What are the latest Centers for Disease Control and Prevention (CDC) guidelines for managing a positive COVID-19 test result?

Latest CDC Guidelines for COVID-19 Positive Test

If you test positive for COVID-19, isolate for at least 5 days from symptom onset or positive test date, and you can end isolation only when you are fever-free for 24 hours without fever-reducing medications AND your symptoms are resolving, ideally with a negative rapid antigen test. 1, 2

Isolation Duration and Exit Criteria

Minimum 5-Day Isolation Period:

• Count day 0 as the first day of symptoms or your positive test date (if asymptomatic) 1, 2
• You must complete at least 5 full days of isolation before considering ending isolation 1, 2
• Never end isolation before day 5, regardless of how quickly symptoms resolve 2

Three Required Criteria to End Isolation After Day 5:

1. Fever-free for at least 24 hours without using antipyretic medications (Tylenol, ibuprofen, etc.) 1, 2
2. Symptoms are resolving or absent (not just stable, but actually improving) 1, 2
3. Ideally, obtain a negative rapid antigen test before ending isolation 1, 2

Extended Isolation (Up to 10 Days):

• If symptoms persist beyond day 5, continue isolation up to day 10 1, 2
• If fever continues, extend isolation until fever-free for 24 hours 1, 2
• If antigen testing remains positive, extend isolation 1, 2

Testing Strategy

Antigen Testing is Preferred:

• Use rapid antigen tests (not PCR) to guide isolation decisions 2, 3
• A positive antigen test means you should continue isolation 3
• Do NOT use repeat PCR testing to determine when to end isolation—PCR can remain positive for weeks after you're no longer contagious 1, 2

Common Pitfall: Patients can show positive RT-PCR tests after 14 days despite no longer being infectious, so never use PCR results to extend isolation unnecessarily 1, 2

Isolation Requirements During Active Infection

Physical Isolation:

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

Masking:

• Wear a medical mask (N95 preferred) whenever in the presence of others, including household members 1, 2
• Continue masking through day 10 even if you end isolation after day 5 4

Hand Hygiene:

• Clean hands immediately after coughing, sneezing, or touching potentially contaminated surfaces 2

Special Populations Requiring Modified Criteria

Immunocompromised Patients:

• Do NOT apply standard 5-day criteria to immunocompromised individuals 1, 2
• These patients require longer isolation periods and potentially test-based strategies 1, 2
• Use a case-by-case approach rather than standard criteria 1, 2

Severe COVID-19 or Immunosuppressive Medications:

• Individualized assessment required rather than standard 5-day criteria 1, 2
• May require isolation for at least 2 weeks from first positive test 1, 2

Hospitalized Patients:

• After discharge, maintain isolation for at least 2 weeks from first positive test until negative RT-PCR obtained 1, 2

Return to Normal Activities

Work and Social Activities:

• Most patients can return to work after meeting the 10-day criterion plus symptom improvement and 24-hour fever resolution 1, 2
• Patients meeting these criteria are unlikely to be infectious 1, 2
• Continue wearing a well-fitting mask around others through day 10 4

Athletes and Exercise:

• Athletes with mild, non-cardiopulmonary symptoms may resume training after symptom resolution 5
• If you have cardiopulmonary symptoms (chest pain, shortness of breath, palpitations, lightheadedness), obtain cardiac evaluation before resuming exercise 5
• Abstain from exercise during the isolation period 5

Critical Pitfalls to Avoid

• Never end isolation before day 5 regardless of symptom resolution 2
• Never use PCR testing to determine when to end isolation—use antigen tests instead 1, 2
• Never apply standard criteria to immunocompromised patients without individualized assessment 1, 2
• Never stop isolation based solely on symptom resolution without meeting the minimum 5-day criterion 1
• Never assume you're not contagious just because symptoms improved—you must meet ALL three exit criteria 1, 2