Association of COVID-19 Quarantine Duration and Postquarantine Transmission Risk in 4 University Cohorts

Abstract

Importance: Optimal quarantine length for COVID-19 infection is unclear, in part owing to limited empirical data.

Objective: To assess postquarantine transmission risk for various quarantine lengths and potential associations between quarantine strictness and transmission risk.

Design, setting, and participants: Retrospective cohort study in 4 US universities from September 2020 to February 2021, including 3641 university students and staff who were identified as close contacts to individuals who tested positive for SARS-CoV-2 infection. Individuals were tested throughout the 10 to 14-day quarantine, and follow-up testing continued at least weekly throughout the 2020-2021 academic year.

Exposures: Strict quarantine, including designated housing with a private room, private bathroom, and meal delivery, vs nonstrict, which potentially included interactions with household members.

Main outcomes and measures: Dates of last known exposure, last negative test result, and first positive test result during quarantine.

Results: This study included 301 quarantined university students and staff who tested SARS-CoV-2-positive (of 3641 quarantined total). These 301 individuals had a median (IQR) age of 22.0 (20.0-25.0) years; 131 (43.5%) identified as female; and 20 (6.6%) were staff. Of the 287 self-reporting race and ethnicity according to university-defined classifications, 21 (7.3%) were African American or Black, 60 (20.9%) Asian, 17 (5.9%) Hispanic or Latinx, 174 (60.6%) White, and 15 (5.2%) other (including multiracial and/or multiethnic). Of the 301 participants, 40 (13.3%; 95% CI, 9.9%-17.6%) had negative test results and were asymptomatic on day 7 compared with 15 (4.9%; 95% CI, 3.0%-8.1%) and 4 (1.4%; 95% CI, 0.4%-3.5%) on days 10 and 14, respectively. Individuals in strict quarantine tested positive less frequently than those in nonstrict quarantine (10% vs 12%; P = .04).

Conclusions and relevance: To maintain the 5% transmission risk used as the basis for US Centers for Disease Control and Prevention's 7-day test-based quarantine guidance, our data suggest that quarantine with quantitative polymerase chain reaction testing 1 day before intended release should be 10 days for nonstrict quarantine and 8 days for strict quarantine, as ongoing exposure during quarantine may be associated with the higher rate of positive test results following nonstrict quarantine.

Figure 1.. Conversion Time Intervals of 301 Quarantined University Students and Staff With Positive Test Results

Figure 2.. Determining Conversion Times of 301 University Students and Staff

Line shows the probability distribution of conversion times. Error bars represent 95% CIs. Conversion values after day 16 sum to 0.3%.

Figure 3.. Transmission Risk After Release From Test-Based Strict and Nonstrict Quarantines of Various Lengths

Individuals were released from quarantine if they received a negative test result and were asymptomatic; thus risk is the percentage of individuals with positive test results who first received positive test results after the given day and were asymptomatic until that day. Plots show transmission risk based on conversions for the positive test results of 301 university students and staff. Values are shown for days 7 (corresponding to the US Centers for Disease Control and Prevention [CDC] quarantine with testing alternative guideline), 10 (corresponding to the CDC quarantine without testing alternative guideline), and 14 (corresponding to the original CDC quarantine guideline). Strict quarantine included designated housing that consisted of a private room, private bathroom, and meal delivery. Nonstrict quarantine potentially included interactions with other household members. Error bars represent 95% CIs.