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10 Days or 14? Understanding COVID-19 Quarantine, Isolation Guidelines

CDC updates recommendations with alternatives to prevent coronavirus spread

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Americans who may have been exposed to the coronavirus now have a few different quarantine options that can help prevent the spread of COVID-19 in the absence of symptoms or before their onset.  

The Centers for Disease Control and Prevention (CDC) has long recommended that people who come into close contact with someone who has COVID-19 stay home and away from others for 14 days. This still remains the gold standard; however, on Dec. 2, the CDC introduced two shorter alternatives to its quarantine guidelines.

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Health officials now say a 10-day quarantine period is sufficient if the person in quarantine experiences no symptoms of COVID-19 during that time. What’s more, quarantine can end after seven days if the person tests negative for COVID-19 and has no symptoms.

“Reducing the length of quarantine may make it easier for people to take this critical public health action by reducing the economic hardship associated with a longer period, especially if they cannot work during that time,” CDC COVID-19 incident manager Henry Walke said in a news conference. “In addition, a shorter quarantine period can lessen stress on the public health system and communities, especially when new infections are rapidly rising.”

The U.S. is experiencing a record-breaking surge in coronavirus cases, hospitalizations and deaths. More than 100,000 Americans were in the hospital with COVID-19 on the day the CDC announced its change in quarantine guidelines — that’s nearly double the number from the peak in the spring. So far, about 14 million people in the U.S. have been infected with the coronavirus and more than 273,000 have died from it.

The updated quarantine recommendations were based on “extensive modeling” and new research, CDC officials stressed. John Brooks, chief medical officer for the CDC’s COVID-19 response, acknowledged that there is a small risk “that a person who is leaving quarantine early can transmit [the virus] to someone else if they become infectious.” That risk, however, was weighed against a reduced burden on the public and public health system.

“In a situation where cases are rising, that means that the number of contacts are rising and the number of people who require quarantine is rising. That’s a lot of burden not just on the people who have to quarantine, but on public health” authorities who have to monitor them, Brooks explained. “We believe that if we can reduce the burden a little bit, accepting it comes at a small cost, we may get a greater compliance overall,” which translates to fewer infections.

After ending an early quarantine, people still need to look out for COVID-19 symptoms for a full 14 days after exposure to the virus.

Quarantine vs. isolation

“Quarantine” and “isolation” are often used interchangeably but are applied to two different scenarios. Quarantine is meant for someone who was exposed or may have been exposed to COVID-19, and isolation is intended for people with a known coronavirus infection. Both, however, share the same purpose: to keep the virus from spreading to others.

People who have COVID-19, with or without symptoms, should isolate themselves from others for at least 10 days after the onset of symptoms. Isolation can end after that 10-day period as long as symptoms are improving and the person has been fever-free for at least 24 hours. The CDC updated its guidelines in July to say that people who have tested positive for COVID-19 no longer need a follow-up test that comes back negative in order to be around other people again.

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The updated guidelines were issued after a number of studies showed that most people are free of the virus and are no longer contagious 10 days after symptoms develop. Individuals who never experience symptoms of COVID-19 (asymptomatics) but who test positive for the virus are also advised by the CDC to self-isolate for 10 days after taking a coronavirus test.

Health experts applauded the CDC’s updated isolation recommendations. In particular, they noted the changes may help to conserve testing materials and ease testing backlogs.

Previously, health care providers had been testing some COVID-19 patients multiple times to ensure they were no longer contagious. This practice became “a draw on resources,” especially among patients who test positive for the virus weeks after their symptoms disappear, Michelle Doll, an associate hospital epidemiologist and an assistant professor of infectious disease at the Virginia Commonwealth University School of Medicine in Richmond, said in an earlier interview with AARP.

According to new research, all of those persistent positive tests were likely a result of “leftover virus fragments,” and not an indication that the virus was still present and transmissible, said William Schaffner, a professor of preventive medicine and infectious diseases at the Vanderbilt University Medical Center in Nashville.

“These are, if you will, dead soldiers. So there’s no point in doing all these follow-up tests anymore, because they just provide potentially confusing results,” Schaffner said in July. Having a more standard, science-based recommendation on when patients can rejoin others in their household means “you can get people off isolation more promptly,” he added.

Exceptions to the 10-day isolation rule

There are a few exceptions to the CDC’s 10-day isolation recommendations — the first being for people who have weakened immune systems due to a health condition or medication. Doll said that the virus is “a little bit more unpredictable” in immunocompromised patients and that “they can shed virus for longer periods of time.”

The CDC says that immunocompromised individuals may need to stay home and away from others for more than 10 days, but that they should talk to their health care provider for additional guidance.

Symptoms may persist long after infection

Just because you are no longer contagious doesn’t mean you will be completely without symptoms. Studies show that recovery time for COVID-19 can last longer than the virus.

A report from the CDC, for example, found that 35 percent of symptomatic adults who tested positive for COVID-19 but who were not hospitalized for the illness had not returned to their usual state of health 14 to 21 days after testing. Even young, healthy adults struggle to recover quickly from an infection. Nearly 1 in 5 surveyed adults 18 to 34 years old with no chronic medical conditions had not returned to their usual state of health 14 to 21 days after testing positive.

The key to coming off isolation is to make sure your symptoms are improving. If they do not improve, touch base with your doctor. Warning signs that require immediate medical attention include trouble breathing, persistent pain or pressure in the chest, new confusion, inability to wake or stay awake, and bluish lips or face.

Finally: If you experience a symptom of COVID-19, such as fever or fatigue, but do not get tested to confirm a coronavirus infection, it’s still a good idea to stay away from other people for 10 days just to be safe, Schaffner said.

Editor’s note: This article, originally published on July 27, has been updated to reflect new information.

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