What are the Centers for Disease Control and Prevention (CDC) guidelines for returning to school after testing positive for Coronavirus disease (Covid-19)?

CDC Recommendations for School Return After COVID-19

Students who test positive for COVID-19 should stay out of school for at least 5 days from symptom onset or positive test date, and may return after being fever-free for 24 hours without fever-reducing medications and showing symptom improvement. 1, 2

Standard Isolation Period

The CDC guidelines stipulate the following criteria for ending isolation and returning to school:

• Minimum 5-day isolation period from symptom onset or date of positive test if asymptomatic 1
• Fever-free for at least 24 hours without use of antipyretics 2, 3
• Improvement in other symptoms (such as cough, shortness of breath) 1

Important Considerations for School Return

Asymptomatic Students

• Students who test positive but remain asymptomatic can return after 5 days of isolation, provided they remain symptom-free 1

Symptomatic Students

• The 5-day count begins from symptom onset, not test date 1
• Students must demonstrate clinical improvement before returning 1
• Isolated loss of smell or taste should not delay return to school 1

Post-Isolation Precautions (Days 6-10)

After the 5-day isolation period, students returning to school should consider:

• Wearing a well-fitting mask when around others for days 6-10 3
• Avoiding close contact with high-risk individuals during this period 3

Special Populations Requiring Extended Isolation

Severely ill students or those on immunosuppressive medications require individualized assessment and may need isolation beyond 10 days 2

The standard 10-day isolation period (rather than 5 days) should be considered for:

• Students with severe COVID-19 illness 2
• Immunocompromised students 2
• Students requiring hospitalization 2

Testing-Based vs. Symptom-Based Strategy

Symptom-Based Strategy (Recommended for Most)

The CDC primarily recommends a symptom-based approach rather than requiring negative tests for school return 1. This approach is more practical and reflects the low likelihood of transmission after meeting time and symptom criteria 1.

Test-Based Strategy (Optional)

While not required by CDC for routine school return, a test-based strategy may be used in specific circumstances:

• Two consecutive negative PCR or NAAT tests collected ≥24 hours apart 1
• All clinical parameters (fever resolution, symptom improvement) must still be met 1

Return to Physical Education and Sports

For students returning to athletic activities after COVID-19, additional considerations apply:

Asymptomatic or Mild Non-Cardiopulmonary Symptoms

• 3 days of exercise abstinence during the isolation period is recommended 1
• May resume training after symptom resolution and completion of isolation 1

Cardiopulmonary Symptoms

Students with chest pain, shortness of breath, palpitations, or lightheadedness require:

• Cardiac evaluation before returning to sports (ECG, troponin, echocardiogram) 1
• Exercise abstinence until symptoms resolve and cardiac testing is completed 1
• Gradual return-to-play protocol after clearance 1

Common Pitfalls to Avoid

• Do not require negative tests for routine school return - this is not part of CDC guidance and can unnecessarily prolong absences 1, 3
• Do not count isolation days from test date if symptoms began earlier - always count from symptom onset 1
• Do not delay return for isolated loss of smell/taste - these symptoms may persist for weeks without indicating ongoing infectiousness 1
• Do not exclude students with non-specific symptoms (nasal congestion, sore throat) without exposure history or positive test, as this leads to excessive missed school days 4

Exposure Management (Close Contacts)

Students exposed to COVID-19 but not infected:

• No longer require routine quarantine if asymptomatic 3
• Should monitor for symptoms and test if symptoms develop 3
• May benefit from wearing masks for 10 days after exposure 3