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

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.