The St. Louis County Department of Public Health ("DPH") has been closely monitoring the global public health crisis caused by a viral illness called COVID-19. Infections with COVID-19 have been reported around the world. The first confirmed instance of person to-person spread of the virus in the United States was reported on January 30, 2020.
The first confirmed instance of COVID-19 in St. Louis County was reported on March 7, 2020. A state of emergency was declared in St. Louis County on March 13, 2020, resulting in several executive orders and DPH orders, policies, and rules to implement those executive orders.
Isolation of individuals diagnosed with certain communicable diseases and quarantine of close contact to those diagnosed with certain communicable disease are core public health practices employed to protect the public. State law provides that the "local health authority ...shall require isolation of a patient... with a communicable disease, quarantine of contacts, concurrent and terminal disinfection, or modified forms of these procedures necessary for the protection of the public health" 19 CSR 20-20.050(1).
COVID-19 is considered an infectious, contagious, communicable, and dangerous disease for purposes of §§ 192.020-1, 192.139, & 192.300 RSMo., 19 CSR 20-20.020, and other state and local laws. The DPH's director is the "local health authority" under 19 CSR 20-20.050(1) pursuant to 19 CSR 20-20.010(26), Section 4.130 of the Charter, and Section 600.010 SLCRO, and has been delegated the authority to act on St. Louis County's behalf for the public health purposes described in § 192.300 RSMo.
Violating a public health order designed to "prevent the entrance of infectious, contagious, communicable or dangerous diseases" into St. Louis County is punishable as a misdemeanor pursuant to § 192.300, RSMo. Further, "[a]ny person ... who shall leave any ... quarantined house or place without the consent of the health officer having jurisdiction, or who evades or breaks quarantine or knowingly conceals a case of contagious, infectious, or communicable disease, or who removes, destroys, obstructs from view, or tears down any quarantine card, cloth or notice by the attending physician or by the health officer, or by direction of the proper health officer, shall be deemed guilty of a class A misdemeanor" pursuant to § 192.320, RSMo.
In the event the trajectory of COVID-19 cases begins to rise again in St. Louis County and in order to best service the public with strategies and resource allocation that supports the most evidence-based approaches for the current COVID-19 caseloads, DPH may adopt emergency policies to alter previously defined strategies for isolation and quarantine of those with COVID-19 and their close contacts.
Even with early data demonstrating high efficacy of several COVID-19 vaccines in preventing laboratory confirmed COVID-19 infection and severity of disease, there is still limited information on how vaccination effects COVID-19 transmission and how long immunity from vaccination is conferred. As such, vaccinated persons should continue to protect themselves and others, including wearing face coverings, maintaining social distancing and avoiding gatherings with persons outside their own households.
In accordance with national guidance, persons vaccinated for COVID-19 as well as patients with recent COVID-19 infection who have had recent exposure to someone with suspected or confirmed COVID-19 may not be required to quarantine in certain circumstances. Such individuals may still need to quarantine in certain situations if specific criteria are not met with respect to timing of the receipt of the vaccine and the possible onset of symptoms. DPH will continue to adjust quarantine policies and guidance as scientific knowledge, guidelines and literature emerge on these topics.
This Order adopts the CDC Interim Guidance with respect to the recommended duration of isolation and quarantine times using a symptoms based strategy.
The intent of this order is to assure isolation and quarantine of identified persons who have COVID-19 or have been exposed to COVID-19. Isolation and quarantine are important components of a multi-layered strategy to prevent, limit, and contain the spread of COVID-19 in St. Louis County. St. Louis County and its employees, contractors, and agents shall treat every person who is isolated or quarantined with compassion, respect, and dignity. This order, and its amendments, incorporates updated isolation and quarantine protocols that reflect advancement of evidence-based information and guidelines regarding COVID-19, including quarantine protocols for vaccinated and recently infected persons. DPH reserves the right to make care decisions that deviate from these policies based on individual patient factors. DPH also reserves the right to implement emergency policies based on best use of resources to implement public health measures aimed at combating the spread of COVID-19.
