Discontinuing Home Isolation for Persons with COVID-19

The CDC has laid out revised recommendations regarding when and how employees may return to work following testing positive for Covid-19.  The approach is for ending isolation and precautions for persons with COVID-19 using a symptom-based strategy. Researchers have reported that people with mild to moderate COVID-19 symptoms remain infectious no longer than 10 days after their symptoms began, and those with more severe illness or those who are severely immunocompromised remain infectious no longer than 20 days after their symptoms began. Therefore, CDC has updated the recommendations for discontinuing home isolation as follows:

For persons with COVID-19 who have symptoms and were directed to care for themselves at home may discontinue isolation under the following conditions:

  1. At least 10 days have passed since symptom onset and;
  2. At least 24 hours have passed since the resolution of fever without the use of fever-reducing medications and;
  3. Other symptoms have improved

Persons infected but who never develop COVID-19 symptoms may discontinue isolation and other precautions 10 days after the date of their first positive test for SARS-CoV-2 RNA.

Role of Testing for Discontinuing Isolation or Precautions

Testing as a basis for discontinuing isolation could be considered for persons who are severely immunocompromised, in consultation with infectious disease experts. For all others, a test-based strategy is no longer recommended except to discontinue isolation or other precautions earlier than would occur under the symptom-based strategy outlined above.

If testing is used to release someone from quarantine at least two consecutive specimens collected 24 hours apart (total of two negative specimens).  All test results should be final before isolation is ended.

Other Considerations

The CDC acknowledges that its newest recommendations for discontinuing isolation in persons known to be infected with Covid-19 could, in some circumstances, appear to conflict with recommendations on when to discontinue quarantine for persons known to have been exposed to Covid-19. The CDC continues to recommend 14 days of quarantine after possible exposure. This recommendation is based upon the time it takes to develop illness if infected. Thus, it is possible that a person known to be infected could leave isolation earlier than a person who is quarantined because of the possibility they are infected.

Finally, the best available evidence suggests that recovered persons can continue to shed detectable SARS-CoV-2 RNA in upper respiratory specimens for up to 3 months after illness onset, albeit at concentrations considerably lower than during illness, in ranges where replication-competent virus has not been reliably recovered and infectiousness is unlikely.  Studies have not found evidence that clinically recovered persons with the persistence of viral RNA have transmitted SARS-CoV-2 to others.