What is the recommended quarantine duration for individuals with Coronavirus Disease (COVID-19)?

COVID-19 Isolation Duration

For most individuals with COVID-19, isolation can be discontinued after 5 days from symptom onset (or positive test if asymptomatic), provided they are fever-free for 24 hours without fever-reducing medications and symptoms are improving. 1, 2

Standard Isolation Protocol

The current evidence-based approach for ending isolation follows these criteria:

• Minimum 5-day isolation period starting from symptom onset or date of positive test if asymptomatic 1, 2
• 24 hours fever-free without using antipyretics (fever-reducing medications) 3, 1, 4
• Improvement in respiratory symptoms such as cough and shortness of breath 3, 1
• Isolated loss of smell or taste should not delay ending isolation, as these symptoms may persist for weeks without indicating ongoing infectiousness 2

Extended Isolation for Special Populations

Certain groups require longer isolation periods or individualized assessment:

• Severe COVID-19 cases: A case-by-case approach is recommended, with consideration for extending isolation beyond 10 days 3, 1, 4
• Immunocompromised patients: Those on immunosuppressive medications require individualized determination of isolation duration, potentially extending to 10-14 days or longer 3, 1
• Surgical patients: Should remain isolated for at least 2 weeks from first positive test until negative RT-PCR is obtained 3, 1
• Healthcare workers: May require negative RT-PCR testing before return to work in high-risk settings, with minimum 10-day isolation from symptom onset 1, 4

Test-Based vs. Symptom-Based Strategy

Two approaches exist for ending isolation:

Symptom-based strategy (preferred):

• At least 5 days since symptom onset 1, 2
• Fever resolution for 24 hours without medications 3, 1
• Improvement in other symptoms 3, 1

Test-based strategy (optional):

• Two consecutive negative RT-PCR or NAAT tests collected ≥24 hours apart 3
• All clinical criteria above must still be met 3
• This approach is not routinely recommended and can unnecessarily prolong isolation 2

Important Considerations After Ending Isolation

• Continued precautions: Wear a well-fitting mask around others through day 10 after symptom onset, as some individuals may remain infectious 5
• Return to work: Most patients can return after meeting the 5-day criterion plus symptom improvement and fever resolution 3, 1, 4
• Viral shedding: Research shows that 54% of persons tested positive on antigen tests after 5-9 days of isolation, with declining positivity over time 5
• Household contacts: Should quarantine for 14 days after last contact with the infected person 3

Common Pitfalls to Avoid

• Do not count isolation days from test date if symptoms began earlier—always count from symptom onset 2
• Do not require negative tests for routine isolation discontinuation—this is not part of standard guidance and can unnecessarily prolong isolation 2
• Do not delay ending isolation for persistent loss of smell/taste alone—these symptoms may persist without indicating infectiousness 2
• Do not use fever-reducing medications to meet the fever-free criterion—patients must be naturally fever-free for 24 hours 3, 1, 4

Evidence Quality Note

While earlier guidance (2020-2021) recommended 10-14 day isolation periods 3, the most recent CDC guidance has shortened this to 5 days for most individuals based on accumulating evidence about viral shedding patterns and infectiousness 1, 2. The 10-day recommendation remains relevant for severe cases and immunocompromised patients 1, 4.