Williamson County Health, TX

Dec. 4, 2020 - On Dec. 2, the Centers for Disease Control (CDC) released new options for shortening quarantine based on local considerations.  This resource notes that “local public health authorities determine and establish the quarantine options for their jurisdictions” and gives two alternatives to the recommended 14-day period. These alternatives need to be heavily weighed with the local context and include (1) quarantine ending after day 10 without testing and if no symptoms have been reported during daily monitoring, and (2) quarantine ending after day 7, if a diagnostic specimen tests negative and if no symptoms were reported during daily monitoring.  

However, the CDC continues to recommend 14 days as the “gold standard” for quarantine as this time duration is based on the upper limit of the incubation period. The incubation period is used for quarantine because it gives reasonable assurance that if people responsibly abide by quarantine recommendations, infections will have almost no chance to spread to others. 

While WCCHD recognizes that a 14-day quarantine may present a challenge for some situations, COVID-19 cases across Central Texas remain rampant and are on an upward trend. Our current rate of new cases is averaging around 35 per 100k people, per day – signifying uncontrolled and exponential growth of the virus spread (nearly three times higher than our threshold for uncontrolled community transmission at 12.7). Our current countywide testing positivity rate is 11.31% – over two times the CDC threshold for a “hotspot.”  

The rationale behind shortening quarantine assumes that shorter quarantine time will result in more people complying with the requirements, reducing the impact of infections versus the traditional quarantine period. Unfortunately, there is no data to support this assumption. With the current level of spread in the community, adding to that spread by increasing the known risk of transmission outside of quarantine is not something WCCHD can support at this time. As a result, WCCHD will continue to strongly recommend the safer, evidence-based guidance of the full 14-day quarantine.   

Additionally, by adding a testing requirement to be released from quarantine, Williamson County testing resources will likely face added strain at a time when those resources are more important than ever. Free testing is significantly limited and disparities in accessing testing could also increase social and economic inequities, particularly in the more rural areas of Williamson County.    

The Texas Education Authority (TEA) also updated their guidance on Dec. 4, 2020 to reflect the new CDC options for shortening quarantine. This guidance allows for schools to utilize the shorter quarantine options for those identified as close contacts, without clarifying that the CDC continues to recommend a quarantine period of 14 days, but provides the shorter options for flexibility to local public health authorities to determine and establish the quarantine options for their jurisdictions. This guidance also allows for asymptomatic staff members identified as close contacts to continue to work in limited circumstances to preserve school operations. These limited circumstances should also be heavily weighed, in collaboration with local public health authorities, against the potential of further transmission within the school setting, particularly as pre-symptomatic and asymptomatic infections substantially contribute to increased disease spread.3 WCCHD will continue to strongly recommend the safer, evidence-based guidance of the full 14-day quarantine for close contacts in schools. Recommendations for asymptomatic staff members to work in order to maintain school operations will be made on a case-by-case basis.   

WCCHD will continue to monitor the situation in the community and revise recommendations if the circumstances improve. We all have a responsibility to slow the spread of the pandemic and eliminate the virus as quickly as possible. Therefore, it is imperative that we take an effective, fact-based approach to curb transmission by isolating when sick, doing an entire 14-day quarantine when exposed, wearing masks, and continuing to social distance. By working together to take responsible action now, we can reduce illness and deaths in our communities, ultimately create a sustainable return to our normal daily activities and a strengthened economy.