COVID-19 Guidance for Isolation, Quarantine and Transmission-Based Precautions

Summary of Current City of St. Louis Department of Health COVID-19 Guidance for Isolation, Quarantine and Transmission-Based Precautions

Overview

The City of St. Louis Department of Health recommends guidance based on the science provided by the Centers for Disease Control and Prevention and local epidemiology.

  • If a person falls into more than one category, use the more conservative guideline or longest duration.
  • With rare exceptions described below, people who test positive for COVID-19 and recover should not be retested after their isolation period, and do not need to quarantine for the three months (90 days) following their date of symptom onset (or date of first positive test if they had no symptoms) per the City of St. Louis Department of Health (CSTLDOH) guidance. This applies even if they have a new exposure to COVID-19. For more information, visit the CDC webpage on isolation and quarantine.
  • A negative PCR test should not be required before someone with confirmed COVID-19 returns to work. This is because viral RNA may be detected for several weeks or months after someone is no longer infectious.
  • Health care personnel (HCP) should notify their employer if they are diagnosed with COVID-19, have symptoms consistent with COVID-19, or have an exposure to a person diagnosed with COVID-19. HCP must adhere to their employer’s guidance, which may be more conservative than that of CDC, CSTLDOH. Guidance for health care workers is not included in this guideline. Please refer to the CDC’s policy page for HCP.
  • For more information on symptoms and home isolation, visit the CSTLDOH COVID-19 Treatments webpage.
  • Proper selection and wearing of masks remains a critical component of risk mitigation. Please see below for guidance.

Definitions

  • Isolation is the separation of people who have a contagious disease to prevent them from transmitting it to others.
  • Quarantine is the separation of people without symptoms who were exposed to a contagious disease to prevent them from further transmitting should they go on to develop the disease.
  • Transmission-based precautions are to be used in addition to standard precautions for patients who may be infected with SARS-CoV-2 or other agents for which additional precautions are needed. For complete infection control guidance for COVID-19, please refer to the CDC’s Infection Control Guidance webpage.
  • Diagnostic tests include any SARS-CoV-2 Nucleic acid amplification-based testing such as a PCR test or antigen test, including at-home diagnostic tests. For more information on at-home tests, visit the CDC webpage on self-testing. Note that at-home test results may not be accepted for some purposes, such as school, employer or travel testing requirements, and are not appropriate for use in hospitalized patients. Diagnostic tests do not include antibody tests.
  • When to begin counting for quarantine or isolation: 
    • Quarantine: The date of your exposure is considered day 0. Day 1 is the first full day after your last contact with a person who has had COVID-19.
    • Isolation: Day 0 is your first day of symptoms or a positive viral test. Day 1 is the first full day after your symptoms developed or your test specimen was collected.

 

Masks: Materials and Wearing

The CDC advises wearing face masks or respirators for all individuals who are able to appropriately do so. CSTLDOH recommends that everyone properly wear a face mask when in public spaces and when they will be in the company of anyone who does not live in their household. When worn properly, face masks primarily contain exhaled respiratory droplets and particles, while providing some protection against inhaling materials exhaled by others. Respirators protect against inhalation of particles as well as containing exhaled respiratory droplets and particles.

KN95 respirators

Designed to meet international safety standards.

  • Difficult to wear with facial hair
  • Cannot be washed
  • Many sold in the US are counterfeit and do not meet standards – check here before purchasing 

N95, N99, N100, P95, P99, P100, R95, R99, and R100 respirators

Approved by National Institute for Occupational Safety and Health (NIOSH).

Workplace Performance Masks and Workplace Performance Plus Masks

Meets NIOSH performance criteria for workplace safety.

Cloth mask covering a medical procedure mask OR medical procedure mask with a fitter or brace

A fitted cloth mask worn over a medical procedure mask greatly reduces transmission of particles.

  • Medical procedure masks are single-use
  • Cloth masks must fit snugly to the cheeks – see here for additional criteria

Double-layered cloth mask with filter OR medical procedure mask

A 3-ply cloth mask or a medical procedure mask will reduce transmission of particles.

