Coronavirus Disease 2019 (COVID-19) Outbreak, Update # 19

On July 22, 2020, NH DHHS issued health alert COVID-19 outbreak update #19. 

NH DPHS Health AlertsKey Points and Recommendations:

  • New Hampshire’s COVID-19 General Travel and Quarantine Guidance has been updated, including employer screening and exclusion criteria. 
  • The U.S. Centers for Disease Control and Prevention (CDC) has updated their guidance for discontinuation of isolation for persons with COVID-19 not in healthcare settings
  • The CDC has updated their guidance for discontinuation of transmission-based precautions in healthcare settings
  • For patients with mild to moderate illness, home isolation or transmission-based precautions for hospitalized patients can be discontinued when the person has met all criteria of the “symptom-based strategy”: 
    1. At least 10 days have passed since symptoms first started, AND 
    2. At least 24 hours have passed since last fever (off any fever-reducing medications), AND 
    3. Symptoms have improved 
    • Asymptomatic patients who test positive can discontinue home isolation 10 days after their initial positive diagnostic test (assuming person remains asymptomatic)

  • For patients with severe to critical illness, or who are severely immunocompromised, transmission-based precautions can be discontinued when the patient has met all the following criteria: 
    1. At least 20 days have passed since symptoms first started, AND 
    2. At least 24 hours have passed since last fever (off any fever-reducing medications), AND 
    3. Symptoms have improved
    • Asymptomatic severely immunocompromised patients who test positive can have transmission-based precautions discontinued 20 days after their initial positive diagnostic test (assuming person remains asymptomatic) 
  • The summary of the current evidence and rationale for CDC’s changes to their isolation and transmission-based precautions recommendations has been updated. 
    • Recovered patients can continue to shed PCR-detectable SARS-CoV-2 RNA in upper respiratory tract specimens up to 3 months after initial infection without evidence of the person being infectious (i.e., likely dead virus being detected). 
    • For patients with mild to moderate COVID-19, replication-competent virus (i.e., infectious virus) has not been recovered after 10 days following symptom onset. For some patients with severe to critical illness (including immunocompromised patients), replication-competent virus has been recovered between 10-20 days after illness onset.
    • For some patients with severe to critical illness (including immunocompromised patients), replication-competent virus has been recovered between 10-20 days after illness onset. 

• The duration of a person’s immunity after infection and ability for re-infection is still being studied; however, CDC has not identified any cases of confirmed SARS-CoV-2 reinfection to date. Other related beta-coronavirus infections, however, do not produce long-lasting immunity and people appear to become susceptible as early as 90 days after onset of infection. Therefore:

  • For persons who remain asymptomatic following recovery from COVID-19, retesting is not recommended within the first 3 months after the date of symptom onset for most recent COVID-19 illness. 
  • For persons who develop new symptoms within the first 3 months after the date of symptom onset for the most recent COVID-19 illness, providers should take appropriate COVID-19 transmission-based precautions, consider re-testing for COVID-19, and work-up patient for alternative etiologies. If alternative etiologies for illness cannot be identified, repeat isolation and contact tracing may be needed if patient tests positive for COVID-19. 
  • Persons who develop new symptoms more than 3 months after the date of symptom onset for the most recent COVID-19 illness should be re-tested, and those who test positive should be considered infectious and undergo repeat isolation. 
  • See CDC Infection Control FAQs for more information.

• As previously recommended, providers should continue to test any patient presenting with even mild symptoms of COVID-19 using a PCR-based test; these patients should be instructed to isolate pending test results. We also recommend PCR testing for close contacts of people with suspected or confirmed COVID-19 in order to detect asymptomatic or pre-symptomatic infection. 

  • Close contacts of people with COVID-19 still need to quarantine for 14 days after their last exposure, regardless of whether or not a person is tested. 
  • Patients can access COVID-19 testing through a variety of specimen collection sites in NH.

• Providers should be aware that currently available point-of-care COVID-19 testing platforms – both PCR-based tests (e.g., Abbott ID NOW) and antigen-based tests (e.g., Quidel, BD Veritor) – have lower test sensitivity: 

  • Point-of-care tests are most helpful if positive. Negative test results should be considered “presumptive negative” and should be confirmed with another labbased PCR test with higher sensitivity. 
  • See the Association of Public Health Laboratories (APHL) Considerations for Implementation of SARS-CoV-2 Rapid Antigen Testing
  • See prior NH HAN, Update #18 for current personal protective equipment (PPE) recommendations, which have not changed.

Full DHHS Alert