Updated: September 16, 2021
Should healthcare workers wear eye protection (i.e. face shield or goggles) in addition to masking?
Yes. CDC’s guidelines are that healthcare workers (HCW) should still continue to wear masks and eyewear (face shields, goggles) while providing patient care, regardless of vaccination status. The vaccines are highly effective, but not 100% effective. While there is still moderate to substantial amounts of COVID-19 transmitting in our community, HCW must continue to follow universal PPE precautions. See CDC’s Interim Infection Prevention and Control Recommendations. Cal/OSHA regulations may also impose additional requirements regarding eye protection in healthcare settings. Please consult Cal/OSHA directly at 833-579-0927 if you have any questions regarding any Cal/OSHA eye protection requirements that may be applicable to your workplace.
*Per CDC, healthcare workers include “all paid and unpaid persons (e.g., doctors, nurses, laboratory workers, facility or maintenance workers, clinical trainees, volunteers) serving in healthcare settings who have the potential for direct or indirect exposure to patients or their infectious secretions and materials.”
Can face shields be used instead of masks in healthcare settings?
No. Face shields are not a substitute for face masks (surgical or N95) but rather should be worn in conjunction with masks when eye protection is needed.
When and where are face coverings required for patients?
The County Health Officer’s August 2, 2021 Health Order Requiring the Use of Face Coverings Indoor by All Persons requires individuals to wear a face covering indoors in public and non-public indoor settings in the county. Furthermore, the California Department of Public Health’s July 28, 2021 Guidance for the Use of Face Coverings requires that all individuals, regardless of vaccination status, wear face coverings in healthcare settings, including long term care facilities.
*Per CDC, “healthcare settings” are defined a “places where healthcare is delivered and includes, but is not limited to, acute care facilities, long term acute care facilities, inpatient rehabilitation facilities, nursing homes and assisted living facilities, home healthcare, vehicles where healthcare is delivered (e.g., mobile clinics), and outpatient facilities, such as dialysis centers, physician offices, and others.”
Screening and Healthcare Worker Testing
How should healthcare workers be screened for symptoms?
Each healthcare facility's employee health program should have COVID-19 screening procedures in place, and employees should follow their employer's screening procedures. In general, symptom screening should occur prior to every shift, as well as mid-shift if the shift is longer than 10 hours. Temperature screening is not required.
How often should healthcare workers be tested?
See the State Public Health Officer Order of July 26, 2021 or the AFL 21-27 (ca.gov) for information on when and how often healthcare workers should be tested. Furthermore, consult the Cal/OSHA COVID-19 Prevention Emergency Temporary Standard for current requirements for employers to offer testing of workplace close contacts after exposure.
Persons experiencing COVID-19 symptoms should get tested and isolate regardless of vaccination status and whether or not they had close-contact to someone confirmed to have COVID-19.
How should healthcare employers monitor vaccinated and unvaccinated healthcare workers?
Healthcare employers and other businesses must:
- ascertain their employees’ vaccination status as required by the County Health Officer’s May 18, 2021 and June 21, 2021 Health Orders,
- ensure that unvaccinated employees working onsite mask indoors, even when they are not in a healthcare setting,
- ensure that all unvaccinated employees, whether or not they have symptoms, quarantine if they are identified as a close contact to a confirmed COVID-19 case,
- ensure that all symptomatic vaccinated employees quarantine if they are identified as a close contact to a confirmed COVID-19 case, and
- provide vaccination information to all unvaccinated employees.
Healthcare employers and other businesses should:
- prohibit work-related travel for unvaccinated employees,
- for unvaccinated employees, conduct weekly PCR testing for COVID-19 OR daily antigen testing, with COVID PCR confirmation of any positives.
For more information see the Public Health Order dated August 2, 2021.
What is the guidance from Santa Clara County regarding healthcare workers returning from travel outside the county?
The Mandatory Directive on Travel is no longer in effect. HCWs who have traveled should follow CDC’s travel recommendations and requirements, including restrictions from work, when recommended for any traveler. See AFL 21-08 (ca.gov) and AFL20-53 (ca.gov) for travel guidance for HCWs who work in congregate settings (e.g. long-term care facilities).
Must healthcare facilities still require their healthcare workers to be vaccinated against influenza? What do I do when a healthcare worker I employ declines flu vaccination?
All healthcare facilities must continue their programs requiring their healthcare workers to receive an annual influenza vaccination by October 31 of each year. All healthcare workers who decline flu vaccination must sign a declination form, and their employer must track what percentage of their workforce has and has not received influenza vaccine. For more information, please see the September 4, 2020 Health Officer Order - Healthcare Workers Required To Receive an Annual Flu Vaccination. Also see the Influenza Information for Clinicians page for the latest information.
What are the current recommendations regarding the timing of mRNA vaccines for COVID-19 and the use of TST and IGRA?
