the infected and exposed persons were wearing a respirator or face 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, although coughs and sneezes may travel further. 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 person. This is because they are all exposed to about the same aerosol concentration after it mixes throughout the room. In a large indoor space, SARS-CoV-2 aerosols get diluted, and the risk of indirect exposures is lower.​

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​Originally published on October 12, 2022​​​​
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