Recommendations

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1. Duration of isolation and precautions

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• For most persons with COVID-19 illness, isolation and precautions can generally be discontinued 10 days after symptom onset1 and resolution of fever for at least 24 hours, without the use of fever-reducing medications, and with improvement of other symptoms.

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• A limited number of persons with severe illness may produce replication-competent virus beyond 10 days that may warrant extending duration of isolation and precautions for up to 20 days after symptom onset; consider consultation with infection control experts.

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• For persons who never develop symptoms, isolation and other precautions can be discontinued 10 days after the date of their first positive RT-PCR test for SARS-CoV-2 RNA.

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2. Role of PCR testing after discontinuation of isolation or precautions

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• For persons previously diagnosed with symptomatic COVID-19 who remain asymptomatic after recovery, retesting is not recommended within 3 months after the date of symptom onset for the initial COVID-19 infection. In addition,  quarantine is not recommended in the event of close contact with an infected person.

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• For persons who develop new symptoms consistent with COVID-19 during the 3 months after the date of initial symptom onset, if an alternative etiology cannot be identified by a provider, then the person may warrant retesting; consultation with infectious disease or infection control experts is recommended. Quarantine may be considered during this evaluation based on consultation with an infection control expert, especially in the event symptoms develop within 14 days after close contact with an infected person.

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• For persons who never developed symptoms, the date of first positive RT-PCR test for SARS-CoV-2 RNA should be used in place of the date of symptom onset.

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3. Role of serologic testing

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• Serologic testing should not be used to establish the presence or absence of SARS-CoV-2 infection or reinfection.

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Summary of Changes to the Guidance

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Except for rare situations, a test-based strategy is no longer recommended to determine when to discontinue Transmission-Based Precautions.

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For patients with severe to critical illness or who are severely immunocompromised 1, the recommended duration for Transmission-Based Precautions was extended to 20 days after symptom onset (or, for asymptomatic severely immunocompromised 1 patients, 20 days after their initial positive SARS-CoV-2 diagnostic test).

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Other symptom-based criteria were modified as follows:

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• Changed from “at least 72 hours” to “at least 24 hours” have passed since last fever without the use of fever-reducing medications.

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• Changed from “improvement in respiratory symptoms” to “improvement in symptoms” to address expanding list of symptoms associated with COVID-19.

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Here are the studies, if you would like to read the evidence behind the CDC’s decisions:

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https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-hospitalized-patients.html#definitions

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COVID-19 Illness Severity Criteria

Mild Illness: Individuals who have any of the various signs and symptoms of COVID-19 (e.g., fever, cough, sore throat, malaise, headache, muscle pain) without shortness of breath, dyspnea, or abnormal chest imaging. (10 days of isolation from when symptoms began and no fever for 24 hours without use of fever reducing medication, unless severely immunocompromised)

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Moderate Illness:

Individuals who have evidence of lower respiratory disease by clinical assessment or imaging, and a saturation of oxygen (SpO2) ≥94% on room air at sea level. (10 days of isolation from when symptoms began and no fever for 24 hours without use of fever reducing medication, unless severely immunocompromised)

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Severe Illness: Individuals who have respiratory frequency >30 breaths per minute, SpO2 <94% on room air at sea level (or, for patients with chronic hypoxemia, a decrease from baseline of >3%), ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2) <300 mmHg, or lung infiltrates >50%. (20 days of isolation from when symptoms began)

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Critical Illness: Individuals who have respiratory failure, septic shock, and/or multiple organ dysfunction. (20 days of isolation from when symptoms began)