The following COVID-19 update was released by the Pennsylvania Department of Health on March 16, 2021:
• This guidance replaces PA-HAN-538 and PA-HAN-551 and provides clarification on quarantine recommendations for person exposed to COVID-19.
• This guidance provides information about the need for quarantine for both individuals who are and are not fully vaccinated.
• Quarantine guidance for health care personnel can be found in PA-HAN-560, however, some quarantine guidance for inpatients and residents in healthcare settings can be found below.
• If you have questions about this guidance, please call your local health department or 1-877-PA-HEALTH (1-877-724-3258).
On March 8, 2021, the Centers for Disease Control and Prevention (CDC) updated their recommendations for individuals who are fully vaccinated. On March 10, 2021, the CDC updated healthcare infection prevention and control recommendations in healthcare settings. Based on these updated recommendations, the Pennsylvania Department of Health (PADOH) is updating guidance for individuals exposed to COVID-19. This guidance, which replaces PA-HAN-538 and PA-HAN-551, provides clarification on quarantine guidance and public health mitigation strategies (e.g., masking, social distancing) for those who are and are not fully vaccinated.
1) Recommendations for Individuals Who Are Not Fully Vaccinated
Individuals who are not fully vaccinated against COVID-19 and are identified as a close contact of a COVID-19 case must quarantine. An individual is considered fully vaccinated when 2 or more weeks have passed after the receipt of the second dose in a 2-dose vaccine series, or 2 or more weeks have passed after receipt of one dose of a single-dose vaccine. Quarantine is used to separate someone who might have been exposed to COVID-19 away from others. This individual may or may not develop illness. The most protective recommended quarantine period remains at 14 days after the date of last exposure (Day 0) to a person who is infectious with SARS-CoV-2. CDC has provide options for reduced quarantine which balances the reduced burden to the individual under quarantine against a small possibility of increasing the spread of the virus.
The following are options to reduce the 14-day quarantine:
- Quarantine can end after Day 10 without testing and if no symptoms have been reported during daily monitoring. However, it is recommended that symptom monitoring continue through day 14.
- If diagnostic testing resources are sufficient and available, quarantine can end after Day 7 if a diagnostic specimen (i.e., RT-PCR or antigen) tests negative and if no symptoms were reported during daily monitoring.
- The specimen must be collected and tested within 48 hours before the time of planned quarantine discontinuation (e.g., in anticipation of testing delays), but quarantine cannot be discontinued earlier than after Day 7.
In order to discontinue quarantine after Day 7, specimens must be collected on or after Day 5. Specimens collected prior to this date will not be sufficient to allow quarantine to end early. Either RT-PCR or antigen tests would be acceptable testing methods for discontinuation of quarantine.
Persons can discontinue quarantine at these time points only if the following criteria are also met:
- No clinical evidence of COVID-19 has been elicited by daily symptom monitoring during the entirety of quarantine up to the time at which quarantine is discontinued; and,
- Daily symptom monitoring continues through quarantine Day 14; and,
- Persons need to adhere strictly through Day 14 after exposure to all recommended nonpharmaceutical interventions (e.g., masking, physical distancing).
- If any symptoms develop, they should immediately self-isolate and contact the DOH at 1-877-PA-HEALTH, their local health department, or their healthcare provider to report this change in clinical status.
Testing for the purpose of discontinuation of quarantine prior to day 10 should be considered only if it will have no impact on community diagnostic testing. Testing of symptomatic persons seeking evaluation for infection must be prioritized.
Persons who have tested positive for COVID-19 within the past 3 months and recovered do not have to quarantine or get tested again as long as they do not develop new symptoms. If they do become symptomatic, the person should isolate and seek testing.
DOH recommends that non-healthcare congregate settings, such as prisons and shelters, continue to follow recommendations for a 14-day quarantine period. COVID-19 transmission within these setting can be difficult to control, and the increased transmission risk associated with shortening the quarantine time periods may be problematic in these settings. Other congregate settings, such as college dormitories, can consider implementing the shortened quarantine period but factors such as mask compliance and density of living conditions, along with the increased risk of transmission, should be carefully considered before implementing a reduced quarantine period. Daycare centers and K-12 schools can opt to shorten quarantine periods as described above as long as continued symptom monitoring for the full 14 days and other non-pharmaceutical interventions (e.g., masking, physical distancing) are strictly adhered to.
2) Recommendations for Asymptomatic Fully Vaccinated Individuals
Asymptomatic fully vaccinated people who are not residents or inpatients in healthcare settings do not need to quarantine after exposure to a person with confirmed or suspected COVID-19 provided they meet the following criteria:
- They are fully vaccinated (i.e., ≥2 weeks following receipt of the second dose in a 2-dose series, or ≥2 weeks following receipt of one dose of a single-dose vaccine); AND
- They have remained asymptomatic since the current COVID-19 exposure. The date of vaccination is day 0 when determining if an individual is fully vaccinated (i.e., > 2 weeks post vaccine dose).
Persons who do not meet all of the above criteria should continue to follow above guidance for individuals who are not vaccinated after exposure to someone with suspected or confirmed COVID-19.
Regardless of vaccination status, any person with new or unexplained symptoms of COVID-19 still needs to isolate and be evaluated for COVID-19 testing.
DOH and CDC continue to discourage any nonessential travel, even for people who are fully vaccinated, because protection is not 100%, durability of immunity is unknown, and there are new circulating strains of SARS-CoV-2 in other states and countries that are being investigated.
Additionally, DOH continues to recommend COVID-19 prevention measures such as masking, physical distancing, and hand hygiene for all people regardless of vaccination status. CDC has also recently provided guidance on how fully vaccinated people can safely visit with other fully vaccinated people or with unvaccinated people who are low-risk for severe COVID-19 disease in private settings.
3) Recommendations for Residents and Patients in Healthcare Settings
Quarantine guidance for healthcare personnel with higher-risk exposures in a healthcare setting, in the community or in their household can be found in PA-HAN-560.
Fully vaccinated inpatients and residents in healthcare settings should continue to quarantine following prolonged close contact (within 6 feet for a cumulative total of 15 minutes or more over a 24-hour period) with someone with SARS-CoV-2 infection, which includes the use of Transmission-Based Precautions for COVID-19 per PA-HAN-524. Outpatients should be cared for using recommended Transmission-Based Precautions. This is due to limited information about vaccine effectiveness in this population, the higher risk of severe disease and death, and challenges with physical distancing in healthcare settings.
Although not preferred, healthcare facilities could consider waiving quarantine for fully vaccinated patients and residents following prolonged close contact with someone with SARS-CoV-2 infection as a strategy to address critical issues (e.g., lack of space, staff, or PPE to safely care for exposed patients or residents) when other options are unsuccessful or unavailable. These decisions should be made in consultation with public health officials and infection control experts and detailed in the facility’s emergency management plan.
Quarantine is no longer recommended for residents who are being admitted to a post-acute care facility if they are fully vaccinated and have not had prolonged close contact with someone with SARS-CoV-2 infection in the prior 14 days (i.e., no known exposure to COVID-19).
If you have questions about this guidance, please call your local health department or 1-877-PA-HEALTH (1-877-724-3258).
Individuals interested in receiving further PA-HANs are encouraged to register at https://han.pa.gov/.