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

Latest 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 and symptoms are resolving or absent. 1

Core Isolation Duration

• The minimum isolation period is 5 days from symptom onset or positive test date. 1, 2
• Isolation can end after 5 days if fever has been absent for at least 24 hours without using fever-reducing medications, symptoms are resolving or absent, and ideally after a negative rapid antigen test. 1
• Extended isolation up to 10 days is recommended if symptoms persist, fever continues, or antigen testing remains positive. 1
• For complete clearance in healthcare 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, 2

Isolation Setting Requirements

• Patients must be placed in well-ventilated single rooms with restricted activity to minimize contact with others. 1, 2
• If single rooms are unavailable, maintain at least 1 meter (approximately 3 feet) bed distance from others. 1, 2
• Open windows for ventilation in shared areas such as toilets and kitchens. 3
• Clean and disinfect frequently touched household surfaces using 500 mg/L chlorine-containing disinfectant daily. 3, 1

Patient Precautions During Isolation

• Patients must wear a medical mask (N95 preferred, surgical mask acceptable) when in the presence of others, including household members. 1, 2
• Clean hands immediately after coughing, sneezing, or touching potentially contaminated surfaces. 1, 2
• Monitor body temperature and symptoms daily. 1, 2
• Seek immediate medical attention if temperature exceeds 38°C (100.4°F) persistently, breathing worsens or dyspnea develops, or signs of pneumonia appear. 1, 2
• Avoid sharing personal items such as toothbrushes, towels, tableware, and bed linens with others. 3, 1

Caregiver and Household Recommendations

• Caregivers should be healthy individuals without underlying diseases when possible. 1, 2
• Caregivers must wear N95 masks (preferred) or surgical masks (alternative) when in the same room as the patient. 1, 2
• Caregivers should clean and disinfect hands after contact with the patient, before leaving patient's room, before and after eating, and after using the toilet. 3
• Wear disposable gloves when providing oral and respiratory care to patients, handling patient's feces and urine, and cleaning the patient's room. 3
• Caregivers should monitor their own body temperature and symptoms closely. 1, 2
• If a symptomatic case is identified in the household, the entire household must remain at home for 14 days. 3

Testing Considerations

• For symptomatic individuals, a single nucleic acid amplification test (NAAT) is recommended using nasopharyngeal, anterior nasal, mid-turbinate, oropharyngeal swab, saliva, or mouth gargle specimens. 1, 2
• Rapid antigen testing is recommended for symptomatic individuals within 5 days of symptom onset for optimal performance. 1
• A positive antigen test has high specificity and can guide isolation decisions without confirmation. 1
• A negative antigen test in high clinical suspicion cases should be confirmed by NAAT. 1
• Repeat testing is NOT recommended to guide discontinuation of isolation in most circumstances. 1

Common Pitfalls and Caveats

• The 5-day minimum isolation period represents a balance between reducing transmission risk and minimizing societal burden. Research shows that 10-day isolation carries only 0-6.6% risk of releasing infectious individuals but results in 4.8-8.3 days of unnecessary isolation. 4
• Approximately 76% of household contacts test positive within 7 days and 86% within 10 days after index patient's illness onset, supporting the rationale for shortened isolation with appropriate precautions. 5
• 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, 2
• Personalized strategies using repeated testing can achieve similar low transmission risks with shorter prolonged isolations compared to fixed-duration approaches. 4, 6