Guidance on quarantine of close contacts to COVID-19 cases and isolation of COVID-19 cases, in the current epidemiological situation, 7 January 2022

The Omicron variant of concern (VOC) is rapidly becoming the dominant variant of SARS-CoV-2 in the EU/EEA. Considering its rapid spread, this guidance aims to provide options for adapting quarantine and isolation, particularly when countries face high or extreme pressure on healthcare systems and other functions in society, including essential services.

The available scientific evidence to support any change to the existing quarantine and isolation guidance is currently limited. Therefore, the suggested options are based on a pragmatic approach, taking into account the need to uphold critical functions in society. Decisions to adapt quarantine and isolation guidance require consideration of the additional risk of transmission, the local epidemiological situation, the testing and contact tracing capacity and the socio-economic effects of the pandemic in the specific setting.

Quarantine is a measure to keep people who have been in close contact with someone with COVID-19 apart from others, to avoid onward transmission. Isolation refers to the separation of people with confirmed or suspected COVID-19 from other people, for the duration of the infectious period.

ECDC’s suggestions for adapting the current guidance for quarantine and isolation are presented below. An update of the current discharge and isolation guidance will be published shortly.

Table 1. Guidance on quarantine of close contacts to COVID-19 cases and non-evidence-based options for adaptation

 

Standard quarantine guidance

High pressure on healthcare systems and society

Extreme pressure on healthcare systems and society

Unvaccinated individuals

Option 1

Test immediately after identification as contact (RADT or RT-PCR)[a]  

AND

10 days quarantine with RT-PCR test[a] on day 10

 

Option 2

Test immediately after identification as contact (RADT or RT-PCR)[a]  

AND  

14 days quarantine, if no test on day 10

Option 1

Test immediately after identification as contact (RADT or RT-PCR)[a]  

AND

7 days[c] quarantine with RADT or RT-PCR test on day 7

 

Option 2

Test immediately after identification as contact (RADT or RT-PCR)[a]  

AND

10 days[c] quarantine, if no test on day 7

5 days quarantine[c]

AND

RADT or RT-PCR test on day 5[a], if possible

AND

5 additional days wearing a high-efficiency (FFP2) mask[d]

 

Vaccinated[b] individuals

Test immediately after identification as contact (RADT or RT-PCR)[a] and quarantine until negative test result

 

AND

 

RADT or RT-PCR test 2-4 days after negative test result[a]

 

AND

 

Self-monitoring for symptoms, wearing a mask, keeping distance from others and avoiding contact with vulnerable populations

Test immediately after identification as contact (RADT or RT-PCR)[a] and quarantine until negative test result

 

AND

 

RADT or RT-PCR test 2-4 days after negative test result[a], if possible

 

AND

 

Self-monitoring for symptoms, wearing a mask, keeping distance from others and avoiding contact with vulnerable populations, if possible

10 days wearing a high-efficiency (FFP2) mask[d]

AND

RADT or RT-PCR test on day 5[a], if possible

AND

 

Self-monitoring for symptoms, wearing a mask, keeping distance from others and avoiding contact with vulnerable populations, if possible

[a] Testing by either RADT or RT-PCR should preferably be performed by a qualified professional. Self-testing by RADTs is not considered adequate for releasing from quarantine.

[b] In this table, the term ‘vaccinated’ refers to people who:

  • have received a full primary COVID-19 vaccination course within the last six months.
    • The duration of protection is subject to evolving evidence and this may need to be taken into account.
    • In areas/countries where the Omicron VOC is dominant, this period may be restricted further to three months*. 
    • This does not apply to one-dose vaccines.
  • have received a booster dose of COVID-19 vaccine.
    • In areas/countries where the Omicron VOC is dominant, this period may be restricted further to three months*. 

* SARS-CoV-2 variants of concern and variants under investigation in England Technical briefing: Update on hospitalisation and vaccine effectiveness for Omicron VOC-21NOV-01 (B.1.1.529). London: UK Health Security Agency; 2021. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1044481/Technical-Briefing-31-Dec-2021-Omicron_severity_update.pdf

Previously infected individuals should follow the recommendations for fully vaccinated individuals if it has been less than six months since the previous diagnosis. If it has been more than six months from the previous diagnosis, they should follow the recommendations for unvaccinated individuals.

[c] When recommending a shorter duration of quarantine, the residual risk of onward transmission of SARS-CoV-2 increases. Therefore, in addition to mask use, individuals identified as close contacts should be advised to avoid non-essential contact with other people and especially vulnerable individuals.

