COVID-19 testing and quarantine guidance

USAG Stuttgart Public Affairs

Stuttgart Army Medical Clinic (Patch) COVID-19 screening and clinical services

NEW: COVID-19 Guidelines for the Stuttgart Military Community, effective November 9, 2020

Note for Tricare beneficiaries: Off-post testing is only reimbursable if required by an off-post provider as part of an evaluation and treatment plan

COVID-19 Testing Protocol

• The testing protocol for everyone is two tests:
  • 1st test upon arrival or contact/infection
  • 2nd test 5-10 days later (no earlier than day 5, no later than day 10 after the initial test)
• Everyone should observe strict quarantine protocol (see details below) while waiting to test or receive results. Results for Service Members, Civilian employees, and contractors should be available the following day, and those of family members within the next 48-72 hours.
  
• New arrivals (PCS or TDY) and any community members returning from travel to the United States (official or non-official) or other locations via commercial air must undergo testing and quarantine once on the ground in Stuttgart.
• If you are not contacted by the clinic due to a positive test and you are not symptomatic, there is no medical clearance required to exit quarantine after 14 days.
• Support for quarantining families is available, whether from the unit sponsor, the volunteer shopper program, or a combination (more details below).

 What does a newcomer/return traveler need to do? 

1. At least three days prior to arrival, send the Army Health Clinic-Stuttgart (AHC-S) an email at the group inbox with the information required to pre-register you at the clinic

1. 1. Last name, first name, middle initial
   2. Date of Birth
   3. Status (Active Duty, Reserves, Guard, Civilian, Contractor)
   4. SSN or DoD ID number
   5. Marital Status
   6. Note: each patient must have their own SSN or DoD ID number in order to be registered. Patients cannot use the sponsor’s SSN or DoD ID number

2. As soon as you arrive, your unit sponsor should bring you directly to the clinic to get tested. If you arrive after the clinic has closed, go to your hotel room and be prepared to come to the clinic the following weekday at 9:00 a.m.

3. After testing, return to your room and wait for results. Everyone should observe strict quarantine protocol while waiting to test or receive results. Results for Service Members, Civilian employees, and contractors should be available the following day, and those of family members within the next 48-72 hours. Due to the volume of testing, clinic staff will only contact individuals with positive results (as well as their unit sponsors due to possible exposure).

4. The next steps are based on your results and your unit’s quarantine guidance:

a) If positive, you will be placed in isolation

b) If negative, and your unit requires a full quarantine, you will remain in the full quarantine for the 14 days

c) If negative, and your unit permits a “working” quarantine, you can get an exemption certificate from your unit

4. Return to the Patch Clinic for a second test no earlier than your fifth day after arrival and no later than your tenth day. Even if you test negative here, you must limit your contact through day 14 after your initial test.

5. On Day 15 after arrival and after two tests, presuming you are not contacted by the clinic due to a positive test, you may exit quarantine status.

Receiving results & exemption certificates

• Test results are protected medical information with strict privacy requirements. Only you can receive them from a medical provider; your sponsor or your spouse cannot get your results for you. 
• You or your spouse can obtain test results from unit medical assets via Relay Health Secure Messaging, or a telephone consult
• If you test negative, you can authorize your unit sponsor to pick up a physician’s certificate of medical exemption which enables you to enter a “working” quarantine–if your unit allows working quarantine.
  
• Units with medical assets (EUCOM, AFRICOM, SOCEUR, SOCAF, MARFOREUR/AF, and 1-10 SFG (A)) will get the certificate from their unit medical staff. Some of these headquarters have different standards for when personnel will enter “working” quarantine, so notification is best through unit means.
• For units without medical staff here at Stuttgart, your exemption certificate can be picked up at the Patch Clinic drive-thru at 3:00 p.m., Monday through Friday.
• The certificate of exemption must be carried at all times by all individuals for 14 days after receipt

