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  • Follow-up of close contacts and home isolation

Follow-up of close contacts and home isolation - advice for healthcare personnel

Advice to health personnel on follow-up of close contacts and home isolation in normal daily life with increased preparedness

Advice to health personnel on follow-up of close contacts and home isolation in normal daily life with increased preparedness


Isolation

Isolation applies to everyone who has confirmed SARS-CoV-2 and also applies if you are fully vaccinated or protected. If the living conditions are suitable and the patient does not need to be admitted to hospital, isolation can be carried out at home. If it is not possible to keep a good distance from others in the home, the patient should be offered another suitable place.

It is important that children and adolescents receive the care they need, even if this means that distance cannot be kept. This applies regardless of whether it is the child or guardian who is in isolation.

More information about what home isolation entails, with advice for the patient:

For each patient, the healthcare service should make a plan to ensure that: 

  • the patient gets any necessary practical assistance
  • any deterioration in health is detected
  • the patient can comply with the measures
  • the patient is told which close contacts need to be contacted for testing.

Follow-up of the patient is done after individual assessment, and both telephone / digital contact and home visits may be relevant. Daily contact should be considered for patients in risk groups. The patient must be told who they should call or otherwise contact if their symptoms get worse.

Healthcare personnel who shall enter the home of, or treat, patients isolated at home or their household members, must follow recommended infection control measures, including the use of personal protective equipment. See the advice given for the different healthcare sectors.

Isolation of people diagnosed with SARS-CoV-2 upon arrival in Norway

Upon arrival in Norway, there is routine testing with rapid antigen tests. In the event of a positive response, a PCR test is taken and the patient is isolated until a PCR result is available. If the PCR result is negative, the person can be come out of isolation.

In some situations, if a person is only PCR-positive (not positive according to a rapid antigen test) and can present documentation of having had COVID-19 in the last 3 months, isolation can end if an antibody test taken in Norway is positive in an analysis that detects IgG or total antibodies. 

People who test positive at border crossings for both rapid antigen testing and positive for confirmatory PCR testing cannot come out of isolation using antibody testing. They shall be in isolation as recommended.

Follow-up of close contacts

A distinction is made between close contacts who are household members or equivalent close contacts to the person who is infected, such as a romantic partner or best friend, and other close contacts.

Recommendation to the municipality for contact tracing is limited to household members and equivalent close contacts who are most exposed to infection. Other close contacts should be notified by the infected person. Other close contacts who are unvaccinated should be encouraged to be tested, the same applies to partially vaccinated people who work in healthcare service.

After a discussion with the contact tracing team, the infected person should be told who to contact.

The municipality should provide information to the inhabitants about how testing can be carried out and how people who test positive with self-testing must notify the municipality. Positive self-tests should be confirmed at the test centre.

Follow-up of household members and equivalent close contacts

See below regarding additional measures for close contacts who are employees of healthcare services. 

  • Household members and equivalent close contacts should follow their own state of health for 10 days.
  • Those who are fully vaccinated or have had COVID-19 within the last 12 months can live as normal
  • Those who have been partially vaccinated should take one test after the infected person has developed symptoms. The test can be taken immediately. They can otherwise live as normal.
  • Unvaccinated people should be tested according to one of the following regimens with:
    • daily rapid antigen test for 7 days
      or
    • PCR test every other day for 7 days.

The municipality must inform about possibilities for testing. Rapid antigen tests can either be taken as a self-test handed out by the municipality or at a test centre.

By carrying out the recommended test regimen, unvaccinated people can otherwise live as normal with negative test results.

If the test is positive, the person must be in isolation (see description above).

  • If unvaccinated people do not carry out the recommended test regimen, they should refrain from contact with others for 7 days (for most, this means staying away from work, school or other activities).
  • Parents decide whether they want their child to be tested.
  • If a person defined as close contact with a household member with confirmed COVID-19 develops symptoms, he or she should be tested, regardless of vaccination status, and stay at home.

Follow-up of other close contacts

See below regarding additional measures for close contacts who are employees of healthcare services. 

