Reasons for Shorter Quarantines Need to be Explained

When the US Centers for Disease Control and Prevention (CDC) released new guidance on shortened quarantine options, there was a mixture of relief and concern. What does it mean for infection prevention though?

As the coronavirus disease 2019 (COVID-19) pandemic reaches new records across all metrics—cases, hospitalizations, and deaths, we are struggling. Vaccine bottlenecks and distribution hurdles are stressing public health and healthcare resources even more and ultimately impact the public’s attitude towards the vaccine.

Saskia v. Popescu, PHD, MPH, MA, CIC

This pandemic has also pulled back the curtain on so many disparities across the United States, many of which we already knew about, but others that have been amplified by the stresses of the pandemic. A year into this, many of us have continued to hear accounts of people unable to quarantine after exposures. For so many, their places of work outside of healthcare have made it hard to be safe while paying bills, like having to take time off to quarantine if you have been exposed. Tough decisions like this make safety a challenging goal and if you have bills to pay and can’t take 14 days unpaid, it leaves little room but to work during quarantine.

Situations like these have challenged public health interventions to get people to quarantine for 14 days following an exposure. Late last year, the CDC released guidance on options to reduce quarantine. The goal was simple—if we can get people to quarantine for at least a minimum amount and get tested, we might have a better chance at getting them to stay home. Two options were presented—10 days of quarantine without a test, or 7 days with a negative test (test must occur on day 5 or after).

In both cases, people were still expected to monitor their symptoms until 14 days had passed since the exposure, Moreover, people still needed to mask, distance, wash their hands, avoid crowds, and other COVID-19 prevention efforts. The CDC noted that people need to follow their local public health department for quarantine requirements, but these recommendations had been made available. “CDC continues to endorse quarantine for 14 days and recognizes that any quarantine shorter than 14 days balances reduced burden against a small possibility of spreading the virus. CDC will continue to evaluate new information and update recommendations as needed.”

I think we can all agree that having some quarantine is better than none, but ultimately this really speaks to bigger issues with employers and how we financially support companies and their employees during a pandemic to encourage safety. When this guidance was released, there was a mixture of gratitude for its message, but also concern for how it would be utilized. With an average incubation period of 4-6 days, testing on day 5 or 6 for a 7-day quarantine period has the potential to miss infections.

A recent study published in the CDC’s Morbidity and Mortality Weekly Report (MMWR) evaluated a shortened quarantine period in Tennessee and Wisconsin from April to September 2020. The authors noted that “Among persons exposed to COVID-19 in the household who were asymptomatic and had negative laboratory test results through 7 days after symptom onset in the index patient, 19% experienced symptoms or received positive test results in the following week.”

The coming months will be telling in terms of how we approach quarantine and the implications of shortened quarantine periods. While it might be easier for people to adhere to, there is still concern for disease transmission and it is critical that those pieces be communicated to the public. For infection preventionists, there is likely pressure to utilize these measures, but it is important that we stick to local public health guidance and work to communicate the limitations of a shortened quarantine while promoting the need for continued infection prevention efforts.