Ending Isolation and Precautions for People with COVID-19: Interim Guidance

Summary of Recent Changes

Key Points

• People who are infected but asymptomatic or people with mild COVID-19 should isolate through at least day 5 (day 0 is the day symptoms appeared or the date the specimen was collected for the positive test for people who are asymptomatic). They should wear a mask through day 10. A test-based strategy may be used to remove a mask sooner.
• People with moderate or severe COVID-19 should isolate through at least day 10. Those with severe COVID-19 may remain infectious beyond 10 days and may need to extend isolation for up to 20 days.
• People who are moderately or severely immunocompromised should isolate through at least day 20. Use of serial testing and consultation with an infectious disease specialist is recommended in these patients prior to ending isolation.

Recommendation for Ending Isolation

For people who are mildly ill with SARS-COV-2 infection and not moderately or severely immunocompromised:

• Isolation can be discontinued at least 5 days after symptom onset (day 0 is the day symptoms appeared, and day 1 is the next full day thereafter) if fever has resolved for at least 24 hours (without taking fever-reducing medications) and other symptoms are improving.
• Loss of taste and smell may persist for weeks or months after recovery and need not delay the end of isolation​.
• A high-quality mask should be worn around others at home and in public through day 10. A test-based strategy may be used to remove a mask sooner.
• If symptoms recur or worsen, the isolation period should restart at day 0.
• People who cannot wear a mask, including children < 2 years of age and people of any age with certain disabilities, should isolate for 10 days.
• In certain high-risk congregate settings that have high risk of secondary transmission, CDC recommends a 10-day isolation period for residents. Isolation may be shortened to 7 days under certain conditions.

For people who test positive, are asymptomatic (never develop symptoms) and not moderately or severely immunocompromised:

• Isolation can be discontinued at least 5 days after the first positive viral test (day 0 is the date the specimen was collected for the positive test, and day 1 is the next full day thereafter).
• A high-quality mask should be worn around others at home and in public through day 10. A test-based strategy may be used to remove a mask sooner.
• If a person develops symptoms within 10 days of testing positive, their 5-day isolation period should start over (day 0 changes to the first day of symptoms).
• People who cannot wear a mask, including children < 2 years of age and people of any age with certain disabilities, should isolate for 10 days.
• In certain high-risk congregate settings that have high risk of secondary transmission, CDC recommends a 10-day isolation period for residents. Isolation may be shortened to 7 days under certain conditions.

For people who are moderately ill and not moderately or severely immunocompromised:

• Isolation and precautions can be discontinued 10 days after symptom onset (day 0 is the day symptoms appeared, and day 1 is the next full day thereafter).

For people who are severely ill and not moderately or severely immunocompromised:

• Isolation should continue for at least 10 days after symptom onset (day 0 is the day symptoms appeared, and day 1 is the next full day thereafter).
• Some people with severe illness (e.g., requiring hospitalization, intensive care, or ventilation support) may remain infectious beyond 10 days. This may warrant extending the duration of isolation and precautions for up to 20 days after symptom onset (with day 0 being the day symptoms appeared) and after resolution of fever for at least 24 hours (without the taking fever-reducing medications) and improvement of other symptoms.
• Serial testing prior to ending isolation can be considered in consultation with infectious disease experts.

For people who are moderately or severely immunocompromised (regardless of COVID-19 symptoms or severity):

• Moderately or severely immunocompromised patients may remain infectious beyond 20 days. For these people, CDC recommends an isolation period of at least 20 days, and ending isolation in conjunction with serial testing and consultation with an infectious disease specialist to determine the appropriate duration of isolation and precautions.
• The criteria for serial testing to end isolation are:
  • Results are negative from at least two consecutive respiratory specimens collected ≥ 24 hours apart (total of two negative specimens) tested using an antigen test or nucleic acid amplification test.
  • Also, if a moderately or severely immunocompromised patient with COVID-19 was symptomatic, there should be resolution of fever for at least 24 hours (without the taking fever-reducing medication) and improvement of other symptoms. Loss of taste and smell may persist for weeks or months after recovery and need not delay the end of isolation​.
  • Re-testing for SARS-CoV-2 infection is suggested if symptoms worsen or return after ending isolation and precautions.
• If a patient has persistently positive nucleic acid amplification tests beyond 30 days, additional testing could include molecular studies (e.g., genomic sequencing) or viral culture, in consultation with an infectious disease specialist.
• For the purposes of this guidance, moderate to severely immunocompromising conditions include, but might not be limited to, those defined in the interim clinical considerations for people with moderate to severe immunocompromise due to a medical condition or receipt of immunosuppressive medications or treatments.
  • Other factors, such as end-stage renal disease, likely pose a lower degree of immunocompromise, and there might not be a need to follow the recommendations for those with moderate to severe immunocompromise.
  • Ultimately, the degree of immunocompromise for the patient is determined by the treating provider, and preventive actions should be tailored to each patient and situation.

Previous Updates