1. To ensure early detection of COVID-19 Symptoms, every person in St. Louis County should engage in self-observation regularly and consistently.
2. If, at any time, a person develops COVID-19 Symptoms, including Vaccinated Persons or Fully Vaccinated Persons, the person shall self-isolate, limit contact with others, and seek advice from a healthcare provider and/or be tested for COVID-19.
a. Any person defined as a Close Contact to a Positive Person by DPH or its designee, whether or not they have had a negative COVID-19 test result during the quarantine period.
b. Every person who knows they have been exposed to COVID-19 and may be a Close Contact shall inform DPH immediately. Every such person shall be quarantined either voluntarily or pursuant to this Public Health Order and must engage in monitoring of their own condition as may be directed by DPH.
c. A Vaccinated Person who knows they have been exposed to COVID-19 and may be a Close Contact, unless the Vaccinated Person meets ALL of the following criteria:
d. Any person who has had a laboratory confirmed case of COVID-19 within the last 90 days and has since recovered, is considered naturally immune and is not required to quarantine if exposed to COVID-19 within that 90 day time period, as long is the individual has remained asymptomatic since exposure. Thereafter, the requirements for quarantine in the case of exposure must be followed.
a. Any Positive Person; and
b. Any Person with COVID-19 Symptoms who has been tested for COVID-19 and is awaiting test results, regardless of whether a Close Contact with a Positive Person is known.
2. Length of Isolation: Every Positive Person shall remain isolated until cleared by DPH in writing. The course of isolation is generally 10 days from the date of the onset of symptoms but is subject to individual factors and DPH clinician judgement, including continued symptoms, such as a fever, that has not resolved without fever-reducing medications. The length of isolation may be modified by DPH at any time, particularly when symptoms continue past 10 days.
3. Outside Activities during Isolation: An isolated person may walk outside of their dwelling on their own property or leasehold but shall not come within six feet of other people and must wear a Face Covering. These individuals must refrain from walking outside of their own property or leasehold.
D. Recommended Practices During Isolation and Quarantine: DPH strongly recommends, but does not require, that any isolated or quarantined person do the following within their place of accommodation:
1. Separate their living quarters and bathroom facilities from other people and secure it against unauthorized access;
2. Not come within six (6) feet of another person;
3. Have food and other necessities delivered to their living quarters; and
4. Wear a Face Covering if they must be in the presence of others.
E. Release from Quarantine or Isolation for Voting
1. Any person under quarantine or isolation shall be allowed a temporary release from quarantine or isolation for the sole purpose of voting.
2. Such voting shall be allowed at a designated St. Louis County election authority drive up-site designed for that purpose. Isolated or quarantined persons shall wear a Face Covering at any time that they are within six (6) feet of another person.
3. Any person exercising such right shall be considered to be in continued compliance with this Order.
F. Cooperation with DPH
1. Any person under quarantine or isolation shall cooperate fully with DPH, including responding in a timely manner to communications from DPH regarding the person's health status, the person's present or past locations, or any other information necessary for protection of the public health.
2. Every person shall comply with any individual monitoring plan prepared by DPH of which that person is aware.
3. Every person shall cooperate with DPH in the performance of visits at the site of isolation or quarantine, or by other methods as technologically available.
4. Every person shall cooperate with DPH with respect to contact tracing to determine possible Contacts to that person or others.
5. Every quarantined or isolated person shall cooperate with any DPH request to confirm that they are present in their quarantine or isolation location.
G. Emergency Exceptions: DPH reserves the right to make exceptions and amendments to this order based on the public health interest of St. Louis County, including, but not limited to the following:
1. DPH may adopt policies requiring individuals to self-isolate or self-quarantine, as well as to contract trace and notify potential Close Contacts.
2. DPH may adopt policies allowing physicians or other defined healthcare professionals to release individuals from isolation and/or quarantine.
