What is the recommended isolation and treatment guidance for individuals diagnosed with Covid-19 (Coronavirus disease 2019)?

COVID-19 Isolation and Treatment Guidelines

Individuals diagnosed with COVID-19 should isolate for at least 5 days from symptom onset or positive test, with isolation ending when body temperature has returned to normal for more than 3 days, respiratory symptoms have significantly improved, and respiratory nucleic acid tests are negative for two consecutive times with at least one-day sampling interval. 1

Isolation Requirements

Home Isolation for Mild Cases

• Patients with mild symptoms without pneumonia should be isolated in well-ventilated single rooms with restricted activity 2
• If a single room is not available, maintain bed distance of at least 1.1 meters from others 1, 2
• Patients should monitor their body temperature and symptoms daily; seek medical attention if temperature exceeds 38°C or breathing worsens 1, 2
• Open windows for ventilation in shared areas such as toilets and kitchens 2
• Clean and disinfect household articles using 500 mg/L chlorine-containing disinfectant frequently 2

Patient Precautions

• Patients should wear a medical mask (N95 preferred) when in the presence of others 1, 2
• Patients should clean hands immediately after coughing and sneezing 2
• Restrict patient activities to minimize contact with others 1, 2
• If medical care is needed, avoid public transportation; use ambulance or private vehicle with windows open for ventilation 1

Caregiver Recommendations

• Caregivers should be healthy family members without underlying diseases when possible 2
• Caregivers should wear N95 masks (preferred strategy) or disposable surgical masks (alternative strategy) when in the same room as patients 1, 2
• Caregivers should also monitor their own body temperature closely 1

Testing and Monitoring

Diagnostic Testing

• For symptomatic individuals, nucleic acid amplification tests (NAATs) are recommended using nasopharyngeal, mid-turbinate, combined anterior nares plus oropharyngeal swab, saliva, or mouth gargle specimens 1
• Anterior nares and mid-turbinate specimens can be either self-collected or collected by a healthcare provider 1
• A single NAAT is sufficient; routine repeat testing is not recommended for individuals whose initial test is negative 1
• Rapid antigen tests (RATs) may be used to determine when an individual is no longer producing infectious virus and may end isolation 3

Follow-up Monitoring

• Healthcare personnel should perform regular follow-up through face-to-face visits or phone interviews to monitor symptom progression 1, 2
• Patients with worsening symptoms should seek immediate medical attention 1, 2

Treatment Guidelines

Supportive Care for Mild Cases

• Mild patients generally use nasal catheter or mask for oxygen therapy if needed; adjust flow as appropriate according to condition 1
• Ensure adequate nutritional support and hydration 4
• Monitor vital signs regularly 4

Antiviral Treatment

• Remdesivir may be considered for non-hospitalized patients diagnosed with mild-to-moderate COVID-19 who are at high risk for progression to severe disease 5
• For non-hospitalized high-risk patients, remdesivir should be initiated as soon as possible after diagnosis and within 7 days of symptom onset with a recommended treatment duration of 3 days 5
• For hospitalized patients not requiring invasive mechanical ventilation, the recommended treatment duration is 5 days 5

Hospital Admission Criteria

When to Consider Hospitalization

• Patients with persistent high fever (>38°C) 2
• Development of dyspnea or respiratory distress 2, 4
• Signs of pneumonia development or worsening symptoms 2, 4
• Patients with comorbidities or risk factors for severe disease 4

Discharge and End of Isolation Criteria

Hospital Discharge Standards

• Body temperature returned to normal for more than 3 days 1
• Respiratory symptoms significantly improved 1
• Lung inflammation showing obvious signs of absorption on imaging 1
• Respiratory nucleic acid negative for two consecutive tests with at least one-day sampling interval 1

End of Home Isolation

• Current evidence suggests that a negative rapid antigen test is a good indicator of loss of infectious virus and ability to end isolation 3
• The adoption of symptom-based criteria (rather than test-based) can lead to significant reduction in isolation period with potential social, economic, and psychological benefits 6
• CDC recommends isolation for at least 5 days from symptom onset or positive test 7

Special Considerations and Pitfalls

• Asymptomatic transmission contributes significantly to COVID-19 spread, making isolation of all positive cases crucial regardless of symptoms 8
• Delayed initiation of antiviral treatment (beyond 3 days after symptom onset) may reduce effectiveness 3
• Symptom resolution typically lags behind viral clearance as assessed by infectious virus assay and rapid antigen tests 3
• Prolonged isolation beyond necessary periods has potential negative social, economic, and psychological impacts, particularly in younger populations with mild/moderate disease 6