From the Guidelines
As of 2025, COVID-19 patients should self-isolate for 10 days with mild to moderate disease, or 15–20 days with severe illness to protect others in the community. This recommendation is based on the most recent and highest quality study available, which suggests that symptoms of COVID-19 present 4–5 days following infection with SARS-CoV-2, and it is most contagious in the 2 days before and the 5 days after the onset of symptoms 1.
Key Considerations
- In asymptomatic and mild to moderately symptomatic patients, it is rare for the virus to be cultured beyond 10 days after symptom onset, which underlies both UK and World Health Organization recommendations for self-isolation of 10 days following a positive SARS-CoV-2 PCR test 1.
- In the severely ill or severely immunocompromised patients, infectivity may continue for longer, with the risk of replication-competent virus being approximately 5% at 15 days after symptom onset and extremely rare at 20 days 1.
- PCR positivity does not correlate with secretion of live virus, so is of little or no value in assessing the risk of infectivity in the 3 months after confirmed SARS-CoV-2 infection 1.
Clinical Implications
- Planned interactions with others in the community should not be considered during the period that a patient may be infectious.
- When interactions with others are required during this period, full transmission-based precautions should be undertaken, such as wearing a high-quality mask around others for an additional 5 days after ending isolation.
- For immunocompromised individuals or those with severe illness, longer isolation periods (10 days or more) may be recommended to minimize the risk of transmission.
From the Research
COVID-19 Isolation Recommendations in 2025
There are no specific studies provided that directly address the new recommendations for COVID-19 isolation in the community in 2025. However, based on the available evidence from 2022 and 2023, the following points can be considered:
- The Centers for Disease Control and Prevention (CDC) recommends a strategic approach to minimizing the impact of COVID-19 on health and society, which relies on vaccination and therapeutics to prevent severe illness 2.
- Current priorities for preventing medically significant illness should focus on ensuring that persons understand their risk, take steps to protect themselves and others through vaccines, therapeutics, and nonpharmaceutical interventions when needed, receive testing and wear masks if they have been exposed, and receive testing if they are symptomatic, and isolate for ≥5 days if they are infected 2.
- The use of antiviral agents, such as nirmatrelvir/ritonavir, has been shown to be effective in preventing the severe clinical progress of COVID-19 in vulnerable patients with comorbidities 3, 4.
- Early administration of antiviral treatment is significant in order to prevent the severe progression of COVID-19 in vulnerable patients with comorbidities 4.
Key Considerations
- The risk for medically significant illness increases with age, disability status, and underlying medical conditions, but is considerably reduced by immunity derived from vaccination, previous infection, or both, as well as timely access to effective biomedical prevention measures and treatments 2.
- The effectiveness of antiviral agents against the omicron variant of SARS-CoV-2 must be urgently assessed 5.
- National health authorities should establish policies on the conditions under which antiviral agents can be prescribed, based on the fulfilment of ethical elements such as transparency, relevance, appeals, enforcement, and fairness 5.
Isolation and Treatment
- Isolation for ≥5 days is recommended for individuals who are infected with COVID-19 2.
- Antiviral treatment, such as nirmatrelvir/ritonavir, can be effective in preventing the severe clinical progress of COVID-19 in vulnerable patients with comorbidities 3, 4.
- Early administration of antiviral treatment is significant in order to prevent the severe progression of COVID-19 in vulnerable patients with comorbidities 4.