What are the current Centers for Disease Control and Prevention (CDC) recommendations for self-isolation for patients with Coronavirus Disease 2019 (Covid-19) on room air?

Current CDC Recommendations for Self-Isolation in COVID-19 Patients on Room Air

Patients with COVID-19 on room air should isolate for a minimum of 5 days from symptom onset (or positive test if asymptomatic), and may end isolation when fever has been absent for at least 24 hours without fever-reducing medications, symptoms are resolving or absent, and ideally after a negative rapid antigen test. 1

Minimum Isolation Duration

• The baseline isolation period is 5 days from symptom onset or date of positive test for asymptomatic individuals. 1, 2
• Isolation can end after 5 days only if specific clinical criteria are met (detailed below). 1
• Extended isolation up to 10 days is recommended if symptoms persist, fever continues, or rapid antigen testing remains positive. 1

Criteria for Ending Isolation After 5 Days

To safely end isolation at day 5, all of the following must be met:

• Body temperature has been normal for at least 24 hours without the use of fever-reducing medications (such as acetaminophen or ibuprofen). 1
• Respiratory symptoms are resolving or absent (improving cough, shortness of breath). 1
• Ideally, a negative rapid antigen test result should be obtained before ending isolation, though this is not absolutely required in all circumstances. 1, 3

Isolation Setting Requirements

• Patients should be placed in well-ventilated single rooms with restricted activity to minimize contact with others. 1, 4
• If a single room is unavailable, maintain at least 1.1 meters (approximately 3.5 feet) of bed distance from others. 1, 4
• Ensure adequate ventilation by opening windows when possible. 1

Patient Precautions During Isolation

• Patients must wear a medical mask (N95 preferred, surgical mask acceptable) when in the presence of others, including household members. 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, dyspnea develops, or signs of pneumonia appear. 1, 4

Post-Isolation Masking

• After ending isolation at day 5, patients should continue to wear a well-fitting mask when around others through day 10. 3, 2
• This is critical because persons may remain infectious to others during the 10-day period after infection onset. 3

Role of Antigen Testing in Isolation Decisions

• A positive rapid antigen test after 5-9 days of isolation indicates ongoing potential infectiousness and warrants continued isolation. 3
• Research shows that 54.3% of persons tested positive on antigen testing after 5-9 days, with declining positivity over time. 3
• A negative antigen test has high specificity and can guide safe discontinuation of isolation without confirmatory testing. 1
• Repeat PCR testing is NOT recommended to guide discontinuation of isolation in most circumstances. 1

Common Pitfalls to Avoid

• Do not end isolation at day 5 if fever persists or has resolved for less than 24 hours without medications - this indicates ongoing active infection. 1
• Do not assume isolation can end at day 5 without assessing symptom resolution - worsening or persistent symptoms require extended isolation. 1
• Do not use public transportation when seeking medical care - use a private vehicle with windows open or an ambulance. 1
• Do not discontinue masking after ending isolation - masking through day 10 is essential to prevent transmission. 3, 2

Caregiver and Household Recommendations

• Caregivers should be healthy individuals without underlying diseases when possible. 1, 4
• Caregivers must wear N95 masks (preferred) or surgical masks (alternative) when in the same room as the patient. 1, 4
• 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, 4
• Clean and disinfect frequently touched surfaces using 500 mg/L chlorine-containing disinfectant daily. 1

Special Considerations for Complete Viral Clearance

• For complete clearance criteria (used in some healthcare or congregate settings), isolation requires body temperature normal for more than 3 days, respiratory symptoms significantly improved, and two consecutive negative RT-PCR tests with at least one-day sampling interval. 1, 4
• This more stringent criterion may apply to nursing home residents, healthcare workers, or immunocompromised patients. 1