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Features & Columns

CDC Updates Definition of What 'Close Contact' Means

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CDC Updates Definition of What 'Close Contact' Means

2020-10-22 21:02:00

By Laura Tucker, Staff writer; Image: COVID-19 Test (Image source: Public domain)

One thing that makes it increasingly difficult to navigate through the warnings, directions, guidelines, etc., for the coronavirus is that it keeps changing. It was referred to initially as the novel coronavirus, as that's what it is: new. Because it's so new, doctors and experts are learning right along with everyone else how to stay safe.

The Centers for Disease Control and Prevention made another change this week to its guidelines. It has redefined "close contact" as new cases mount, reaching the second or third wave we've been hearing about for months.

Previously, "close contact" was defined as someone who spent at least 15 consecutive minutes within six feet of a confirmed coronavirus case. In the updated guidelines released Wednesday that are relied on for contact tracing, "close contact" is now defined as someone who was within six feet of on infected individual for a total of 15 minutes or more over a 24-hour period.

Jay Butler, the CDC's deputy director for infectious diseases, noted that along with this update, the United States is "unfortunately seeing a distressing trend, with cases increasing in nearly 75 percent of the country."

In the first news conference the administration has permitted in more than eight weeks, Butler said wearing a mask is more important than ever now as everyone moves indoors, where there is greater risk for transmission.

CDC scientists had been discussing this new guidance for several weeks, according to a CDC official. New evidence was received in a report that showed the CDC and Vermont health officials discovered that a 20-year-old prison employee contracted COVID-19 after having 22 interactions in an eight-hour shift. He was exposed for a total of 17 minutes with people who later tested positive for the virus.

"Available data suggests that at least one of the asymptomatic [infectious detainees] transmitted" COVID-19 during the brief encounters with the prison employee, explained the report.

"This article adds to the scientific knowledge of the risk to contacts of those with COVID-19 and highlights against the importance of wearing face masks to prevent transmission," explained the CDC.

Noting that as many as half the people who have COVID-19 never show symptoms, the CDC said, "It's critical to wear a mask because you could be carrying the virus and not know it."

"While a mask provides some limited protection to the wearer, each additional person who wears a mask increases the individual protection for everyone. When more people wear masks, more people are protected."

Epidemiologist Caitlin Rivers with the Johns Hopkins Center for Health Security sees the new guidance as an important change.

"It's easy to accumulate 15 minutes in small increments when you spend all day together — a few minutes at the water cooler, a few minutes in the elevator, and so on," she said. "I expect this will result in many more people being identified as close contacts."

"This change underscores the importance of vigilant social distancing — even multiple brief interactions can pose a risk."

However, Rivers also admitted that it's unclear whether those multiple brief encounters were the only explanation for the prison employee getting infected. It's also possible the virus was airborne, or there was surface transmission.

Rivers believes the new guidance "will be difficult for contact tracing programs to implement, and schools and businesses will have a difficult time operating under this guidance."

The Obama administration CDC director, Tom Frieden, sees the revised guidance as "a sensible change." Yet, he also said that "whether someone is a contact depends on the exposure, environment, and infectivity of the source patient."

The presidential campaigns of both Joe Biden and Donald Trump have relied on the CDC's previous definition of close contact to know when staffers and the candidates need to be quarantined. Last week both Biden and his running mate, Sen. Kamala Harris (D-CA), have been near charter airline workers who tested positive. Additionally, one of Harris's staff members tested positive. Under the old guidelines, these interactions did not qualify as "close contacts."

The prison worker had multiple brief encounters on July 28 with six prisoners while their test results were pending. All six tested positive the next day. A contact-tracing investigation was conducted, and it was determined the officer didn't meet the definition, so he continued to work.

A week later, he had COVID-19 symptoms. He lost his sense of smell and taste and had a runny nose, cough, shortness of breath, and loss of appetite. He was tested the following day and found out he was positive.

Video surveillance footage was reviewed by Vermont authorities, and they determined the employee was never present for 15 consecutive minutes within six feet of any of the people who tested positive. But he did have "numerous brief (approximately one-minute) encounters that cumulatively exceeded 15 minutes."

In his eight-hour shift, he was within six feet of an infected person more than 22 times, for a total time of exposure of about 17 minutes.

The employee wore a cloth mask, gown, and eye protection during all the interactions. The infected individuals wore masks during most of the interactions with him. However, they were not masked during some of the interactions in a cell doorway and a prison recreation room, according to the report. 

The prison employee did not have any other known close contact exposures to people with COVID-19 outside of work and didn't travel outside Vermont during the 14 days he became sick. Investigators said, "His most likely exposures occurred in the correctional facility" through those multiple brief encounters with the six infected individuals.

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