Idaho Health Alert Network: Update

The following are updated CDC guidelines.  Eastern Idaho Public Health would like to take this opportunity to also remind all healthcare providers to instruct their patients, while waiting for COVID-19 test results, to remain isolated at home until test results are available.

Discontinuation of Isolation or Precautions for People Who Test Positive for SARS-CoV-2 by PCR:
Test-based Strategy No Longer Recommended; Time after Resolution of Fever Shortened.

Based on the best information available as of mid-July 2020, the Centers for Disease Control and Prevention (CDC) has updated recommendations for discontinuation of isolation or precautions for people who have a positive PCR test for SARS-CoV-2. Key changes include: shortening of the time after resolution of fever before discontinuation of isolation or precautions; removal of recommendations for a test-based strategy except for certain circumstances; and recommendation to not retest individuals who have recovered from COVID-19 and remain asymptomatic during the 3 months following symptom onset.

1. Duration of isolation and precautions

o     Most patients with COVID-19 illness: isolation and precautions can be discontinued 10 days after symptom onset (including non-respiratory symptoms) and resolution of fever for at least 24 hours, without the use of fever-reducing medications, and with improvement of other symptoms.

o     Patients with severe illness: extending duration of isolation and precautions for up to 20 days after symptom onset may be warranted and is recommended for healthcare workers with severe to critical illness or healthcare workers who are severely immunocompromised and were not asymptomatic throughout infection.

o     Individuals who never develop symptoms: isolation and other precautions can be discontinued 10 days after the collection date of their first positive RT-PCR test result for SARS-CoV-2 RNA.

2. Use of PCR testing to discontinue isolation or precautions

o     Most patients: a test-based strategy is no longer recommended. A test-based strategy may be considered for some healthcare workers (see https://www.cdc.gov/coronavirus/2019-ncov/hcp/return-to-work.html).

o     Severely immunocompromised patients: a test-based strategy could be considered in consultation with infectious disease experts

3. Use of PCR testing after discontinuation of isolation or precautions

o     Individuals who were previously symptomatic with COVID-19 who, after recovery, remain asymptomatic:

• Retesting is not recommended within 3 months after the date of symptom onset for the initial COVID-19 case
• During these 3 months, isolation is not recommended in the event of close contact with a SARS-CoV-2 infected individual

o     Individuals 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, retesting for SARS-CoV-2 may be warranted.
• Isolation may be considered during this evaluation especially if symptoms develop within 14 days after close contact with an infected person.

o     Individuals 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.

For more information, see https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation.html