We’ve gotten quite good at putting today negative pressure rooms for our patients who are hospitalized with COVID. We’ve gotten our PPE sorted out. We’re pretty solid with our donning and doffing. But when should we discontinue contact precautions on these patients? Should they be on isolation for their entire hospitalization? When can family members finally get a chance to hug their loved ones again?
If you are like me, you’ve have or currently are taking care of patients who have been in the hospital for over a month. Are those patients still contagious? Should we test them until negative? Let’s seek some guidance from the CDC on this. Should we keep them on isolation with contact precautions until they get discharged? I have been quite critical of the CDC in the past. I’d like to know what you all think of their take. Let’s look at what they’re saying about al this. Please check my citations for all this and don’t trust me. The CDC recommends consultation with infection control experts on most of these. These are current as of August 10th and 16th.
How long should COVID patients be isolated and precautions taken?
Asymptomatic carriers: 10 days after testing positive
Majority of the population (Mild to Moderate Disease): 10 days after symptom onset and resolution of fever for at least 24 hours (without using fever-reducing meds) and symptoms have improved.
Severe or critical illness: up to 20 days after symptom onset AND 24 hours since last fever (without fever-reducing meds) and symptoms have improved.
Should we test patients for COVID to discontinue isolation or precautions?
Severe illness: consult infectious disease specialists
Do not re-test within 3 months after date of symptom onset.
How do they define the types of illnesses?
Mild are the ones who stay home. Moderate are the ones who have lower respiratory disease but are on room air. Severe are the ones who are hospitalized. Need supplemental oxygen. RR > 30 bpm. P/F ratio less than 300, abnormal chest x-ray. Critical illness are hanging out in the ICU with respiratory failure and/or multiple organ compromise. Hope this has helped you learn when to discontinue COVID precautions. For additional data on COVID click here.
Link to Podcast on the topic
Link to my YouTube video on the topic
Final citation from where all this came from. Add ended on 8/30/20.
Chanu Rhee, MD, MPH, Sanjat Kanjilal, Meghan Baker, MD, ScD, Michael Klompas, MD, MPH, Duration of SARS-CoV-2 Infectivity: When is it Safe to Discontinue Isolation?, Clinical Infectious Diseases, , ciaa1249, https://doi.org/10.1093/cid/ciaa1249
Link to Article
Link to FULL FREE PDF
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