Home quarantine and home isolation -advice for healthcare personnel
Home quarantine applies for people who are not ill but who have a known possible exposure. If someone develops symptoms of suspected COVID-19 during the quarantine period, they should contact their doctor and be isolated until the suspicion is clarified.
Home quarantine does not apply for people who have had confirmed COVID-19, documented by approved laboratory methods during the last six months. Currently, only rt-PCR for SARS-CoV-2 is recommended.
Regulations have been introduced about the requirements for quarantine for close contacts of confirmed COVID-19 cases and for quarantine after travel abroad.
- People who have been in countries covered by the quarantine decision. See Travel advice
- Overview of new regulations concerning coronavirus - Lovdata.
In addition, it is recommended that household members, or their equivalent, with close contact to people with probable COVID-19 should be in quarantine.
Home quarantine measures
People who are in quarantine can leave their home but should avoid close contact with others:
In each case it should be considered whether closer follow-up by the healthcare service is necessary during the quarantine period.
People in home quarantine should monitor their own symptoms and stay at home if they develop symptoms of respiratory tract infections. Anyone who needs medical attention should contact their doctor.
Healthcare professionals who need to visit people in home quarantine should follow basic infection control measures but do not need extra protection as long as nobody else in the household has symptoms.
Household members of people in quarantine should monitor their own symptoms but are not in quarantine themselves.
Duration of home quarantine or home isolation
- Close contacts who are not household members of someone with confirmed COVID-19 must be in home quarantine for 10 days after the last contact with the patient diagnosed with the virus.
- Close contacts who are household members of people with confirmed or probable* COVID-19 must be in home quarantine until home isolation for the patient ceases, and for a minimum of 10 days after quarantine began.
- People who have travelled outside Norway shall be in home quarantine for 10 days after their arrival in Norway.
- The quarantine period is not shortened with a negative test result.
*Probable case: Close contact in home quarantine who develops symptoms of COVID-19 (acute respiratory tract infection and fever, cough or difficulty breathing, or considered by a doctor to have suspected COVID-19) where there are no test results.
From 1st June, the regulations for quarantine will change. At the same time, the Government will open for similar quarantine regulations between the Nordic countries:
Exemption from duty of quarantine
There are exemptions for people who have had confirmed COVID-19, documented by approved laboratory methods during the last six months. Currently, only rt-PCR for SARS-CoV-2 is a recommended method.
In the regulations about quarantine, people with essential roles in maintaining operations related to health may be exempt from quarantine when they are at work. Use of this exemption shall be clarified with the employee's management.
The exemption only applies when they are at work, and during travel to and from work. Otherwise, they shall be in quarantine at home. They should not use public transport to and from work.
Before making a quarantine exception, the following should be considered:
- Ability to reallocate personnel from other parts of the operation.
- Ability to downgrade activity.
If this is not sufficient to safeguard operations, there should be a local assessment of who should be called back to work.
- Employees who are in quarantine after travel abroad.
- Employees who are at the end of their quarantine period (the average incubation period for COVID-19 is 5-6 days).
- Employees who are least exposed to infection, after an assessment of the exposure.
The following should not be exempt from the quarantine obligation:
- Employees who have respiratory tract symptoms or fever during the quarantine period are considered to be probable COVID-19 cases. They must be isolated and thus not work.
- Employees who have had close contact with a confirmed case with symptoms over a period of time.
- Employees who have a household member / partner who has confirmed COVID-19.
Personnel who attend work during the quarantine period shall:
- Immediately leave work if they develop symptoms of infection.
- Keep a safe distance from employees and others.
- Organise work so that close contact with employees and others is limited.
- For work in the vicinity of patients, use a face mask when you are less than 2 metres from the patient
- Avoid preparation and handling of food for others.
- Be extra careful with cough etiquette and hand hygiene.
Home isolation applies to people with confirmed COVID-19, and people who have been assessed by a doctor to be a probable case, but who do not need to be admitted to hospital.
Measures with home isolation
Home isolation means that the patient shall not go out. See further details on this page:
Home isolation is only appropriate if the living situation allows for it. For each patient, the healthcare service should make a follow-up plan to ensure that:
- the patient gets any necessary practical assistance
- any deterioration in health is detected
- the patient can comply with the measures
In the majority of cases, and always for patients in risk groups, strive to maintain daily contact. Telephone/digital contact or home visits are appropriate. The patient should be told who they should contact if their condition deteriorates.
Healthcare professionals who visit patients isolated at home, or their household members, must follow recommended infection control measures, including the use of personal protective equipment.
Household members of people with confirmed COVID-19 shall be in home quarantine if they are defined as close contacts.
Duration of home isolation
Home isolation is usually lifted 7 days after symptoms are gone.
The measures described below are based on the following assessment:
- People without symptoms pose little risk of transmission but the disease may develop gradually with non-specific symptoms. Measures depend on the probability of being infected.
- People with symptoms pose a high risk of transmission
Quarantine means the temporary restriction of movement / social interaction for people who have been exposed to an infectious agent but who have not yet developed a clinical disease. People in quarantine are healthy but have been in a situation where they may have become infected. This can apply to individuals, for example, in their own home (home quarantine) or to larger groups in an apartment block, cruise ship, village or city.
