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Social Distancing, Quarantine, and Isolation
Taking Care of Your Behavioral Health
Isolation and quarantine help protect the public by preventing exposure to people who have or may have a contagious disease. Learn about social distancing, quarantine, and isolation in the event of an infectious disease outbreak.
Corona, World, Mask
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Social Distance
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Isolation and quarantine help protect the public by preventing exposure to people who have or may have a contagious disease.
Source: Centers for Disease Control and Prevention (CDC)
Quarantine
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The practice of quarantine, as we know it, began during the 14th century in an effort to protect coastal cities from plague epidemics. Ships arriving in Venice from infected ports were required to sit at anchor for 40 days before landing. This practice, called quarantine, was derived from the Italian words quaranta giorni which mean 40 days.
When the United States was first established, little was done to prevent the importation of infectious diseases. Protection against imported diseases fell under local and state jurisdiction. Individual municipalities enacted a variety of quarantine regulations for arriving vessels.
State and local governments made sporadic attempts to impose quarantine requirements. Continued outbreaks of yellow fever finally prompted Congress to pass federal quarantine legislation in 1878. This legislation, while not conflicting with states’ rights, paved the way for federal involvement in quarantine activities.
Outbreaks of cholera from passenger ships arriving from Europe prompted a reinterpretation of the law in 1892 to provide the federal government more authority in imposing quarantine requirements. The following year, Congress passed legislation that further clarified the federal role in quarantine activities. As local authorities came to realize the benefits of federal involvement, local quarantine stations were gradually turned over to the U.S. government. Additional federal facilities were built and the number of staff was increased to provide better coverage. The quarantine system was fully nationalized by 1921 when administration of the last quarantine station was transferred to the U.S. government.
The Public Health Service Act of 1944 clearly established the federal government’s quarantine authority for the first time. The act gave the U.S. Public Health Service (PHS) responsibility for preventing the introduction, transmission, and spread of communicable diseases from foreign countries into the United States.
This PHS cutter ship was used to transport quarantine inspectors to board ships flying the yellow quarantine flag. The flag was flown until quarantine and customs personnel inspected and cleared the ship to dock at the port.
Originally part of the Treasury Department, Quarantine and PHS, its parent organization, became part of the Federal Security Agency in 1939. In 1953, PHS and Quarantine joined the Department of Health, Education, and Welfare (HEW). Quarantine was then transferred to the agency now known as the Centers for Disease Control and Prevention (CDC) in 1967. CDC remained part of HEW until 1980 when the department was reorganized into the Department of Health and Human Services.
When CDC assumed responsibility for Quarantine, it was a large organization with 55 quarantine stations and more than 500 staff members. Quarantine stations were located at every port, international airport, and major border crossing.
After evaluating the quarantine program and its role in preventing disease transmission, CDC trimmed the program in the 1970s and changed its focus from routine inspection to program management and intervention. The new focus included an enhanced surveillance system to monitor the onset of epidemics abroad and a modernized inspection process to meet the changing needs of international traffic.
By 1995, all U.S. ports of entry were covered by only seven quarantine stations. A station was added in 1996 in Atlanta, Georgia, just before the city hosted the 1996 Summer Olympic Games. Following the severe acute respiratory syndrome (SARS) epidemic of 2003, CDC reorganized the quarantine station system, expanding to 18 stations with more than 90 field employees.
The Division of Global Migration and Quarantine is part of CDC’s National Center for Emerging and Zoonotic Infectious Diseases and is headquartered in Atlanta. Quarantine stations are located in Anchorage, Atlanta, Boston, Chicago, Dallas, Detroit, El Paso, Honolulu, Houston, Los Angeles, Miami, Minneapolis, New York, Newark, Philadelphia, San Diego, San Francisco, San Juan, Seattle, and Washington, D.C. (see contact lists and map).
Under its delegated authority, the Division of Global Migration and Quarantine is empowered to detain, medically examine, or conditionally release individuals and wildlife suspected of carrying a communicable disease.
The list of quarantinable diseases is contained in an Executive Order of the President and includes cholera, diphtheria, infectious tuberculosis, plague, smallpox, yellow fever, viral hemorrhagic fevers (such as Marburg, Ebola, and Congo-Crimean), and severe acute respiratory syndromes.
Many other illnesses of public health signficance, such as measles, mumps, rubella, and chicken pox, are not contained in the list of quarantinable illnesses, but continue to pose a health risk to the public. Quarantine Station personnel respond to reports of ill travelers aboard airplanes, ships, and at land border crossings to make an assessment of the public health risk and initiate an appropriate response.
Source: Centers for Disease Control and Prevention (CDC)
Isolate at home
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Isolation and quarantine are public health practices used to stop or limit the spread of disease.
