COVID-19 Isolation Guidelines

Standard Isolation Duration

Isolation can be ended after at least 5 days from symptom onset when fever has been absent for 24 hours without fever-reducing medications, symptoms are resolving, and ideally after a negative rapid antigen test 1
The current evidence-based approach uses a minimum 5-day isolation period from symptom onset or positive test, with specific clinical criteria required before ending isolation 1
Fever-free for at least 24 hours without antipyretics is required before ending isolation 1, 2
Symptoms must be resolving or absent before ending isolation 1
A negative rapid antigen test is ideally required before ending isolation 1
Extended isolation up to 10 days is recommended if symptoms persist, fever continues, or antigen testing remains positive 1, 2

Repeat testing is NOT recommended to guide discontinuation of isolation in most circumstances 1
Rapid antigen testing is preferred for symptomatic individuals within 5 days of symptom onset 1
A positive antigen test has high specificity and can guide isolation decisions without confirmation 1
A negative antigen test in high clinical suspicion cases should be confirmed by NAAT 1

Patients should be placed in well-ventilated single rooms with restricted activity 1
If single rooms are unavailable, maintain at least 1.1 meters (3.5 feet) bed distance from others 1
Patients must wear medical masks (N95 preferred) when in the presence of others, including household members 1
Patients should clean hands immediately after coughing, sneezing, or touching potentially contaminated surfaces 1

For patients with severe COVID-19 or those on immunosuppressive medications, a case-by-case approach is recommended rather than standard criteria 2
For surgical or hospitalized COVID-19 patients, after hospital discharge, confirmed cases should be kept in isolation for at least 2 weeks from the first positive test and until negative RT-PCR test is obtained 3, 4, 5, 6
Some guidelines require two consecutive negative RT-PCR tests with at least 1-day interval for complete clearance, particularly in healthcare or congregate settings 1

Body temperature normal for more than 3 days without fever-reducing medications is required for complete clearance 1, 2
Respiratory symptoms must be significantly improved for complete clearance 1, 2
Two consecutive negative RT-PCR tests with at least one-day sampling interval are required for complete clearance 1, 2

Do not use repeat PCR testing routinely to determine when to end isolation, as patients can show positive RT-PCR tests after 14 days despite no longer being contagious 3, 4, 5, 6, 1
Do not end isolation based solely on symptom resolution without meeting the minimum 5-day criterion 1
Do not apply the same criteria to immunocompromised patients as immunocompetent individuals, as they require longer isolation and potentially test-based strategies 2

Most patients can return to work after meeting the 10-day criterion plus symptom improvement and 24-hour fever resolution 2
Patients meeting these criteria are unlikely to be infectious 2