  • Cloth masks are reusable
  • While this option still provides protection, care must be taken to keep masks free of contaminants

 

Quarantine, Isolation and Transmission-Based Precautions

If a person has a positive diagnostic test for OR symptoms of COVID-19

Non-hospitalized people, including healthcare personnel

  • For asymptomatic or symptomatic individuals regardless of vaccination status, isolate at home or residence.
  • Individuals can discontinue isolation after 5 days IF fever-free for 24 hours without medication, OR on day 10 if an antigen test taken on day 5 is positive.
  • Individuals must also continue to properly wear a well-fitting mask around others for 10 days after the start of symptoms, or after receiving a positive test.

Severely immunocompromised people in any setting*

  • Individuals should speak with their medical provider(s) to determine if they are identified as severely immunocompromised
  • Isolation, or transmission-based precautions for those receiving medical care.
  • Individuals can discontinue isolation at the discretion of their healthcare provider.

* CDC defines severely immunocompromised as certain conditions, including being on chemotherapy for cancer, untreated HIV with CD4 count of less than 200, combined primary immunodeficiency disorder, and receipt of prednisone of more than 20 milligrams per day for more than 14 days, that may cause a higher degree of immunosuppression and therefore require different isolation considerations.  Per CSTLDOH guidance, severely immunocompromised patients who were asymptomatic at the time of their first positive test and subsequently developed symptoms attributed to COVID-19 must isolate for at least 5 days and up to 20 days after symptom onset at the discretion of their healthcare provider.

For households experiencing COVID-19 amongst multiple family members

All family members should remain socially distanced and separate from each other. For individuals who cannot remain socially distanced, please follow the requirements below.

Vaccinated and boosted OR had COVID-19 recently:

If a family member who is not ill has completed the recommended series of vaccine doses, including boosters and additional primary shots for some immunocompromised individuals, OR has recovered from COVID-19 within the last 90 days (with a confirmed positive viral test):

No quarantine is required, but wear a well-fitting mask around others for 10 days from the date of exposure.

Unvaccinated OR unboosted:

If a family member who is not ill has completed primary series of vaccine doses, but has not received a recommended booster dose when eligible OR is unvaccinated:

Not symptomatic: 

  • Stay at home for five (5) days or while the positive family member has symptoms. Once symptoms have resolved, get tested to learn your status. 
    • If the test is negative, resume your regular activities
    • If the test is positive, refer to the guidelines for isolation
    • If a test is unavailable: stay at home for five (5) days from the date that the positive family member’s symptoms have resolved, for no longer than a maximum of ten (10) days total in quarantine

Symptomatic:

  • Stay at home
  • Get tested at day 5 
  • Testing means (1) PCR test or (2) antigen tests 24 hours apart starting day 5
    • For a positive test, stay home an additional 5 days
  • Properly wear a well-fitting mask around others at home and in public for an additional 5 days

NOTE: Individuals who cannot wear a mask appropriately must quarantine for ten (10) days.

If a person has been in close contact with someone who has a positive COVID-19 diagnostic test

Vaccinated and boosted OR had COVID-19 recently:

If the person has completed the recommended series of vaccine doses, including boosters and additional primary shots for some immunocompromised individuals OR has recovered from COVID-19 within the last 90 days (with a confirmed positive viral test):

No quarantine is required, but properly wear a well-fitting mask around others for 10 days from the date of exposure.

Unvaccinated OR unboosted:

If the person has completed the primary series of vaccine doses, but has not received a recommended booster dose when eligible, OR is unvaccinated:

Asymptomatic: 

  • Stay at home for 5 days after last contact
  • Properly wear a well-fitting mask around others at home and in public for an additional 5 days

Symptomatic:

  • Stay at home
  • Get tested at day 5 
  • Testing means (1) PCR test or (2) antigen tests 24 hours apart starting day 5
    • For a positive test, stay home an additional 5 days
  • Properly wear a well-fitting mask around others at home and in public for an additional 5 days
  • If a test is unavailable after 5 days: stay at home until fever-free for 72 hours without medication 
    • Properly wear a well-fitting mask around others at home and in public for an additional 5 days

NOTE: Individuals who cannot wear a mask appropriately must quarantine for ten (10) days.

The City of St. Louis Department of Health may change recommendations as the situation evolves.

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