Isolation is used to separate ill persons who have a communicable disease from those who are healthy. Isolation restricts the movement of ill persons to help stop the spread of certain diseases. For example, hospitals use isolation for patients with infectious tuberculosis.
Quarantine is used to separate and restrict the movement of well persons who may have been exposed to a communicable disease to see if they become ill. These people may have been exposed to a disease and do not know it, or they may have the disease but do not show symptoms. Quarantine can also help limit the spread of communicable disease.
For Coronavirus (COVID-19) information, follow CDC guidance:
Quarantine when you might have been exposed to the virus.
Isolate when you have been infected with the virus, even if you don’t have symptoms.
Source: U.S. Department of Health and Human Services
Quarantine
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If a quarantinable disease is suspected or identified, the CDC may issue a Federal isolation or quarantine order. Public health authorities at the federal, state, local, and tribal levels may sometimes seek help from police or other law enforcement officers to enforce a public health order.
U.S. Customs and Border Protection and U.S. Coast Guard officers are authorized to help enforce federal quarantine orders. Breaking a federal quarantine order is punishable by fines and imprisonment. Federal law allows the conditional release of persons from quarantine if they comply with medical monitoring and surveillance.
Source: U.S. Department of Health and Human Services
Baliuag enhanced community quarantine
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The Federal government derives its authority for isolation and quarantine from the Commerce Clause of the U.S. Constitution. Under section 361 of the Public Health Service Act (42 U.S. Code § 264), the U.S. Secretary of Health and Human Services is authorized to take measures to prevent the entry and spread of communicable diseases from foreign countries into the United States and between states.
The authority for carrying out these functions on a daily basis has been delegated to the Centers for Disease Control and Prevention (CDC).
Under 42 Code of Federal Regulations parts 70 and 71, CDC is authorized to detain, medically examine, and release persons arriving into the and traveling between states who are suspected of carrying these communicable diseases. As part of its federal authority, CDC routinely monitors persons arriving at land border crossings and passengers and crew arriving at U.S. ports of entry for signs or symptoms of communicable diseases.
When alerted about an ill passenger or crew member by the pilot of a plane or captain of a ship, CDC may detain passengers and crew as necessary to investigate whether the cause of the illness on board is a communicable disease.
Source: U.S. Department of Health and Human Services
Bacterial Diseases in Humans
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By Executive Order of the President, federal isolation and quarantine are authorized for these communicable diseases:
Source: U.S. Department of Health and Human Services
Respiratory System and Covid-19 Virus
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If you were exposed
You quarantine and stay away from others when you have been in close contact with someone who has COVID-19.
If you are sick or test positive
You isolate when you are sick or when you have been infected with the virus, even if you don’t have symptoms.
Calculating Quarantine
The date of your exposure is considered day 0. Day 1 is the first full day after your last contact with a person who has had COVID-19. Stay home and away from other people for at least 5 days.
IF YOU
Were exposed to COVID-19 and are NOT up-to-date on COVID-19 vaccinations
Quarantine for at least 5 days
Stay home
Stay home and quarantine for at least 5 full days.
Wear a well-fitted mask if you must be around others in your home.
Get tested
Even if you don’t develop symptoms, get tested at least 5 days after you last had close contact with someone with COVID-19.
After quarantine
Watch for symptoms
Watch for symptoms until 10 days after you last had close contact with someone with COVID-19.
If you develop symptoms
Isolate immediately and get tested. Continue to stay home until you know the results. Wear a well-fitted mask around others.
Take precautions until day 10
Wear a mask
Wear a well-fitted mask for 10 full days any time you are around others inside your home or in public. Do not go to places where you are unable to wear a mask.
Avoid travel
Avoid being around people who are at high risk
IF YOU
Were exposed to COVID-19 and are up-to-date with vaccination OR had confirmed COVID-19 within the past 90 days (you tested positive using a viral test)
No quarantine
You do not need to stay home unless you develop symptoms.
Get tested
Even if you don’t develop symptoms, get tested at least 5 days after you last had close contact with someone with COVID-19
Watch for symptoms
Watch for symptoms until 10 days after you last had close contact with someone with COVID-19.
If you develop symptoms
Isolate immediately and get tested. Continue to stay home until you know the results. Wear a well-fitted mask around others.
Take precautions until day 10
Wear a mask
Wear a well-fitted mask for 10 full days any time you are around others inside your home or in public. Do not go to places where you are unable to wear a mask.
Avoid travel
Avoid being around people who are at high risk
Calculating Isolation
Day 0 is your first day of symptoms or a positive viral test. Day 1 is the first full day after your symptoms developed or your test specimen was collected. If you have COVID-19 or have symptoms, isolate for at least 5 days.