Per CDC, testing for tuberculosis (TB) infection with one of the immune-based methods, either the tuberculin skin test (TST) or an interferon release assay (IGRA), can be done before, after, or during the same encounter as COVID-19 vaccination. COVID-19 vaccination should not be delayed because of testing for TB infection.
TSTs and IGRAs were previously recommended to be administered > 4 weeks after completion of COVID-19 vaccination to minimize potential theoretical interference between vaccination and TB testing. This was out of an abundance of caution during a period when these vaccines were new. However, given logistical challenges faced in delaying TB infection testing, the recommendation has been updated so that these tests may now be administered without regard to timing of COVID-19 vaccination.
Visit CDC's Interim Clinical Considerations for Use of COVID-19 Vaccines for more information.
Who should healthcare providers test?
See the CDPH Testing Guidance for current recommendations on who healthcare providers should test. Furthermore, consult the Cal/OSHA COVID-19 Prevention Emergency Temporary Standard for current requirements for employers to offer testing of workplace close contacts after exposure.
Who should receive post exposure testing?
- Individuals who have not been fully vaccinated and have close contact with someone who has tested positive for COVID-19 should be tested.
- Consult Cal/OSHA COVID-19 Prevention Emergency Temporary Standard for current requirements for employers to offer testing of workplace close contacts after exposure.
Fully vaccinated individuals
- Fully vaccinated individuals who are a close contact and/or symptomatic should be tested immediately and on day 5 after last exposure to the case.
- The County of Santa Clara recommends that fully vaccinated people who are asymptomatic close contacts should be tested immediately and on day 5 following an exposure to someone with suspected or confirmed COVID-19, but they do not need to quarantine if they remain asymptomatic.
- Testing (but not quarantine) is especially important following an exposure to someone with suspected or confirmed COVID-19 in the following settings:
- Fully vaccinated residents and employees of non-healthcare congregate settings
- Fully vaccinated employees of high-density workplaces (e.g., food processing plants)
- Fully vaccinated dormitory residents (or similar high-density housing settings) at educational institutions
Testing in these settings is especially important because they may face high turnover of residents and/or a higher risk of transmission.
Should all patients be tested for COVID-19 a day prior to elective surgery?
Should all patients be tested for COVID-19 upon hospital admission?
Who is responsible for notifying patients about their COVID-19 test results?
The physicians who order COVID-19 tests are responsible for notifying their patients of their test results, regardless of where the tests are conducted.
What is the appropriate test to diagnose an acute COVID-19 infection?
The CDPH COVID-19 Testing Task Force has provided guidance regarding Testing for COVID-19: PCR, Antigen, and Serology. The document includes information around the types of tests available and their reliability, as well as guidelines around interpretation. While PCR testing has been the mainstay for diagnosing acute COVID-19 infection, antigen testing may be appropriate in certain situations (i.e., symptomatic individuals in whom point of care testing is necessary). CDPH has also published a Diagnostic Algorithm for SARS COV-2 and Testing Guidance to provide further guidance on when to use a PCR test versus an antigen test.
What are antigen tests, in what situations are these useful, and what are their limitations?
Antigen tests directly detect fragments of SARS-CoV-2 viral protein (as opposed to viral RNA detected by nucleic acid amplification tests [NAAT aka PCR tests]). The main advantages of antigen tests are fast turnaround time, simple to perform point-of-care use, and lower cost.
Antigen tests are generally less sensitive (more false negatives) compared to PCR testing, particularly among asymptomatic individuals. The specificity of antigen tests is generally high (few false positives). However, specificity decreases when the manufacturer's directions are not strictly adhered to or if the test is used in communities with low COVID-19 prevalence.
Among symptomatic individuals, the test is ideally performed within 5-12 days of symptom onset.
Antigen tests can be used for diagnostic, screening, and surveillance testing. However, the interpretation of the test and the need for confirmatory PCR (aka NAAT) depends on several factors including the presence of symptoms, exposure to a confirmed COVID-19 case, and test positivity percent in the community.
For more information, please refer to the following resources:
- CDPH Diagnostic Algorithm for SARS COV-2
- CDPH Fact Sheet for Antigen Tests
- CDC Guidance on Using Antigen Tests
- CDPH Testing Guidance
When do I need to order a PCR test after an antigen test?
A positive antigen test result in an asymptomatic individual has the potential to be a false positive, especially if at low risk based on vaccination and exposure status.
For non-SNF (Skilled Nursing Facility) settings, please refer to the CDPH Testing Guidance and table below:
Presence of Symptoms
Positive antigen test
Do not need confirmatory PCR. Follow guidance for COVID-19 case.
Negative antigen test
Should receive a confirmatory PCR testing because there is potential for false negative antigen test results. Patient should be excluded from work and isolate until PCR results return.
Positive antigen test
Should receive a confirmatory PCR because there is potential for false positive antigen test results. Patient should be excluded from work and isolate until PCR results return.
