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COVID-19

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In general, reinfection means a person was infected (got sick) once, recovered, and then later became infected again. Based on what we know from similar viruses, some reinfections are expected. We are still learning more about the virus that causes COVID-19. Ongoing COVID-19 studies will help us understand:
How likely is reinfection
How often reinfection occurs
How soon after the first infection can reinfection take place
How severe are cases of reinfection
Who might be at higher risk for reinfection
What reinfection means for a person’s immunity
If a person is able to spread COVID-19 to other people when reinfected
What CDC is doing
CDC is actively working to learn more about reinfection to inform public health action. CDC developed recommendations for public health professionals to help decide when and how to test someone for suspected reinfection. CDC has also provided information for state and local health departments to help investigate suspected cases of reinfection. We will update this guidance as we learn more about reinfection.
Prevention
At this time, whether you have had COVID-19 or not, the best way to prevent infection is to take steps to protect yourself:
Wear a mask in public places
Stay at least 6 feet away from other people
Wash your hands
Avoid crowds and confined spaces

People who have been in close contact with someone who has COVID-19—excluding people who have had COVID-19 within the past 3 months.
People who have tested positive for COVID-19 do not need to quarantine or get tested again for up to 3 months as long as they do not develop symptoms again. People who develop symptoms again within 3 months of their first bout of COVID-19 may need to be tested again if there is no other cause identified for their symptoms.
What counts as close contact?
You were within 6 feet of someone who has COVID-19 for a total of 15 minutes or more
You provided care at home to someone who is sick with COVID-19
You had direct physical contact with the person (hugged or kissed them)
You shared eating or drinking utensils
They sneezed, coughed, or somehow got respiratory droplets on you

Stay home and monitor your health
Stay home for 14 days after your last contact with a person who has COVID-19
Watch for fever (100.4◦F), cough, shortness of breath, or other symptoms of COVID-19
If possible, stay away from others, especially people who are at higher risk for getting very sick from COVID-19

Confirmed and suspected cases of reinfection of the virus that causes COVID-19
Cases of reinfection of COVID-19 have been reported but are rare. In general, reinfection means a person was infected (got sick) once, recovered, and then later became infected again. Based on what we know from similar viruses, some reinfections are expected.
When to start and end quarantine
You should stay home for 14 days after your last contact with a person who has COVID-19.

For all of the following scenarios, even if you test negative for COVID-19 or feel healthy, you should stay home (quarantine) since symptoms may appear 2 to 14 days after exposure to the virus.

See scenarios below to determine when you can end quarantine and be around others.
Scenario 1: Close contact with someone who has COVID-19—will not have further close contact
I had close contact with someone who has COVID-19 and will not have further contact or interactions with the person while they are sick (e.g., co-worker, neighbor, or friend).
Your last day of quarantine is 14 days from the date you had close contact.

Date of last close contact with person who has COVID-19 + 14 days= end of quarantine

Please note if your quarantine starts at noon on day 1, then it would end at noon on the last day.

Scenario 2: Close contact with someone who has COVID-19—live with the person but can avoid further close contact
I live with someone who has COVID-19 (e.g., roommate, partner, family member), and that person has isolated by staying in a separate bedroom. I have had no close contact with the person since they isolated.
Your last day of quarantine is 14 days from when the person with COVID-19 began home isolation

Date person with COVID-19 began home isolation + 14 days = end of quarantine

Please note if your quarantine starts at noon on day 1, then it would end at noon on the last day.

Scenario 3. Under quarantine and had additional close contact with someone who has COVID-19
I live with someone who has COVID-19 and started my 14-day quarantine period because we had close contact. What if I ended up having close contact with the person who is sick during my quarantine? What if another household member gets sick with COVID-19? Do I need to restart my quarantine?
Yes. You will have to restart your quarantine from the last day you had close contact with anyone in your house who has COVID-19. Any time a new household member gets sick with COVID-19 and you had close contact, you will need to restart your quarantine.

Date of additional close contact with person who has COVID-19 + 14 days = end of quarantine

Please note if your quarantine starts at noon on day 1, then it would end at noon on the last day.

Scenario 4: Live with someone who has COVID-19 and cannot avoid continued close contact
I live in a household where I cannot avoid close contact with the person who has COVID-19. I am providing direct care to the person who is sick, don’t have a separate bedroom to isolate the person who is sick, or live in close quarters where I am unable to keep a physical distance of 6 feet.
You should avoid contact with others outside the home while the person is sick, and quarantine for 14 days after the person who has COVID-19 meets the criteria to end home isolation.

