What is the latest recommendation for Covid-19 isolation?

COVID-19 Isolation Guidelines

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

Minimum Isolation Duration

• All patients must complete at least 5 full days of isolation before considering ending isolation, regardless of how quickly symptoms resolve. 2
• The 5-day minimum begins from symptom onset for symptomatic individuals or from the date of the first positive test for asymptomatic individuals. 1, 2

Three Required Criteria to End Isolation After Day 5

To discontinue isolation after the minimum 5-day period, all three of the following criteria must be met:

1. Fever-free for at least 24 hours without using antipyretic medications 1, 2
2. Symptoms are resolving or absent 1, 2
3. Ideally, obtain a negative rapid antigen test 1, 2

Extended Isolation (Days 6-10)

• If symptoms persist, fever continues, or antigen testing remains positive, extend isolation up to 10 days from symptom onset. 1
• For most patients with standard COVID-19, isolation can be discontinued at 10 days after symptom onset if they have been fever-free for at least 24 hours without antipyretics and other symptoms have improved. 3
• Research demonstrates that after 5-9 days of isolation, 54.3% of individuals still tested positive on rapid antigen tests, with declining positivity over time, supporting the rationale for extended isolation when tests remain positive. 4

Testing Strategy for Isolation Decisions

• Antigen testing is strongly preferred over PCR testing to guide isolation decisions, as PCR can remain positive for weeks after a patient is no longer contagious. 2
• A positive antigen test means the patient should continue isolation, while a negative antigen test can be used to determine when to end isolation. 2
• For optimal performance, antigen tests should be performed within 5 days of symptom onset. 5
• A single antigen test has high specificity; a positive result can guide isolation decisions without confirmation by PCR. 5, 1
• Repeat testing is NOT recommended to guide discontinuation of isolation in most circumstances. 1

Special Populations Requiring Modified Criteria

Immunocompromised or Severely Ill Patients

• Immunocompromised patients and those with severe COVID-19 require a case-by-case approach to isolation duration, potentially extending beyond 10 days. 3, 1, 2
• For patients on immunosuppressive medications, individualized isolation duration determination is necessary. 3, 1
• Surgical COVID-19 patients should remain isolated for at least 2 weeks from first positive test until a negative RT-PCR is obtained. 3, 2

Healthcare Workers and High-Risk Settings

• Healthcare workers and those in high-risk settings may require negative testing before return to work. 3
• In congregate settings (nursing homes, correctional facilities), more stringent criteria may apply, including the requirement for two consecutive negative RT-PCR tests before ending isolation. 1

Isolation Environment Requirements

• Patients should be placed in well-ventilated single rooms with restricted activity to minimize contact with others. 1
• If single rooms are unavailable, maintain at least 1.1 meters (approximately 3.5 feet) bed distance from others. 1
• Ensure adequate ventilation by opening windows when possible. 1

Patient Precautions During Isolation

• Patients should wear a medical mask (N95 preferred) when in the presence of others, including household members. 1, 2
• Patients should clean hands immediately after coughing, sneezing, or touching potentially contaminated surfaces. 1
• Patients should monitor body temperature and symptoms daily. 1
• Seek immediate medical attention if temperature exceeds 38°C (100.4°F) persistently, breathing worsens, or signs of pneumonia appear. 1

Caregiver and Household Recommendations

• Caregivers should be healthy individuals without underlying diseases when possible. 1
• Caregivers must wear N95 masks (preferred) or surgical masks (alternative) when in the same room as the patient. 1
• Caregivers should 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 using 500 mg/L chlorine-containing disinfectant daily. 1

Return to Normal Activities

• Most patients can return to work after meeting the 10-day criterion plus symptom improvement and 24-hour fever resolution. 3, 2
• Patients should be counseled that they are unlikely to be infectious after meeting these criteria. 3, 2
• Athletes with mild, non-cardiopulmonary symptoms may resume training after symptom resolution, but those with cardiopulmonary symptoms should obtain cardiac evaluation before resuming exercise. 2

Common Pitfalls to Avoid

• Never end isolation before completing 5 full days, even if symptoms resolve quickly. 2
• Do not rely on PCR testing to determine when to end isolation, as it can remain positive long after infectiousness has resolved. 2
• Do not assume asymptomatic individuals can end isolation early without meeting all three criteria. 1, 2
• For immunocompromised patients, do not apply standard 5-day criteria without medical consultation. 2