Negative antigen test
Do not need confirmatory PCR testing in most non-SNF, non-outbreak settings
See CDPH Diagnostic Algorithm for SARS COV-2 for additional information
For SNF settings, recommendations for confirmatory PCR testing are dependent on presence of symptoms and presence of an active outbreak within the facility. For additional information on antigen testing in SNFs, please see CDC’s Guidance on the Use of SARS-CoV-2 Antigen Testing in Long Term Care Facilities.
I think my patient's COVID-19 test result is a false positive. Should they be re-tested?
As COVID-19 transmission continues at increasing levels in Santa Clara County, testing is needed to detect asymptomatic infection, a well-known driver of the pandemic. It is generally recommended not to re-test a patient with a positive PCR result, even if they are fully vaccinated or asymptomatic.
Why is re-testing a patient with a positive PCR result generally recommended against?
False positives may occur with any test, but there is no recommended procedure to determine that a PCR result is false. A negative result following a positive one does not verify that the positive result was wrong, as viral shedding may be intermittent. Therefore, isolation requirements still apply for persons with a positive PCR or other molecular test result regardless of subsequent negative test results.
Should fully vaccinated persons get COVID-19 tested?
Fully vaccinated persons can get (and may transmit) COVID-19. However, COVID-19 testing is generally not recommended for fully vaccinated persons without symptoms, unless they have been identified as a close contact to a confirmed COVID-19 case. Persons experiencing COVID-19 symptoms should get tested regardless of vaccination status. See the CDPH Testing Guidance for more information. These recommendations continue to evolve.
Where can I find more information about COVID-19 testing?
For information about testing, including considerations for when to test, setting-specific testing guidance, and selection and interpretation of tests, visit CDC’s web pages on COVID-19 Testing and Point-of-Care Testing, and the CDPH Testing Guidance.
What is serology for COVID-19, what are the limitations, and how can it be useful at this time?
COVID-19 serology test detects the presence of IgM and IgG antibodies, which reflects the body’s immune response to the infection. Because it takes 2-3 weeks for the body to make antibodies, serology tests are not useful for detection of early infection. In addition, some persons may not mount an antibody response at all. For these reasons, serology should not be used as the sole basis to diagnose COVID-19.
What information is available about At-Home Testing for COVID-19?
The CDC has published a guide for patients on the use of at-home collection kits or at-home tests for COVID-19. Some are available by prescription only (Lucira COVID-19 all-in-one kit) and others are available over-the-counter (Ellume COVID-19 Home Test). Abbot’s BinaxNOW COVID-19 test must be performed only with the supervision of a telehealth provider. CDC recommends these tests be used for individuals who are symptomatic and cannot receive testing from a healthcare provider. The ability of these tests to correctly identify positive samples ranges from 91-96%, depending on which test is used and whether the individual is symptomatic or asymptomatic. The ability of these tests to identify negative samples ranges from 96-100%, depending on which test is used and whether the individual is symptomatic or asymptomatic
How does nasal or mid-turbinate specimen collection compare to traditional nasopharyngeal (NP) testing?
Existing published scientific data suggest sampling the anterior nares or mid-turbinate has similar sensitivity to a nasopharyngeal test.
Re-Infection and Immunity
Should I report patients who tested positive after being fully vaccinated?
NEW – As of 7/23/21, case report form submission is required only for COVID-19 cases who are (1) hospitalized, (2) deceased, or (3) in a congregate living setting (e.g., jail, shelter, or LTCF). Unless the case meets one or more of the above criteria, reporting of post-vaccination cases is not required. Fully vaccinated is defined as: at least 14 days following receipt of the second dose in a 2-dose series, or at least 14 days following receipt of one dose of a single-dose vaccine. Follow the same procedure as for reporting non-vaccinated cases by using the Case Report Form here, and include information regarding the patient’s vaccination history. Cases who have been fully vaccinated are still required to isolate according to standard county guidance for isolation (isolate for 10 days since symptoms first appeared, and 24 hours with no fever and improvements of other symptoms).
What are the current recommendations regarding persistent positives and reinfection?
Persistent Positives: For persons who are asymptomatic following recovery from COVID-19, Santa Clara County Department of Public Health does not recommend retesting within 3 months after the date of symptom onset. Should such a person test positive for COVID-19 3 or more months after recovery, clinicians should consider the possibility of reinfection.
Reinfection: Confirmed and suspected cases of reinfection of the virus that causes COVID-19 have been reported but remain rare. SARS-CoV-2 reinfection is a rapidly evolving area of research, and there is currently no widely accepted definition of what constitutes SARS-CoV-2 reinfection. To help better understand the potential for reinfection and to create a standardized case definition of SARS-CoV-2 reinfection, CDC developed proposed criteria for further investigation.
Please see diagram below to aid in decision making.
Persistent Positive/Re-infection Diagram (PDF)
Among individuals in whom you suspect persistent or recurrent infection, which isolates should be sent to Public Health Lab (PHL) for additional testing at the State level?
