HJNO Jan/Feb 2021

34 JAN / FEB 2021  I  HEALTHCARE JOURNAL OF NEW ORLEANS   Healthcare Briefs The Louisiana Department of Health adopted the Centers for Disease Control and Prevention’s (CDC) recently updated guidance that allows people who may have been exposed to COVID-19 to shorten their quarantine period from 14 days to 10 days, or as few as 7 days with a negative test. associated with more than 35.5 million illnesses, 16.5 million medical visits, 490,600 hospitaliza- tions, and 34,200 deaths during the 2018–2019 influenza season. Everyone, six months of age and older, should receive a flu vaccination annu- ally, especially people at high-risk. Louisiana Adopts CDC Guidance Allowing Shortened COVIDQuarantine The Louisiana Department of Health (LDH) adopted the Centers for Disease Control and Prevention’s (CDC) recently updated guidance that allows people who may have been exposed to COVID-19 to shorten their quarantine period from 14 days to 10 days, or as few as seven days with a negative test. Still, the shorter quarantine periods do come with a risk that a person may be infectious when he or she leaves quarantine, and should be care- fully evaluated when weighing options. Because even a small post-quarantine transmission risk could result in substantial secondary clusters in settings where there is a high risk for transmission, LDH is currently recommending the full 14-day quarantine period for use among residents and staff of congregate living settings such as nursing homes and correctional facilities. CDC continues to recommend a quarantine period of 14 days, but now provides two new options to shorten quarantine based on local cir- cumstances and resources. The Louisiana Depart- ment of Health has reviewed the updated CDC guidance and underlying data and accepts the following options to shorten quarantine for close contacts of an individual infected with COVID-19: Quarantine can end after 10 days, on day 11, if no symptoms have been reported during daily monitoring. For the 10-day quarantine, the risk that an individual who is leaving quarantine early could transmit to someone else if they became infected is about one percent with an upper limit of 10%. If communities have enough testing resources, quarantine can end after seven days, on day eight, if the individual takes a COVID test (molec- ular/PCR or antigen), receives a negative result, and if no symptoms were reported during daily monitoring. The individual leaving quarantine should be tested within 48 hours before the time of planned quarantine discontinuation (e.g., in anticipation of testing delays). The individual needs to stay in quarantine until they receive their negative test result. Quarantine cannot be dis- continued earlier than day eight. For the seven- day quarantine, the risk that an individual who is leaving quarantine early could transmit to some- one else if they became infected is about 5%, with an upper limit of 12%. Should an individual choose to shorten their quarantine the following guidance is critical: • Daily symptom monitoring should continue through quarantine day 14. • Individuals should adhere strictly through quarantine day 14 to all recommended non-pharmaceutical interventions includ- ing social distancing, avoiding crowded indoor spaces, hand washing, and espe- cially wearing masks/face coverings when outside the home. Should any symptoms develop, they should immediately self-iso- late and contact their healthcare provider to report this change in clinical status. Adher- ing to non-pharmaceutical interventions like masking and distancing are impor- tant always and for everyone but, due to the increased transmission risk, they are of vital importance to those wishing to shorten their quarantine. • Visitation to hospitals or to high-risk con- gregate facilities such as nursing homes or correctional facilities should not occur until after quarantine day 14. • Individuals may continue to quarantine for 14 days without testing per existing recom- mendations. The existing 14-day quarantine protocol is the “gold standard”; it guaran- tees maximum reduction of post-quarantine transmission risk and is the strategy with the greatest collective experience at present. • In addition, LDH recommends that any close contacts who develop symptoms within the 14 days after their last exposure to a person with COVID-19 infection should get tested as soon as possible. About quarantine Quarantine is used to separate someone who might have been exposed to COVID-19 and may develop illness away from other people. Quar- antine helps prevent spread of disease that can occur before a person knows they have the virus. The recommendation for a 14-day quarantine was based on estimates of the upper bounds of the COVID-19 incubation period. Quarantine’s importance grew after it was evident that per- sons are able to transmit COVID before symp- toms develop, and that a substantial portion of infected people never develop symptomatic ill- ness but can still transmit the virus. In this con- text, quarantine is a critical measure to control transmission. Quarantine is intended to reduce the risk that infected persons might unknowingly transmit infection to others. n