NC leaders support symptom-based strategy for ending COVID-19 isolation

NC leaders support symptom-based strategy for ending COVID-19 isolation
World Health Organization Epidemiologist Dr. Maria Van Kerkhove suggested it's not very common for patients who don't show coronavirus symptoms to spread the virus to someone else. (Source: Annie Spratt)

CHARLOTTE, N.C. (WBTV) - North Carolina leaders are hoping new guidance released by the CDC will make it easier for residents to return to work after testing positive for COVID-19.

The CDC is now supporting a symptom-based strategy rather than a test-based strategy for ending isolation of people infected with COVID-19. The CDC says accumulating evidence supports ending isolation using the symptom-based strategy, “while limiting unnecessary prolonged isolation and unnecessary use of laboratory testing resources.”

Of the key findings, concentrations of the virus measured in upper respiratory specimens decline after the onset of symptoms. “The likelihood of recovering replication-competent virus also declines after onset of symptoms,” the CDC posted.

“We know more work is needed to get faster turnaround times for tests,” NCDHHS Secretary Mandy Cohen said. “Data is now showing that people with mild to moderate COVID-19 remain infectious no longer than 10 days after symptom onset.”

Someone who has had symptoms and tested positive can stop isolating after the can answer “yes” to the following three questions, Cohen says:

  1. Has it been at least 10 days since your symptoms started?
  2. Has it been 24 hours since you last had a fever (without using fever-reducing medicines)?
  3. Have your symptoms, such as cough or shortness of breath, improved?
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Posted by WBTV News on Tuesday, July 21, 2020

North Carolina is updating the state guidance to align with the new guidance from the CDC in hopes of making it easier for employees to get back to work. Before, Cohen said, many businesses were requiring a negative test result before employees could return to work.

Reinfection with SARS-CoV-2 has not yet been definitively confirmed in any recovered persons to date. If, and if so when, persons can be reinfected with SARS-CoV-2 remains unknown and is a subject of investigation.,” the CDC says.

CDC officials released the following guidance:

  • If such a person remains asymptomatic during this 90-day period, then any re-testing is unlikely to yield useful information, even if the person had close contact with an infected person.
  • If such a person becomes symptomatic during this 90-day period and an evaluation fails to identify a diagnosis other than SARS-CoV-2 infection (e.g., influenza), then the person may warrant evaluation for SARS-CoV-2 reinfection in consultation with an infectious disease or infection control expert. Quarantine may be warranted during this evaluation, particularly if symptoms developed after close contact with an infected person.
  • For most persons with COVID-19 illness, isolation and precautions can generally be discontinued 10 days after symptom onset1 and resolution of fever for at least 24 hours, without the use of fever-reducing medications, and with improvement of other symptoms.
    • A limited number of persons with severe illness may produce replication-competent virus beyond 10 days that may warrant extending duration of isolation and precautions for up to 20 days after symptom onset; consider consultation with infection control experts.
  • For persons who never develop symptoms, isolation and other precautions can be discontinued 10 days after the date of their first positive RT-PCR test for SARS-CoV-2 RNA.

For those who are severely immunocompromised, a test-based strategy could be considered in consultation with infectious diseases experts. “For all others, a test-based strategy is no longer recommended except to discontinue isolation or precautions earlier than would occur under the strategy outlined in Part 1, above,” the CDC says.

Health leaders also do not reccomend being retested within 3 months after the date of symptom onset for the initial COVID-19 infection. Quarantine is also not recommended by the CDC in the event of close contact with an infected person.

“For persons who develop new symptoms consistent with COVID-19 during the 3 months after the date of initial symptom onset, if an alternative etiology cannot be identified by a provider, then the person may warrant retesting,” the CDC says. “Quarantine may be considered during this evaluation based on consultation with an infection control expert, especially in the event symptoms develop within 14 days after close contact with an infected person.”

Click here for further guidance from the CDC.

On July 20, NCDHHS unveiled an updated COVID-19 Dashboard that includes “more granular information about hospital capacity and hospitalization trends, both statewide and broken down by region.”

Additional data reported through the interactive COVID-19 Dashboard include:

  • Case and death counts searchable by county and ZIP code;
  • Case counts by date reported or date of specimen collection;
  • County map of ongoing outbreaks in congregate living settings; and
  • Rollover functions to see daily numbers.

Health officials say the new hospitalization data will provide additional insight into N.C.‘s hospital capacity during the pandemic. Click here for more information.

On July 14, Gov. Roy Cooper announced that schools would be returning in August with a mix of in-classroom and virtual learning options.

On Tuesday, July 7, the North Carolina Department of Health and Human Services (NCDHHS) took action to decrease barriers to COVID-19 testing by issuing a Statewide Standing Order for COVID-19 Diagnostic Testing, as well as a State Health Director Temporary Order on COVID-19 Diagnostic Test Reporting.

Officials say these actions “will help to increase access to testing across the state, especially for members of historically marginalized populations, and increase reporting of North Carolina test results, both positive and negative, to the state.”

The Statewide Standing Order allows testing sites to collect and submit samples to a laboratory for COVID-19 testing without requiring a specific order and authorizes testing sites to receive results directly from laboratories.

You can read the complete Statewide Standing Order for COVID-19 Diagnostic Testing here.

On June 24, N.C. Governor Roy Cooper announced that residents would be required to wear face masks in public and that the state’s Phase 2 will continue for three more weeks, as coronavirus cases continue to rise at an alarming rate.

People must wear face coverings when in public places, indoors or outdoors, where physical distancing of 6 feet from other people who aren’t in the same household or residence isn’t possible.

This Executive Order became effective at 5 p.m. on Friday, June 26. The full executive order can be found here.

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