Recommendations to End Isolation in COVID-19
Isolation can be ended after at least 5 days from symptom onset when fever has been absent for 24 hours without fever-reducing medications, symptoms are resolving, and ideally after a negative rapid antigen test. 1
Standard Isolation Duration
The current evidence-based approach uses a minimum 5-day isolation period from symptom onset or positive test, with specific clinical criteria required before ending isolation 1:
- Fever-free for at least 24 hours without antipyretics 1, 2
- Symptoms resolving or absent 1
- Negative rapid antigen test (ideally, though not absolutely required) 1
Extended isolation up to 10 days is recommended if symptoms persist, fever continues, or antigen testing remains positive 1, 2. The 10-day criterion provides a low risk (0-6.6%) of releasing an infectious individual, though it may result in 4.8-8.3 days of unnecessary isolation 3.
Testing Strategy for Ending Isolation
Repeat testing is NOT recommended to guide discontinuation of isolation in most circumstances 1. However, when testing is used:
- Rapid antigen testing is preferred for symptomatic individuals within 5 days of symptom onset 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
The personalized testing approach can achieve similar low transmission risks with shorter unnecessary isolation periods compared to fixed-duration strategies 3.
Isolation Setting Requirements During Active Isolation
Patients should be placed in well-ventilated single rooms with restricted activity 1. If single rooms are unavailable, maintain at least 1.1 meters (3.5 feet) bed distance from others 1.
Patients must wear medical masks (N95 preferred) when in the presence of others, including household members 1. They should clean hands immediately after coughing, sneezing, or touching potentially contaminated surfaces 1.
Special Populations Requiring Modified Criteria
Immunocompromised Patients
For patients with severe COVID-19 or those on immunosuppressive medications, a case-by-case approach is recommended rather than standard criteria 2, 4. These patients are at higher risk of prolonged viral shedding and may require consultation with infectious disease specialists 4.
Hospitalized or Surgical Patients
For surgical or hospitalized COVID-19 patients, after hospital discharge, confirmed cases should be kept in isolation for at least 2 weeks from the first positive test and until negative RT-PCR test is obtained 5. This more stringent criterion reflects the higher risk of nosocomial transmission 5.
Some guidelines require two consecutive negative RT-PCR tests with at least 1-day interval for complete clearance, particularly in healthcare or congregate settings 1.
Complete Clearance Criteria (Stricter Standard)
For situations requiring absolute confirmation of viral clearance (nursing homes, healthcare workers, immunocompromised contacts):
- Body temperature normal for more than 3 days without fever-reducing medications 1, 2
- Respiratory symptoms significantly improved 1, 2
- Two consecutive negative RT-PCR tests with at least one-day sampling interval 1, 2
Common Pitfalls to Avoid
Do not use repeat PCR testing routinely to determine when to end isolation, as patients can show positive RT-PCR tests after 14 days despite no longer being contagious 5, 1. The RT-PCR test detects viral RNA fragments that may persist long after infectious virus has cleared 5.
Do not end isolation based solely on symptom resolution without meeting the minimum 5-day criterion 1. Viral shedding can occur even as symptoms improve.
Do not apply the same criteria to immunocompromised patients as immunocompetent individuals, as they require longer isolation and potentially test-based strategies 2, 4.
Return to Normal Activities
Most patients can return to work after meeting the 10-day criterion plus symptom improvement and 24-hour fever resolution 2. Patients meeting these criteria are unlikely to be infectious 2.
For the 5-day strategy, patients should continue to wear masks around others through day 10 and avoid high-risk individuals 6.