3. DPH may adopt policies allowing individuals to use specified criteria to be released from quarantine without a written release from a healthcare or public health professional.
4. DPH may periodically announce the implementation of these or other emergency exceptions on stlcorona.com based on the number of COVID-19 cases in St. Louis County, available public health resources, and the intent to focus resources on interventions most likely to protect the public.
For purposes of this policy, these terms, regardless of whether capitalized, are defined as follows:
1. "CDC" means the Centers for Disease Control and Prevention of the United States Department of Health and Human Services;
2. "Close Contact" is an individual who was within 6 feet of a Positive Person for a cumulative total of 15 minutes or more over a 24 hour period starting from 2 days before illness onset, or for asymptomatic Positive Persons, 2 days prior to the date of testing;
3. "COVID-19" is a highly infectious respiratory illness caused by SARS-CoV-2, identified on February 11, 2020 by the World Health Organization and causing the 2019 novel coronavirus outbreak. The name of this disease is coronavirus disease 2019, abbreviated as COVID-19. In COVID-19, 'CO' stands for 'corona,' 'VI' for 'virus,' and 'D' for disease;
4. "COVID-19 Symptoms" means a temperature greater than 100.4 degrees Fahrenheit, cough, shortness of breath or trouble breathing, sore throat, loss of smell and/or taste, diarrhea or vomiting, or abdominal pain;
5. "Designee" means a person selected by a Person Under Investigation or a Positive Person to carry out the notification and reporting responsibilities required by DPH or DHSS;
6. "DHSS" means the Department of Health and Senior Services of the State of Missouri;
7. "DPH" means the St. Louis County Department of Public Health;
8. "Face Covering" means a device, usually made of cloth, that covers the nose and mouth. Consistent with current CDC guidelines, face coverings prevent those who may have COVID-19 from spreading it to others;
9. “Fully Vaccinated Person” means a person who 14 days prior received a second dose of a 2 dose series or 14 days prior received one dose of a single dose vaccine. A person is not fully vaccinated until this time period of 14 days from the last date of the required dose has lapsed. Additionally, after 3 months from the last dose, a person is no longer considered to be a Fully Vaccinated Person.
10. "Isolation" and "isolated" mean the separation of a Positive Person or of a Person Under Investigation from any other person;
11. "Positive Person" means a person who has tested positive for COVID-19 or has been determined to have suspected COVID-19 by a physician or DPH, regardless of whether the person displays COVID-19 Symptoms;
12. "Public Health Order" means instruction issued by a DPH director that is denominated orally and in writing as an "Order";
13. "Quarantine" means the restriction of movement and separation of a person or group of people reasonably believed to have been exposed to COVID-19 but who is/are not symptomatic from people who have not been exposed to COVID- 19;
14. "Self-observation" means a person remaining alert for COVID-19 Symptoms;
15. "Self-isolate" means a person who has self-observed COVID-19 Symptoms separating themselves from others who are asymptomatic while seeking advice from a healthcare provider or DPH.
16. “Vaccinated Person” means a person who has received a vaccine or vaccines for COVID-19 but is not considered to be a Fully Vaccinated Person.
V. Effective Date
This Amended Order replaces the prior Order dated February 16, 2021. This Amended Order shall be effective at 6:00 a.m. on March 15, 2021 and will continue to be in effect until it is extended, rescinded, superseded, or amended in writing.
This Order by the St. Louis County Department of Public Health establishing restrictions for Quarantine and Isolation for COVID-19 is authorized pursuant to sections 192.006,
192.200 and 192.300 of the Revised Statutes of Missouri, 19 CSR 20-20.050 of the Rules of the Department of Health and Senior Services and by the Executive Order declaring a State of Emergency by County Executive Sam Page effective March 13, 2020 at 5:00 p.m., as maybe further amended. The purpose of this order is to enhance the public health and prevent the entrance of infections, contagious, communicable or dangerous diseases into St. Louis County.
So ordered this 15th day of March 2021.
Dr. Faisal Khan
St. Louis County Department of Public Health