Nebraska DHHS Guidance

• Required: testing within 3 days prior to return to US via airline or documentation of recovery
• Recommended: testing 3-5 days after return to US AND quarantine 7 days after travel, or quarantine 10 days if no testing

CDC's Updates

• For not vaccinated
• Recommended: get tested 1-3 days prior to travel out of the US
• Required: testing within 3 days prior to return to US via airline or documentation of recovery
• Recommended: testing 3-5 days after return to US AND quarantine 7 days after travel, or quarantine 10 days if no testing
• For fully vaccinated
• Required: testing within 3 days prior to return to US via airline or documentation of recovery
• Recommended: testing 3-5 days after return to US but NO need to quarantine
• https://www.cdc.gov/coronavirus/2019-ncov/travelers/international-travel-during-covid19.html

Definitions

• Self-Quarantine: persons with known or potential exposure to a person with COVID-19 infection should remove themselves from situations where others could be exposed/infected should they develop infection and be self or actively monitored.
• Self-Monitor: monitor yourself for symptoms consistent with COVID-19 infection, including cough, shortness of breath, fever, sore throat, and fatigue. Persons with known exposure to COVID-19 infection are asked to check for symptoms including fever twice daily (e.g., 8 am and 8 pm). Persons with COVID-19 infection should document symptoms to enable accurate determination of duration of isolation.
• Self-Isolate: persons who develop symptoms consistent with COVID-19 (e.g. cough, shortness of breath, fever, loss of taste or smell) should eliminate contact with others.
• Social Distancing: minimize interactions in crowded spaces by working from home, closing schools/switching to online classes, cancelling/postponing conferences and large meetings, and keeping individuals spaced at least 6 feet apart.
• Close Contact: an individual who has been 6 feet (2 meters) of a person who tested positive or someone with the following symptoms including: fever 100.4 F. or above or sudden onset of cough or sudden onset of shortness of breath, for at least 15 minutes or more.
• COVID-19 Illness Severity:
• Mild Illness: Individuals who have any of the various signs and symptoms of COVID-19 (e.g., fever, cough, sore throat, malaise, headache, muscle pain) without shortness of breath, dyspnea, or abnormal chest imaging.
• Moderate Illness: Individuals who have evidence of lower respiratory disease by clinical assessment/imaging, and a saturation of oxygen (SpO2) ≥94% on room air at sea level.
• Severe Illness: Individuals who have respiratory frequency >30 breaths per minute, SpO2 <94% on room air at sea level (or, for patients with chronic hypoxemia, a decrease from baseline of >3%), ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2) <300 mmHg, or lung infiltrates >50%.
• Critical Illness: Individuals who have respiratory failure, septic shock, and/or multiple organ dysfunction.

When Isolation Is Over

• Discontinuation from self-isolation for a symptomatic case with mild to moderate illness (confirmed or probable)
• Symptom-based strategy: an individual can end self-isolation if it has been at least 10 days since symptoms first appeared AND no fever for at least 24 hours (without the use of fever-reducing medications) AND other symptoms have improved (e.g., cough has improved).
• Test-based strategy: Except for rare situations, a test-based strategy is no longer recommended to determine when to discontinue isolation. Please refer to DHHS and ICAP for guidance in rare situations.
• Discontinuation from self-isolation for an asymptomatic laboratory-confirmed case who is not immunocompromised:
• Time-based strategy: isolation should continue until at least 10 days have passed since the date of the positive test AND no symptom development. For 3 days following discontinuation of isolation, the individual should practice strict social distancing and wear a facemask. If they develop symptoms, then a symptom-based should be substituted.
• Discontinuation of self-isolation for cases with severe to critical illness or immunocompromised:
• Symptomatic: At least 20 days after symptom onset AND at least 24 hours have passed since last fever (without the use of fever-reducing medications) AND symptoms have improved.
• Asymptomatic: At least 20 days have passed since the date of their positive test.
• Return to work for HCP who experienced mild illness and are not severely immunocompromised
• Except for rare situations, a test-based strategy is no longer recommended to determine when to discontinue isolation. HCP should follow “symptom-based" criteria or “time-based" criteria (if asymptomatic) to discontinue isolation.
• Return to work for HCP who experienced severe to critical illness or who are severely immunocompromised
• Symptomatic: At least 20 days have passed since symptoms first appeared and at least 24 hours have passed since their last fever without the use of fever-reducing medications and symptoms have improved.
• Asymptomatic: At least 20 days have passed since the date of their positive test.