Classifications for individuals

• Confirmed positive: The person has tested positive for COVID-19 at AHC-S or another testing location. COVID-19 positive persons may display symptoms or may have no symptoms (asymptomatic).
• Presumed positive: The person has COVID-19 symptoms and a strong epidemiologic link to a case, without a positive COVID-19 test result. A medical provider has determined that the individual will be considered COVID-19 positive and managed in the same way as a confirmed positive case.
• Person under investigation (PUI): A person with symptoms possibly consistent with COVID-19 that is awaiting COVID-19 testing results.
• Close contact: A person who had close contact with a confirmed or presumed positive COVID-19 case. Close contact is defined as being within six feet of a person for 15 minutes (cumulative). The timeline of concern for close contact is from two days prior to onset of the COVID-19 positive person’s symptoms, or two days prior to the collection of test specimen in an asymptomatic COVID-19 positive person. Examples of close contacts include family members, household members, friends, sports teammates, coaches, and small group members. Persons with less than 15 minute duration of contact but with a significant exposure (e.g., directly coughed or sneezed on) are considered close contacts. The wear of cloth face coverings decreases risk of transmission, but does not eliminate risk for close contacts and does not impact whether quarantine will be recommended.
• Ring Contact: Applies to students within a classroom. Specifically, a student sitting immediately next to a positive case in either the classroom or on the bus. Includes seats in front of, behind, left, right and diagonals. In the current setting of high prevalence and widespread community transmission, ring contacts will be considered close contacts and will incur the same quarantine requirements.

Isolation, Quarantine, and Social Distancing:

• Isolation: Confirmed or presumed positive persons will enter “isolation.” Those in isolation will remain in their quarters and stay separate from household members to the maximum extent possible. If possible, the person in isolation should have their own room, own bathroom, and food should be brought to them. Those in isolation will only leave the home, wearing a face mask and maintaining six feet of physical distance from others, to seek medical care, if necessary. Even if a person can effectively isolate from the rest of their household members, in most cases those other members of the household will likely qualify as close contacts and will also be required to quarantine in their quarters.
• Quarantine: Close contacts will quarantine; this means they are not known to be infected but are at risk due to exposure, and therefore must stay away from others. Those in quarantine will remain in their quarters and stay separate from household members to the maximum extent possible. If possible, they will have their own room, own bathroom, and food brought to them. Those in quarantine will depend on units for life support. They will only leave the home, wearing a face mask and maintaining six feet of physical distance from others, to seek medical care, if necessary.

Social Distancing: Distancing measures taken by persons with symptoms who have tested negative for COVID-19 and do not have a strong epidemiologic link that would require them to quarantine. Persons who are social distancing should try to keep their distance from others and be extra vigilant regarding hand washing, mask wear, coughing and other hygiene measures. Household members are not required to quarantine for exposure to someone social distancing. However, they should take common sense measures such as avoiding “get-togethers”, having people over to the house, visiting others, etc.

14-day Quarantine Protocol

• There are no exceptions to the restriction of movement based on rank or duty positions, nor exceptions for shopping, in-processing tasks, or signing for quarters.
• While under a full quarantine, you must stay in your hotel room or quarters for 14 days. This includes eating in your room (food must be delivered to your room) and coordinating with your hotel for laundry service.
• Sponsors are responsible for providing life support and procuring necessary supplemental items; the volunteer Commissary Concierge service is also available to support.
• As much as possible, stay in a specific room and away from other people and pets in your home. If possible, you should use a separate bathroom. If you need to be around other people or animals in or outside of the home, wear a mask.
• Under a full quarantine, a single member of the family may leave to:
  • Walk a dog
  • Take out trash (only in quarters; not a hotel)
  • Medical emergency/medical appointment/follow-on testing (must call to coordinate with the clinic so that appropriate precautions are taken during clinic visit)
• Civilians, contractors, and family members who refuse to test will be assumed positive and will need to complete the full 14 day quarantine with no “working” allowances

Isolation, Quarantine, and Testing Protocol for COVID-19 cases and contacts

• COVID-19 positive persons: These people will isolate as directed by the PHEO for AHC-S for a minimum of 10 days past the onset of symptoms or when the specimen was taken for the lab test that was positive. Repeat testing is generally not recommended or required for confirmed COVID-19 persons but may be in unique situations; the medical provider will advise if this is the case. Asymptomatic testing (e.g., for sentinel surveillance, or following travel) will not be conducted in the 90 days following a positive COVID-19 test. If a recovered COVID-19 positive person develops symptoms within 90 days following their infection, they should be tested to evaluate for the possibility of a new COVID-19 infection.
• Close contacts of COVID-19 positive persons: These people will quarantine until 14 days after the last contact with the COVID-19 positive person. Close contacts will usually be tested for COVID-19 soon after being identified and may be tested again 5-7 days later to determine if they were infected from their exposure. If any test is positive, the close contact becomes a confirmed positive and begins isolation until 14 days past the day their positive test was taken. Close contacts will self-monitor for symptoms of COVID and seek evaluation if they develop. Close contacts cannot test out of quarantine. The 14-day duration of quarantine covers the range of the incubation period of the virus that causes COVID-19.
• Contacts of contacts generally do not incur a quarantine obligation and may continue interacting in the community. However, when household members are unable to separate from a close contact within the home, they must quarantine for 14 days along with the close contact.

