The quandaries of quarantine: Local public health director explains the process
STEAMBOAT SPRINGS — When it comes to people complying with COVID-19 quarantines, Routt County Director of Public Health Roberta Smith said the response has been variable.
“I think the majority of people get it,” she said this week.
Quarantine guidelines, which apply only to close contacts of positive cases, were updated Dec. 2, 2020, by the Centers for Disease Control and Prevention, allowing for a seven- and 10-day quarantine option, but Smith said the 14-day quarantine remains the “gold standard.”
What is quarantining?
Quarantining is a precautionary measure taken by people who were likely exposed but don’t know if they are infected.
According to the Routt County Department of Public Health, quarantine can end after 10 days if a person has not had any signs or symptoms of COVID-19. It is suggested individuals still monitor for signs and symptoms for 14 days.
Under state guidelines, issued by the Colorado Department of Public Health and Environment, quarantining means close monitoring of symptoms; avoiding high-risk individuals; restricting activities outside the house other than to seek medical care; not going to work, school or public areas; and avoiding the use of public transportation, ride shares or taxis. It also includes wearing a mask and increasing cleaning and hygiene measures.
Isolating, which is different than quarantining, is for people who test positive for COVID-19. According to the CDHPE, isolating means staying away from other people entirely. Isolation lasts until the person has not experienced a fever for 24 hours, symptoms have improved and 10 days have passed since their first symptoms appeared.
Those who test positive but have no symptoms should isolate for 10 days starting with the date of the positive test.
Because of the transparency and communication with families and the media, the Steamboat Springs School District is the most visible place to see the recent impact of quarantines.
Since students returned to school following the holiday break, there have been more than 200 students placed in quarantine across four schools along with about 20 staff members.
Those aren’t positive cases — those are the students and staff identified as close contacts of positive cases, of which there were about 10. That means each positive case quarantined a rough average of 20 other people.
At Steamboat Springs High School, two unrelated cases announced Jan. 13 resulted in the quarantining of 79 students.
If there is a positive case in a house, that means the whole household is in quarantine, Smith said, so don’t send the sibling of an infected student to school.
The burden of quarantining
The quarantine process is undoubtedly burdensome for everyone.
For some people, quarantining comes with the ability to work or go to school from home. For others, it means missing work.
Lost wages are cited as a primary reason people don’t adhere to quarantine orders.
The federal Families First Coronavirus Response Act went into effect in April 2020 and provided two full weeks of pay to some workers who tested positive for COVID-19 or were directed into quarantine. It also provided partial paid leave for workers caring for sick household members.
In Colorado, the Healthy Families and Workplaces Act was signed into law in July 2020 and required nearly all private employers of any size to provide paid sick leave for COVID-19-related absences.
The federal COVID-19 paid sick leave provisions expired Dec. 31, 2020.
In Colorado, sick leave provisions for 2021 apply to employers with 16 or more employees.
Most self-employed people and numerous other workers have never received additional support.
Smith advises businesses not to force people to come to work.
“Have plans to incentivize people to stay home and obey quarantine orders,” Smith said. “If you come to work and are positive, we are not going to end this cycle.”
Recent studies show shortened quarantines can lead to better compliance, reduce the economic and mental health burden and be as effective at interrupting disease transmission. But the shortest quarantines require tests.
As detailed in a December National Geographic article, “Shorter quarantines could actually help prevent COVID-19 outbreaks,” a Yale University team reports in a preliminary study that an eight-day quarantine with PRC testing at the beginning and end of the quarantine is more effective at preventing the spread of COVID-19 than a 14-day quarantine.
“One caveat: The test needs to be administered on the seventh day of the quarantine, with results arriving within 24 hours, given what’s now known about the incubation window and infectiousness,” the study reported.
When people first hear they are a close contact of a positive case, Smith said a common reaction is to go get a test.
This can be a valuable step, but depending on the timeline, a negative test may only give a false sense of security. The general consensus among scientists is that the SARS-CoV-2 viral load increases exponentially after exposure, peaking around the fifth day before slowly decreasing.
That means a test may not pick the virus up if taken only a day or two after exposure.
And with about 20% or 30% of COVID-19 cases being entirely asymptomatic, having symptoms is not a reliable diagnostic tool.
Much of the quarantine and isolation process requires a significant amount of public trust and personal responsibility. Thus, as Smith said, adherence is varied.
While a vital tool, contact tracing has its limits. As the county continues to identify around 100 new cases each week, there are not enough contract tracers to make immediate contact with each positive case, much less every close contact provided.
If a person takes a diagnostic test Wednesday, they may not get their positive results until Friday. They then may not hear from the contact tracer until Monday or potentially over the weekend. By the time the contact tracer gets in touch with the people who may have been exposed to that positive case, a week could have passed.
“We really see the highest level of contagiousness two days prior to symptom onset,” Smith said. “That’s the most opportune time to give it to someone.”
Given the period deemed most contagious is actually in the days before the positive person exhibits symptoms — if a week or even several days pass before close contacts are informed about a positive test result — the chain of transmission easily continues despite best contact tracing efforts.
Many people take it upon themselves to let their close contacts know immediately if they test positive, Smith said.
Thus, people should know what to do and what not to do without waiting on a call from public health.
“Quarantining should be taken seriously,” Smith said. “And if you are in quarantine from school, it also means do not go out and ski. Do not go out and visit friends. Limit your contacts.”
To reach Kari Dequine Harden, call 970-871-4205, email kharden@SteamboatPilot.com or follow her on Twitter @kariharden.
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