Should You Test Before Leaving COVID Isolation? Here's What the CDC, Chicago's Top Doctor Say

The Centers for Disease Control and Prevention released a new set of COVID guidelines Thursday, clarifying whether recovering individuals need to test out of isolation.

In its updated guidelines, the CDC recommended different approaches for patients based on their symptoms.

Those who experience traditional mild symptoms, including fevers and coughs, do not have to be symptom-free to get out of isolation after five days. While a negative test isn't required to end isolation, individuals must be fever-free for at least 24 hours without the use of medication and show improvement in their symptoms, according to officials.

Those who experience more severe symptoms, including difficulty breathing and shortness of breath, are recommended to remain in isolation for at least 10 days.

Additionally, the CDC is advising patients with severe symptoms to consult with a doctor before ending isolation. During the consultation, the CDC recommends physicians to do a viral test to demonstrate that the patient is no longer positive. However, a negative test is not required to end isolation.

The guideline changes came just two days after Chicago's top doctor teased the potential shift away from COVID quarantine requirements, while stressing isolation guidelines.

"I believe they're going to be doubling down on this idea of isolation," Arwady said about the CDC during a Facebook Live update Tuesday. "... You've got to be home. You've got to mask. And I think we'll see more of, you know, if you've potentially been in contact, wear that mask, get tested."

The CDC's reminder about potentially testing out of isolation also comes amid questions about whether such a move is required. Questions particularly surfaced after President Joe Biden tested negative following his infection and began to leave isolation before testing positive a second time just days later.

The BA.5 subvariant of omicron has shown an increased ability to get around the immunity built up in patients thanks to COVID vaccines and boosters, and the illness has also shown an increased ability to cause positive tests for longer stretches, even if patients don't get as sick with the new variants.

Some COVID patients infected with the BA.5 subvariant have reported that they have continued testing positive for longer than with previous variants, but no studies have been completed to show whether or not the variant keeps patients infectious for longer periods of time.

Arwady said the availability of tools like vaccines and, more importantly, COVID antivirals such as Paxlovid have helped the public to make large strides in keeping the virus at bay, even as each iteration of COVID-19 becomes progressively more infectious.

Among the new guidelines are the following recommendations:

• Continuing to promote the importance of being up to date with vaccination to protect people against serious illness, hospitalization, and death. Protection provided by the current vaccine against symptomatic infection and transmission is less than that against severe disease and diminishes over time, especially against the currently circulating variants. For this reason, it is important to stay up to date, especially as new vaccines become available. 
• Updating its guidance for people who are not up to date on COVID-19 vaccines on what to do if exposed to someone with COVID-19.  This is consistent with the existing guidance for people who are up to date on COVID-19 vaccines.
• Recommending that instead of quarantining if you were exposed to COVID-19, you wear a high-quality mask for 10 days and get tested on day 5.
• Reiterating that regardless of vaccination status, you should isolate from others when you have COVID-19.
  • You should also isolate if you are sick and suspect that you have COVID-19 but do not yet have test results.
    • If your results are positive, follow CDC’s full isolation recommendations.
    • If your results are negative, you can end your isolation.
• Recommending that if you test positive for COVID-19, you stay home for at least 5 days and isolate from others in your home.  You are likely most infectious during these first 5 days. Wear a high-quality mask when you must be around others at home and in public. 
  • If after 5 days you are fever-free for 24 hours without the use of medication, and your symptoms are improving, or you never had symptoms, you may end isolation after day 5. 
  • Regardless of when you end isolation, avoid being around people who are more likely to get very sick from COVID-19 until at least day 11. 
  • You should wear a high-quality mask through day 10. 
• Recommending that if you had moderate illness (if you experienced shortness of breath or had difficulty breathing) or severe illness (you were hospitalized) due to COVID-19 or you have a weakened immune system, you need to isolate through day 10.
• Recommending that if you had  severe illness or have a weakened immune system, consult your doctor before ending isolation. Ending isolation without a viral test may not be an option for you. If you are unsure if your symptoms are moderate or severe or if you have a weakened immune system, talk to a healthcare provider for further guidance.

• Clarifying that after you have ended isolation, if your COVID-19 symptoms worsen, restart your isolation at day 0. Talk to a healthcare provider if you have questions about your symptoms or when to end isolation.  
• Recommending screening testing of asymptomatic people without known exposures will no longer be recommended in most community settings. 
• Emphasizing that physical distance is just one component of how to protect yourself and others.  It is important to consider the risk in a particular setting, including local COVID-19 Community Levels and the important role of ventilation, when assessing the need to maintain physical distance.