CDC’s updated guidance, released on July 17, 2020, no longer recommends use of PCR testing to decide when to discontinue isolation precautions at home and transmission-based precautions in healthcare settings, except for rare exceptions.
For patients who are severely immunocompromised, a test-based strategy could be considered in consultation with an infectious diseases expert. For all other symptomatic patients, a symptom-based strategy is recommended. For mild to moderate diseases, home isolation and healthcare transmission-based precautions can be discontinued when:
At least 10 days have passed since symptoms first appeared
AND
At least 24 hours have passed since last fever without the use of fever-
reducing medications (previous recommendation was “at least 72 hours
afebrile”)
AND
Other symptoms have improved (previous recommendation was
“improvement in respiratory symptoms”)
Patients with severe to critical illness* or who are severely immunocompromised should have precautions continued until 20 days after symptom onset with fever and symptom improvement. Orange County recommends a more cautious approach to release from transmission-based precautions in residents of long-term care facilities (LTCF) and other congregate living facilities for older adults (e.g., memory care units); see attached document
here,
under section 3.c
.,
for guidance.
Asymptomatic patients with laboratory-confirmed COVID-19 should have precautions continued until 10 days have passed since the date of their first positive COVID-19 diagnostic test, assuming they have not subsequently developed symptoms. Asymptomatic severely immunocompromised patients should have precautions continued for 20 days after their initial positive SARS-CoV-2 diagnostic test.
*CDC defines a patient as having severe illness when they have one or more of the following characteristics: respiratory frequency >30 breaths per minute, SpO2 <94% on room air at sea level (or, for patients with chronic hypoxemia, a decrease from baseline of >3%), ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2) <300 mmHg, or lung infiltrates >50%.
Critical Illness is defined as respiratory failure, septic shock, and/or multiple organ dysfunction.
The above guidance also applies to infected healthcare providers (HCPs) who are returning to work. HCPs who return to work while still symptomatic should wear a facemask for source control at all times while in the healthcare facility until all symptoms are completely resolved or at baseline. After this time period, they should revert to their facility policy regarding universal source control during the pandemic.
Medical providers are asked to educate cases about home isolation precautions as well as quarantine recommendations for the cases’ close contacts. Close contacts (those who have been within 6 feet of a case for 15 minutes anytime during the 48 hours before symptom onset until isolation) are recommended to self-quarantine for 14 days. According to Orange County health officer order, all patients with COVID-19 and all close contacts are directed to adhere to isolation and quarantine guidance respectively.
Guidance on home isolation and quarantine can be found at:
https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/isolation.html
.
For those who need assistance in finding an appropriate site for isolation due to homelessness, or for those unable to safely isolate to avoid exposing high-risk household contacts, OCHCA can assist with arranging temporary lodging in area hotels.