  • Everyone should follow their own state of health for 10 days after exposure. In case of symptoms, they should stay at home and be tested, regardless of their vaccination status.
  • Unvaccinated other close contacts should take a test as soon as they are informed that they are a close contact.
  • Parents decide whether they want their child to be tested

Advice on testing and use of personal protective equipment for employees in the health and care service who are defined as close contacts

Employees in the health and care service follow the same advice as for the general population, but with some additional infection control measures.

  • All employees, regardless of vaccination status, who are defined as close contacts (whether they have an infection in the household or are “other close contacts”), should wear face masks until 5 days after the last exposure when they have close contact with the patient / resident. They should strive to keep their distance from colleagues.
  • Both unvaccinated and partially vaccinated employees who have an infection in the household should either be tested daily with an antigen rapid test or with PCR every 2 days for 7 days. The days should be counted from when the infected in the household went into isolation. If the test regimen is not followed, they should not go to work for 7 days.
  • Both unvaccinated and partially vaccinated employees who are defined as «other close contacts», one test is recommended as soon as they are informed of their status as «other close contact».

There are separate guidelines for employees who are defined as close contacts in connection with outbreaks in health and care institutions (Norwegian only):

More information on the use of personal protective equipment is available in Norwegian

References

  1. European Centre for Disease Prevention and Control. Guidance for discharge and ending isolation in the context of widespread community transmission of COVID-19, 8 April 2020. Stockholm: ECDC2020.
  2. Considerations in the investigation of cases and clusters of COVID-19. Interim guidance. 13 March 2020. WHO. 2020.
  3. Wei WE LZ, Chiew CJ, Yong SE, Toh MP, Lee VJ. Presymptomatic Transmission of SARS-CoV-2 — Singapore, January 23–March 16, 2020. MMWR Morbidity and mortality weekly report. 2020;2020;69::411-5.
  4. Du Z, Xu X, Wu Y, Wang L, Cowling BJ, Meyers LA. Serial Interval of COVID-19 among Publicly Reported Confirmed Cases. Emerging infectious diseases. 2020;26(6).
  5. Lauer SA, Grantz KH, Bi Q, Jones FK, Zheng Q, Meredith HR, et al. The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application. Annals of internal medicine. 2020.
  6. Zhang J, Litvinova M, Wang W, Wang Y, Deng X, Chen X, et al. Evolving epidemiology and transmission dynamics of coronavirus disease 2019 outside Hubei province, China: a descriptive and modelling study. The Lancet Infectious Diseases. 2020.05.09.
  7. Zhao S, Gao D, Zhuang Z, Chong M, Cai Y, Ran J, et al. Estimating the serial interval of the novel coronavirus disease (COVID-19): A statistical analysis using the public data in Hong Kong from January 16 to February 15, 2020. medRxiv. 2020:2020.02.21.20026559.
  8. Luo L, Liu D, Liao X-l, Wu X-b, Jing Q-l, Zheng J-z, et al. Modes of contact and risk of transmission in COVID-19 among close contacts. medRxiv. 2020:2020.03.24.20042606.
  9. Bi Q, Wu Y, Mei S, Ye C, Zou X, Zhang Z, et al. Epidemiology and Transmission of COVID-19 in Shenzhen China: Analysis of 391 cases and 1,286 of their close contacts. medRxiv. 2020:2020.03.03.20028423.
  10. Wölfel R, Corman VM, Guggemos W, Seilmaier M, Zange S, Müller MA, et al. Virological assessment of hospitalized patients with COVID-2019. Nature. 2020

History

05.10.2021: Clarification of advice for employees in the health and care service who are defined as close contacts.

04.10.2021: Updated information regarding employees in the health and care service who are unvaccinated / partially vaccinated and who are defined close contacts outside the workplace.

25.09.2021: The title has been adjusted and the text has been updated in connection with the transition to normal daily life with increased preparedness.

25.09.2021: Revised and adapted content for adjusted TISK and normal daily life with increased preparedness. The quarantine part has been removed as it is no longer valid, but entry quarantine is described in a separate chapter.