The California Department of Public Health is evaluating potential cases of COVID-19 reinfections. They request that COVID-19 specimen meeting the following criteria be sent to PHL for additional testing.
Specimen Submission Criteria
Cases in which first and second episodes are 45 – 90 are days apart:
- A previous RT-PCR confirmed COVID-19 case
- Met criteria for ending isolation
- Positive RT-PCR test 45-90 days after initial diagnosis.
- New or recurrent symptoms consistent with COVID-19 (without alternate explanation for symptoms)
Cases in which first and second episodes are > 90 days apart:
- A previous, RT-PCR confirmed COVID-19 case
- Met criteria for ending isolation
- Positive RT-PCR test more than 90 days after prior diagnosis
- Symptoms may or may not accompany the second episode.
Additionally, the specimen from the suspected reinfection (second episode) must have a PCR – Ct value threshold ≤ 33 in order to ensure that there is sufficient viral load to perform testing.
If you have cases that meet the above criteria, please call the Public Health Department at (408) 885-4214, ext. 3 (ask for Provider Branch) to arrange for specimen submission.
Why is the period of isolation to 20 days for persons with COVID-19 who are severely ill or immunocompromised?
For most persons with COVID-19, viral cultures of upper respiratory specimens are negative when specimens are collected more than 10 days after symptom onset. In some persons with severe disease or immunocompromised state, viral culture of specimens collected between 10 and 20 days after symptom onset have been positive. This is the basis for the recommendation to isolate such persons for up to 20 days.
Treatment and Management
How should I manage my patient with COVID-19?
Please see CDC’s clinical guidance page for more information. A number of investigational drugs that are approved for other conditions are currently being studied in clinical trials for the treatment of COVID-19. For more information, please see NIH COVID-19 Treatment Guidelines.
When is the use of remdesivir indicated?
As of July 24, 2020, The NIH COVID-19 Treatment Guidelines Panel (Panel) recommends prioritizing remdesivir for limited use in hospitalized patients with COVID-19 who require supplemental oxygen but who do not require oxygen delivery through a high-flow device, noninvasive ventilation, invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) (BI).
For patients with mild to moderate COVID-19 symptoms, the Panel does not have a recommendation either for or against the use of remdesivir in treatment. For more information, please see NIH COVID-19 Treatment Guidelines for remdesivir.
What are the indications for use of hydroxychloroquine?
Based on the results of several clinical trials showing lack of efficacy of Hydroxychloroquine +/- Azithromycin, the NIH COVID-19 Treatment Guidelines Panel recommends against the use of this medication for prevention or treatment of COVID-19. For more information, please see NIH COVID-19 Treatment Guidelines.
What are the indications for use of steroids in the treatment of COVID-19? What is the recommended dose and duration of therapy?
Patients with severe COVID-19 develop a systemic inflammatory response that can lead to lung injury and multisystem organ dysfunction. It has been proposed that the anti-inflammatory effects of corticosteroids might prevent or reduce these effects.
Please see the NIH Therapeutic Management of Patients with COVID-19 for recommendations on use of dexamethasone with or without remdesivir in certain hospitalized patients. For more information about the use of corticosteroids in patients with COVID-19, please see NIH guidance here.
What are the indications for the use of monoclonal antibody therapy in the treatment of COVID-19?
Antibody therapy should be considered in patients with mild to moderate COVID-19 who are not hospitalized. For more information, please see the NIH treatment guidelines.
Isolation for Confirmed Cases
Have the County of Santa Clara Public Health Department’s recommendations on isolation changed?
Effective September 22, 2020, Santa Clara County (SCC) aligned with California Department of Public Health (CDPH) recommendations on isolation. Isolation should last at least 10 days since symptom onset; AND at least 24 hours since resolution of fever without the use of fever-reducing medications; AND other symptoms have improved. See the Isolation and Quarantine table.
Do patients who test positive for COVID-19 have to be cleared by the Public Health Department or re-tested at the end of their isolation period before they can stop isolating
Patients are no longer considered contagious if they meet the criteria detailed in the Return to Work Letter. The patient does not need a medical note or a negative test to return to work as long as the criteria detailed are met.
In contrast, people experiencing symptoms consistent with COVID-19 may be required to have a negative test or medical note to return to work or school 24 hours after resolution of fever and improvement of other symptoms. Individuals who refuse testing and/or evaluation may be treated as a COVID-19 case and can return based on the usual isolation criteria of 10 days after symptom onset and 24 hours after resolution of fever and improvement of other symptoms.
When can a case or close contact return to school or another program for children/youth? (TK-12; Programs for Children/Youth)
Students and staff are no longer considered contagious if they meet the criteria detailed in the Return to School Letter. Employers and schools should not request that individuals who were diagnosed with the COVID-19 virus provide proof of negative COVID-19 virus tests before allowing them to return to work or school.