When Quarantine Is Over

• Quarantine for Contacts of Persons with COVID-19 Infection Using Symptom Monitoring and Diagnostic Testing
• According to the CDC, local public health authorities determine and establish the quarantine options for their jurisdictions. CDC currently recommends a quarantine period of 14 days. However, based on local circumstances and resources, the following options to shorten quarantine are acceptable alternatives.
• 7 Day Quarantine Guidelines
• Quarantine may discontinue with testing under the following conditions:
• At least seven (7) days have passed since the quarantined individuals last Close Contact exposure AND
• Has had no COVID-19 symptom development AND
• Results of a diagnostic specimen test (molecular or antigen) is negative AND the specimen was collected no earlier than 5 days since the quarantined individuals last Close Contact exposure AND
• Continues to self-monitor daily for COVID-19 symptoms development through day 14 since last Close Contact exposure AND
• Wears a facial covering (such as a cloth mask) through day 14 since last Close Contact exposure
• With this strategy, the residual post-quarantine transmission risk is estimated to be about 5% with an upper limit of about 12%.
• 10 Day Quarantine Guidelines
• Quarantine may discontinue without testing under the following conditions:
• At least ten (10) days have passed since the quarantined individuals last Close Contact exposure AND
• Has had no COVID-19 symptom development AND
• Continues to self-monitor daily for COVID-19 symptom development through day 14 since last Close Contact exposure AND
• Wears a facial covering (such as a cloth mask) through day 14 since last Close Contact
• With this strategy, residual post-quarantine transmission risk is estimated to be about 1% with an upper limit of about 10%.
• Additional Criteria for 7 or 10 Day Quarantine Guidelines
• Persons can discontinue quarantine at these time points only if the following criteria are also met:
• No clinical evidence of COVID-19 has been elicited by daily symptom monitoring during the entirety of quarantine up to the time at which quarantine is discontinued AND
• Daily symptom monitoring continues through quarantine Day 14 AND
• Persons are counseled regarding the need to adhere strictly through quarantine Day 14 to all recommended non-pharmaceutical interventions. They should be advised that if any symptoms develop, they should immediately self-isolate and contact the local public health authority or their healthcare provider to report this change in clinical status.
• Testing for the purpose of earlier discontinuation of quarantine should be considered only if it will have no impact on community diagnostic testing. Testing of persons seeking evaluation for infection must be prioritized.
• Persons can continue to be quarantined for 14 days without testing per existing recommendations. This option maximally reduces risk of post-quarantine transmission risk and is the strategy with the greatest collective experience at present.

**Please Note: Shortening quarantine might be offset with potential enhanced compliance among persons who might otherwise be reluctant to quarantine the full 14 days.

• For more information regarding 7 day or 10 day quarantine guidance visit: CDC Quarantine Guidelines
• 14 Day Quarantine Guidelines
• Discontinuation of self-monitoring and self-quarantine: self-quarantine and self-monitoring may stop if after 14 days from most recent exposure, there has been NO development of respiratory illness symptoms.
• Discontinuation of quarantine for household members of a person with COVID-19 who is under self-isolation and you can separate:
• Start date of quarantine is the date the COVID-19 case began home isolation and then continuing for 14 days 　
• Discontinuation of quarantine for household members of a person with COVID-19 who is under self-isolation and you CANNOT separate:
• Start date of quarantine is the date the COVID-19 case ends home isolation and then continuing for 14 days
• Discontinuation of quarantine for household members of a person with COVID-19 who is under self-isolation and you can separate:

• Start date of quarantine is the date the COVID-19 case began home isolation and then continuing for 10 days.
• Discontinuation of quarantine for household members of a person with COVID-19 who is under self-isolation and you CANNOT separate:
• Start date of quarantine is the date the COVID-19 case ends home isolation and then continuing for 10 days.
• Recently exposed to COVID-19, but have had COVID-19 within the past 3 months:
• People who have tested positive for COVID-19 do not need to quarantine or get tested again for up to 3 months as long as they do not develop symptoms again. People who develop symptoms again within 3 months of their first COVID-19 infection may need to be tested again if there is no other cause identified for their symptoms.