Date the person with COVID-19 ends home isolation + 14 days = end of quarantine

Please note if your quarantine starts at noon on day 1, then it would end at noon on the last day.

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You will be subject to the destination website’s privacy policy when you follow the link.
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For more information on CDC’s web notification policies, see Website Disclaimers.

Cruise lines that have ships operating or planning to operate in U.S. waters during the period of the No Sail Order extension
Parent Company
Cruise Line
No Sail Order Response Plan Status
Ship Name
Ship Status
Commercial Travel Allowed¥
Bahamas Paradise Cruise Line
Bahamas Paradise Cruise Line
Complete and accurate with signed acknowledgement
Grand Celebration
Green
Yes
Grand Classica
Green
Yes
Walt Disney Company
Disney Cruise Line
Complete and accurate with signed acknowledgement
Disney Wonder
Green
Yes
MSC Cruise Management (UK) Limited
MSC Cruises
Complete and accurate with signed acknowledgement
MSC Armonia
Green
Yes
MSC Meraviglia
Green
Yes
MSC Preziosa
Green
Yes
MSC Seaside
Green
Yes
Norwegian
Cruise Line Holdings

NorwegianCruise Line
Complete and accurate with signed acknowledgement
Norwegian Gem
Provisionally Green*
No
Norwegian Jewel
Green
Yes
Pride of America
Green
Yes
Oceania Cruises
Complete and accurate with signed acknowledgement
Oceania Regatta
Green
Yes
Royal Caribbean Group
Celebrity Cruises
Complete and accurate with signed acknowledgement
Celebrity Apex
Green
Yes
Celebrity Eclipse
Green
Yes
Celebrity Edge
Green
Yes
Celebrity Equinox
Green
Yes
Celebrity Millennium
Green
Yes
Celebrity Reflection
Green
Yes
Celebrity Silhouette
Green
Yes
Celebrity Summit
Green
Yes
Royal Caribbean International
Complete and accurate with signed acknowledgement
Adventure of the Seas
Green
Yes
Brilliance of the Seas
Green
Yes
Enchantment of the Seas
Green
Yes
Freedom of the Seas
Green
Yes
Grandeur of the Seas
Red
No
Harmony of the Seas
Green
Yes
Independence of the Seas
Green
Yes
Liberty of the Seas
Green
Yes
Mariner of the Seas
Green
Yes
Navigator of the Seas
Green
Yes
Oasis of the Seas
Green
Yes
Rhapsody of the Seas
Green
Yes
Serenade of the Seas
Green
Yes
Symphony of the Seas
Green
Yes
Vision of the Seas
Green
Yes

