What are the updated COVID-19 isolation guidelines and treatment options?

Updated 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, ideally confirmed by a negative rapid antigen test. 1

Core Isolation Duration

• The minimum isolation period is 5 days from symptom onset or positive test date, whichever comes first 1, 2

• Isolation can end after 5 days if:

  • Fever has been absent for at least 24 hours without using fever-reducing medications 1, 3
  • Symptoms are resolving or absent 1, 3
  • Ideally, a negative rapid antigen test is obtained 1, 4

• Extended isolation up to 10 days is recommended if:

  • Symptoms persist or worsen 1
  • Fever continues 1
  • Antigen testing remains positive 1, 4

• For immunocompromised patients or those with severe COVID-19, a case-by-case approach to isolation duration is recommended, potentially extending beyond 10 days 3

Post-Isolation Precautions

• Wear a well-fitting mask around others through day 10 after symptom onset, even if isolation ends after 5 days 4, 2
• Avoid contact with high-risk individuals during this extended precautionary period 2

Home Isolation Requirements

Environmental Setup:

• Isolate in a well-ventilated single room with restricted activity 1, 5
• If a single room is unavailable, maintain at least 1 meter (approximately 3.5 feet) bed distance from others 1, 5
• Open windows for ventilation in shared areas such as bathrooms and kitchens 1
• Clean and disinfect frequently touched surfaces using 500 mg/L chlorine-containing disinfectant daily 1, 5

Patient Precautions:

• Wear a medical mask (N95 preferred, surgical mask acceptable) when in the presence of others 1, 5
• Clean hands immediately after coughing, sneezing, or touching potentially contaminated surfaces 1, 5
• Avoid sharing personal items including toothbrushes, towels, tableware, and bed linens 1
• Monitor body temperature and symptoms daily 1, 5

When to Seek Medical Attention

Seek immediate medical care if:

• Temperature persistently exceeds 38°C (100.4°F) 1, 5
• Breathing worsens or dyspnea develops 1, 5
• Signs of pneumonia appear (new chest pain, severe shortness of breath, confusion) 1

Caregiver Guidelines

• Caregivers should ideally be healthy individuals without underlying diseases 1, 5
• Wear N95 masks (preferred) or surgical masks (alternative) when in the same room as the patient 1, 5
• Avoid direct contact with patient's secretions, especially respiratory discharges 3
• Clean and disinfect hands after contact with the patient, before leaving the patient's room, before and after eating, and after using the toilet 3
• Monitor own body temperature and symptoms closely 5

Testing Considerations

For Diagnosis:

• A single nucleic acid amplification test (NAAT) using nasopharyngeal, anterior nasal, mid-turbinate, or saliva specimens is recommended for symptomatic individuals 1, 5
• Rapid antigen testing is recommended for symptomatic individuals within 5 days of symptom onset for optimal performance 1

For Ending Isolation:

• A positive antigen test has high specificity and indicates ongoing potential infectiousness 1
• A negative antigen test can support ending isolation after day 5 if other criteria are met 1, 4
• Repeat testing is NOT routinely recommended to guide discontinuation of isolation in most circumstances 1
• Research shows that after 5-9 days of isolation, 54.3% of persons still had positive antigen tests, with declining positivity over time 4

Special Populations

Immunocompromised or Severe Cases:

• Use a case-by-case approach for determining isolation length 3, 1
• May require extended isolation beyond 10 days 3
• Consider requiring two consecutive negative RT-PCR tests at least 24 hours apart before ending isolation 1, 5

Healthcare and Congregate Settings:

• More stringent criteria may apply, including requirement for negative testing before ending isolation 1
• After emergency surgery, stable COVID-19 patients should be placed in dedicated COVID-19 wards 1

Close Contact Quarantine

• Persons with close contact to someone with COVID-19 should quarantine for 14 days after the last contact 3
• Monitor for symptoms and seek testing if symptoms develop 3

Common Pitfalls to Avoid

• Do not end isolation based solely on time if fever persists or symptoms are worsening 1
• Do not use public transportation when seeking medical care; use private vehicle or ambulance with windows open 3
• Do not routinely perform repeat PCR testing to clear isolation in immunocompetent patients, as viral RNA can persist long after infectiousness ends 1
• Do not assume isolation can end at 5 days without meeting all criteria (fever resolution, symptom improvement, ideally negative antigen test) 1, 2