Covid: how many days of isolation are indicated

Anyone who has typical symptoms of Covid or has received a positive diagnosis should be in isolation, restricting contact with other people as much as possible, for at least seven days.

This is the recommendation of most health entities and doctors working in the area.

The measure is necessary to cut the chains of transmission of the virus and prevent the transmission of the pathogen to other individuals – especially to those who can develop the severe forms of the disease, related to hospitalization, intubation and death.

But this quarantine time can be longer or shorter, depending on a series of individual characteristics and conditions.

In some situations, five days of isolation may be acceptable. In others, it is important to wait until the tenth day and monitor the evolution of symptoms.

Another important recommendation: after a positive result, it is not recommended to do rapid tests every day to see if it is possible to leave the quarantine before the stipulated deadline.

Understand the basic isolation recommendations and the points that help define whether this period at home can be shortened — or extended.

What to do in practice

We can summarize all the guidelines and considerations in three main scenarios, with isolations of five, seven and ten days, according to the most recent information made available by the Ministry of Health.

First scenario: do you have typical symptoms of covid or did you take a test and the result was positive? Start isolation immediately.

You can check the most frequent symptoms of Covid in the report below. And it’s important to start isolation as soon as they appear — even if you have a negative first test result (or haven’t taken the test yet).

The duration of this isolation depends on a few criteria:

five days isolation

• Indicated for those who do not have any symptoms and have no contact with people at high risk for serious forms of Covid (such as the elderly and immunosuppressed).
• After completing the fifth day, if you are feeling well, do not have a fever and have not taken antipyretic medicines (which control body temperature, such as acetylsalicylic acid, dipyrone, ibuprofen and paracetamol) in the last 24 hours, take a new test .
• If the result is negative, you are released.
• If the result is positive, stay in isolation for another five days.

seven days isolation

• Indicated for those who have mild and moderate Covid symptoms.
• After the seventh full day since the onset of symptoms or the positive test, make an assessment: if you are feeling well, do not have a fever and have not used antipyretic drugs in the last 24 hours, you are released from isolation.
• In this case, there is no need to test again at the end of the quarantine.

ten days isolation

• Indicated for those who live with people who are at high risk of developing more serious forms of Covid (such as the elderly and immunosuppressed).
• If you are still having symptoms on the seventh day, get a new rapid test or RT-PCR.
• If the result of this test is positive, maintain isolation until the tenth day.
• If the result is negative and the symptoms improve (and there is no fever or use of antipyretics in the last 24 hours) it is possible to leave the isolation.

How the guidelines have changed

At the beginning of the pandemic, the general recommendation was for Covid patients to be isolated for up to two weeks.

“With the passage of time and the advancement of vaccination, the lethality rate of the disease has decreased”, observes infectious disease specialist and virologist Nancy Bellei, a professor at Unifesp (Federal University of São Paulo).

“And we also cannot ignore the fact that we need people for the functioning of society, public transport and hospitals, so this window of isolation has been gradually reduced.”

“Nowadays, five to seven days is an acceptable time of restriction of contact in some situations”, adds the specialist, who also integrates the SBI (Brazilian Society of Infectious Diseases).

Currently, the Ministry of Health recommends a seven-day isolation for mild and moderate cases of Covid.

The person would be allowed to leave from the eighth day onwards, “provided he has not had respiratory symptoms and fever for at least 24 hours and without the use of [remédios] antipyretics”.

The UK public health service advises people with typical symptoms of Covid or who have tested positive to stay at home and avoid interacting with other individuals for five days.

“It’s also important to avoid contact with people who are at high risk for ten days, even if they are vaccinated.”

In high-risk individuals, such as the elderly and patients with compromised immune systems, the coronavirus can cause more serious cases, which require hospitalization and increase the risk of death.

If you need to leave the house during this period for some reason, the orientation is always to wear quality masks and not go through places with agglomeration or little air circulation, precisely to avoid the transmission of the virus.

For now, the World Health Organization (WHO) is still asking people with Covid to stay at home for ten days.

‘Common sense’

Bellei stresses that the ideal time of isolation must follow a series of criteria.

“And the first decisive factor in this account is common sense”, he says.

Let’s look at some practical examples: if you have Covid and interact on a daily basis with older people or people who have immunological problems, it is better to respect the quarantine of at least ten days.

“Now, if you only deal with young people, who are vaccinated and have already had Covid, it is possible to reduce it to seven or even five days”, guides the doctor.

“It’s all a matter of probability and risk, which must be measured individually.”

Bellei warns that setting a generic deadline, in which everyone can come out of isolation after five days, poses a danger.

“We do not have data to support this statement. Some research shows that 50% of patients still carry viral particles after the fifth day”, he warns.

Another factor that weighs when deciding the time of isolation is the evolution of symptoms.

“Those who have fever and cough tend to have a higher viral load and excrete virus for a longer time compared to an individual who has little or no discomfort”, compares Bellei.

That is: if five or seven days after the infection you continue to have the typical symptoms of Covid (cough, sneezing, runny nose, fever…) it is worth restricting contact for a few more days.

“We can safely say that after the tenth day of the onset of symptoms, you will no longer transmit the virus further”, points out the infectious disease specialist.

Tests every day?

Finally, there is no need to be doing quick tests every day after a positive diagnosis.

They can be useful to release an individual from quarantine from the fifth or seventh day onwards — as long as the steps mentioned above are followed.

“The tests were not done to determine whether someone can still transmit the virus or not,” explains Bellei.

“And we have to consider here the risk of errors when taking the exam or even in the way the results are interpreted by each one”, he adds.

It is normal that, in rapid antigen tests, the second trace (the one that confirms the diagnosis of Covid) becomes clearer as the days go by. But his “disappearance” before the deadline of seven or ten days does not eliminate the risk of the person having the pathogen and passing it on.

When in doubt, it is always worth counting on the support of a health professional, who can evaluate the case and provide more personalized guidelines.

– This text was originally published in https://www.bbc.com/portuguese/brasil-61970347