Isolation and Quarantine for Coronavirus Disease 2019 in the United States, 2020–2022

• Published in: Clinical infectious diseases 2023-07, Vol.77 (2), p.212-219
• Main Authors: Oeltmann, John E, Vohra, Divya, Matulewicz, Holly H, DeLuca, Nickolas, Smith, Jonathan P, Couzens, Chandra, Lash, R Ryan, Harvey, Barrington, Boyette, Melissa, Edwards, Alicia, Talboy, Philip M, Dubose, Odessa, Regan, Paul, Loosier, Penny, Caruso, Elise, Katz, Dolores J, Taylor, Melanie M, Moonan, Patrick K
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Contact Tracing; COVID-19 - epidemiology; COVID-19 - prevention & control; Female; Humans; Male; Middle Aged; Patient Isolation - statistics & numerical data; Quarantine - statistics & numerical data; United States - epidemiology; Young Adult
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/ciad163

Abstract Background Public health programs varied in ability to reach people with coronavirus disease 2019 (COVID-19) and their contacts to encourage separation from others. For both adult case patients with COVID-19 and their contacts, we estimated the impact of contact tracing activities on separation behaviors from January 2020 until March 2022. Methods We used a probability-based panel survey of a nationally representative sample to gather data for estimates and comparisons. Results An estimated 64 255 351 adults reported a positive severe acute respiratory syndrome coronavirus 2 test result; 79.6% isolated for ≥5 days, 60.2% isolated for ≥10 days, and 79.2% self-notified contacts. A total of, 24 057 139 (37.7%) completed a case investigation, and 46.2% of them reported contacts to health officials. More adults who completed a case investigation isolated than those who did not complete a case investigation (≥5 days, 82.6% vs 78.2%, respectively; ≥10 days, 69.8% vs 54.8%; both P < .05). A total of 84 946 636 adults were contacts of a COVID-19 case patient. Of these, 73.1% learned of their exposure directly from a case patient; 49.4% quarantined for ≥5 days, 18.7% quarantined for ≥14 days, and 13.5% completed a contact tracing call. More quarantined among those who completed a contact tracing call than among those who did not complete a tracing call (≥5 days, 61.2% vs 48.5%, respectively; ≥14 days, 25.2% vs 18.0%; both P < .05). Conclusions Engagement in contact tracing was positively correlated with isolation and quarantine. However, most adults with COVID-19 isolated and self-notified contacts regardless of whether the public health workforce was able to reach them. Identifying and reaching contacts was challenging and limited the ability to promote quarantining, and testing. Engagement in contact tracing positively correlated with isolation and quarantine. Encouraging separation behaviors was limited by inabilities to reach most case patients and contacts. Gains noted in separation behaviors alongside costs of maintaining tracing programs could assist planning future efforts.