In addition, unvaccinated close contacts or vaccinated, symptomatic close contacts, who meet the criteria for completion of their quarantine period, do not need to provide a negative COVID-19 virus test to return to school. CDPH’s COVID-19 Public Health Guidance for K-12 Schools in California, 2021-2022 School Year outlines options to modify or shorten quarantine requirements for students only.
Fully vaccinated close contacts may not need to quarantine if they meet the conditions described in the Quarantine Guidance for Fully Vaccinated People. However, all close contacts, regardless of vaccination status, should get tested immediately and on day 5 after last exposure to capture any asymptomatic cases.
In contrast, anyone who was not a close contact but who has symptoms of COVID-19 is required to have a negative test or a medical note that details an alternative explanation for the symptoms before returning to school.
Individuals who refuse testing and/or evaluation should be treated as a COVID-19 case and can return based on the usual isolation criteria of 10 days after symptom onset and 24 hours after resolution of fever and improvement of other symptoms.
If a student or staff member has COVID-like symptoms, when is a doctor’s note needed before returning to school? (TK-12)
If a student or staff person, who is not a close contact to a confirmed COVID-19 case, has COVID-like symptoms that may be common to a variety of illnesses, the person should get tested.
If the final test result is negative, the student or staff member can return to school when at least 24 hours have passed since resolution of any fever (without the use of fever-reducing medications) and other symptoms have improved. The negative test result should be provided to the school, and a doctor’s note is not needed.
A doctor’s note can only be used in place of a negative test to return to school if:
- the symptoms experienced are identical to those of a documented underlying chronic condition(e.g., asthma or diabetes); or
- the healthcare provider determined, through a medical evaluation of the person, that there is an alternative, named diagnosis(e.g., streptococcal pharyngitis or coxsackievirus) that explains the symptoms experienced.
For a doctor’s note to be valid documentation of the above situations, the doctor must provide a written explanation that includes all of the following: certification that a medical evaluation was completed; an alternative explanation for symptoms; and a statement that COVID-19 testing is not indicated.
Does the 10-day isolation recommendation apply to all individuals?
Severely ill and immunocompromised individuals (e.g., currently receiving chemotherapy, or recent organ transplant), or who had critical illness (e.g., required intensive care) may shed detectable SARS-CoV-2 RNA for up to 20 days, and therefore may need prolonged isolation. Discontinuation of isolation policies in hospital settings should be determined by the individual institution.
Individuals who test positive after being fully vaccinated must still follow standard county guidance for isolation (isolate for 10 days since symptoms first appeared, and 24 hours with no fever and improvements of other symptoms).
Should patients be isolated again if they previously tested positive outside of Santa Clara County and later tested positive again after returning to Santa Clara County?
We advise isolating again unless the patient provides documentation (e.g., doctor’s note or lab result) of a positive test dated within the last 3 months.
How do I assist a homeless patient who has been identified as a case to receive housing accommodations including support for isolation?
Refer to “Homeless Referrals Including Support for Isolation and Quarantine” under Resources for Patients.
How do I refer a patient who is housed but is unable to self-isolate (e.g., they share a room where they cannot adequately physically distance or a bathroom or kitchen facility that they cannot adequately disinfect)?
Refer to “Isolation and Quarantine Support Referrals for Housed Patients” under Resources for Patients.
Quarantine Guidance for Fully Vaccinated People
Do people who have been vaccinated still need to quarantine after being exposed to a COVID-19 Case?
According to CDC’s definition, people are considered fully vaccinated:
- At least 14 days have passed since they received the second dose in a 2-dose vaccine series (such as Pfizer or Moderna), or
- At least 14 days have passed since they received one dose of a single-dose vaccine (such as Johnson & Johnson)
When Quarantine is not required:
In general, fully vaccinated individuals are not required to quarantine after being exposed to a case if they meet ALL of the following criteria:
- Are fully vaccinated
- Have remained asymptomatic since the last COVID-19 exposure; and
- Are not an inpatient or resident in a healthcare setting or facility.
The County of Santa Clara recommends that fully vaccinated people who are asymptomatic should be tested immediately and on day 5 following an exposure to someone with suspected or confirmed COVID-19, but they do not need to quarantine if they remain asymptomatic.
Quarantine Exemption for Previous Infection: If an exposed person tested positive for COVID-19 before their new, recent exposure and it has been less than 3 months since they started having symptoms from that previous infection (or since their first positive COVID-19 test if asymptomatic), they do not need to quarantine, as long as they have not had any new symptoms since their recent exposure to someone with COVID-19.
*Your workplace may still be required to comply with Cal/OSHA’s COVID-19 Prevention Emergency Temporary Standards (“ETS”), regardless of vaccination status. (See the ETS FAQs for further guidance.)
When Quarantine or Isolation is still required:
Fully vaccinated individuals experiencing COVID-19 symptoms should still follow standard County guidance for testing and quarantine. They should get tested and quarantine immediately if experiencing COVID-19 symptoms. If they test positive for COVID-19, they must follow standard County guidance for isolation.