Special Quarantine Requirements for Schools:

• School populations have special quarantine requirements. Students identified as close contacts (including ring contacts) of other students (friend groups, sitting right next to the positive student, same sport teams, small groups, etc.) will quarantine for 14 days from last exposure and will be tested immediately as well as 5-7 days later. Classroom contacts and bus contacts, who are not identified as close contacts/ring contacts, will incur no quarantine obligation. They are expected to be extra-vigilant to any COVID-19 symptoms and test immediately if any symptoms develop. Classroom contacts and bus contacts, as a group, will not be tested unless symptoms develop. This policy may change as community prevalence rates change and/or as the policies of the local German schools change.

Extended Quarantine:

There is potential for extended quarantine requirements within households. Families with confirmed or presumed COVID-19 cases will consult with Team Trace to ensure understanding of each person’s quarantine requirements. For example: a parent tests positive and the family is quarantined. A child in the family develops symptoms and also tests positive. The parent recovers and is cleared to return to work. Other family members may still be in quarantine due to risk of infection and the virus spreading within the household. Households will need to develop their own specific plans to minimize extended quarantines from daily exposure to the positive within their household.

Working Quarantine

Note – “Working Quarantine” is a unit decision and does not apply uniformly across the Garrison.

• “Working” quarantine status will be applied based upon unit/command guidance.
• “Working” quarantine is only possible with a Doctor’s Certificate of Exemption from your unit medical personnel or the Clinic for smaller units.  This certificate must be carried by all exempted individuals for at least 14 days.
• The exemption certificate does NOT constitute a freedom to interact normally with the community; it only allows newcomers to do the few things necessary to provide basic life support for themselves and arrival tasks that cannot wait until the 14-day quarantine has ended. Examples include exercising in open areas which allow for sufficient physical distancing and in-processing tasks such as installation access and getting an ID card for a new employee.
• Those whose units do not permit a “working” quarantine status, as well as non-Service Members who refuse to test, will follow a “full” 14-day quarantine.

Do’s and Don’ts for ALL quarantined personnel

• Do’s:
  • Always wear a mask
  • Always physically distance
  • Always wash your hands
  • If you have a working quarantine exemption certificate, keep it with you at all times for the 14 days from your first test
• Don’ts:
  • Visit places of social interaction or recreation such as movie theaters, bars, nightclubs, dance halls, pools, spas, massage parlors, hookah lounges, etc.
  • Playgrounds, on or off post
  • Gyms or physical fitness facilities, on or off post
  • Sit down to eat at a restaurant (in “working” quarantine, retrieving a to-go order and returning to your quarantine location is permissible when observing all normal precautions)

What to do when feeling ill:

Members of the USAG Stuttgart Community must self-monitor for symptoms of COVID-19 every day. If symptoms are noted, they should stay at home, avoid group activities (work, school, sports), and seek medical evaluation through the Army Health Clinic-Stuttgart. If symptoms develop at work, they should contact their supervisor, leave the work space, and seek medical evaluation. In the school setting, parents will be contacted and students who develop symptoms will be isolated from others in a supervised setting with climate control while awaiting pickup. Click here for additional information on clinic testing hours and procedures.

Those who have been tested for COVID-19 due to symptoms are considered Persons Under Investigation (PUI) and will remain in isolation until their COVID-19 status is determined. PUIs who test negative for COVID-19 are expected to socially distance from others. If the COVID-19 test is negative and the person has been symptom free for 48 hours, they can return to work or school as long as they have self-isolated for at least 72 hours.

For example, someone who had a sore throat on Monday and tests negative for COVID 19, then has no sore throat on Tuesday or Wednesday, can return to work on Thursday having self-isolated since Monday. If symptoms worsen, medical personnel may recommend continued social distancing and/or repeat testing.

Travel Quarantine and Testing Guidance:

Those who arrive or return to USAG Stuttgart from areas outside of Germany considered high risk by the Robert Koch Institute (RKI) will quarantine for 14 days from arrival. They should test for COVID-19 on day 1-2 after arrival, and again 5-10 days later.

USAG Stuttgart does not authorize any working or modified quarantine following travel. Some units/commands on USAG Stuttgart have policies for modified quarantine for their personnel. If those in a quarantine following travel develop symptoms concerning for COVID-19, they will seek testing.

