COVID-19 Isolation Discontinuation Guidelines

Standard Isolation Discontinuation Criteria

• For most patients with COVID-19, isolation can be discontinued 10 days after symptom onset, provided they have been fever-free for at least 24 hours without the use of antipyretics and other symptoms have improved 1, 2
• Patients should follow CDC guidance on home isolation and discuss with their healthcare providers when they can end home isolation 1, 3

Special Considerations

• For patients with severe COVID-19 or those on immunosuppressive medications, a case-by-case approach to determining the length of isolation is recommended 1, 3

Test-Based vs. Symptom-Based Strategies

• According to WHO recommendations, clinical criteria for hospital discharge include: normal temperature for more than 3 days without fever-reducing medications, significantly relieved respiratory symptoms, substantially improved acute lesions on chest CT, and two consecutive negative RT-PCR tests with at least 1-day interval 4, 5

Home Isolation Considerations

• Patients discharged to home should have appropriate caregivers available at home, ability to isolate from other household members, no household members at high risk for COVID-19 complications, and household members capable of adhering to recommended precautions 4, 5, 6

Return to Work/Normal Activities

• Most patients can return to work after meeting the 10-day criterion plus symptom improvement and 24-hour fever resolution 1, 2
• Patients should be counseled that they are unlikely to be infectious after meeting these criteria 1, 3

COVID-19 Contagious Period and Isolation Guidelines

Viral Clearance and Infectiousness

• Viral shedding in the upper respiratory tract continues beyond 10 days in severe COVID-19 cases 7

Special Populations and Isolation Duration

• Severely ill patients or those on immunosuppressive medications need individualized isolation duration determination, and healthcare workers and high-risk settings may require negative testing before return to work 8, 9, 10, 11
• Surgical COVID-19 patients should remain isolated for at least 2 weeks from first positive test until negative RT-PCR is obtained 8, 9, 10, 11