Non- fully vaccinated close contacts who were exposed to fully vaccinated cases should still follow standard county guidance for testing and quarantine, whether or not the close contact is experiencing COVID-19 symptoms.
Fully vaccinated healthcare workers please see section above on Managing Exposures Among Healthcare Workers for workplace specific guidance based on their vaccination status.
*Fully vaccinated inpatients and residents in healthcare settings should continue to follow CDPH quarantine guidance for healthcare settings following an exposure to someone with suspected or confirmed COVID-19; outpatients should be cared for using appropriate Transmission-Based Precautions.
For more information, see CDC webpage on COVID-19 Vaccines.
Should people still get tested, wear a mask, and avoid indoor gatherings and breakrooms if they have been fully vaccinated?
Fully vaccinated asymptomatic individuals are recommended to follow CDC and CDPH guidance for travel, social gatherings, and other activities. Furthermore, the County Health Officer’s August 2, 2021, Health Order requires individuals, regardless of vaccination status, to wear face coverings in indoor settings in the County. Also, as described above, CDPH guidance requires that all individuals, regardless of vaccination status, wear face coverings in healthcare settings. Where there is a difference between state and federal guidelines, the more restrictive guideline should be followed.
The Health Officer recommends that use of indoor breakrooms by unvaccinated staff be minimized as much as possible. Unvaccinated employees should preferably eat outside, alone in their vehicles or alone at their own desk/workspaces. Employers are strongly encouraged to take steps to encourage these safety measures (for example, by staggering break times and/or setting up outdoor areas where employees can eat and stay at least six feet apart from one another). If unvaccinated employees want to eat with coworkers, they should do so outdoors and distanced more than six feet apart from each other.
In general, fully vaccinated asymptomatic individuals are allowed to conduct the following activities*:
- Gather in-doors with other fully vaccinated people of any age (individuals at indoor gatherings must wear face coverings in compliance with the County Health Officer’s August 2, 2021 Health Order),
- Travel domestically without the need to test before or after travel,
- Refrain from quarantine and testing after domestic travel.
*Your workplace may still be required to comply with Cal/OSHA’s COVID-19 Prevention Emergency Temporary Standards (“ETS”), regardless of vaccination status. (See the ETS FAQs for further guidance.)
Fully vaccinated asymptomatic individuals should continue to do the following:
- Wear a mask indoors and practice social distancing, when going out in public or gathering with people who are not fully vaccinated,
- Get tested and quarantine immediately if experiencing COVID-19 symptoms,
- Get tested immediately and on day 5 after exposure if identified as a close contact to a confirmed case of COVID-19,
- Follow standard county guidance for isolation and work exclusion if tested positive for COVID-19.
There are other restrictions and considerations that may apply to fully vaccinated individuals. Please see CDC and CDPH guidance for more information.
What is the guidance around travel for people who have been fully vaccinated?
The Mandatory Directive on Travel is no longer in effect. Fully vaccinated individuals are recommended to follow CDC guidance for domestic and international travel. In general, for domestic travel, fully vaccinated individuals who do not have COVID-19 symptoms do not need to get tested before or after travel, or quarantine after travel. For international travel, fully vaccinated individuals should follow CDC recommendations, and may still need to test or quarantine depending on requirements issued by the destination authority.
For individuals who have not been fully vaccinated, non-essential travel should still be avoided to reduce the risk of virus transmission. Non-vaccinated travelers should still get tested before and after travel, and quarantine after travel, unless traveling for essential purposes. Please see CDPH Travel Advisory for detailed guidance.
What is the quarantine guidance for fully vaccinated inpatients and residents in healthcare facilities?
*Fully vaccinated inpatients and residents in healthcare settings should continue to follow CDPH quarantine guidance for healthcare settings following an exposure to someone with suspected or confirmed COVID-19; outpatients should be cared for using appropriate Transmission-Based Precautions. For more information, see CDC webpage on COVID-19 Vaccines.
Quarantine for Close Contacts
What changes have been made to County of Santa Clara Public Health Department’s general quarantine recommendations?
The County has revised quarantine guidance to align with the California Department of Public Health.
The major changes are:
- the new CDPH guidance allows for testing out after Day 7 for asymptomatic, unvaccinated close contacts
- the testing guidance for all individuals who are close contacts (regardless of vaccination status or symptom status) is to test immediately and on Day 5
See the Isolation and Quarantine Protocols table for the complete quarantine recommendations.
The general quarantine guidance above applies to healthcare workers under normal circumstances, and HCWs who have routine workplace exposures that are not high risk should continue to follow their employer’s guidance for returning to work. However, if critical staffing shortages exist, healthcare workers may follow the recommendations outlined under “How do you manage healthcare workers who were exposed but are asymptomatic?”.
Do patients who tested positive for COVID need to subsequently quarantine after their isolation period if their household contact becomes positive?
