For roughly 4 out of 5 of people infected with COVID-19, it will mean a mild to moderate illness that will last from 7 to 10 days, which can be treated in home isolation (see CDC : Home Care For COVID-19 Cases). The remaining 20% will need some amount of hospital care, and of those, roughly 25% may require an ICU bed.
Those who are isolated, and treated, in a hospital environment will be released when medical professionals determine they are no longer contagious and have recovered sufficiently to leave.The vast majority, however, will have to make that call based on guidance released by the WHO, the CDC, ECDC, or some other local health authority. Three weeks ago, in A Wide Range of Guidance On Release Of COVID-19 Patients From Home Isolation, we saw a significant difference of opinion on `how soon', and under what conditions, someone can exit home isolation.
None of these plans are 100% foolproof, as some patients may shed the virus longer than others.But initial studies suggests that most patients shed the virus early in their illness (see Clinical presentation and virological assessment of hospitalized cases of coronavirus disease 2019 in a travel-associated transmission cluster), and while they may still test positive for weeks, are likely non-infectious after about 10 days.
Over the weekend the CDC issued updated interim guidance (see below) on discontinuation of home isolation (both with, and without, testing).
Discontinuation of Isolation for Persons with COVID-19 Not in Healthcare Settings (Interim Guidance)
Related Pages
Ending Home Isolation for Immunocompromised Patients
CDC guidance for COVID-19 may be adapted by state and local health departments to respond to rapidly changing local circumstances.
Summary Page
Who this is for:
Healthcare providers and public health officials managing persons with coronavirus disease 2019 (COVID-19) under isolation who are not in healthcare settings. This includes, but is not limited to, at home, in a hotel or dormitory room, or in group isolation facility.
For Hospitalized Patients, see (Interim Guidance for Discontinuation of Transmission-Based Precautions Among Hospitalized Patients with COVID-19).
Summary of Recent Changes
Updates as of April 4, 2020Revised title to inclusive of all persons who are not in health care settings (LTCF, hospitals, etc)
Additional information for asymptomatic persons with laboratory-confirmed COVID-19 on limiting contact and wearing a face covering after isolation to prevent spread
Limited information is available to characterize the spectrum of clinical illness, transmission efficiency, and the duration of viral shedding for persons with novel coronavirus disease (COVID-19). This guidance is based on available information about COVID-19 and subject to change as additional information becomes available.
For Persons with COVID-19 Under Isolation:
The decision to discontinue isolation should be made in the context of local circumstances. Options now include both 1) a time-since-illness-onset and time-since-recovery (non-test-based) strategy, and 2) test-based strategy.
Time-since-illness-onset and time-since-recovery strategy (non-test-based strategy)*
Persons with COVID-19 who have symptoms and were directed to care for themselves at home may discontinue isolation under the following conditions:
- At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and
- Improvement in respiratory symptoms (e.g., cough, shortness of breath); and,
Test-based strategy (simplified from initial protocol)
- At least 7 days have passed since symptoms first appeared.
Previous recommendations for a test-based strategy remain applicable; however, a test-based strategy is contingent on the availability of ample testing supplies and laboratory capacity as well as convenient access to testing. For jurisdictions that choose to use a test-based strategy, the recommended protocol has been simplified so that only one swab is needed at every sampling.
Persons who have COVID-19 who have symptoms and were directed to care for themselves at home may discontinue isolation under the following conditions:
- Resolution of fever without the use of fever-reducing medications and
- Improvement in respiratory symptoms (e.g., cough, shortness of breath) and
Persons with laboratory-confirmed COVID-19 who have not had any symptoms may discontinue isolation when at least 7 days have passed since the date of their first positive COVID-19 diagnostic test and have had no subsequent illness provided they remain asymptomatic. For 3 days following discontinuation of isolation, these persons should continue to limit contact (stay 6 feet away from others) and limit potential of dispersal of respiratory secretions by wearing a covering for their nose and mouth whenever they are in settings where other people are present. In community settings, this covering may be a barrier mask, such as a bandana, scarf, or cloth mask. The covering does not refer to a medical mask or respirator.
- Negative results of an FDA Emergency Use Authorized molecular assay for COVID-19 from at least two consecutive nasopharyngeal swab specimens collected ≥24 hours apart** (total of two negative specimens). See Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens from Persons Under Investigation (PUIs) for 2019 Novel Coronavirus (2019-nCoV) for specimen collection guidance.
Footnote
*This recommendation will prevent most but may not prevent all instances of secondary spread. The risk of transmission after recovery, is likely substantially less than that during illness.
**All test results should be final before isolation is ended. Testing guidance is based upon limited information and is subject to change as more information becomes available.
