COVID-19 Isolation Discontinuation Guidelines
COVID-19 isolation can be discontinued after a minimum of 10 days from symptom onset, along with fever resolution for 24 hours without antipyretics and improvement in other symptoms, as patients are unlikely to be infectious after this point. 1
Standard Isolation Discontinuation Criteria
- For most patients with COVID-19, isolation can be discontinued 10 days after symptom onset, provided they have been fever-free for at least 24 hours without the use of antipyretics and other symptoms have improved 1
- This 10-day criterion carries a low risk (0-6.6%) of releasing individuals who are still infectious 2
- Patients should follow CDC guidance on home isolation and discuss with their healthcare providers when they can end home isolation 1
Special Considerations
- For patients with severe COVID-19 or those on immunosuppressive medications, a case-by-case approach to determining the length of isolation is recommended 1
- Immunocompromised patients may shed infectious virus for longer periods (up to 20 days) and require extended isolation 3
- Patients with severe-to-critical illness may shed infectious virus for longer periods (up to 32 days in some studies) and should be evaluated individually 3
Test-Based vs. Symptom-Based Strategies
Two main strategies exist for ending isolation: 2
- Symptom-based (time-based): Fixed isolation period of 10 days since symptom onset
- Test-based: Personalized approach based on repeated testing
According to WHO recommendations, clinical criteria for hospital discharge include: 1
- Normal temperature for more than 3 days without fever-reducing medications
- Significantly relieved respiratory symptoms
- Substantially improved acute lesions on chest CT
- Two consecutive negative RT-PCR tests with at least 1-day interval
While the test-based strategy may reduce unnecessary isolation days, the symptom-based approach is more practical for most settings 2
Home Isolation Considerations
- Patients discharged to home should have: 1
- Appropriate caregivers available at home
- Ability to isolate from other household members (single room, good ventilation, mask wearing)
- No household members at high risk for COVID-19 complications
- Household members capable of adhering to recommended precautions
Return to Work/Normal Activities
- Most patients can return to work after meeting the 10-day criterion plus symptom improvement and 24-hour fever resolution 1
- Patients should be counseled that they are unlikely to be infectious after meeting these criteria 1
Potential Pitfalls
- Using a fixed isolation period may result in unnecessary isolation days (4.8-8.3 days) for some patients 2
- Ending isolation too early, especially for immunocompromised patients or those with severe disease, may risk continued transmission 3
- Relying solely on RT-PCR tests can be problematic as patients may continue to test positive due to non-viable viral RNA long after they are no longer infectious 3