*Provisionally Green: Ship meets the surveillance criteria for “Green” status, but the following have not been completed:
Review and revision of the cruise line’s No Sail Order response plan, or
Cruise line’s signed acknowledgement of a complete and accurate plan, or
Ship’s submission of a signed attestation to CDC for crew to travel commercially.
ⱽProvisionally Yellow: Ship meets the surveillance criteria for “Yellow” status, but the following have not been completed:
Review and revision of the cruise line’s No Sail Order response plan, or
Cruise line’s signed acknowledgement of a complete and accurate plan, or
Ship’s submission of a signed attestation to CDC for crew to travel commercially.
^Provisionally Red: Ship meets the surveillance criteria for “Red” status, but the following have not been completed:
Review and revision of the cruise line’s No Sail Order response plan, or
Cruise line’s signed acknowledgement of a complete and accurate plan.
¥Commercial Travel Allowed: Allowed for ships that are “Green” and have submitted a signed attestation to CDC for crew to travel commercially.
Note: The above list includes cruise ships operating in U.S. waters or seeking to operate in U.S. waters during the period of the No Sail Order extension.
Frequently Asked Questions
What does it mean for a cruise ship operator to have a plan that is complete and accurate?
A complete and accurate plan adequately addresses every element of the No Sail Order. A cruise ship operator must be in compliance with the No Sail Order, the operator’s No Sail Order response plan, and CDC’s Interim Guidance for Mitigation of COVID-19 Among Cruise Ship Crew During the Period of the No Sail Order. CDC assesses compliance through implementation checks on a sample of ships covered under a cruise ship operator’s plan. There must be no evidence of noncompliance.
What steps is CDC taking to make sure ships stay in compliance with the criteria for commercial transport of crew?
CDC will review weekly surveillance data provided by ships, and only those ships that continue to report no cases of COVID-19 or COVID-like illness will maintain this status.
What other changes can cruise ships make if they meet these criteria?
CDC is committed to helping cruise lines provide for the safety and well-being of their crew members onboard. As cruise ships are able to show they have no cases of confirmed COVID-19 or COVID-like illnesses on board, crew members will be able to resume some of their daily interactions with fellow crew members.
Some examples of decreased restrictions on cruise ships if they meet these criteria include resuming in-person meetings, events, and social gatherings; reopening bars, gyms, or other group settings onboard for crew member use; and removing requirements to wear face coverings.
What is the difference between the two attestations CDC requires under the No Sail Order?
Under the No Sail Order, cruise lines are required to develop and implement comprehensive plans to prevent, detect, respond to, and contain COVID-19 among crew members onboard. While these response plans have been under review, CDC has allowed cruise lines to disembark crew members if they submit a signed attestation stating they have complied with the requirements to safely disembark crew members. This attestation included a requirement that crew members only use noncommercial travel to disembark and reach their final destinations and do not interact with the public during travel.
Cruise lines that have a complete and accurate No Sail Order response plan may disembark crew members without a signed attestation if they use noncommercial travel and follow CDC requirements. Cruise company officials must sign an acknowledgment of the completeness and accuracy of their response plan. Cruise ships that want to use commercial travel for crew members must meet additional requirements, which include demonstrating there are no confirmed cases of COVID-19 or COVID-like illness on board and submitting a signed attestation for commercial travel.
What does it mean if a cruise line is not listed on the table above?
If a cruise line is not listed, it means the cruise line is not operating and does not plan to operate any of its ships in U.S. waters during the period of the No Sail Order.
What does it mean if a cruise ship is not listed on the table above?
If a cruise ship is not listed, it means the ship is not operating in U.S. waters and does not plan to operate in U.S. waters during the period of the No Sail Order.

Revisions were made on October 27, 2020, to reflect the following:
Updated content to Reinfection
Revisions were made on September 10, 2020, to reflect the following:
Updated content to Reinfection
Revisions were made on June 20, 2020, to reflect the following:
Revisions were made on May 29, 2020, to reflect the following:
Revisions were made on May 25, 2020, to reflect the following:
Revisions were made on May 20, 2020, to reflect the following:
Revisions were made on May 12, 2020, to reflect the following:
New information about COVID-19-Associated Hypercoagulability
Updated content and resources to include new NIH Treatment Guidelines
Minor revisions for clarity

This interim guidance is for clinicians caring for patients with confirmed infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19). CDC will update this interim guidance as more information becomes available.
Clinical Presentation
Incubation period
The incubation period for COVID-19 is thought to extend to 14 days, with a median time of 4-5 days from exposure to symptoms onset.1-3 One study reported that 97.5% of persons with COVID-19 who develop symptoms will do so within 11.5 days of SARS-CoV-2 infection.3
Presentation

The signs and symptoms of COVID-19 present at illness onset vary, but over the course of the disease, most persons with COVID-19 will experience the following1,4-9:

Fever or chills
Cough
Shortness of breath or difficulty breathing
Fatigue
Muscle or body aches
Headache
New loss of taste or smell
Sore throat
Congestion or runny nose
Nausea or vomiting
Diarrhea

