Journal
CLINICAL INFECTIOUS DISEASES
Volume 72, Issue 8, Pages 1467-1474Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/cid/ciaa1249
Keywords
SARS-CoV-2; COVID-19; transmission-based precautions; isolation
Categories
Funding
- Centers for Disease Control and Prevention [6U54CK000484-04-02]
- Agency for Healthcare Research and Quality [K08HS025008]
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SARS-CoV-2 is most contagious around symptom onset, with infectivity rapidly decreasing to near-zero afterwards; mild-moderately ill patients can safely discontinue isolation after about 10 days, while severely-critically ill and immunocompromised patients may need 15 days. The longest duration associated with replication-competent virus is 20 days.
Defining the duration of infectivity of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has major implications for public health and infection control practice in healthcare facilities. Early in the pandemic, most hospitals required 2 negative RT-PCR tests before discontinuing isolation in patients with Covid-19. Many patients, however, have persistently positive RT-PCR tests for weeks to months following clinical recovery, and multiple studies now indicate that these generally do not reflect replication-competent virus. SARS-CoV-2 appears to be most contagious around the time of symptom onset, and infectivity rapidly decreases thereafter to near-zero after about 10 days in mild-moderately ill patients and 15 days in severely-critically ill and immunocompromised patients. The longest interval associated with replication-competent virus thus far is 20 days from symptom onset. This review summarizes evidence-to-date on the duration of infectivity of SARS-CoV-2, and how this has informed evolving public health recommendations on when it is safe to discontinue isolation precautions.
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