COVID-19 Outbreak Update #14

On May 4, 2020, NH DHHS issued health alert COVID-19 update #14 regarding updated CDC guidance on removal from isolation and discontinuation of transmission-based precautions.

NH DPHS Health AlertsKey Points and Recommendations:

  • The U.S. Centers for Disease Control and Prevention (CDC) has updated their guidance about removing patients with suspect or confirmed COVID-19 from isolation and discontinuing use of transmission-based precautions: 
    • Discontinuation of Isolation for persons in non-healthcare/home settings 
    • Discontinuation of transmission-based precautions in healthcare settings 
    • Return to work criteria for healthcare personnel 
  • In general, a person can be removed from isolation and COVID-19 precautions if at least 10 days have passed since symptoms first began, as long as the person has also been afebrile (off fever-reducing medications) and symptoms have been improving for at least 72 hours. This new 10 day/72 hour criteria is the CDC’s “symptom-based strategy”. 
  • Asymptomatic persons can be removed from isolation and precautions after 10 days have passed from the date of the person’s first positive COVID-19 test, assuming the person does not subsequently develop symptoms (then the symptom-based criteria should be used). 
  • The U.S. CDC has published a review of the science surrounding the changes to their guidance, and we encourage providers to review here. Per CDC, “replication-competent virus has not been successfully cultured more than 9 days after onset of illness.” 
  • A test-based criteria remains, but we recommend using the symptom-based criteria for most situations (i.e. removal from home isolation, discontinuation of healthcare precautions, determining when healthcare personnel can return to work) except for individuals who are severely immunocompromised (see CDC guidance for immunocompromised persons). 
    • CDC has removed their preference for a test-based strategy for allowing healthcare personnel return to work
    • CDC has removed their preference for a test-based strategy for healthcare settings and long-term care facilities 
  • If a patient with COVID-19 is discharged to a nursing home or other long-term care facility and they have met the CDC criteria for removal from isolation and precautions but the patient has persistent symptoms, the patient should be placed in a single room, be restricted to their room to the extent possible, and wear a facemask (if tolerated) during care activities until all symptoms are completely resolved or at baseline.

Read the full DHHS alert