The main point of quarantine is to ensure that people do not infect others before they develop symptoms themselves, but it must be practically feasible.
If someone is in home quarantine because a household member is sick with COVID-19, the home quarantine lasts for at least 10 days. After that, they can leave home quarantine when the person who has been sick has ended their isolation, even though 10 days have not passed since the last exposure.
In practice, this can mean that it is less than 10 days since the last exposure. However, they have been exposed for more than 10 days without developing symptoms and the sick are considered to be less contagious late in the course of the disease. The risk that those in home quarantine become ill after this period is therefore considered low.
People who live with a person in home quarantine are not in quarantine themselves, but like everybody else in the population, they should monitor their own symptoms.
Isolation is most often used as a term when patients with infectious disease are isolated in their own room within a health institution. Similarly, home isolation means that patients with a clinical presentation of and / or confirmed infection are isolated at home.
Isolation and quarantine of individuals can occur in other settings than the home if necessary. For example, tourists can be quarantined/isolated in a hotel. The same principles for quarantine and isolation apply when these measures are introduced outside of the home.
Background for changes in quarantine from 7th May 2020
Quarantine is used to prevent the spread of infection before symptoms of COVID-19 infection have been reported. Over time, better knowledge of COVID-19 has made it clear that most of the transmission occur at the very beginning of the disease course. Extensive use of quarantine is unfortunate where there is very low risk of disease. Ideally, you will detect as many sick people as possible with the fewest possible quarantine days.
The NIPH has therefore recommends that the days in quarantine be targeted by these three changes.
- One is considered to be a close contact 48 hours before symptoms start (increased from 24 hours)
- Quarantine time is shortened from 14 to 10 days
- People who have had COVID-19 disease are exempt from quarantine duty for the subsequent six months.
Reasons for the changes
Quarantine is effective in preventing transmission of COVID-19 to uninfected people. At the same time, it is a costly measure and can impair preparedness if an entire work team is taken out of a business. Several countries, including Sweden and Denmark, have therefore stopped using quarantine. Countries that still use quarantine have used a quarantine period of 14 days since the start of the epidemic. This is in line with the advice of the World Health Organization (WHO) and the European Centre for Disease Control (ECDC).
Preliminary experience in Norway shows that a few hundred days are spent in quarantine per person who develops illness. The NIPH has therefore assessed whether the use of quarantine can be better targeted. Is there a better alternative between 0 and 14 days? When should quarantine start? Is a new quarantine period necessary for a person who has had the disease?
Close contact from 48 hours before symptom onset
ECDC recommends that contact tracing be done from 48 hours before symptom onset (1), as does the WHO (2). Additional knowledge indicates that the infectivity is relatively high 1-2 days before symptoms appear (3,4). Therefore, NIPH recommends that close contacts should now be quarantined from 48 hours before symptoms start instead of 24 hours before.
Quarantine from 14 to 10 days
We get an increasingly accurate estimate of the average incubation time (the time from infection to becoming sick). Recently published studies have found an incubation period of 4-6 days, and similar times have been found from the time of onset of symptoms in a person with confirmed infection to onset of symptoms in infected close contacts (4-7). Overall, this indicates that much of the infection occurs early in the course and probably before the onset of symptoms.
Based on figures from these studies, there is a clear tendency for the quarantine effect to flatten out after 8-9 days. After 8-9 days, the main effect of the quarantine measure is already considered to have been gained, as very few become ill after this. If the overall risk of a close contact being infected is 15 per cent, one will lose just under 1 per cent of infected close contacts by shortening the quarantine time to 10 days (5,6,8,9). However, it is important to note that some people will have longer incubation times. Therefore, the risk will be small, but not completely removed, by shortening the quarantine period from 14 to 10 days. Nor will the risk be removed by maintaining a 14-day quarantine period.
Exemption from quarantine following disease
Based on the Norwegian Institute of Public Health's systematic review of immunity after COVID-19 infection, which also looked at knowledge about immunity after SARS, it is likely that undergoing infection with COVID-19 provides protection, but it is uncertain how long the protection lasts. Seroconversion has been identified to start early after symptom onset, and is detected in most patients after 14-24 days (10). Most likely, you are protected at least one to two years from reinfection, but this cannot be determined yet. Based on this, we recommend that a person who has undergone COVID-19 confirmed by approved laboratory method during the past 6 months should be exempt from quarantine.
Total focus of quarantine time
By extending the definition of close contact to apply to all those who have been exposed to COVID-19 infection for 48 hours before symptom onset, work in the municipalities to find close contacts is increased. More people will be taken out of work and quarantined. In some places, this will increase the burden considerably, while some municipalities have already chosen to do so. Evaluated together with the recommendation to reduce the duration of the quarantine, the change will mean that the use of quarantine days is centred on the time around illness and early in the course of the disease. This is also the most contagious period. Quarantine use is also reduced by exempting people who have undergone the disease. Overall, this provides a better focusing of quarantine time.