10? 14? Explaining quarantine lengths

There’s been a LOT of confusion over how long mandatory quarantine (aka self-isolation or בידוד, “Bidud“) lasts in Israel. I probably get a few messages a week asking me about it, and it’s a popular topic on Secret Jerusalem too.

Basically, there are two categories of quarantine in Israel, as there are in many other countries:

Infection quarantine

People who have tested positive for Covid-19 are in infection quarantine. These people have or recently had Covid-19. They must self-isolate for:

  • (Ten days from the onset of their symptoms,
  • OR ten days from their first positive test if they have no symptoms)
  • AND three days from the end of their symptoms if they had symptoms

So, for example,

  • someone with a positive test and no symptoms has to self-isolate for ten days from the test date.
  • someone with a positive test, a cough and a fever that goes away after five days has to self-isolate for ten days.
  • someone with a positive test, a cough and a fever that lingers two weeks has to stay in quarantine for 17 days.

It isn’t necessary to have a negative virus test to get out of quarantine, and Israel doesn’t even administer tests to people who are already known cases.

Exposure quarantine

Anyone who has not tested positive for Covid-19 but is still in quarantine is in exposure quarantine. These people were in suspected contact with someone else who had Covid-19.

The precise rules for who has to go into exposure quarantine are complicated. It includes people who were in close contact with a confirmed case, but the definition of ‘close contact’ is unclear; the Ministry of Health says it means being within two metres of an infected person for 15 minutes. In practice, though, people who were in the same shop or room as a case are sometimes sent to quarantine, too.

Exposure quarantine rules in schools are also applied differently. And then there are people who are sent into self-isolation by the General Security Service’s phone tracing. Basically, it’s all a great big mess.

Travellers who arrive from abroad are considered to have been exposed in transit unless they came from a ‘green country’. So travel quarantine is just a special case of exposure quarantine.

People in exposure quarantine must self-isolate for 14 days from the exposure. If the person tests positive for the virus, then they move over into infection quarantine rules (above). If not, out in 14 days.

Why is infection quarantine shorter than exposure? That seems backwards but it actually makes sense and is the international standard. It’s because exposure quarantine includes four days of hypothetical incubation period to develop the virus, plus the ten days of hypothetical asymptomatic infection.

On the other hand, once someone actually tests positive for the virus, they’re probably not infectious for very long. In fact, for mild or asymptomatic cases, it seems like people are at their most infectious in the first few days. Ten is already on the safe side.

In reality, though, many Israelis will spend less time in exposure quarantine anyway, because often the exposure was a week ago or even more. I know lots of people who were in exposure quarantine for just two or three days by the time they found out about it.

Did I say two categories? Well, there’s sort of a third one too:

Symptom Quarantine…?

You wake up in the morning with a cough and a temperature. You call your doctor who tells you to get a coronavirus test and writes you a referral. The next testing slot is tomorrow afternoon.

In this case, where there is no known contact with a confirmed case, the law says are supposed to be in quarantine from the time you get the doctor’s referral for a coronavirus test until the test results are returned. This is likely to be a day or two assuming the test is negative. Despite this, the major HMOs are telling people with symptoms to remain self-isolated in this case even with a negative test, until 48 hours from the end of your symptom

But… the form for notifying the Ministry of Health about entering quarantine doesn’t include having symptoms alone as an option; that form is only for people who’ve been near a confirmed case. And it seems like the legal requirement for quarantine doesn’t kick in until the sick person gets referred by their doctor for a test. So a person with symptoms is under no legal obligations at all to see a doctor; they can go around infecting people. I hope I’ve misunderstood this, and will correct it if I have. I suspect that a lot of Israel’s infection chains are caused by people with symptoms like this.

There are a couple of other cases where I’m not sure what happens.

Imagine a traveller arrives in Israel on Monday morning, develops a fever on Monday afternoon and gets a coronavirus test which tests positive. Then say the fever goes away within a couple of days. Does the traveller get to leave quarantine after ten days like a ‘normal’ infected person? Or do they have to stay for the full two weeks as a ‘traveller’? I assume the former, but I don’t know for sure.

One thing I’m asked a lot is if I’ve heard that travel quarantine will be shortened. I see no real prospect of the 14-day exposure quarantine being shortened any time soon. It’s a global standard based on incubation times, and there’s no indication that the government plans on shortening it. That said, as more countries join the Green List with no quarantine requirements, perhaps it doesn’t matter very much.