[d] Where a high-efficiency mask is recommended, an FFP2 (or equivalent) without a valve should be used. To be effective, these need to be worn properly at all times. Fit testing is recommended, especially for those working in the healthcare sector. 

 

Table 2. Guidance on isolation of COVID-19 cases and non-evidence-based options for adaptation

This table aims to provide options for isolation of essential workers (for example, individuals working in healthcare, transportation or law enforcement) and does not address the isolation of hospitalised patients.

 

Standard isolation guidance

High pressure on healthcare systems and society

Extreme pressure on healthcare systems and society

Unvaccinated COVID-19 cases

Option 1

Resolution of fever for 24 hours and clinical improvement of symptoms[a]

AND

10 days isolation after the onset of symptoms

 

Option 2

Resolution of fever for 24 hours and clinical improvement of symptoms[a]

 

AND

 

Two consecutive negative RADT or RT-PCR tests[b],[c] from respiratory specimens, with a minimum interval of 24 hours

Resolution of fever for 24 hours and clinical improvement of symptoms[a]  

AND

5 days isolation[e] after the onset of symptoms and 5 additional days wearing a high-efficiency (FFP2) mask[f]  

AND

A negative RADT or RT-PCR test[b] from respiratory specimen on day 5 after onset of symptoms

Resolution of fever for 24 hours and clinical improvement of symptoms[a]  

AND  

5 days isolation[e] after the onset of symptoms and 5 additional days wearing a high-efficiency (FFP2) mask[f]

 

If possible, test by RADT or RT-PCR[b] on day 5 after onset of symptoms

Vaccinated[d] COVID-19 cases 

Option 1 Resolution of fever for 24 hours and clinical improvement of symptoms[a]

 

AND

 

6 days isolation after the onset of symptoms and a negative RADT or RT-PCR test[b] from respiratory specimen on day 6

 

Option 2

Resolution of fever for 24 hours and clinical improvement of symptoms[a]

 

AND

 

Two consecutive negative RADT or RT-PCR tests[b],[c] from respiratory specimens, with minimum interval of 24 hours

Resolution of fever for 24 hours and clinical improvement of symptoms[a]

 

AND

 

3 days isolation[e] after onset of symptoms

 

AND

 

3 additional days wearing a high-efficiency (FFP2)f mask   AND

A negative RADT or RT-PCR test[b] from respiratory specimen on day 3 after onset of symptoms

Resolution of fever for 24 hours and clinical improvement of symptoms[a]  

AND  

3 days isolation[e] after onset of symptoms

AND

 

3 additional days wearing a high-efficiency (FFP2)[f] mask

 

AND

 

If possible, test by RADT or RT-PCR[b] on day 3 after onset of symptoms

[a] Asymptomatic COVID-19 cases should follow the same guidance as symptomatic cases. They should start counting days from the date of their diagnosis.

[b] Testing by either RADT or RT-PCR should preferably be performed by a qualified professional. Self-testing by RADTs is not considered adequate for releasing from isolation.

[c] First test for release of isolation is, at the earliest, on day 3 after the onset of symptoms.

[d] In this table, the term ‘vaccinated’ refers to people who:

  • have received a full primary COVID-19 vaccination course within the last six months.
    • The duration of protection is subject to evolving evidence and this may need to be taken into account.
    • In areas/countries where the Omicron VOC is dominant, this period may be restricted further to three months*.  
    • This does not apply to one-dose vaccines.
  • have received a booster dose of COVID-19 vaccine.
    • In areas/countries where the Omicron VOC is dominant, this period may be restricted further to three months*. 

* SARS-CoV-2 variants of concern and variants under investigation in England Technical briefing: Update on hospitalisation and vaccine effectiveness for Omicron VOC-21NOV-01 (B.1.1.529). London: UK Health Security Agency; 2021. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1044481/Technical-Briefing-31-Dec-2021-Omicron_severity_update.pdf

[e] When recommending a shorter duration of isolation, the residual risk of onward transmission of SARS-CoV-2 increases. Therefore, in addition to mask use, COVID-19 cases should be advised to avoid non-essential contact with other people and especially vulnerable individuals. The end of isolation should be differentiated from the potential need for sick leave.

[f] Where a high-efficiency mask is recommended, an FFP2 (or equivalent) without a valve should be used. To be effective, these need to be worn properly at all times. Fit testing is recommended, especially for those working in the healthcare sector. 

Page last updated 7 Jan 2022