No, persons who have tested positive for COVID with onset in the last 3 months, but who have completed their recommended period of isolation, do not need to quarantine or repeat testing if re-exposed during the three months after onset of most recent infection.
For the purposes of contact tracing, should the date of symptom onset be based only on fever or cough?
COVID-19 illness can begin with symptoms other than fever or cough, such as chills, night sweats, sore throat, shortness of breath, nausea, vomiting, diarrhea, fatigue, myalgias, headaches, change in mental status, or loss of sense of taste or smell. Use the earliest date of these symptoms for date of symptom onset. Patients are considered contagious starting two days before symptom onset through the last day of their recommended isolation period.
Healthcare Worker Cases and Exposures
How do you manage healthcare workers who test positive (confirmed COVID-19 case)?
Please see the Isolation and Quarantine Protocols for more information. These requirements apply regardless of vaccination status.
How do you manage healthcare workers who were exposed but are asymptomatic?
Fully Vaccinated Healthcare Workers
Fully vaccinated Healthcare Workers (HCWs) should follow CDC guidance for healthcare settings, as well as their employer’s guidance. In general, fully vaccinated HCWs who are asymptomatic do not need to be excluded from work or quarantine after a high-risk exposure, but should still be tested for COVID-19 immediately and 5 days after last exposure. Work exclusion may still be considered for HCWs who have underlying immunocompromising conditions. HCWs who have traveled should follow CDC’s travel recommendations and requirements, including restrictions from work, when recommended for any traveler. HCWs who work in congregate settings (e.g. long-term care facilities) please see CDPH All Facilities Letter dated March 23, 2021.
Non-vaccinated or Partially Vaccinated Healthcare Workers
Non-vaccinated or partially vaccinated HCWs should continue to follow CDC guidance for Potential Exposure at Work, as well as CDPH All Facilities Letter dated March 23, 2021, which provides guidance for HCWs based on vaccination status.
Mitigation Strategies During Critical Staffing Shortages
HCWs who are not fully vaccinated after experiencing a higher risk exposure in the workplace or identified as a close contact in the community should continue to follow County guidance for quarantine. However, during times of critical staffing shortage, healthcare facilities are recommended to follow CDC staffing shortage mitigation strategies and guidance on Potential Exposure at Work, as well as CDPH guidance. In general, to alleviate critical staffing shortage, asymptomatic HCWs who are not fully vaccinated may return to work after Day 7 from date of last exposure if they received negative PCR test result from specimen collected on or after Day 5. See CDPH All Facilities Letter for more information.
- Healthcare workers who are not fully vaccinated and who have been exposed to a COVID-19 positive person in the household or in the community, or during a high-risk exposure in the workplace (e.g., not wearing required PPE), may continue to work or return to work during the quarantine period (which, for this scenario, is defined as 10 days from the date of last exposure to the COVID-19 positive person) under the following conditions: The HCW remains asymptomatic.
- The HCW undergoes the following testing regimen:
- A COVID-19 test is done immediately upon learning of their exposure and the test result is negative.
- The HCW remains off work until this initial COVID-19 test is resulted.
- Thereafter, during the remainder of the quarantine period, the HCW’s COVID-19 status shall be monitored with daily rapid antigen tests or RT-PCR tests every 3 days. Test type and frequency will depend on the facility’s testing availability and schedules.
- The HCW wears an N95 respirator and all other required PPE at all times while at work during the quarantine period.
- The HCW does not eat, drink, or unmask around others at any time, regardless of social distancing.
- The HCW continues to monitor COVID-19 symptoms daily. If the HCW develops symptoms, the HCW should leave work, contact their manager/employee health, and be tested.
- The HCW maximizes social distancing (even beyond 6 feet) wherever possible with both patients and co-workers, and maintains excellent hand hygiene at all times.
- The HCW does not work with severely immunocompromised patients or individuals (e.g., cancer, organ transplants).
- The HCW’s work duties are assigned in a manner that minimizes the number of different patients cared for by the HCW.
- The HCW is still under home quarantine for 10 days after last exposure except to go to work. The HCW must not carpool, taxi, or rideshare.
Significance of Variants
What is Whole Genome Sequencing (WGS)?
Per CDC, WGS is a laboratory procedure that determines the order of bases in the genome of an organism or virus in one process. When a patient tests positive for COVID-19 and SARS-CoV-2 is detected in a laboratory specimen, the “isolate” (specific virus that is found) can be sequenced to identify that virus’s features and lineage. This process as applied in COVID-19 pandemic response does not sequence the human DNA in any sample, only the genetic material of the virus. To characterize the public health significance of COVID-19 variants and their prevalence in the community, CDC and CDPH are increasing efforts for WGS and the capacity to identify and monitor variants of concern or interest. For more information on WGS and guidance for laboratories, see the CDC WGS website.
What is a Variant?
