Can You End COVID Isolation If You're Still Testing Positive? What to Know About the Guidelines

If you test positive for COVID and isolate, what should you do if you continue testing positive even after your isolation period has ended?

While there is currently no requirement to test out of isolation after having COVID, Chicago's top doctor has warned that the new BA.5 omicron subvariant is making people test positive longer.

Questions surfaced after news first broke that President Joe Biden tested negative, then positive again days later following his initial COVID diagnosis.

While it may not be required to test out, Biden's experience, Arwady said, is a reason to stay masked following isolation.

"So just a reminder if you catch COVID, regardless of your vaccination status, you need to stay home for five days," Chicago Department of Public Health Commissioner Dr. Allison Arwady said. "If your symptoms are resolving, are gone by day five, you can leave your house, but you must continue to mask while around others for days six to 10. We're seeing some examples, especially with the BA.4 and [BA.5] of people testing positive for longer, occasionally testing negative and then positive again later. We actually saw that with President Biden, for example. You've got to wear that mask for days six through 10."

Here's the guidance for quarantine and isolation.

Do you need to test out of isolation or quarantine?

Quarantine

If you come into close contact with someone with COVID-19, you should quarantine if you are not up-to-date on COVID-19 vaccines or are unvaccinated. For these individuals, the CDC and IDPH recommend you:

• Stay home and away from other people for at least 5 days (day 0 through day 5) after your last contact with a person who has COVID-19. The date of your exposure is considered day 0. Wear a well-fitting mask when around others at home, if possible.
• For 10 days after your last close contact with someone with COVID-19, watch for fever (100.4◦F or greater), cough, shortness of breath, or other COVID-19 symptoms.
• If you develop symptoms, get tested immediately and isolate until you receive your test results. If you test positive, follow isolation recommendations.
• If you do not develop symptoms, get tested at least 5 days after you last had close contact with someone with COVID-19.
  • If you test negative, you can leave your home, but continue to wear a well-fitting mask when around others at home and in public until 10 days after your last close contact with someone with COVID-19.
  • If you test positive, you should isolate for at least 5 days from the date of your positive test (if you do not have symptoms). If you do develop COVID-19 symptoms, isolate for at least 5 days from the date your symptoms began (the date the symptoms started is day 0). Follow recommendations in the isolation section below.
  • If you are unable to get a test 5 days after last close contact with someone with COVID-19, you can leave your home after day 5 if you have been without COVID-19 symptoms throughout the 5-day period. Wear a well-fitting mask for 10 days after your date of last close contact when around others at home and in public.
  • Avoid people who are have weakened immune systems or are more likely to get very sick from COVID-19, and nursing homes and other high-risk settings, until after at least 10 days.
• If possible, stay away from people you live with, especially people who are at higher risk for getting very sick from COVID-19, as well as others outside your home throughout the full 10 days after your last close contact with someone with COVID-19.
• If you are unable to quarantine, you should wear a well-fitting mask for 10 days when around others at home and in public.
• If you are unable to wear a mask when around others, you should continue to quarantine for 10 days. Avoid people who have weakened immune systems or are more likely to get very sick from COVID-19, and nursing homes and other high-risk settings, until after at least 10 days.
• Do not travel during your 5-day quarantine period. Get tested at least 5 days after your last close contact and make sure your test result is negative and you remain without symptoms before traveling. If you don’t get tested, delay travel until 10 days after your last close contact with a person with COVID-19. If you must travel before the 10 days are completed, wear a well-fitting mask when you are around others for the entire duration of travel during the 10 days. If you are unable to wear a mask, you should not travel during the 10 days.
• Do not go to places where you are unable to wear a mask, such as restaurants and some gyms, and avoid eating around others at home and at work until after 10 days after your last close contact with someone with COVID-19.

Those who are close contacts of someone with COVID but are up-to-date on their vaccinations or have had a confirmed case of COVID-19 within the last 90 days do not need to quarantine, but the CDC does recommend they wear a well-fitting mask around others for 10 days after their most recent exposure and get tested after at least five days.

Isolation

According to the CDC, people who are positive for COVID should stay home until it's safe for them to be around others, including even other members of their home.

Health officials recommend a "sick room" or area for those who are infected and a separate bathroom, if possible.

But isolation may not just be for those who test positive. The CDC also recommends those who have symptoms of COVID-19 and are awaiting test results or have not yet been tested isolate, "even if they do not know if they have been in close contact with someone with COVID-19."

How do you end isolation?

• You can end isolation after five full days if you are fever-free for 24 hours without the use of fever-reducing medication and your other symptoms have improved (Loss of taste and smell may persist for weeks or months after recovery and need not delay the end of isolation​).
• If you continue to have fever or your other symptoms have not improved after 5 days of isolation, you should wait to end your isolation until you are fever-free for 24 hours without the use of fever-reducing medication and your other symptoms have improved. Continue to wear a well-fitting mask through day 10. Contact your healthcare provider if you have questions.
• Do not go to places where you are unable to wear a mask, such as restaurants and some gyms, and avoid eating around others at home and at work until a full 10 days after your first day of symptoms.

So how do you calculate your isolation period?

According to the CDC, "day 0 is your first day of symptoms." That means that Day 1 is the first full day after your symptoms developed.

For those who test positive for COVID but have no symptoms, day 0 is the day of the positive test. Those who develop symptoms after testing positive must start their calculations over, however, with day 0 then becoming the first day of symptoms.

