Return to Work After COVID-19

General Guidelines

The Centers for Disease Control and Prevention recommends a symptom-based approach for return to work, requiring at least 10 days to have passed since symptoms first appeared, at least 72 hours since fever resolution without fever-reducing medications, and clinically meaningful improvement in respiratory symptoms 1, 2, 3
For asymptomatic individuals who tested positive, return to work is permitted 10 days after the positive test date, assuming no symptoms developed subsequently 3
The American College of Cardiology is not mentioned in this article, however, the Centers for Disease Control and Prevention allows a shortened isolation period of 5 days minimum from symptom onset or positive test date for asymptomatic cases, with return permitted after being fever-free for 24 hours without medications and showing symptom improvement 1, 2

A test-based approach may be necessary in specific scenarios, particularly for healthcare workers or high-risk settings, requiring two consecutive negative nasopharyngeal or oropharyngeal COVID-19 molecular assays (RT-PCR or NAAT) with specimens collected ≥24 hours apart 2, 3
The Centers for Disease Control and Prevention notes that reliance on nasopharyngeal swabs alone has significant limitations, as viral RNA can be detected long after viable virus is no longer present, and antibody testing is not recommended for determining return to work due to variable performance, false-negatives, and lack of evidence that seropositivity protects against reinfection 2

Severely ill patients or those on immunosuppressive medications require individualized assessment and may need isolation beyond 10 days, with shared decision-making with infectious disease specialists, rheumatologists, or other relevant specialists recommended 1, 4
Workers with persistent respiratory symptoms can return to work but should ideally work in settings where appropriate infection control measures can be maintained 3, 5

Asymptomatic or mild non-cardiopulmonary symptoms require 3 days of exercise abstinence during the isolation period 1
Cardiopulmonary symptoms present require cardiac evaluation before returning to physically demanding work, including ECG, troponin, and echocardiogram 1

Do not apply COVID-19-specific criteria to routine viral illnesses, as the 10-day isolation and 72-hour fever-free requirements are specific to COVID-19, not general upper respiratory infections 6
Do not require negative tests for routine return to work, as this is not part of standard CDC guidance and can unnecessarily prolong work absences 1
Do not count isolation days from test date if symptoms began earlier, always count from symptom onset 1
Do not delay return for isolated loss of smell or taste, as these symptoms may persist for weeks without indicating ongoing infectiousness 1
Do not restart immunosuppressive medications prematurely in patients on such therapies, with the timing balancing disease control needs against COVID-19 severity 3, 5