What are the current COVID-19 (Coronavirus Disease 2019) isolation guidelines?

Current 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 or absent, ideally confirmed by a negative rapid antigen test. 1

Minimum Isolation Duration

• The core isolation period is 5 days minimum from symptom onset or date of positive test for asymptomatic individuals 1, 2
• Isolation can end after 5 days only if all of the following criteria are met:
  • No fever for ≥24 hours without using fever-reducing medications 1, 3
  • Symptoms are resolving or absent 1, 4
  • Ideally, a negative rapid antigen test result 1, 3

Extended Isolation Considerations

• Extend isolation up to 10 days if symptoms persist, fever continues, or antigen testing remains positive 1
• After the Omicron variant, research shows that 13.5% of patients continue viral shedding at day 10, and 11% of symptom-free cases remain culture-positive 5
• For complete viral clearance (primarily relevant for healthcare or high-risk settings), isolation requires body temperature normal for >3 days, respiratory symptoms significantly improved, and two consecutive negative RT-PCR tests with ≥1-day sampling interval 1, 2

Post-Isolation Precautions

• Wear a well-fitting mask around others through day 10 after infection onset, even if isolation ends at day 5 3, 4
• This masking recommendation applies to all settings where exposure to others occurs 4

Isolation Environment Requirements

• Isolate in a well-ventilated single room with restricted activity 1, 2, 6
• If single rooms unavailable, maintain ≥1.1 meters (3.5 feet) bed distance from others 1, 2
• Open windows for ventilation in shared spaces like bathrooms and kitchens 1, 6
• Clean and disinfect frequently touched surfaces daily using 500 mg/L chlorine-containing disinfectant 1, 6

Patient Precautions During Isolation

• Wear a medical mask (N95 preferred, surgical mask acceptable) when in the presence of others, including household members 1, 2, 6
• Clean hands immediately after coughing, sneezing, or touching potentially contaminated surfaces 1, 6
• Avoid sharing personal items: toothbrushes, towels, tableware, bed linens 1
• Monitor body temperature and symptoms daily 1, 2, 6

When to Seek Medical Attention

• Temperature persistently exceeds 38°C (100.4°F) 1, 6
• Breathing worsens or dyspnea develops 1, 2
• Signs of pneumonia appear (new chest pain, severe shortness of breath, confusion) 1

Caregiver and Household Recommendations

• Caregivers should be healthy individuals without underlying diseases when possible 1, 2, 6
• Caregivers must wear N95 masks (preferred) or surgical masks (alternative) when in the same room as the patient 1, 2, 6
• Avoid direct contact with patient's secretions, especially respiratory discharges 1
• Clean and disinfect hands after any contact with the patient or their environment 1
• Caregivers should monitor their own temperature and symptoms closely 1, 2

Role of Rapid Antigen Testing

• Rapid antigen tests can guide isolation decisions and may allow earlier safe discontinuation of isolation 1, 3, 7
• A negative antigen test after day 5 supports ending isolation if other criteria are met 1, 3
• After 5-9 days of isolation, 54.3% of individuals still test positive on rapid antigen tests, with declining positivity over time 3
• Positive antigen tests correlate with detection of viable virus and potential infectiousness 3, 7
• Do NOT use repeat testing to guide isolation discontinuation in routine circumstances—clinical criteria (fever resolution, symptom improvement) are primary 1

Special Populations

• Immunocompromised patients or those with severe COVID-19 may require case-by-case assessment with isolation potentially extending beyond 10 days 1
• Healthcare workers caring for high-risk patients should consider extending isolation to ≥10 days regardless of symptom resolution 5
• For nursing homes or congregate settings, more stringent criteria may apply, including requirement for two consecutive negative RT-PCR tests 1

Transportation to Medical Care

• Avoid public transportation—use private vehicle or ambulance with windows open for ventilation 1, 6
• Inform the healthcare facility in advance when possible 8
• Maintain ≥1 meter distance from others when walking or waiting 8

Common Pitfalls to Avoid

• Do not end isolation based solely on time if fever persists or symptoms are worsening 1
• Do not rely on PCR testing to determine end of isolation—PCR can remain positive long after infectiousness has resolved 9, 5
• Do not assume symptom resolution equals non-infectiousness—11% of symptom-free cases at day 10 still had viable virus 5
• Remember that the 5-day minimum is just that—a minimum, not an automatic endpoint 1, 4