COVID-19: Management of recovered patients
- This section discusses protocols for the management of "recovered" COVID patients.
- Such patient may present for non-COVID-related care.
Infection Prevention Considerations
- For those with mild to moderate COVID, replication-competent virus (i.e., potentially contagious) has not been recovered after 10 days following symptom onset. Recovery of replication-competent virus between 10 and 20 days after symptom onset has been documented in some persons with severe COVID-19 that, in some cases, was complicated by immunocompromised state. However, in this series of patients, it was estimated that 88% and 95% of their specimens no longer yielded replication-competent virus after 10 and 15 days, respectively, following symptom onset.
- A large contact tracing study demonstrated that high-risk household and hospital contacts did not develop infection if their exposure to a case patient started 6 days or more after the case patient’s illness onset.
- Recovered patients can continue to have SARS-CoV-2 RNA detected in their upper respiratory specimens for up to 12 weeks. Investigation of 285 “persistently positive” persons, which included 126 persons who had developed recurrent symptoms, found no secondary infections among 790 contacts attributable to contact with these case patients. Efforts to isolate replication-competent virus from 108 of these case patients were unsuccessful.
- Specimens from recovered symptomatic patients did not have replication-competent virus detected.
- There have been no confirmed cases of SARS-CoV-2 reinfection to date.
- Equivalent data from children and infants are not presently available.
Infection Prevention Actions
- For most patients with COVID (and those who are asymptomatic, but test (+)), Special Precautions can be discontinued 10 days after symptom onset and resolution of fever for at least 24 hours, without the use of fever-reducing medications, and with improvement of other symptoms (or 10d after test (+) date if asymptomatic).
- CDC recently changed to a 24 hour time period from the previously recommended 72 hours.
- Those with severe illness or severe immunocompromise should be isolated for 20 days after symptom onset.
- The “test-based strategy” is no longer recommended except for certain patients in certain locked-down facilities (e.g. psych patients).
- Such patients, housed on a non-psych unit, and who are to be transferred back to congregant care (psych ED, outside facility) should be isolated for a minimum of 10d and have 1 negative before such transfer.
- This test should be sent using a non-rapid test process.
- For persons who develop new symptoms consistent with COVID and for whom an alternative etiology cannot be identified, then do the test and isolate until results are known. Discussion with ID or IPC is recommended if the test is (+).
- Update on the science: https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation.html