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Recommending Isolation and Quarantine Timeframes for Coronavirus: Why Is There So Much Confusion?

Recommending Isolation and Quarantine Timeframes for Coronavirus: Why Is There So Much Confusion?

I have been working in a drive-through coronavirus testing site since March; part of this entails calling patients with positive COVID-19 test results to discuss care. I discuss self-care at home, ER precautions, and recommendations for home isolation, as well as when it's safe to discontinue isolation based on transmissibility of the virus. There seems to be a lot of confusion pertaining to home isolation, not only from patients, but from colleagues as well. Let's review the current CDC guidelines.

For patients with a positive PCR test: this is referring to period of contagion or transmissibility. Patients are considered to be contagious from day 1 of symptom onset through day 10, and must stay in home isolation during that time period, only taking themselves out of isolation IF it is past day 10 AND they are generally improving AND they have no fever without taking antipyretics for at least 24 hours. I recommend this to all symptomatic patients, whether they test positive or not (to account for the false negatives); for those who are truly asymptomatic, we use the date of test positivity as day 1.

When I call patients with positive results and they say they have no symptoms, I ask probing questions, and they can generally recall a date when they had SOME symptom(s), even mild, so I tell them that is their day 1. If a patient is positive and severely immunocompromised, the recommended period of isolation is 20 days from symptom onset. The CDC has guidelines on what constitutes severe immunocompromise.

The other question pertains to those who have been exposed and what that means for them in terms of recommended home self-quarantine.

For people with COVID-19 exposures (such as household members): this is referring to the virus incubation period. It is recommended they stay in home quarantine for 14 days from the day of last unprotected exposure (think being unmasked/for >15 minutes/less than 6 feet away from the positive source patient). The virus incubation period is 2 to 14 days, which is why this quarantine recommendation is 14 days (vs the above quarantine period which refers to period of transmissibility, not incubation). Data show most patients develop symptoms on day 5, but there is variability of 2 to 14 days, accounting for this timeframe recommendation.

Distinguishing these two isolation/quarantine periods requires some clear patient education. For more information, look to the current CDC recommendations on isolation and community-related exposure.


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Filed under: Health Policy and Trends, Infectious Diseases, Public Health

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