In spite of options to reduce quarantine periods offered by the Centers for Disease Control and Prevention (CDC) and the Missouri Department of Health and Senior Services (DHSS), the Crawford County Health Department (CCHD) will continue to recommend 14-day quarantines for close contacts to a COVID-19 case because the county is still in an extreme risk status.
In information released on December 15, the CCHD noted the local health department “recognizes the incredible burden that quarantine requirements place on individuals, families, and businesses” and had spent much time and consideration in collaborating with local and regional partners to determine the best course of action for quarantine guidelines moving forward.
The reevaluation came after the CDC issued “Options to Reduce Quarantine for Contacts of Persons with SARS-CoV-2 Infection Using Symptom Monitoring and Diagnostic Testing” on December 2.
The revised CDC guidance states, “Local public health authorities determine and establish the quarantine options for their jurisdictions. CDC currently recommends a quarantine period of 14 days. However, based on local circumstances and resources, the following options to shorten quarantine are acceptable alternatives.
“Quarantine can end after Day 10 without testing and if no symptoms have been reported during daily monitoring. With this strategy, residual post-quarantine transmission risk is estimated to be about one percent with an upper limit of about 10 percent.
“When diagnostic testing resources are sufficient and available, then quarantine can end after Day 7 if a diagnostic specimen tests negative and if no symptoms were reported during daily monitoring. The specimen may 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. With this strategy, the residual post-quarantine transmission risk is estimated to be about five percent with an upper limit of about 12 percent.”
In both cases, additional criteria, including continued symptom monitoring and masking through Day 14, must be met and are outlined in the full text found on the CDC website at https://www.cdc.gov/coronavirus/2019-ncov/more/scientific-brief-options-to-reduce-quarantine.html.
The CCHD pointed out the CDC did not change quarantine guidance, but instead offered additional options for local public health authorities to implement, if appropriate in the local area.
In response to the new guidance from the CDC, the Missouri DHSS released a statement including some clarifications for Missouri Local Public Health Agencies (including the county health department). The DHSS statement noted, “Local decisions regarding the implementation of a quarantine Day 7 test out option or a quarantine Day 10 end should consider a tiered approach that includes reduced restrictions when the local community is within a County Action Plan Level 3 status or better, and should consider key risk factors such as residence in a congregate care facility, hypertension, diabetes, and similar COVID risk factors. Testing availability should also be considered as a factor that will impact these decisions.”
The state issued three County Action Plan Levels as follows:
The Category 1 County Action Plan (Extreme Risk) is for counties with a PCR seven-day positivity rate of 15 percent or above (using the CDC method), and a seven-day case rate per 100k of 350 or above. In those counties, business occupancy limits should be reflective of social distancing, and social groups sizes should be limited to 10 or less. Mask are strongly advised in all offices and businesses where social distancing is not possible.
The state noted, for the purposes of its advisory, a “social group” is defined as any planned or spontaneous event or convening that would bring together a group of people in a single space at the same time, excluding normal business activities, religious services, schools and school activities, and extended family gatherings.
The Category 2 County Action Plan (Critical Risk) is for counties with a PCR seven-day positivity rate of 10 to 14 percent (using CDC method), and a seven-day case rate per 100k of 100-349. Business occupancy limits should be reflective of social distancing. Social group sizes should be limited to 25 or less; and masks are advised in all offices and businesses with 10 or more people where social distancing is not possible.
The Category 3 County Action Plan (Serious Risk) is for counties with a PCR seven-day positivity rate of five to nine percent, and a seven-day case rate per 100k of 10-99. In these counties, there are no business occupancy limits, and social groups sizes are only limited to maintaining six feet of distance. Masks are still advised in all offices and businesses with 10 or more people where social distancing is not possible.
More details from the State of Missouri Public Health Warning, which includes the above information in the local government advisory section along with a personal behavior advisory, business advisory, travel advisory can be found online at https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/pdf/advisory-20201119.pdf.
Based on Crawford County’s current seven-day positivity rate of 23.7 percent, the county is placed in the County Action Plan Category 1 (Extreme Risk) status according to the state. As a result, the CCHD will continue to recommend 14-day quarantine for close contacts to a COVID-19 case without the option of a seven-day test out or 10-day quarantine. The local health department will continue to monitor the situation and current guidance, and noted, “Our decision is based on the health of our entire population, as that is our top priority.”