Why is the CDC not Recommending Quarantine for Vaccinated People who have Been Exposed to the Coronavirus?

The first set of updated public health recommendations for fully vaccinated people was published by the Centers for Disease Control on March 8, 2021 and has been met with a sigh of relief by those vaccinated. While limited, the list of meaningful returns to ‘normalcy’ for those who are two weeks out from their last COVID-19 vaccine dose is a breath of fresh air.

To read more about the list of activities fully vaccinated people can now resume, see the CDC Interim Public Health Recommendations for Fully Vaccinated People here.

In terms of the updated recommendations for quarantine for fully vaccinated people following a COVID-19 exposure:

• • Exposure, No Symptoms, No Congregate Setting
    • Fully vaccinated people with no COVID-like symptoms who do not live in a congregate setting do not need to quarantine or be tested following an exposure to someone with suspected or confirmed COVID-19, as their risk of infection is low.
    • Fully vaccinated people who do not quarantine should still monitor for symptoms of COVID-19 for 14 days following an exposure. If they experience symptoms, they should isolate themselves from others, be clinically evaluated for COVID-19, including SARS-CoV-2 testing, if indicated, and inform their health care provider of their vaccination status at the time of presentation to care.

• Exposure, No Symptoms, Congregate Setting

• • Fully vaccinated residents of non-healthcare congregate settings (e.g., correctional and detention facilities, group homes) should continue to quarantine for 14 days and be tested for SARS-CoV-2 following an exposure to someone with suspected or confirmed COVID-19. This is because residential congregate settings may face high turnover of residents, a higher risk of transmission, and challenges in maintaining recommended physical distancing.
  • Fully vaccinated employees of non-healthcare congregate settings and other high-density workplaces (e.g., meat and poultry processing and manufacturing plants) with no COVID-like symptoms do not need to quarantine following an exposure; however testing following an exposure and through routine workplace screening programs (if present) is still recommended.
• Exposure, Symptoms
  • Although the risk that fully vaccinated people could become infected with COVID-19 is low, any fully vaccinated person who experiences symptoms consistent with COVID-19 should quarantine according to CDC guidelines, be clinically evaluated for COVID-19, and tested for SARS-CoV-2 if indicated. 

The CDC summarizes the rationale behind these updates with the following statement:

Currently authorized vaccines in the United States are highly effective at protecting vaccinated people against symptomatic and severe COVID-19. Additionally, a growing body of evidence suggests that fully vaccinated people are less likely to have asymptomatic infection and potentially less likely to transmit SARS-CoV-2 to others. How long vaccine protection lasts and how much vaccines protect against emerging SARS-CoV-2 variants are still under investigation. Until more is known and vaccination coverage increases, some prevention measures will continue to be necessary for all people, regardless of vaccination status. However, the benefits of reducing social isolation and relaxing some measures such as quarantine requirements may outweigh the residual risk of fully vaccinated people becoming ill with COVID-19 or transmitting SARS-CoV-2 to others. Additionally, taking steps towards relaxing certain measures for vaccinated persons may help improve COVID-19 vaccine acceptance and uptake. Therefore, there are several activities that fully vaccinated people can resume now, at low risk to themselves, while being mindful of the potential risk of transmitting the virus to others.

“We know that people want to get vaccinated so they can get back to doing the things they enjoy with the people they love,” said CDC director Dr. Rochelle Walensky, according to an article by the Mercury News.

While emerging evidence suggests that risk of virus transmission after vaccination is low, until completion of further studies, the list of precautions above that vaccinated people should continue to adhere to is critical to protect those who are still awaiting vaccines. Over time, as the majority of Americans are vaccinated, restrictions likely will further ease.

“Think of a vaccine as applying a veneer to protect the population from COVID-19,” said UCSF infectious disease expert Dr. Monica Gandhi during the podcast “In the Bubble,” hosted by UCSF’s Dr. Bob Wachter. “Remove restrictions slowly, as you apply veneer, to give time to seal the protection.”

Jennifer Abrams, MD, March 8, 2021