Symptoms differ with severity of disease.  For example, fever, cough, and shortness of breath are more commonly reported among people who are hospitalized with COVID-19 than among those with milder disease (non-hospitalized patients). Atypical presentations occur often, and older adults and persons with medical comorbidities may have delayed presentation of fever and respiratory symptoms.10,14 In one study of 1,099 hospitalized patients, fever was present in only 44% at hospital admission but eventually developed in 89% during hospitalization.1 Fatigue, headache, and muscle aches (myalgia) are among the most commonly reported symptoms in people who are not hospitalized, and sore throat and nasal congestion or runny nose (rhinorrhea) also may be prominent symptoms.  Many people with COVID-19  experience gastrointestinal symptoms such as nausea, vomiting or diarrhea, sometimes prior to developing fever and lower respiratory tract signs and symptoms.9 Loss of smell (anosmia) or taste (ageusia) preceding the onset of respiratory symptoms has been commonly reported in COVID-19 especially among women and young or middle-aged patients who do not require hospitalization.11,12 While many of the symptoms of COVID-19 are common to other respiratory or viral illnesses, anosmia appears to be more specific to COVID-19.12
Several studies have reported that the signs Signs and symptoms of COVID-19 in children are similar to adults vary by age of the child,  and are usually milder compared to adults.15-19 For more information on the clinical presentation and course among children, see Information for Pediatric Healthcare Providers.
Asymptomatic and Pre-Symptomatic Infection
Several studies have documented SARS-CoV-2 infection in patients who never develop symptoms (asymptomatic) and in patients not yet symptomatic (pre-symptomatic).16,18,20-30 Since asymptomatic persons are not routinely tested, the prevalence of asymptomatic infection and detection of pre-symptomatic infection is not yet well understood. One study found that as many as 13% of reverse transcription-polymerase chain reaction (RT-PCR)-confirmed cases of SARS-CoV-2 infection in children were asymptomatic.16 Another study of skilled nursing facility residents who were infected with SARS-CoV-2 after contact with a healthcare worker with COVID-19 demonstrated that half of the residents were asymptomatic or pre-symptomatic at the time of contact tracing, evaluation, and testing.27 Patients may have abnormalities on chest imaging before the onset of symptoms.21,22.
Asymptomatic and Pre-Symptomatic Transmission
Increasing numbers of epidemiologic studies have documented SARS-CoV-2 transmission during the pre-symptomatic incubation period,21,31-33. Virologic studies using RT-PCR detection have reported tests with  low cycle thresholds, indicating larger quantities of viral RNA and viable virus has been cultured from persons with asymptomatic and pre-symptomatic SARS-CoV-2 infection.25,27,30,34 The relationship between SARS-CoV-2 viral RNA shedding and  transmission risk is not yet clear. The proportion of SARS-CoV-2 transmission due to asymptomatic or pre-symptomatic infection compared to symptomatic infection is unclear.35
Clinical Course
Illness Severity
The largest cohort reported of >44,000 persons with COVID-19 from China showed that illness severity can range from mild to critical:36
Mild to moderate (mild symptoms up to mild pneumonia): 81%
Severe (dyspnea, hypoxia, or >50% lung involvement on imaging): 14%
Critical (respiratory failure, shock, or multiorgan system dysfunction): 5%
In this study, all deaths occurred among patients with critical illness, and the overall case fatality rate was 2.3%.36 The case fatality rate among patients with critical disease was 49%.36 Among children in China, illness severity was lower with 94% having asymptomatic, mild, or moderate disease; 5% having severe disease; and 44,000 confirmed cases of COVID-19 in China, the case fatality rate was highest among older persons: ≥80 years, 14.8%; 70–79 years, 8.0%; 60–69 years, 3.6%; 50–59 years, 1.3%; 40–49 years, 0.4%;

Traveling overnight

Wear a mask in the lobby or other common areas

Check the hotel’s COVID-19 prevention practices before you go
Use options for online reservation and check-in, mobile room key, and contactless payment.
Before you go, call and ask if all staff are wearing masks at work.
Look for any extra prevention practices being implemented by the hotel, such as plexiglass barriers at check-in counters, and physical distancing signs in the lobby.
Ask if the hotel has updated policies about cleaning and disinfecting or removing frequently touched surfaces and items (such as pens, room keys, tables, phones, doorknobs, light switches, elevator buttons, water fountains, ATMs/card payment stations, business center computers and printers, ice/vending machines, and remote controls).
Wear masks and limit close contact with others
Wear a mask in the lobby or other common areas.
Minimize use of areas that may lead to close contact (within 6 feet) with other people as much as possible, like break rooms, outside patios, inside lounging areas, dining areas/kitchens, game rooms, pools, hot tubs, saunas, spas, salons, and fitness centers.
Consider taking the stairs. Otherwise wait to use the elevator until you can either ride alone or only with people from your household.
Choose contactless options, when possible
Request contactless delivery for any room service order.
If you are considering cleaning your travel lodgings, see CDC’s guidance on how to clean and disinfect.
Protect yourself and others when you travel away your community

Links with this icon indicate that you are leaving the CDC website.The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website.
Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website.
You will be subject to the destination website’s privacy policy when you follow the link.
CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website.

For more information on CDC’s web notification policies, see Website Disclaimers.

Links with this icon indicate that you are leaving the CDC website.The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website.
Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website.
You will be subject to the destination website’s privacy policy when you follow the link.
CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website.

For more information on CDC’s web notification policies, see Website Disclaimers.