The standard 14-day coronavirus quarantines potentially can be shortened to 10 days or even seven, according to revised guidance issued Wednesday by the Centers for Disease Control and Prevention in an effort to boost compliance with one of the most important tools for limiting spread of the virus.
The move reflects the agency’s recognition that the two-week quarantine rule is onerous for many people and that most of the public health benefit from quarantining people exposed to the virus can be gained with a more flexible approach.
The CDC acknowledges that this new guidance involves a trade-off. The existing 14-day quarantine recommendation reflects the ability of the virus to incubate for a long period before symptoms appear. But lack of compliance—for example, among people who fear that they will lose a job, or two weeks of income, if they admit to being exposed—can undermine the public health benefit from that standard.
“It can be burdensome enough that we are hearing many reports that jurisdictions are having trouble having people comply with the quarantine that is recommended,” said a senior federal official who spoke on the condition of anonymity to provide context for the guidance in advance of a CDC news briefing scheduled for late Wednesday morning. “We are accepting some risk in exchange for reduction in burden that will allow us to better control this epidemic.”
The 14-day quarantine recommendation from the CDC remains in effect, but the revised guidance being given to public health agencies offers two ways for people to shorten the period. If a community has adequate testing resources, the quarantine can end after seven days if a person tests negative for the virus at some point in the final two days of that period. The test can be either a rapid-response antigen test or the more reliable PCR test that takes longer to process.
The quarantine can end after 10 days without a test if a person monitors potential symptoms, such as fever, on a daily basis and has none. The exposed person is expected to continue monitoring symptoms and wearing a mask for the full 14 days despite discontinuing quarantine.
The CDC was looking for “the sweet spot,” the federal official said, where the recommended quarantine would capture the majority of potentially infectious people but also lead to higher compliance. CDC scientists calculated that, for people discontinuing quarantine after seven days, the “residual post-quarantine transmission risk” is about 5%, dropping to 1% for those who quarantine for 10 days under the new guidance.
Two prominent infectious-disease experts welcomed the news of the revised guidance Wednesday.
“Behind the scenes, many of us had been urging the CDC to move forward with this, because I think it’s in the best interest of public health, and it’s in the best interest of the economy and it’s in the best interest of the mental health of people who have to be quarantined,” said William Schaffner, a professor of infectious disease at the Vanderbilt University Medical Center. “This is a win all around.”
Jennifer Nuzzo, an epidemiologist at the Johns Hopkins Center for Health Security, also welcomed the revision in the CDC guideline, saying it will focus on the period in which most people exposed to the virus are most likely to become contagious. Right now, she said, contact tracing efforts are hindered by “deep disincentives” for people to quarantine.
“A seven- or 10-day quarantine recommendation may be easier for people to bear and hopefully may help get more contacts of cases to comply and better enable efforts to stop transmission of the virus,” Nuzzo said Wednesday in an email.
Quarantines apply to people who have been exposed to the virus but have no confirmed infection or illness. The goal is to separate those people from the rest of the population to prevent them from spreading the virus.
The virus incubates slowly. Symptoms may not appear for many days, or even two weeks, and in rare cases even longer. People can become infectious to others one or two days before symptoms appear.
What makes this pandemic even more difficult to contain is that 20% to 40% of people who are infected never develop symptoms, yet potentially are still capable of transmitting the virus to others, according to the CDC.