What are the current guidelines for COVID-19 (Coronavirus Disease 2019) isolation?

Current COVID-19 Isolation Guidelines

Individuals with COVID-19 should isolate for at least 5 days from symptom onset or positive test, and may end isolation when fever has been absent for at least 24 hours without fever-reducing medications, symptoms are resolving or absent, and ideally after a negative rapid antigen test. 1

Core Isolation Duration and Criteria

• Minimum isolation period is 5 days from symptom onset (or from positive test date if asymptomatic), with the option to end isolation if specific clinical criteria are met 1, 2

• Isolation can end after 5 days if ALL of the following are met:

  • Body temperature has been normal for at least 24 hours without fever-reducing medications 1, 3
  • Respiratory symptoms are resolving or absent 1, 2
  • A rapid antigen test is negative (if available and used) 1, 3

• Extended isolation up to 10 days is recommended if symptoms persist, fever continues, or antigen testing remains positive 1, 3

• For complete clearance criteria (primarily relevant for healthcare/congregate settings): isolation requires body temperature normal for more than 3 days, respiratory symptoms significantly improved, and two consecutive negative RT-PCR tests with at least one-day sampling interval 1

Post-Isolation Precautions

• Continue wearing a well-fitting mask around others through day 10 after symptom onset or positive test, even if isolation ends at day 5 3, 2

• Approximately 54% of individuals still test positive on rapid antigen tests after 5-9 days of isolation, indicating potential ongoing infectiousness 3

• The proportion with positive tests declines over time, with 84% achieving negative or high cycle-threshold results by day 10 4

Isolation Setting Requirements

• Place patients in well-ventilated single rooms with restricted activity to minimize contact with others 1, 5

• If single rooms are unavailable, maintain at least 1.1 meters (approximately 3.5 feet) bed distance from others 1, 5

• Ensure adequate ventilation by opening windows when possible 1

Patient Precautions During Isolation

• Wear a medical mask (N95 preferred) when in the presence of others, including household members 1, 5

• Clean hands immediately after coughing, sneezing, or touching potentially contaminated surfaces 1

• Monitor body temperature and symptoms daily 1, 5

• Seek immediate medical attention if:

  • Temperature exceeds 38°C (100.4°F) persistently 1, 5
  • Breathing worsens or dyspnea develops 1, 5
  • Signs of pneumonia appear 1

Caregiver and Household Recommendations

• Caregivers should be healthy individuals without underlying diseases when possible 1, 5

• Caregivers must wear N95 masks (preferred) or surgical masks (alternative) when in the same room as the patient 1, 5

• Avoid sharing personal items such as toothbrushes, towels, tableware, and bed linens 5

• Caregivers should monitor their own body temperature and symptoms closely 1, 5

• Clean and disinfect frequently touched surfaces using 500 mg/L chlorine-containing disinfectant daily 5

Testing Considerations

• For symptomatic individuals, a single NAAT (nucleic acid amplification test) is recommended using nasopharyngeal, anterior nasal, mid-turbinate, oropharyngeal swab, saliva, or mouth gargle specimens 6, 1

• Rapid antigen testing is recommended for symptomatic individuals within 5 days of symptom onset for optimal performance 6

• A positive antigen test has high specificity and can guide isolation decisions without confirmation 6

• A negative antigen test in high clinical suspicion cases should be confirmed by NAAT 6

• Repeat testing is NOT recommended to guide discontinuation of isolation in most circumstances 6

Factors Affecting Test Positivity Duration

Research from the Omicron period demonstrates that certain factors influence how long individuals remain test-positive:

• Symptomatic infection is associated with longer test positivity (adjusted OR = 9.63 for positive test after 5 days) 3

• Previous infection reduces likelihood of prolonged test positivity (adjusted OR = 0.30) 3

• Receipt of primary COVID-19 vaccination series reduces prolonged test positivity (adjusted OR = 0.60) 3

• Both previous infection AND vaccination provides the greatest reduction in prolonged test positivity (adjusted OR = 0.17) 3

Common Pitfalls to Avoid

• Do not use RT-PCR testing to determine end of isolation, as PCR can remain positive long after infectiousness has resolved 6, 4

• Do not end isolation based solely on day count without considering symptom resolution and fever clearance 1, 2

• Do not discontinue masking after ending isolation at day 5; continue through day 10 3, 2

• Do not assume asymptomatic individuals are non-infectious; they require the same isolation duration 1, 2

Special Populations

For surgical or hospitalized COVID-19 patients:

• After emergency surgery, stable asymptomatic or mild symptomatic patients should be placed in dedicated COVID-19 wards to prevent nosocomial transmission 6

• Suspected cases with negative initial testing but clinical/radiographic findings consistent with COVID-19 should be managed as positive until repeat testing confirms status 6

For nursing home or congregate settings:

• More stringent criteria may apply, including the requirement for two consecutive negative RT-PCR tests before ending isolation 1, 5