13.09.2021: Changes in regular testing alternatives, reformulations

10.09.2021: Clarifications in table under Testing and follow-up in the health service, added link to use of protective equipment

08.09.2021: clarification of care for children in isolation

02.09.2021: added alternatives to regular testing.

01.09.2021: Interval for tests in quarantine test. Regular testing as an alternative test regime in quarantine testing. No quarantine exempions for pupils and students in health professions

30.08.2021: Updated text about accepted COVID-19 certificates and added link to list of accepted COVID-19 certificates (Lovdata)

29.08.2021: Updated according to extended exemption from quarantine after being defined as close contact, for those who have recovered from covid-19 within the last 12 months.

24.08.2021: Updates to "Testing as an alternative to quarantine"

17.08.2021: Amended text in accordance with amendments to COVID--19 regulations §6d on exemptions for children crossing the border in connection with agreed visitation or shared residence, Added that the NHS COVID pass from England / Wales is considered secure documentation of vaccination / recovery from illness. Added about testing as alternative to quarantine as per 16.8

10.08.2021: Clarification about testing with symptoms

29.07.2021: Updated sentence: Isolation applies to those who have confirmed SARS-CoV-2 or probable COVID-19 and also applies if you are fully vaccinated or protected

27.07.2021: Minor change i section about "isolation of people with confirmed SARS-CoV-2 upon arrival in Norway"

01.07.2021: Added clarification regarding time of exposure / first close contact for exemptions from the infection quarantine for partially vaccinated people.

01.07.2021: Updated text in accordance with a change in the COVID-19 regulations that the waiting quarantine scheme will be removed from 1 July. Changed from 1 to 2 m and added alternative test regime in table 1.

29.06.2021: New tables 1 and 2 and advice for health personnel

28.06.2021: clarification of sentence about partially vaccinated healthcare professionals

24.06.2021: Changed to refer to EU COVID-19 certificates

23.06.2021: Added that the Swedish COVID-19 certificate is not yet ready for this use.

23.06.2021: Clarification that other nucleic acid amplification tests (NAT) are considered equivalent to PCR tests (also specified in the COVID-19 regulations)

23.06.2021: Added that Fully vaccinated health personnel from Sweden and Finland who are employed in the Norwegian health service are granted an exemption from entry quarantine. The employer and client are obliged to obtain and assess documentation that the health personnel are protected.

21.06.2021: Added that Swedish and Danish COVID-19 certificates are approved documentation of vaccination and having had COVID-19, plus some minor language changes.

17.06.2021: Added that vaccination with single dose vaccine is considered fully vaccinated from 3 weeks after vaccination

14.06.2021: Updated documentation requirements

11.06.2021: From 11.6, fully vaccinated and people who have had COVID-19 in the last 6 months will not go into quarantine. Updated information on exemptions from quarantine according to this.

08.06.2021: New sentence: For exemption from quarantine in a quarantine hotel and the possibility of shortening entry quarantine, currently the only secure and verifiable way to document status as protected is through login to helsenorge.no.

07.06.2021: From 4.6, children under the age of 12 and those who are protected against COVID-19, provided reliable documentation, can shorten the quarantine after a negative test after 3 days.

03.06.2021: Clarifications and changes added, cf. changes in the regulations §6e and §6k.

01.06.2021: Follow-up frequency should be determined based on an individual assessment.

19.05.2021: In the section "Isolation of persons who have been diagnosed with SARS-CoV-2 in connection with arrival in Norway": clarification of antibody test IgG or total antibody.

18.05.2021: change from protected to partially vaccinated in advice about healthcare workers and exposure. Change in table from 3-12 weeks to 3-15 weeks

18.05.2021: Addition of advice for protected health personnel with an infected household member. Changes in exemption from the quarantine duty for those who have been vaccinated or undergone infection.

13.05.2021: Added to the EEA and Schengen area or the United Kingdom, cf. Amendments to the COVID-19 regulation from 13.5.