IF YOU
Tested positive for COVID-19 or have symptoms, regardless of vaccination status
Stay home for at least 5 days
Stay home for 5 days and isolate from others in your home.
Wear a well-fitted mask if you must be around others in your home.
Ending isolation if you had symptoms
End isolation after 5 full days if you are fever-free for 24 hours (without the use of fever-reducing medication) and your symptoms are improving.
Ending isolation if you did NOT have symptoms
End isolation after at least 5 full days after your positive test.
If you were severely ill with COVID-19
You should isolate for at least 10 days. Consult your doctor before ending isolation.
Take precautions until day 10
Wear a mask
Wear a well-fitted mask for 10 full days any time you are around others inside your home or in public. Do not go to places where you are unable to wear a mask.
Avoid travel
Avoid being around people who are at high risk
DEFINITIONS
Contact with someone infected with SARS-CoV-2, the virus that causes COVID-19, in a way that increases the likelihood of getting infected with the virus.
Close contacts are someone who was less than 6 feet away from an infected person (laboratory-confirmed or a clinical diagnosis) for a cumulative total of 15 minutes or more over a 24-hour period. For example, three individual 5-minute exposures for a total of 15 minutes.
Quarantine is a strategy used to prevent transmission of COVID-19 by keeping people who have been in close contact with someone with COVID-19 apart from others.
If you came into close contact with someone with COVID-19 and you are in one of the following groups, you do not need to quarantine.
You should wear a well-fitting mask around others for 10 days from the date of your last close contact with someone with COVID-19 (the date of last close contact is considered day 0). Get tested at least 5 days after you last had close contact with someone with COVID-19. If you test positive or develop COVID-19 symptoms, isolate from other people and follow recommendations in the Isolation section below. If you tested positive for COVID-19 with a viral test within the previous 90 days and subsequently recovered and remain without COVID-19 symptoms, you do not need to quarantine or get tested after close contact. You should wear a well-fitting mask around others for 10 days from the date of your last close contact with someone with COVID-19 (the date of last close contact is considered day 0).
If you come into close contact with someone with COVID-19, you should quarantine if you are in one of the following groups:
In certain congregate settings that have high risk of secondary transmission (such as correctional and detention facilities, homeless shelters, or cruise ships), CDC recommends a 10-day quarantine for residents, regardless of vaccination and booster status. During periods of critical staffing shortages, facilities may consider shortening the quarantine period for staff to ensure continuity of operations. Decisions to shorten quarantine in these settings should be made in consultation with state, local, tribal, or territorial health departments and should take into consideration the context and characteristics of the facility. CDC’s setting-specific guidance provides additional recommendations for these settings.
Isolation is used to separate people with confirmed or suspected COVID-19 from those without COVID-19. People who are in isolation should stay home until it’s safe for them to be around others. At home, anyone sick or infected should separate from others, or wear a well-fitting mask when they need to be around others. People in isolation should stay in a specific “sick room” or area and use a separate bathroom if available. Everyone who has presumed or confirmed COVID-19 should stay home and isolate from other people for at least 5 full days (day 0 is the first day of symptoms or the date of the day of the positive viral test for asymptomatic persons). They should wear a mask when around others at home and in public for an additional 5 days. People who are confirmed to have COVID-19 or are showing symptoms of COVID-19 need to isolate regardless of their vaccination status. This includes:
If you had COVID-19 and had symptoms, isolate for at least 5 days. To calculate your 5-day isolation period, day 0 is your first day of symptoms. Day 1 is the first full day after your symptoms developed. You can leave isolation after 5 full days.
If an individual has access to a test and wants to test, the best approach is to use an antigen test1 towards the end of the 5-day isolation period. Collect the test sample only if you are fever-free for 24 hours without the use of fever-reducing medication and your other symptoms have improved (loss of taste and smell may persist for weeks or months after recovery and need not delay the end of isolation). If your test result is positive, you should continue to isolate until day 10. If your test result is negative, you can end isolation, but continue to wear a well-fitting mask around others at home and in public until day 10. Follow additional recommendations for masking and restricting travel as described above.
1As noted in the labeling for authorized over-the counter antigen tests: Negative results should be treated as presumptive. Negative results do not rule out SARS-CoV-2 infection and should not be used as the sole basis for treatment or patient management decisions, including infection control decisions. To improve results, antigen tests should be used twice over a three-day period with at least 24 hours and no more than 48 hours between tests.
Note that these recommendations on ending isolation do not apply to people with severe COVID-19 or with weakened immune systems (immunocompromised). See section below for recommendations for when to end isolation for these groups.
