Question Period Note: Current advice regarding isolation and quarantine periods

N/A

• The Public Health Agency of Canada (PHAC) currently recommends an isolation period of 10 days for individuals infected with COVID-19 and a quarantine period of 14 days for high-risk contacts. Provinces and territories continue to adapt these recommendations based on a risk assessment to respond to the needs of their respective jurisdictionsThe Public Health Agency of Canada recommends that individuals continue to follow the advice of their local public health authority regarding isolation and quarantine requirements, including the recommended length of time and public health measures to use in the days after.
• The Agency is engaged in regular discussions with provincial and territorial counterparts and is actively monitoring and evaluating the international and domestic evidence on isolation and quarantine requirements.
• Provinces and territories will continue to assess their risk and respond to the needs of their respective jurisdictions.
• Going forward, we will continue to closely monitor and respond to important signals (e.g., increased COVID-19 transmission, hospitalizations, deaths, and burden on the health care system), and be prepared for additional waves and new variants.
• Our goal of minimizing serious illness and overall deaths, while minimizing societal disruption, remains unchanged.

If pressed on the Centers for Disease Control and Prevention’s (CDC) updated guidance on length of quarantine
• On August 11, 2022, the CDC updated its COVID-19 guidance to reflect the current COVID-19 context in the United States.
• The CDC states that in light of high levels of immunity, and to limit social and economic impacts, quarantine of exposed persons is no longer recommended, regardless of vaccination status.
• The CDC guidance recommends that individuals exposed to COVID-19 wear a high-quality mask for 10 days and get tested on day 5.
• While this advice is not in alignment with the Public Health Agency of Canada’s current guidance on quarantine, the Agency’s guidance allows jurisdictions flexibility in their case and contact management activities, which should be informed by a risk assessment and local circumstances.

If pressed on the World Heath Organization’s (WHO) updated guidance on length of quarantine
• On July 6, 2022, the World Health Organization (WHO) updated its guidance for contact tracing and quarantine.
• WHO guidance does not recommend quarantine for individuals who have within the last 90 days: completed the primary series of vaccination; received a vaccine booster dose; or reported a previous COVID-19 infection.
• WHO guidance recommends a 10-day quarantine period for high-risk contacts of cases and those living in high-risk settings, if they have not completed a primary series or received a booster vaccine dose, or have not reported a previous infection in the last 90 days.
o Quarantine can be shortened to 5 days if the contact tests negative on day 5 and presents no symptoms.
• Additionally, under uncertain situations (such as the emergence of a new variant of concern), the WHO recommends that all contacts should quarantine for 14 days as a precautionary measure, although this period could be shortened with testing, if the characteristics of the new variant and detection methods are suitable.
• This advice is not in alignment with the Public Health Agency of Canada’s current guidance on quarantine, as the Agency continues to recommend a quarantine period of 14 days for high-risk contacts of cases from the date of last known exposure to the case. The Agency’s guidance does include flexibility for jurisdictions to adjust their case and contact management activities based on local epidemiology, public health context and risk assessment.

If pressed on why PHAC’s recommendation for length of quarantine is different from CDC/WHO
• The Public Health Agency of Canada’s quarantine period recommendation has primarily been based on the evidence regarding the COVID-19 incubation period (i.e. the period from exposure to symptom onset).
• 95% of symptomatic cases show symptoms by day 14 following exposure. Throughout the COVID-19 pandemic and across the different variants of concern, evidence regarding the COVID-19 incubation period has remained relatively consistent.
• Recommendations for contact management, including the quarantine period, are evidenced-informed public health policy decisions.
• The Public Health Agency of Canada’s guidance allows jurisdictions flexibility in their case and contact management activities to adjust their approach based on local circumstances and risk assessment.\

If pressed on whether the evidence differs
• The scientific evidence available to the CDC, WHO and the Public Health Agency of Canada is consistent. However, evidence sources also include the local epidemiological and public health context in addition to other indicators, such as health system capacity and other risk mitigation measures in place.

If pressed on whether there is active consideration to review/update the length of quarantine
• The Public Health Agency of Canada is continually reviewing the evidence and the epidemiological context, consulting with experts, including provincial and territorial public health authorities, and conducting risk assessments to determine the need to update guidance on public health measures, including the recommended guidance for contacts.

The Public Health Agency of Canada (PHAC) actively monitors scientific evidence to ensure its guidance is up to date. In light of the impact of Omicron and changes made by jurisdictions, PHAC continues to review emerging evidence and to consult with international counterparts regarding the characteristics of the Omicron variant (e.g. transmission dynamics, vaccine effectiveness, incubation period, disease severity).
PHAC’s current case and contact management guidance allows flexibility for jurisdiction-specific activities and responses based on local circumstances and capacities.
Provinces and territories continue to adapt these recommendations based on risk assessments and their specific context, which may include the following considerations:
• The epidemiology of COVID-19 in their jurisdiction
• Vaccination coverage in the community
• Implications of and uncertainties around new variants of concern
• Sufficient health care and public health capacity
• Risk reduction measures for high-risk populations and settings, as necessary.
On August 11, 2022, the Centers for Disease Prevention and Control (CDC) streamlined its COVID-19 guidance to help people better understand their risk, how to protect themselves and others, what actions to take if exposed to COVID-19, and what actions to take if they are sick or test positive for the virus. Updates were made in the context of available tools for reducing COVID-19 severity, and the significantly lower risk of severe illness, hospitalization and death compared to earlier in the pandemic. The CDC guidance recommends that instead of quarantining if exposed to COVID-19, individuals wear a high-quality mask for 10 days and get tested on day 5.
On July 6, 2022, the World Health Organization (WHO) updated its guidance for contact tracing and quarantine of contacts in the context of growing global population immunity from COVID-19 vaccination and past SARS-CoV-2 infection. The WHO recommends that identification, contact, quarantine and follow-up should be prioritized for individuals at high risk who have been in contact with a confirmed or probable case of SARS-CoV-2 infection, rather than targeting all contacts.
The WHO recommends a 10 day quarantine period for contacts at high risk and those living in high-risk settings, who have not completed a primary series or received a booster vaccine dose, or who have not reported a previous infection in the last 90 days. Quarantine can be shortened to 5 days if the contact tests negative on day 5 and presents with no symptoms.
Under uncertain situations (such as the emergence of a new variant of concern), the WHO recommends that all contacts should quarantine for 14 days as a precautionary measure, although this period could be shortened with testing, if the characteristics of the new variant and detection methods are suitable.

• PHAC’s guidance for public health authorities on the management of COVID-19 cases and contacts in the community was last updated on December 24, 2021.
• The update reflects emerging evidence regarding vaccine effectiveness, provides clarification on considerations for risk of exposure, and expands on enhanced case and contact management strategies in the context of newly circulating variants of concern.
• The guidance uses an evidence-based approach to recommend isolation and quarantine periods aimed at mitigating the health impacts of COVID-19 on individuals in Canada.
• Specifically, the guidance recommends an isolation period of at least 10 days for COVID-19 cases from the date of symptom onset or a positive test, and a quarantine period of 14 days for high-risk contacts of cases from the date of last known exposure to the case.
• PHAC continues to maintain this guidance, however, PHAC’s current case and contact management guidance allow flexibility for jurisdiction-specific activities based on local context and needs, the current epidemiological situation, indicators of readiness, evidence, and other factors.
• Canada continues to be guided by the latest available scientific evidence, epidemiology, and expert opinion. Guidance is subject to change as new information becomes available.