What are the isolation precautions for individuals infected with Covid-19 (Coronavirus disease 2019)?

Isolation Precautions for COVID-19 Infected Individuals

COVID-19 infected individuals should be isolated in well-ventilated single rooms, limit contact with others, wear masks when around others, practice proper hand hygiene, and maintain isolation for at least 14 days from symptom onset until a negative RT-PCR test is obtained. 1

General Isolation Requirements

Home Isolation for Mild Cases

For individuals with mild symptoms who can be managed at home:

• Environment setup:

  • Use a well-ventilated single room (strong recommendation) 1
  • If a single room is not possible, maintain a bed distance of at least 1 meter from others 1
  • Open windows for ventilation in shared areas such as toilets and kitchens 1
  • Restrict the patient's activity and movement within the home 1

• Hygiene measures:

  • Clean and disinfect household articles using 500 mg/L chlorine-containing disinfectant daily 1
  • Avoid sharing personal items (toothbrush, towel, tableware, bed sheets) 1
  • When coughing or sneezing, wear a medical mask or cover with tissue and bent elbow 1
  • Clean hands immediately after coughing or sneezing 1

• Personal protective equipment:

  • Patient should wear a mask when in the same room with others 1
  • Caregivers should wear N95 masks when in the same room (preferred strategy) 1
  • If N95 masks are unavailable, disposable surgical masks are an alternative 1

Hospital Isolation for Moderate to Severe Cases

For patients requiring hospitalization:

• Create dedicated COVID-19 units to prevent contamination of non-COVID patients 1
• After emergency surgical procedures, re-admit COVID-19 patients with severe pneumonia to COVID-ICU 1
• For stable or mildly symptomatic COVID-19 patients, create a dedicated surgical ward to limit exposure 1

Duration of Isolation

• Maintain isolation for at least 14 days from symptom onset or positive test 1
• Continue isolation until a negative RT-PCR nasopharyngeal swab test is obtained 1
• Be aware that some patients may continue to test positive after the established 14-day quarantine period 1

Caregiver Precautions

Caregivers of COVID-19 patients should:

• Be a healthy family member without underlying diseases when possible 1
• Clean and disinfect hands after contact with the patient, before leaving the patient's room, before and after eating, and after using the toilet 1
• Avoid direct contact with patient's secretions, especially respiratory discharges 1
• Wear appropriate PPE including N95 masks, goggles, and protective gowns 1
• Be trained in the correct use of PPE (donning and doffing) 1

Social Distancing Measures

In addition to isolation of confirmed cases, broader social distancing measures help control transmission:

• Case isolation at home: Symptomatic cases to remain home for 7 days, reducing outside household contacts by 75% 1
• Voluntary home quarantine: If a symptomatic case is identified in a household, the entire household should remain home for 14 days 1
• Social distancing for vulnerable populations: Those over 70 years old should maintain 2m distance from others 1
• General population social distancing: All individuals should practice social distancing, reducing contacts by 75% 1

Transportation Considerations

When COVID-19 patients need medical care:

• Avoid public transportation 1
• Use ambulance or private vehicle with windows open for ventilation 1
• Patient should wear a mask during transport 1
• Clean and disinfect the vehicle with 500 mg/L chlorine-containing disinfectant after use 1

Common Pitfalls and Caveats

1. Silent transmission risk: The majority of COVID-19 transmission may occur through presymptomatic and asymptomatic carriers 2. Isolation of symptomatic cases alone is insufficient to control outbreaks.

2. Aerosol transmission potential: Evidence suggests COVID-19 can spread beyond the traditional 1-2 meter droplet distance. Some studies show droplets can travel up to 8 meters, and the virus can remain viable in aerosols for up to 3 hours 3. This supports the need for proper ventilation and appropriate PPE.

3. False negative test results: RT-PCR tests may yield false negatives due to incorrect sample collection or missing the viral replication window 1. For individuals with high clinical suspicion but negative tests, consider repeating the test and using chest imaging for diagnosis 1.

4. Prolonged viral shedding: Some patients continue to test positive beyond the 14-day quarantine period 1. Isolation should continue until negative test confirmation.

5. Environmental contamination: SARS-CoV-2 can be detected on surfaces and in the air of rooms occupied by infected individuals 4, highlighting the importance of proper cleaning and ventilation.

By following these comprehensive isolation precautions, the risk of COVID-19 transmission can be significantly reduced, protecting both the infected individual's contacts and the broader community.