Why Do Some People Test Before Leaving COVID Isolation? Do You Need To?

The Centers for Disease Control and Prevention released a new set of COVID guidelines this week, but for those who test positive, do you need to test out of isolation? According to the CDC, it depends.

“We are in a stronger place today as a nation, with more tools – like vaccination, boosters and treatments – to protect ourselves, and our communities, from severe illness from COVID-19,” the CDC's Greta Massetti, who helped author the guidelines, said in a statement. “This guidance acknowledges that the pandemic is not over, but also helps us move to a point where COVID-19 no longer severely disrupts our daily lives.”

One of the biggest recommendation changes the CDC streamlined was geared toward “rebound COVID,” an increasingly-studied phenomenon that has led to some individuals testing positive for the virus after appearing to have recovered from it.

President Joe Biden and White House medical advisor Dr. Anthony Fauci both tested positive for the virus before ending their respective isolations.

So, in light of recent events, many were left wondering whether they also needed to test out of isolation.

According to the CDC, there is no requirement for any individual, regardless of vaccination status, to receive a negative test before ending their five-to-10-day isolation periods.

However, the CDC does recommend that individuals who experience more severe symptoms, including difficulty breathing and shortness of breath, remain in isolation for at least 10 days and consult a doctor before leaving. During the consultation, physicians are encouraged to do a viral test to demonstrate that the patient is no longer positive.

The Food and Drug Administration also has recommended that individuals who were exposed to the virus take three tests at home to ensure they are not infected. The previous advisement was to take two.

For those who choose to test out of isolation, masking guidelines could be different.

The CDC notes that after ending isolation, those who had COVID should continue wearing a mask through day 10. The CDC also notes, however, that if you have access to antigen tests, "you should consider using them."

"With two sequential negative tests 48 hours apart, you may remove your mask sooner than day 10," the guidance states, adding that if your antigen test results are positive, "you may still be infectious."

Those who continue to test positive should still mask.

"You should continue wearing a mask and wait at least 48 hours before taking another test," the CDC recommends. "Continue taking antigen tests at least 48 hours apart until you have two sequential negative results. This may mean you need to continue wearing a mask and testing beyond day 10."

If your symptoms worsen or return even after you end isolation, you'll need to restart your isolation at day 0, per the guidelines.

While the CDC has not set testing out of isolation as a standard, individuals, such as Biden and Fauci, are choosing to do so as an added precaution.

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 been shown 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 the variant keeps patients infectious for longer periods of time.

Chicago Department of Public Health Commissioner Dr. Allison 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.

Here's a further look at some of the changes made by the CDC:

Quarantine

The CDC previously said that if people who are not up to date on their COVID-19 vaccinations come into close contact with a person who tests positive, they should stay home for at least five days. Now, the agency says quarantining at home is not necessary, but it urges those people to wear a high-quality mask for 10 days and get tested after five.

Isolation

The agency continues to say that people who test positive should isolate from others for at least five days, regardless of whether they were vaccinated. CDC officials advise that people can end isolation if they are fever-free for 24 hours without the use of medication and they are without symptoms or the symptoms are improving.

Those who feel sick should also isolate until they receive test results, according to the guidance.

But symptoms also play a role in isolation timelines. The guidelines state:

• 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.
• 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.

Also if you leave isolation but your symptoms worsen, you must restart isolation for another 10 days.

• 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.  

Testing

The new guidelines also include information about testing asymptomatic people and those who had severe symptoms.

• Recommending screening testing of asymptomatic people without known exposures will no longer be recommended in most community settings. 
• 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.

Also on Thursday, the Food and Drug Administration updated its recommendations for how many times people exposed to COVID-19 should test.

Previously, the FDA had advised taking two rapid antigen tests over two or three days to rule out infection. Now the agency recommends three tests.

Social Distancing

The Centers for Disease Control and Prevention also said people no longer need to stay at least 6 feet away from others in some situations.

The guidelines emphasize 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," the CDC states.