Under the CDC guidance, those in isolation should:

• Monitor your symptoms. If you have an emergency warning sign (including trouble breathing), seek emergency medical care immediately.
• Stay in a separate room from other household members, if possible.
• Use a separate bathroom, if possible.
• Take steps to improve ventilation at home, if possible.
• Avoid contact with other members of the household and pets.
• Don’t share personal household items, like cups, towels, and utensils.
• Wear a well-fitting mask when you need to be around other people.

Why don't you need to test out of isolation?

The CDC notes that tests "are best used early in the course of illness to diagnose COVID-19 and are not authorized by the U.S. Food and Drug Administration to evaluate duration of infectiousness."

Some health experts are warning that reinfection can occur even faster with the latest variants, particularly BA.4 and BA.5. That can make it challenging to determine if you are among the rare rebound infections or if you have been reinfected.

"We don't know know exactly how soon, but people have been recorded to get the infection as soon as four weeks after having a previous infection," said Dr. Sharon Welbel, director of hospital epidemiology and infection control at Cook County Health, adding that as early as two weeks can't be ruled out.

Dr. Monica Gandhi, an infectious disease specialist at the University of California, San Francisco, previously told CNBC she’d “feel really comfortable” with a symptom-free person emerging after five days of isolation, even if they’re still testing positive for COVID-19.

“Follow CDC guidance and wear a mask for the following five days,” she said.

Still, Arwady noted that some may take at-home tests as they prepare to end their isolation.

"If it is negative, that's another piece of information that suggests you're very unlikely to be contagious at that point. So, you know, no test is 100% just like no vaccine is 100%, but those tests are pretty good," she said.

Some doctors assert the safest course of action is to remain in isolation until you test negative. However, Dr. Stephen Kissler, a postdoctoral fellow at the Harvard T.H. Chan School of Public Health, said it's not unreasonable to gradually leave isolation — even if you’re still testing positive using a rapid test.

That's especially the case if you're fully vaccinated, symptoms have resolved and you continue to practice masking.

“You might be able to begin slowly sort of reintegrating while still being mindful of your contact," Kissler said.

What kind of test should you use if you do want to test before leaving isolation?

The CDC recommends antigen testing for those looking to test before leaving isolation.

Chicago Department of Public Health Commissioner Dr. Allison Arwady agreed.

"If it is a PCR test - one that you get at the doctor's office, one that you get at a testing center - that is not telling me anything except that you had COVID not that long ago," Arwady said during a Facebook Live, adding that a PCR test "can stay positive for weeks sometimes after you've had COVID because it's so sensitive it can pick up even dead virus." "If it is a home test, we can't 100% know, but if it's been, I mean, I don't know, a few weeks ago, it would be unlikely that you would still be testing positive in a way that you would be contagious, sort of at that point. I'm going to tell you that if you are in doubt, please wear a mask and please don't have close contact with folks who are immunocompromised."

How long after COVID exposure could you test positive?

According to the CDC, the incubation period for COVID is between two and 14 days, though the newest guidance from the agency suggests a quarantine of five days for those who are not boosted, but eligible or unvaccinated. Those looking to get tested after exposure should do so five days after the exposure or if they begin experiencing, the CDC recommends.

What should you do if you keep testing positive?

If you continue to test positive after the 10-day period, should you remain in isolation? The CDC hasn't provided specific guidance for what to do in this situation, but experts widely assert that as long as your symptoms are gone, you likely don't need to isolate any longer.

Dr. Monica Gandhi, an infectious disease specialist at the University of California, San Francisco, previously told CNBC she’d “feel really comfortable” with a symptom-free person emerging after five days of isolation, even if they’re still testing positive for COVID-19.

“Follow CDC guidance and wear a mask for the following five days,” she said.

The CDC previously said people can possibly test positive for up to three months after contracting an infection.

If you continue to test positive, is it possible you're still infectious?

A Boston University study revealed that just 17% of people were likely still contagious six days after their first positive tests.

If you're concerned about how long you've been testing positive, check in with a health care provider for their guidance on your situation, the doctor said.

When is the best time to get tested after exposure?

The CDC states that anyone who may have been exposed to someone with COVID should test five days after their exposure, or as soon as symptoms occur.

"If symptoms occur, individuals should immediately quarantine until a negative test confirms symptoms are not attributable to COVID-19," the guidance states.

Illinois Department of Public Health Director Dr. Ngozi Ezike said that incubation times could be changing, but those who test early should continue testing even if they get negative results.

"We might be learning that the time of incubation might be a little shorter. So maybe you'd be testing at two days," Ezike said. "Obviously if you're symptomatic, you test right away. But you know, if you want to test at two days, but that negative test... the two days should not make you think, 'Oh good, I'm clear,' you know? You might want to test again and of course symptoms you cannot ignore - scratchy throat, headaches, all kinds of symptoms - anything new can be a symptom of this new illness."

How soon might COVID symptoms appear?

According to earlier CDC guidance, COVID symptoms can appear anywhere from two to 14 days after someone is exposed to the virus.

Anyone exhibiting symptoms should get tested for COVID-19.

Some people may never experience symptoms, though they can still spread the virus.

A person is also considered contagious before symptoms appear.

When are people with COVID most contagious?

The CDC says that its guidelines were updated to reflect growing evidence that suggests transmission of COVID-19 often occurs one to two days before the onset of symptoms and during the two to three days afterward. 

"This has to do with data from the CDC that really showed after seven days there's virtually no risk of transmission at this point," Arwady said. "And in that five-to-seven-day window, you know, there's some depending on whether people have been vaccinated, underlying conditions, etc., but the risk drops a lot and the feeling is that in the general population, combined with masking, etc. the risk really is very low."

For those without symptoms, CDC guidance states they are considered contagious at least two days before their positive test.