There have been many questions around “when do we let COVID positive residents off of isolation… even if they continue to test positive?” Please see the information on “persistent positive” below when making this decision. What is the current policy for having a resident leave isolation? Symptom-based or testing based? We can have a conversation around this.
CDC Guidance
Testing to determine the resolution of infection.
- A test-based strategy, which requires serial tests and improvement of symptoms, can be used as an alternative to a symptom-based or time-based strategy, to determine when a resident with SARS-CoV-2 infection no longer requires transmission-based Precautions.
Symptomatic patients with COVID-19 should remain in transmission-based Precautions until either
- Symptom-based strategy
– At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); and,- At least 10 days have passed since symptoms first appeared
- Test-based strategy
– Resolution of fever without the use of fever-reducing medications and
– Improvement in respiratory symptoms (e.g., cough, shortness of breath), and
– Negative results of an FDA Emergency Use Authorized COVID-19 molecular assay for detection of SARS-CoV-2 RNA from at least two consecutive respiratory specimens collected ≥24 hours apart (total of two negative specimens) [1]. See Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens for 2019 Novel Coronavirus (2019-nCoV). Of note, there have been reports of prolonged detection of RNA without a direct correlation to viral culture.
Patients with laboratory-confirmed COVID-19 who have not had any symptoms should remain in transmission-based Precautions until either
- Time-based strategy
– 10 days have passed since the date of their first positive COVID-19 diagnostic test, assuming they have not subsequently developed symptoms since their positive test. Note, because symptoms cannot be used to gauge where these individuals are in the course of their illness, it is possible that the duration of viral shedding could be longer or shorter than 10 days after their first positive test.
- Test-based strategy
– Negative results of an FDA Emergency Use Authorized COVID-19 molecular assay for detection of SARS-CoV-2 RNA from at least two consecutive respiratory specimens collected ≥24 hours apart (total of two negative specimens). Note, because of the absence of symptoms, it is not possible to gauge where these individuals are in the course of their illness. There have been reports of prolonged detection of RNA without a direct correlation to viral culture.
Note that detecting viral RNA via PCR does not necessarily mean that the infectious virus is present.
Persistent Positive (An individual continues to test positive even after recovered from COVID)
- Viral RNA can be persistently detected by RT-PCR in respiratory tract samples after clinical recovery.
- In some persons, after testing negative by RT-PCR in two consecutive samples, later samples can test positive again.
- Studies that have looked at how long SARS-CoV-2 RNA can be detected in adults have demonstrated that in some persons it can be detected for weeks.