If you test positive for COVID-19 and never develop symptoms, isolate for at least 5 days. Day 0 is the day of your positive viral test (based on the date you were tested) and day 1 is the first full day after the specimen was collected for your positive test. You can leave isolation after 5 full days.
If an individual has access to a test and wants to test, the best approach is to use an antigen test1 towards the end of the 5-day isolation period. If your test result is positive, you should continue to isolate until day 10. If your test result is negative, you can end isolation, but continue to wear a well-fitting mask around others at home and in public until day 10. Follow additional recommendations for masking and restricting travel described above.
1As noted in the labeling for authorized over-the counter antigen tests: Negative results should be treated as presumptive. Negative results do not rule out SARS-CoV-2 infection and should not be used as the sole basis for treatment or patient management decisions, including infection control decisions. To improve results, antigen tests should be used twice over a three-day period with at least 24 hours and no more than 48 hours between tests.
People who are severely ill with COVID-19 (including those who were hospitalized or required intensive care or ventilation support) and people with compromised immune systems might need to isolate at home longer. They may also require testing with a viral test to determine when they can be around others. CDC recommends an isolation period of at least 10 and up to 20 days for people who were severely ill with COVID-19 and for people with weakened immune systems. Consult with your healthcare provider about when you can resume being around other people.
People who are immunocompromised should talk to their healthcare provider about the potential for reduced immune responses to COVID-19 vaccines and the need to continue to follow current prevention measures (including wearing a well-fitting mask, staying 6 feet apart from others they don’t live with, and avoiding crowds and poorly ventilated indoor spaces) to protect themselves against COVID-19 until advised otherwise by their healthcare provider. Close contacts of immunocompromised people – including household members – should also be encouraged to receive all recommended COVID-19 vaccine doses to help protect these people.
In certain high-risk congregate settings that have high risk of secondary transmission and where it is not feasible to cohort people (such as correctional and detention facilities, homeless shelters, and cruise ships), CDC recommends a 10-day isolation period for residents. During periods of critical staffing shortages, facilities may consider shortening the isolation period for staff to ensure continuity of operations. Decisions to shorten isolation in these settings should be made in consultation with state, local, tribal, or territorial health departments and should take into consideration the context and characteristics of the facility. CDC’s setting-specific guidance provides additional recommendations for these settings.
This CDC guidance is meant to supplement—not replace—any federal, state, local, territorial, or tribal health and safety laws, rules, and regulations with which homeless shelters must comply.
Source: Centers for Disease Control and Prevention (CDC)
social distancing
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Source: Centers for Disease Control and Prevention (CDC)
San Francisco Under Quarantine
Image by Christopher Michel from San Francisco, USA/Wikimedia
In the event of an infectious disease outbreak, local officials may require the public to take measures to limit and control the spread of the disease. The government has the right to enforce federal and state laws related to public health if people within the country get sick with highly contagious diseases that have the potential to develop into outbreaks or pandemics.
Source: Substance Abuse and Mental Health Services Administration (SAMHSA)
Male Figure in Yoga Pose with Chest and Abdominal Anatomy
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When you hear, read, or watch news about an outbreak of an infectious disease such as Ebola, you may feel anxious and show signs of stress—even when the outbreak affects people far from where you live and you are at low or no risk of getting sick. These signs of stress are normal, and may be more likely or pronounced in people with loved ones in parts of the world affected by the outbreak. In the wake of an infectious disease outbreak, monitor your own physical and mental health. Know the signs of stress in yourself and your loved ones. Know how to relieve stress, and know when to get help.
What follows are behavioral, physical, emotional, and cognitive responses that are all common signs of anxiety and stress. You may notice some of them after you learn about an infectious disease outbreak.
YOUR BEHAVIOR:
YOUR BODY:
YOUR EMOTIONS:
YOUR THINKING:
You can manage and alleviate your stress by taking time to take care of yourself.
KEEP THINGS IN PERSPECTIVE:
Set limits on how much time you spend reading or watching news about the outbreak. You will want to stay up to date on news of the outbreak, particularly if you have loved ones in places where many people have gotten sick. But make sure to take time away from the news to focus on things in your life that are going well and that you can control.
GET THE FACTS:
Find people and resources you can depend on for accurate health information. Learn from them about the outbreak and how you can protect yourself against illness, if you are at risk. You may turn to your family doctor, a state or local health department, U.S. government agencies, or an international organization. Check out the sidebar on the next page for links to good sources of information about infectious disease outbreaks.
KEEP YOURSELF HEALTHY:
USE PRACTICAL WAYS TO RELAX:
PAY ATTENTION TO YOUR BODY, FEELINGS, AND SPIRIT:
Source: Substance Abuse and Mental Health Services Administration (SAMHSA)
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