COVID-19 Isolation Guidelines

Core Isolation Duration and Criteria

• 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, symptoms are resolving or absent, and ideally after a negative rapid antigen test 1
• The minimum isolation period is 5 days from symptom onset, with the option to end isolation if specific clinical criteria are met 1
• Extended isolation up to 10 days is recommended if symptoms persist, fever continues, or antigen testing remains positive 1
• For complete clearance criteria, 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

Isolation Setting Requirements

• Patients should be placed in well-ventilated single rooms with restricted activity to minimize contact with others 1, 2
• If single rooms are unavailable, maintain at least 1.1 meters (approximately 3.5 feet) bed distance from others 1, 2
• Ensure adequate ventilation by opening windows when possible 1

Patient Precautions During Isolation

• Patients should wear a medical mask (N95 preferred) when in the presence of others, including household members 1, 2
• Patients should clean hands immediately after coughing, sneezing, or touching potentially contaminated surfaces 1
• Patients should monitor body temperature and symptoms daily 1, 2
• Patients should seek immediate medical attention if temperature exceeds 38°C (100.4°F) persistently, breathing worsens or dyspnea develops, or signs of pneumonia appear 1, 2

Caregiver and Household Recommendations

• Caregivers should be healthy individuals without underlying diseases when possible 1, 2
• Caregivers must wear N95 masks (preferred) or surgical masks (alternative) when in the same room as the patient 1, 2
• Caregivers should avoid sharing personal items such as toothbrushes, towels, tableware, and bed linens 2
• Caregivers should monitor their own body temperature and symptoms closely 1, 2
• Caregivers should clean and disinfect frequently touched surfaces using 500 mg/L chlorine-containing disinfectant daily 2

Testing Considerations

• For symptomatic individuals, a single NAAT (nucleic acid amplification test) is recommended using nasopharyngeal, anterior nasal, mid-turbinate, oropharyngeal swab, saliva, or mouth gargle specimens 3, 1
• Rapid antigen testing is recommended for symptomatic individuals within 5 days of symptom onset for optimal performance 3
• A positive antigen test has high specificity and can guide isolation decisions without confirmation 3
• A negative antigen test in high clinical suspicion cases should be confirmed by NAAT 3
• Repeat testing is NOT recommended to guide discontinuation of isolation in most circumstances 3

Special Populations

• For surgical or hospitalized COVID-19 patients, after emergency surgery, stable asymptomatic or mild symptomatic patients should be placed in dedicated COVID-19 wards to prevent nosocomial transmission 4
• For nursing home or congregate settings, more stringent criteria may apply, including the requirement for two consecutive negative RT-PCR tests before ending isolation 1, 2

COVID-19 Isolation and Quarantine Guidelines

Isolation Duration and Precautions

• For immunocompromised patients or those with severe COVID-19, a case-by-case approach to isolation duration is recommended, potentially extending beyond 10 days, as suggested by the American Academy of Dermatology 5
• Persons with close contact to someone with COVID-19 should quarantine for 14 days after the last contact, and monitor for symptoms, as recommended by the American Academy of Dermatology 5
• Caregivers should avoid direct contact with patient's secretions, especially respiratory discharges, and clean and disinfect hands after contact with the patient, as advised by Military Medical Research 6
• When seeking medical care, patients should not use public transportation, but instead use a private vehicle or ambulance with windows open, as recommended by Military Medical Research 7

Testing and Quarantine Considerations

• After exposure to someone with COVID-19, individuals should monitor for symptoms and seek testing if symptoms develop, as recommended by Military Medical Research 6 and 7

COVID‑19 Isolation Duration and Return‑to‑Exercise Guidelines

Minimum Isolation Period

• The American College of Cardiology recommends a minimum isolation of 5 days from symptom onset (or from the date of a positive test if asymptomatic) to balance transmission risk with practical adherence. 8
• This 5‑day recommendation aligns with current CDC guidance that weighs community transmission risk against feasibility of compliance. 9

Definition of Day 0

• Day 0 is defined as the day symptoms first appear or, for asymptomatic individuals, the day of the positive COVID‑19 test, not the day preceding these events. 8

Return‑to‑Exercise Guidance for Athletes

• For athletes who are asymptomatic, the American College of Cardiology advises resuming training after 3 days of exercise abstinence during isolation. 9
• Athletes experiencing mild non‑cardiopulmonary symptoms (e.g., fever, chills, fatigue, muscle aches) may return to training once all symptoms have resolved. 9
• Athletes with cardiopulmonary symptoms (e.g., chest pain, shortness of breath, palpitations, lightheadedness) should obtain a cardiac evaluation before restarting intense exercise. 8
• All athletes returning to activity should follow a graded return‑to‑exercise program rather than immediately resuming full‑intensity workouts. 9