Those who arrive for Permanent Change of Station from any international location must quarantine for 14 days (even if coming from a low risk area per USAREUR guidance).

The RKI list of high-risk locations changes frequently and will be monitored before and during any travel.

Household members of persons who are in a quarantine due to international travel must remain physically separated from the traveler. If this cannot be achieved, then the members of the household must also quarantine. If there is daily interaction between a recent traveler and the household, then the household will incur a quarantine obligation. Recently infected household members could transmit virus for two or more days at work if allowed to freely interact with a recent traveler and continue with work and school.

Essential Item Shopping for Quarantined Personnel

• Programs are available at both the Exchange and Commissaries to accommodate the needs of quarantined personnel accessing bare essential items.
• Orders placed through the “Buy Online, Pick Up In Store” option at shopmyexchange.com may be picked up curbside by those under “working” quarantine orders. Families under full quarantine should ask their sponsor or contact ACS to request that a volunteer pick up the items and deliver them to the hotel room/quarters. If an authorized agent (sponsor or volunteer) will be picking up your items, be sure to let the Exchange Associate know.
• The Commissary Concierge program is also available for grocery needs. Contact the ACS volunteer program for guidance. 

Release from home isolation or quarantine:

• COVID-19 positive: Persons who tested positive for COVID-19 will be released from isolation by the public health authority at AHC-S. These persons will drive through the COVID-19 testing line once the PHEO-directed isolation period is complete. They will return to work or school after release in accordance with their school or unit COVID-19 policy.
• Close Contacts in quarantine: The public health authority at AHC-S will provide quarantine release information. Those who do not develop symptoms or test positive during quarantine will be released after 14 days. No visit to the clinic is necessary. Return to work or school in accordance with the school or unit COVID-19 policy.
• Other Contacts: If classroom or other groups of contacts are directed to stay at home, public health authorities will provide guidance on when to return to school and re-engage with the community

Communication

• DODEA schools in Stuttgart will notify parents each time a COVID-19 case occurs in the school or during bus transport. This is to allow for informed decisions regarding in-person education. Personal health information is protected by law and will not be disseminated.
• Individuals are expected to notify their immediate supervisor that they have been placed in isolation. Units may receive notification through the USAG Stuttgart channels. Return to work is in accordance with local policy and coordinated through the chain of command.

Health protection guidance for sponsors and family members of quarantined or isolating personnel

• Sponsors should follow these recommendations:
  • Ensure that all newly arrived individuals use face coverings at all times while in the presence of other people 
  • The sponsor should also use a face covering when in the presence of the incoming individuals
  • The sponsor should maintain physical distance (6 feet/2 meters) from the member/family to the extent possible
  • Avoid shaking hands or any other close physical contact
  • The sponsor and incoming individuals should use deliberate hand hygiene (wash hands frequently and use hand sanitizer)
  • Consider helping arriving individuals and families hire transport from the airport (reimbursable PCS expense) to lodging with the sponsor following separately, in order to reduce time spent in close contact 
  • Use disinfecting wipes to clean vehicles surfaces & other frequently touched surfaces
  • If sponsors must drive in-bounds to the clinic for COVID-19 testing, all should wear face coverings to the extent possible & in-bound individuals should sit in back seats if possible 
  • Sponsors providing food and other essentials to incoming personnel should minimize contact when delivering these items, such as leaving items outside the door of hotel rooms
  • Sponsors are not required to quarantine following contact with incoming personnel, UNLESS the in-bounds test positive for COVID-19; follow medical provider or public health guidance
  • Sponsors should, as always, self-monitor for any symptoms consistent with COVID-19 (fever, cough, shortness of breath, chills/shaking, sore throat, muscle aches, loss of smell or taste, headaches)
  • if a newcomer tests positive and the unit sponsor has come into contact, the sponsor will be part of the tracing effort, will be tested and will put into isolation, and then into quarantine.
  • In a household where a member returns from CONUS (or any RED country), whether from leave or TDY, the cohabitating family members do not need to quarantine. The returning member should isolate as much as possible within the domicile.

If you have questions about the terms of screening or quarantine, the clinic may be contacted directly at usarmy.stuttgart.id-europe.list.covid-screening@mail.mil.

Clinic Hours: The Stuttgart Army Health Clinic’s Acute Respiratory Drive-Thru is open from 9:00 a.m. to 12:00 p.m and 1 p.m. to 3 p.m., Monday through Friday, except federal holidays.