After testing positive for COVID-19, understanding the appropriate isolation period is important to help prevent further transmission. Guidelines from public health authorities, such as the Centers for Disease Control and Prevention (CDC), provide a framework for determining how long individuals should isolate.
Standard Isolation Duration
Current guidance for COVID-19 focuses on a symptom-based approach rather than a fixed isolation period. The previous recommendation of a minimum 5-day isolation has been updated. Individuals should stay home and away from others until at least 24 hours have passed since both their symptoms are improving overall and they have not had a fever without the use of fever-reducing medication.
The start date for this isolation period is determined by when symptoms began. For symptomatic individuals, Day 0 is considered the day their symptoms started. If someone tests positive but has no symptoms, Day 0 is the day they took their positive test. This updated guidance aligns the isolation recommendations for COVID-19 with those for other common respiratory viruses, like influenza and RSV.
Criteria for Ending Isolation
To end isolation, individuals must be fever-free for at least 24 hours without medication, and their other symptoms must be generally improving. A lingering cough or fatigue may persist for some time, and these do not necessarily require continued isolation if other symptoms are getting better.
A negative test is not typically required to end isolation. However, if someone chooses to test, especially if they wish to reduce precautions sooner, rapid antigen tests can be used. If testing, some sources suggest two negative tests taken at least 48 hours apart to confirm reduced contagiousness.
Post-Isolation Precautions
After isolation, additional precautions are recommended to further reduce the risk of transmission. For five additional days, individuals should consider wearing a high-quality mask when around others. This includes wearing a well-fitting mask, such as an N95 or KN95, especially in indoor public settings or when interacting closely with others.
Maintaining physical distance from others is also advisable during this post-isolation period. It is particularly important to avoid contact with individuals who are at higher risk for severe COVID-19, such as the elderly or those who are immunocompromised, for a full 10 days from the onset of symptoms or positive test date. These precautions help protect vulnerable populations as residual contagiousness may still be present.
Special Circumstances
Certain situations may require a different or extended isolation period. Individuals who experience severe COVID-19, such as those requiring hospitalization, may need to isolate for a longer duration, potentially up to 20 days or more. For these cases, consulting a healthcare provider for personalized guidance is important, as medical clearance may be necessary before ending isolation.
Immunocompromised individuals often require extended isolation. They may shed the virus for a longer time, and an isolation period of at least 20 days, often with serial testing and consultation with an infectious disease specialist, is recommended.
Furthermore, some individuals may experience “COVID-19 rebound,” where symptoms return or they test positive again after initial recovery. If this occurs, it is advised to re-isolate for at least 5 days, restarting the isolation period from the day symptoms return or a new positive test occurs.