Official guidance for managing a COVID-19 infection has changed significantly as the virus has evolved and population immunity levels have risen. These recommendations are designed to reduce the spread of respiratory viruses in the community by shifting the focus from a fixed isolation period to one based on the progression of symptoms. Understanding the current guidelines for both confirmed cases and those who have been exposed is important for public health. This article breaks down the current approach to staying home when sick with COVID-19 and the necessary precautions afterward.
Isolation Rules for Positive Cases
When an individual tests positive for COVID-19, current guidance recommends staying home and avoiding others until symptoms have improved. This period is often referred to as isolation, and the rules have been aligned with those for other common respiratory illnesses like the flu. The primary goal of this initial period is to keep the infected person away from others when they are likely most contagious.
A person must remain at home and away from others until two criteria are met for at least 24 hours: symptoms are improving overall, and they have been fever-free without the assistance of fever-reducing medications. This symptom-based approach recognizes that the duration of infectiousness can vary widely between individuals. The most infectious period generally occurs in the one to two days before symptoms begin and the two to three days afterward.
The requirement to stay home is not tied to a specific number of days, but rather to the resolution of fever and the noticeable improvement of other symptoms. The previous fixed five-day isolation rule has been replaced with this more flexible, symptom-driven approach. If symptoms are severe or do not improve, the period of staying home may extend well beyond the typical five-day mark until the two conditions for release are satisfied.
Criteria for Ending Isolation
Ending the period of staying home is based entirely on achieving the two specific symptom milestones rather than a calendar date. The first condition is being without a fever for a full 24 hours without taking any medication like acetaminophen or ibuprofen to suppress it. The second condition is that all other symptoms, such as cough or fatigue, must be mild and clearly improving.
Once these conditions are met, the individual can resume normal activities, but with a critical caveat involving a follow-up precaution period. For the five days immediately following the end of the isolation period, extra precautions are strongly recommended to further reduce the risk of transmission. This post-isolation phase focuses on reducing the low-level risk that may remain as the viral load continues to decrease.
Post-Isolation Precautions
These precautions include wearing a high-quality, well-fitting mask whenever around other people indoors. The mask serves as a source control measure, limiting the release of respiratory droplets into the shared air space. Other suggested measures during this five-day period include:
- Maintaining physical distance from others.
- Practicing frequent hand hygiene.
- Improving ventilation in shared spaces.
If symptoms worsen or a fever returns after a person has resumed normal activities, they should immediately revert to the initial guidance and stay home again. They must remain home until they once again meet the 24-hour fever-free and symptom-improving criteria. While not required to end isolation, using antigen tests can provide reassurance; a negative test suggests a lower concentration of active virus, potentially allowing for the removal of the mask sooner than the recommended five days.
Guidance for Close Contacts
A close contact is defined as someone who was within six feet of an infected individual for a cumulative total of 15 minutes or more over a 24-hour period. For people who have been exposed to the virus but have not yet tested positive, the guidance emphasizes monitoring for symptoms and taking preventative measures rather than a mandatory quarantine. The distinction is that “isolation” is for confirmed cases, while “quarantine” was historically for exposed people, though that term is now less emphasized in general guidance.
Regardless of a person’s vaccination status, they should take heightened precautions for a full 10 days following the last exposure. This 10-day period covers the typical incubation time of the virus. During this time, wearing a mask when indoors and around others is highly recommended, as is testing for the virus at the appropriate time.
A close contact should test for the virus at least five full days after the last known exposure to the confirmed case. Testing earlier than this five-day mark may produce a false negative result because the virus has not had sufficient time to replicate to detectable levels. If symptoms develop at any point during the 10-day monitoring period, the individual should immediately isolate and get tested.
The development of symptoms by a close contact transitions them immediately from the exposure guidance to the isolation rules for positive cases, even before a test result is confirmed. They must then stay home until their fever has resolved for 24 hours without medication and their symptoms are improving. This immediate action is necessary to prevent the further spread of the virus while awaiting confirmation of infection.