10 Days or 14? Understanding COVID-19 Quarantine, Isolation Guidelines

Quarantine vs. isolation

“Quarantine” and “isolation” are often used interchangeably but are applied to two different scenarios. Quarantine is meant for someone who was exposed or may have been exposed to COVID-19, and isolation is intended for people with a known coronavirus infection. Both, however, share the same purpose: to keep the virus from spreading to others.

People who have COVID-19, with or without symptoms, should isolate themselves from others for at least 10 days after the onset of symptoms. Isolation can end after that 10-day period as long as symptoms are improving and the person has been fever-free for at least 24 hours. The CDC updated its guidelines in July to say that people who have tested positive for COVID-19 no longer need a follow-up test that comes back negative in order to be around other people again.

The updated guidelines were issued after a number of studies showed 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.

Health experts applauded the CDC’s updated isolation recommendations. In particular, they noted the changes may help to conserve testing materials and ease testing backlogs.

Previously, health care providers had been testing some COVID-19 patients multiple times to ensure they were no longer contagious. This practice became “a draw on resources,” especially among patients who test positive for the virus weeks after their symptoms disappear, Michelle Doll, an associate hospital epidemiologist and an assistant professor of infectious disease at the Virginia Commonwealth University School of Medicine in Richmond, said in an earlier interview with AARP.

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, said 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 said in July. 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 added.

Exceptions to the 10-day isolation rule

There are a few exceptions to the CDC’s 10-day isolation recommendations — the first being for people who have weakened immune systems due to a health condition or medication. Doll said 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.

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 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.

The key to coming off isolation is to make sure your symptoms are improving. If they do not improve, 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 said.

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