12.05.2021: Added that people who have been outside the EEA and Schengen area for the last 10 days cannot use public transport to the quarantine hotel, cf. the changes in section 5 of the COVID-19 regulations which came into force on 9.5.21.

10.05.2021: Removed sentence: "The following should not be exempt from quarantine duty: Employees who are household members or in an equivalent close contact circle with the person with confirmed COVID-19."

10.05.2021: Clarification of exemptions from infection quarantine for vaccinated healthcare personnel

10.05.2021: Clarification that people who have received the first vaccine dose between 3 and 15 weeks ago should not be in infection quarantine if they take a PCR test between 3 and 7 days after exposure.

04.05.2021: Clarification about vaccinated people and infection quarantine

04.05.2021: Added information about changes in infection quarantine for vaccinated after regulatory changes

30.04.2021: Persons who have stayed in Bangladesh, India, Iraq, Nepal or Pakistan during the last 10 days before arrival in Norway shall not use public transport from the place of arrival to the quarantine hotel.

12.04.2021: Added table about exemptions after vaccination and recovery from infection.

30.03.2021: Updated because waiting quarantine for household members is added to the regulations

22.03.2021: specification of exemptions for vaccinated health workers, regardless of vaccine type.

19.03.2021: New exemption, section 6k, for vaccinated healthcare workers.

10.03.2021 Added "3 weeks after first dose" in section about "People in functions critical to society"

03.03.2021 Updated paragraph about quarantine, link to TISK

25.02.2021 It is specified that vaccinated foreign health personnel can be exempted from entry quarantine during working hours after a negative test upon entry.

19.02.2021: Updated according to Norwegian version. Added that fully vaccinated healthcare personnel with critical functions may be exempt from entry quarantine. 

04.02.2021: Added text about South African virus variant

02.02.2021: Added text about how household members who continue to live with someone who is infected can shorten quarantine with a negative test taken 7 days after the last exposure at the earliest.  

01.02.2021: Removed section about Exemptions for cross-border workers from EEA countries and Switzerland (§ 6c in covid-19 regulations) that ceased 31.1.21. Added No longer exemption from quarantine for people who have had COVID-19.

29.01.2021:  Added justification for shortening quarantine by negative PCR test taken after 7 days.

26.01.2021: Updated to reflect changes to the Covid-19 regulation sections 4 and 6, in effect January 25th, 2021.

10.01.2021: 
23.59: Updated list of countries requiring quarantine

08.01.2021: Adjusted text about exemption according to §6d after regulation changes, added vaccinated to the list of people who can be considered to be exempt according to  §6e.

23.12.2020 Added that vaccination does not provide exemption from quarantine, added that separate provisions have been introduced for travellers from the United Kingdom, specified that the requirement for a 2-week-old test for exemption after undergoing COVID-19, applies at entry.

20.12.2020: 23.59: Updated list of countries requiring quarantine

11.12.2020: 23.59: Updated list of countries requiring quarantine

27.11.2020: 23.59: Updated list of countries requiring quarantine

10.12.2020: Added "The test must have been done be at least 2 weeks ago" to section about exemptions.

05.12.2020: 23.59: Updated list of countries requiring quarantine

27.11.2020: 23.59: Updated list of countries requiring quarantine

20.11.2020: 23.59: Updated list of countries requiring quarantine

17.11.2020: Added "The certificate shall be in Norwegian, Swedish, Danish, English, French or German."

13.11.2020 23:59: updated list of countries requiring quarantine. Added sentence "The recommended test timepoint is between day 3 and day 7 after exposure, preferably on day 5."

11.11.2020: Added "Anyone who has been exposed to COVID-19 infection, who are of lower secondary school age or above, should be tested."

07.11.2020 00:00 a.m.: Updated with tables for regions and countries affected by different exemptions from quarantine decisions for cross-border workers. 

04.11.2020: Updated flow chart

02.11.2020: Quarantine section - added that household members to probable cases are in quarantine while waiting for test results. Simplified text about quarantine duration.

