What are the guidelines for Covid-19 isolation and treatment?

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

Minimum Isolation Duration

• The core isolation period is 5 days from symptom onset or date of positive test for asymptomatic individuals 1
• Isolation can end after 5 days if three conditions are met: (1) no fever for ≥24 hours without antipyretics, (2) symptoms are improving or absent, and (3) ideally a negative rapid antigen test 1
• Extended isolation up to 10 days is recommended if symptoms persist, fever continues, or rapid antigen testing remains positive 1, 2

Optimal Discharge Criteria (Most Stringent)

For complete viral clearance and minimal transmission risk, the following criteria should all be met 3, 1:

• Body temperature normal for more than 3 days without fever-reducing medications 3, 1
• Respiratory symptoms significantly improved 3, 1
• Two consecutive negative RT-PCR tests with at least one-day sampling interval 3, 1

Important caveat: This stringent approach is primarily used in hospital settings or high-risk congregate facilities (nursing homes), not routine community isolation 1, 2

Isolation Setting Requirements

• Place patients in well-ventilated single rooms with restricted activity to minimize contact with others 1, 4
• If single rooms are unavailable, maintain at least 1.1 meters (approximately 3.5 feet) distance between beds 1, 4
• Open windows when possible to ensure adequate ventilation 1

Patient Precautions During Isolation

• Wear an N95 mask (preferred) or surgical mask (alternative) when in the presence of others, including household members 3, 1, 4
• Clean hands immediately after coughing, sneezing, or touching potentially contaminated surfaces 1, 4
• Monitor body temperature and symptoms daily 1, 4
• Seek immediate medical attention if: temperature exceeds 38°C (100.4°F) persistently, breathing worsens or dyspnea develops, or signs of pneumonia appear 1, 4

Caregiver and Household Recommendations

• Caregivers should ideally be healthy individuals without underlying diseases 1, 4
• Caregivers must wear N95 masks (preferred) or surgical masks (alternative) when in the same room as the patient 1, 4
• Avoid sharing personal items such as toothbrushes, towels, tableware, and bed linens 1
• Caregivers should monitor their own body temperature and symptoms closely 3, 1
• Clean and disinfect frequently touched surfaces using 500 mg/L chlorine-containing disinfectant daily 1

Testing Strategy for Ending Isolation

Rapid antigen testing is the preferred method for determining when to end isolation 1, 5:

• A negative rapid antigen test after day 5 supports ending isolation if other criteria are met 1
• Antigen tests correlate well with infectiousness and viable virus detection 5
• After 5-9 days of isolation, approximately 54% of individuals still test positive on rapid antigen tests, with declining positivity over time 5
• A positive antigen test has high specificity and indicates continued potential for transmission 1
• Repeat RT-PCR testing is NOT recommended for routine isolation discontinuation decisions in most circumstances 1

Common pitfall: RT-PCR can remain positive for weeks to months after infectiousness has resolved due to detection of non-viable viral RNA 6, 7. Do not use RT-PCR to determine when to end isolation in routine cases.

Special Populations Requiring Extended Isolation

Immunocompromised patients and those with severe COVID-19 require individualized assessment and potentially longer isolation 3, 2:

• Immunocompromised patients may shed viable virus for prolonged periods (up to 20+ days or longer) 3, 6
• Isolation should extend to at least 20 days following symptom onset in immunocompromised individuals 3
• Healthcare workers and those in high-risk settings may require negative testing before return to work 2
• Surgical COVID-19 patients should remain isolated for at least 2 weeks until negative RT-PCR is obtained 2

Critical consideration: Even immunocompetent patients can occasionally shed infectious virus for extended periods (documented up to 128 days in research settings), though this is uncommon 6

Post-Isolation Precautions

• Wear a well-fitting mask around others through day 10 after symptom onset, even if isolation ends after day 5 5, 8
• Avoid contact with high-risk individuals during days 6-10 when possible 8
• Continue monitoring for symptom recurrence 8

Close Contact Quarantine

• Persons with close contact to someone with COVID-19 should quarantine for 14 days after the last contact 3, 1
• Monitor for symptoms throughout the quarantine period 3, 1
• Seek testing if symptoms develop 1
• When seeking medical care, do not use public transportation; use a private vehicle or ambulance with windows open 3, 1

Transportation to Medical Care

If medical evaluation is needed during isolation 3, 1:

• Avoid public transportation entirely 3, 1
• Use ambulance or private vehicle with windows open for ventilation 3, 1
• Patient must wear N95 mask (preferred) or surgical mask during transport 3, 1
• Maintain at least 1 meter distance from others when walking or waiting 3
• Disinfect vehicle afterward with 500 mg/L chlorine-containing disinfectant 3