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10 Days or 14? Understanding COVID-19 Quarantine Guidelines

CDC revises isolation rules based on mounting data about contagiousness of coronavirus

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En español | If you've tested positive for COVID-19, you no longer need a follow-up test that comes back negative to let you know it's OK to be around other people again. A 10-day isolation period that starts at the onset of symptoms is sufficient, as long as your symptoms are improving and you are fever-free for at least 24 hours at the end of the 10-day stretch, under new recommendations from the Centers for Disease Control and Prevention (CDC).

The change in guidelines comes after a number of new studies show that most people are free of the virus and are no longer contagious 10 days after symptoms develop. Individuals who never experience symptoms of COVID-19 (asymptomatics), but who test positive for the virus are also advised by the CDC to self-isolate for 10 days after taking a coronavirus test.

Changes discourage needless testing

Health experts are applauding the new CDC recommendations. In particular, the latest guidelines should help to conserve testing materials and ease a testing backlog that has been building as new coronavirus cases continue to surge in the U.S.

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For the last several months, health care providers have been testing some COVID-19 patients multiple times to ensure they are no longer contagious. This practice has become “a draw on resources,” especially among patients who test positive for the virus weeks after their symptoms disappear, says Michelle Doll, an associate hospital epidemiologist and an assistant professor of infectious disease at the Virginia Commonwealth University School of Medicine in Richmond.

According to new research, all of those persistent positive tests were likely a result of “leftover virus fragments,” and not an indication that the virus was still present and transmissible, says William Schaffner, a professor of preventive medicine and infectious diseases at the Vanderbilt University Medical Center in Nashville.

"These are, if you will, dead soldiers. So there's no point in doing all these follow-up tests anymore, because they just provide potentially confusing results,” Schaffner says. Having a more standard, science-based recommendation on when patients can rejoin others in their household means “you can get people off isolation more promptly,” he adds.

Exceptions to the 10-day rule

There are a few exceptions to the CDC's new recommendations — the first being for people who have weakened immune systems due to a health condition or medication. Doll says that the virus is “a little bit more unpredictable” in immunocompromised patients and that “they can shed virus for longer periods of time.” The CDC says that immunocompromised individuals may need to stay home and away from others for more than 10 days, but that they should talk to their health care provider for additional guidance.

Also: People who have been exposed to somebody with COVID-19 face a longer self-isolation period than people who test positive for the virus. The CDC says anyone who has close contact with someone who has COVID-19 should quarantine at home for 14 days after exposure.

"The reason for that is because there is a little bit less predictability in terms of the incubation period for this virus and when you might get sick if you were exposed to somebody,” Doll says. The extra four days help to account for the time it takes for symptoms to develop, or if they never develop, for the virus to run its course.

People who have already recovered from COVID-19 do not need to quarantine or get tested again for up to three months — even after close contact with someone who has the illness — as long as they do not develop new symptoms. 

The CDC sent a statement on Aug. 14 saying this new recommendation does not imply a person is immune to reinfection in the three months following infection. “The latest data simply suggests that retesting someone in the 3 months following initial infection is not necessary unless that person is exhibiting the symptoms of COVID-19 and the symptoms cannot be associated with another illness,” the CDC said.

Symptoms may persist long after infection

Just because you are no longer contagious doesn't mean you will be completely without symptoms. Studies show that recovery time for COVID-19 can last longer than the virus.

A new report from the CDC, for example, found that 35 percent of symptomatic adults who tested positive for COVID-19 but who were not hospitalized for the illness had not returned to their usual state of health 14 to 21 days after testing. Even young, healthy adults struggle to recover quickly from an infection. Nearly 1 in 5 surveyed adults 18 to 34 years old with no chronic medical conditions had not returned to their usual state of health 14 to 21 days after testing positive.

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The key to coming off isolation is to make sure your symptoms are improving. If they do not, touch base with your doctor. Warning signs that require immediate medical attention include trouble breathing, persistent pain or pressure in the chest, new confusion, inability to wake or stay awake, and bluish lips or face.

Finally: If you experience a symptom of COVID-19, such as fever or fatigue, but do not get tested to confirm a coronavirus infection, it's still a good idea to stay away from other people for 10 days just to be safe, Schaffner says.

Editor’s Note: This article, originally published on July 27, has been updated to reflect new information.

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