Variants emerge when virus mutations create new strains of the virus over time. Some variants are short-lived while others persist in the population. Throughout the COVID-19 pandemic, multiple variants of SARS-CoV-2 have appeared around the world, many of which are also circulating within the US. Though most variants do not have significant health impact, some may affect COVID-19 transmission, severity, diagnostics, treatment, or vaccine effectiveness.
How are Variants Identified?
Variants are identified through WGS. The County of Santa Clara Public Health Department is working closely with the State, as well as with academic and clinical partners, to ensure widespread WGS of isolates from County cases and timely identification and notification of variants of concern and interest. Most laboratories, particularly those that are not clinical or hospital-based, are not equipped to perform WGS. As such, the County of Santa Clara Public Health Laboratory has conducted genomic sequencing of SARS-CoV-2 since the beginning of the pandemic and now has sufficient capacity to sequence a large proportion of the isolates detected in clinical and hospital-based laboratories all over the County.
Why Track Variants?
Some variants may have significant impact on diagnostics, treatments, vaccines, or disease outcomes. As such, it is important to track prevalence and trends over time to understand and control their spread in Santa Clara County, a practice known as genomic surveillance. Using genomic surveillance, the Public Health Department can help public health officials at the state and federal levels, as well as academic researchers, understand more about a variant’s transmissibility, severity, and response to treatment, to inform local preventive measures.
What do we know about the different Classifications of Variants?
Following CDC classifications and definitions, the term variant of interest (VOI) is used to describe a variant with specific genetic markers that have been associated with changes to receptor binding, reduced neutralization by antibodies generated against previous infection or vaccination, reduced efficacy of treatments, potential diagnostic impact, or predicted increase in transmissibility or disease severity. The term variant of concern (VOC) is used to describe a variant for which there is already evidence of an increase in transmissibility, more severe disease (e.g., increased hospitalizations or deaths), significant reduction in neutralization by antibodies generated during previous infection or vaccination, reduced effectiveness of treatments or vaccines, or diagnostic detection failures. Lastly, the term variant of high consequence is used to describe a variant that has clear evidence that prevention measures or medical countermeasures (MCMs) have significantly reduced effectiveness relative to previously circulating variants.
The CDC defines which lineages or variants are classified as VOI, VOC or Variants of High Consequence and provides up-to-date information at its Variants website.
For more information on which variants the California Department of Public Health (CDPH) is tracking and on the number of cases per variant reported across California, see the CDPH website on Tracking Variants.
What impact do Variants have on Vaccine Effectiveness?
Several VOC, some of which have a reported increase in transmissibility, have been detected in the San Francisco Bay Area. It is not yet known how these VOC will impact vaccine effectiveness, although we are reassured by clinical trial and real-world data that they will still work as intended. Until more is known about this impact, the opening of sectors does not necessarily signify that these activities are “safe.”
Which Variants are Being Tracked in Santa Clara County?
Santa Clara County is monitoring all VOCs and VOIs that are being monitored by CDPH, as well as additional VOIs identified in Santa Clara County. For more information, please see April 1stpress release and SCC COVID-19 Variant Dashboard.
Which specimens or isolates are being sequenced?
Given the improvement in overall WGS capacity by the County of Santa Clara Public Health Laboratory and other partners, the County is coordinating with all major healthcare providers and their labs in the area to receive all positive SARS-CoV-2 specimens, with the aim of processing the majority of isolates with enough virus for WGS (meaning, ensuring a sufficient amount of virus genetic material is obtained to conduct WGS).
Should I contact the County to request sequencing on any specific type of patient?
No. At this time, the increased capacity for WGS in many labs means that nearly all isolates that can be sequenced will be. Providers do not need to contact the Public Health Department specifically to request sequencing on a given isolate, as most likely this isolate will be sequenced already if possible to do so. The best support from providers is to ensure timely completion of the COVID-19 Case Report Form, including travel and vaccination history, and to encourage case patients to participate in Contact Tracing interviews. These methods of data collection will ensure that we can match the findings of WGS with details about specific case patients and outbreaks.
Will I or my patients receive results if their isolate is sequenced or if a variant is found?
No. The results of WGS are not approved for individual clinical use, and there are no recommendations for different treatment, follow up, or disease prevention in individual patients based on their WGS result. Therefore, the County will not share the results of individual isolates with either patients or their providers. However, there may be circumstances where information regarding specific clusters or outbreaks are shared among LHJ personnel for infection prevention and control purposes. More information about WGS results and which variants have been found in the County can be found at the SCC COVID-19 Variant Dashboard.
Where can I find more Information about variants?
- CDPH - Tracking Variants
- CDC - Variants of the Virus that Causes COVID-19
- CDC - SARS-CoV-2 Variant Classifications and Definitions
Skilled Nursing Facilities
I run a dental facility – should I continue to provide cleanings and non-urgent dental services to patients?
Dentists should follow the CDC’s guidance on dental services.
- COVID-19 for Providers Home
- Vaccine Info for Providers
- Provider Responsibilities and Guidance
- Resources for Patients
- Provider FAQs
- Health Alerts Archive