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Coronavirus: New guidelines for contacts of virus cases

The health ministry has issued updated instructions based on the ECDC guidelines regarding self-isolation rules for contacts of coronavirus cases as well as how a contact is defined.

A contact of a Covid-19 case is any person who has had contact with a Covid-19 case within a timeframe ranging from 48 hours before the onset of symptoms of the case to 14 days after the onset of symptoms.

If the case had no symptoms, a contact person is defined as someone who has had contact with the case within a timeframe ranging from 48 hours before the sample which led to confirmation was taken, to 14 days after the sample was taken.

The associated risk of infection depends on the level of exposure, which will, in turn, determine the type of management and monitoring.

High-risk exposure

A person: having had face-to-face contact with a Covid-19 case within two metres for

more than 15 minutes; having had physical contact with a Covid-19 case; having unprotected direct contact with infectious secretions of a Covid-19 case (e.g. being coughed on); who was in a closed environment (e.g. household, classroom, meeting room, hospital waiting room, etc.) with a Covid-19 case for more than 15 minutes; in an aircraft, sitting within two seats (in any direction) of the Covid-19;  case, travel companions or persons providing care, and crew members serving in the section of the aircraft where the index case was seated (if severity of symptoms or movement of the case indicate more extensive exposure, passengers seated in the entire section or all passengers on the aircraft may be considered close contacts); A healthcare worker or other person providing care to a Covid-19 case, or laboratory workers handling specimens from a Covid-19 case, without recommended PPE or with a possible breach of PPE

Low risk exposure:

A person: having had face-to-face contact with a Covid-19 case within two metres for less

than 15 minutes; who was in a closed environment with a Covid-19 case for less than 15 minutes; travelling together with a Covid-19 case in any mode of transport; A healthcare worker or other person providing care to a Covid-19 case, or laboratory workers handling specimens from a Covid-19 case, wearing the recommended PPE.

Longer duration of contact is assumed to increase the risk of transmission; the 15-minute limit is arbitrarily selected for practical purposes. Public health authorities may consider some persons who had a shorter duration of contact with the case as having had high-risk exposure, based on individual risk assessments.

Using only part of the recommended set of PPE increases the exposure of healthcare workers thus increasing the risk.

Quarantine of close contacts

Quarantine is compulsory and people must remain at home in another space for at least 14 days since their latest contact with the confirmed case. The quarantine must be completed and cannot be interrupted for any reason, for example by presenting an initial negative test result. This is because incubation is two to 14 days from the last contact.

Preconditions for ending quarantine in less than 14 days

A negative PCR test on the 10th day can be used to interrupt the quarantine before the 14 days as studies show that this strategy is nearly as effective as the first. However, full release from the quarantine must be assessed on a case by case basis for contacts who work with vulnerable groups or high risk environments such as long term care facilities, prisons migrants facilities etc. All those released early must be briefed to be particularly careful until the full 14 days are over.

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