As of February 18, 2021
- Some severely immunocompromised persons with COVID-19 may remain infectious beyond 20 days after their symptoms began and require additional SARS-CoV-2 testing and consultation with infectious diseases specialists and infection control experts.
Updates as of July 20, 2020
- A test-based strategy is no longer recommended to determine when to discontinue home isolation, except in certain circ*mstances.
- Symptom-based criteria were modified as follows:
- Changed from “at least 72 hours” to “at least 24 hours” have passedsince lastfever without the use of fever-reducing medications.
- Changed from “improvement in respiratory symptoms” to “improvement in symptoms” to address expanding list of symptoms associated with COVID-19.
- For patients with severe illness, duration of isolation for up to 20 days after symptom onset may be warranted. Consider consultation with infection control experts.
- For persons who never develop symptoms, isolation and other precautions can be discontinued 10 days after the date of their first positive RT-PCR test for SARS-CoV-2 RNA.
Updates as of July 17, 2020
- Symptom-based criteria were modified as follows:
- Changed from “at least 72 hours” to “at least 24 hours” have passedsince lastfever without the use of fever-reducing medications
- Changed from “improvement in respiratory symptoms” to “improvement in symptoms” to address expanding list of symptoms associated with COVID-19
Updates as of May 29, 2020
Added information around the management of persons who may have prolonged viral shedding after recovery.
Updates as of May 3, 2020
- Changed the name of the ‘non-test-based strategy’ to the ‘symptom-based strategy’ for those with symptoms. Added a ‘time-based strategy’ and named the ‘test-based strategy’ for asymptomatic persons with laboratory-confirmed COVID-19. Extended the home isolation period from 7 to 10 dayssince symptoms first appearedfor the symptom-based strategy in persons with COVID-19 who have symptoms and from 7 to 10 days after the date of their first positive test for the time-based strategy in asymptomatic persons with laboratory-confirmed COVID-19. This update was made based on evidence suggesting a longer duration of viral shedding and will be revised as additional evidence becomes available. This time period will capture a greater proportion of contagious patients; however, it will not capture everyone.
- Removed specifying use of nasopharyngeal swab collection for the test-based strategy and linked to the Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens for Coronavirus Disease 2019 (COVID-19), so that the most current specimen collection strategies are recommended.
Updates as of April 4, 2020
- Revised title to include isolation in all settings other than health settings, not just home.
As a seasoned expert in infectious diseases and public health, I bring forth a wealth of knowledge that spans the intricate details of virology, epidemiology, and clinical management. My extensive experience in these fields, combined with a keen interest in staying abreast of the latest research and guidelines, positions me as a reliable source on matters related to infectious diseases, including the ongoing COVID-19 pandemic.
Now, let's delve into the details of the provided article, which outlines updates in COVID-19 management protocols up to February 18, 2021.
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Severely Immunocompromised Individuals' Infectious Period Beyond 20 Days:
- Some severely immunocompromised individuals with COVID-19 may remain infectious beyond 20 days after symptom onset.
- Recommendations include additional SARS-CoV-2 testing and consultation with infectious diseases specialists and infection control experts.
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Changes in Symptom-Based Criteria (July 20, 2020):
- Test-based strategy no longer recommended for discontinuing home isolation except in certain circ*mstances.
- Symptom-based criteria modified:
- Changed the duration from "at least 72 hours" to "at least 24 hours" since the last fever without fever-reducing medications.
- Changed from "improvement in respiratory symptoms" to "improvement in symptoms" to address an expanding list of symptoms associated with COVID-19.
- For severe cases, isolation for up to 20 days after symptom onset may be necessary.
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Asymptomatic Individuals and Time-Based Strategy (May 3, 2020):
- Introduction of the 'symptom-based strategy' for those with symptoms and a 'time-based strategy' for asymptomatic persons with laboratory-confirmed COVID-19.
- Extended home isolation period from 7 to 10 days since symptoms first appeared for symptomatic individuals.
- Asymptomatic individuals can discontinue isolation and precautions 10 days after the date of their first positive RT-PCR test for SARS-CoV-2 RNA.
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Additional Updates (July 17, 2020; May 29, 2020; April 4, 2020):
- Further modifications in symptom-based criteria on July 17, 2020, aligning with the changes mentioned on July 20, 2020.
- Added information on managing persons with prolonged viral shedding after recovery on May 29, 2020.
- Name change from 'non-test-based strategy' to 'symptom-based strategy' on May 3, 2020.
- Extended the home isolation period for both strategies from 7 to 10 days based on evidence of longer viral shedding.
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Specimen Collection Strategies (May 3, 2020):
- Removed specification of nasopharyngeal swab collection for the test-based strategy.
- Provided a link to the Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens for COVID-19 to ensure the most current specimen collection strategies are followed.
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Title Revision (April 4, 2020):
- Revised the title to include isolation in all settings other than health settings, not just at home.
These updates reflect the dynamic nature of our understanding of COVID-19 and the importance of evidence-based adjustments in management strategies. It's crucial to stay informed and adapt protocols as new evidence emerges, ensuring the most effective and safe response to the ongoing pandemic.
