What are the current COVID-19 isolation recommendations?

Current COVID-19 Isolation Recommendations

Individuals with COVID-19 should isolate for at least 5 days from symptom onset or positive test, and may end isolation when they have been fever-free for 24 hours without fever-reducing medications, symptoms are resolving or absent, and ideally after obtaining a negative rapid antigen test. 1, 2

Minimum Isolation Duration

• The core isolation period is 5 days from symptom onset or the date of the first positive test (if asymptomatic). 1, 2
• Extended isolation up to 10 days is recommended if symptoms persist, fever continues, or antigen testing remains positive. 1, 2, 3
• For most patients, isolation can be discontinued after 10 days from symptom onset if they meet clinical criteria. 3

Specific Criteria to End Isolation

You must meet ALL of the following criteria before ending isolation:

• Fever-free for at least 24 hours without using antipyretics (fever-reducing medications). 1, 2, 3
• Symptoms are resolving or absent. 1, 2
• Ideally, obtain a negative rapid antigen test before ending isolation. 1, 2
• Minimum 5 days have passed since symptom onset or positive test. 1, 2

Testing Strategy for Ending Isolation

• Rapid antigen testing is preferred for determining when to end isolation, NOT PCR testing. 1, 2
• Do NOT use repeat PCR (NAAT) testing to guide discontinuation of isolation - patients can remain PCR-positive for weeks despite no longer being contagious. 2, 3
• A positive antigen test has high specificity and indicates continued isolation is needed. 1, 2
• If antigen testing is unavailable, use the symptom-based criteria alone (5 days minimum plus fever-free 24 hours plus symptom improvement). 2, 3

Isolation Setting Requirements

During the active isolation period:

• Stay in a well-ventilated single room with restricted activity to minimize contact with others. 1, 2
• If single rooms are unavailable, maintain at least 1.1 meters (approximately 3.5 feet) distance from others. 1, 2
• 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

Household and Caregiver Precautions

• Caregivers must wear N95 masks (preferred) or surgical masks when in the same room as the infected person. 1
• Avoid sharing personal items such as toothbrushes, towels, tableware, and bed linens. 1
• Caregivers should monitor their own body temperature and symptoms closely. 1
• Clean and disinfect frequently touched surfaces daily using appropriate disinfectants. 1

Monitoring During Isolation

• Monitor body temperature and symptoms daily. 1
• Seek immediate medical attention if temperature persistently exceeds 38°C (100.4°F), breathing worsens, or signs of pneumonia appear. 1

Special Populations Requiring Modified Criteria

Severely ill patients or those on immunosuppressive medications require individualized, case-by-case determination of isolation duration - the standard 5-10 day criteria do not apply. 2, 3

For healthcare settings or congregate facilities, stricter criteria may apply:

• 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

Critical Pitfalls to Avoid

• Do NOT end isolation based solely on symptom resolution without meeting the minimum 5-day criterion. 2
• Do NOT use PCR testing to determine when to end isolation - PCR can remain positive for weeks after infectiousness has resolved. 2, 3
• Do NOT apply standard criteria to immunocompromised patients - they require longer isolation and potentially test-based strategies. 2

Return to Normal Activities

• Most patients can return to work and normal activities after meeting the 10-day criterion plus symptom improvement and 24-hour fever resolution. 2, 3
• Patients meeting these criteria are unlikely to be infectious. 2, 3
• Current CDC guidance prioritizes sustainable measures that allow return to social, educational, and economic activity while minimizing medically significant illness. 4