30.10.2020: Updated paragraph about cross-border workers according to new decisions that apply from 31 October 2020.

23.10.2020: Updated figure

08.10.2020: Updated section about duration of quarantine according to Norwegian version. Changed from Day 0 to Day 1 in bullet point about testing.

24.09.2020: Small adjustment: Carry out a new test on day 5 after arrival at the earliest...

21.09.2020: In the paragraph on exemptions for work travel the following is corrected: The exemptions in § 6c can also include people arriving from countries outside Schengen and EEA.

15.09.2020: Updated figure, changes to text about duration, as per Norwegian version. Changes to text about exemption from quarantine.

13.08.2020: Changed text so the distinction between household members and other close contacts is removed with regards to quarantine.

31.07.2020: Added the following bullet point in the section on follow-up of "other close contacts": For advice on necessary transport to the home/suitable place to stay for "other close contacts", see Infection tracing in different situations - at the bottom of the section on infection tracing after flight (in Norwegian).

10.07.2020: Updated section about Nordic, Schengen and EU/EEA countries.

03.07.2020 Added sentence that "quarantine applies during leisure time until the second test result is negative" in the list about follow-up of other close contacts and when people are exempt from quarantine duty. Clarified that "people in the "other close contacts" group should inform their employer to ensure that the above measures are followed". Specified time point for testing with exemption from quarantine so it is in accordance with the regulations. Referred to advice for different healthcare services for infection control measures when they will enter the home or treat people who are isolated or in quarantine.

01.07.2020 Updated figure about duration of quarantine and isolation. Collated measures for "other close contacts" and for exemption from quarantine in one paragraph. Explained time points for testing. Added that for healthcare workers  from Sweden, the decisions for workers from the Schengen area and EEA countries apply. Added advice to employers who give exemption from quarantine.

24.06.2020
Section about exemption from quarantine - specified which groups and which quarantine rules apply - for those who have had the disease, workers from Sweden, workers from Schengen and EEA countries and key workers in critical functions.

16.06.2020
Adjustment to text about exemption from quarantine duty, including infection control measures when people are exempt.

12.06.2020
Added "if this is feasible within the follow-up time of 10 days" to the section about testing.

05.06.2020 Added figure with examples of duration. Some restructuring as per Norwegian version. Removed text about when to have exemption and what should be considered with quarantine and work.

04.06.2020 Added examples of equivalent close contacts. Added sentence about testing

03.06.2020
"Close contacts" split into "household members and equivalent" and "other", and how they should be followed up is described. Changes in order (isolation first), text adjustments and links to other pages.   

29.05.2020
Added references. Added links about impending quarantine rules. Added information about background for updates to quarantine (7th May) that had not been translated.

26.05.2020
Added first paragraph under section "exemption from quarantine."

08.05.2020
Changed duration of quarantine to 10 days from 14 days. Added sentence about quarantine not applying to people who have had confirmed COVID-19

30.04.2020

Added definition of probable case under "Duration of home quarantine."

29.04.2020
Added "Employees who have recovered from COVID-19 disease, confirmed by a recommended laboratory method".

17.04.2020
Updated two sentences as per Norwegian version. First sentence under Home isolation and sentence in Background about quarantine lasting until the person comes out of isolation.

14.04.2020
Updated text. Added "probable COVID-19" as a category.

03.04.2020

Updated text according to Norwegian version

31.03.2020
Removed "or no" from first bullet point under background, as per Norwegian version 

17.03.2020 - updated text about quarantine according to changes in the Norwegian text

14.03.2020 - added link to travel advice with information about quarantine rules

13.03.2020

Updates to reflect changes in the Norwegian text "everyone who has travelled outside of the Nordic Region

12.03.2020

Changed text according to Norwegian text. Moved section about background. Added "Healthcare personnel who live in the same household as suspected cases until laboratory test results are ready".

09.03.2020

Changed text according to Norwegian text. Removed text about work restrictions for employees in health service after changes in quarantine advice. Quarantine applies to everyone who has been in areas with ongoing transmission.