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Criteria for releasing COVID-19 patients from isolation

Scientific Brief

17 June 2020


On 27 May 2020, WHO published updated interim guidance on the clinical management of COVID-19,1,2 and provided updated recommendations on the criteria for discharging patients from isolation. The updated criteria reflect recent findings that patients whose symptoms have resolved may still test positive for the COVID-19 virus (SARS-CoV-2) by RT-PCR for many weeks. Despite this positive test result, these patients are not likely to be infectious and therefore are unlikely to be able to transmit the virus to another person.

This scientific brief provides the rationale for the changes made to the clinical management of COVID-19 guidance, based on recent scientific evidence.  WHO will update these criteria as more information becomes available. For more information about clinical care of COVID-19 patients, see WHO’s full guidance.1

Previous recommendation

Initial recommendation (published on 12 January 2020)

WHO’s first technical package of guidance for the clinical management of the novel coronavirus, now known as COVID-19, was published in early January 2020, shortly after a cluster of atypical pneumonia cases was first reported in Wuhan, People’s Republic of China,3 and included recommendations on when a patient with COVID-19 is no longer considered infectious.

The initial recommendation to confirm clearance of the virus, and thus allow discharge from isolation, required a patient to be clinically recovered and to have two negative RT-PCR results on sequential samples taken at least 24 hours apart.4 This recommendation was based on our knowledge and experience with similar coronaviruses, including those that cause SARS and MERS.5

Updated recommendation

New recommendation (published on 27 May 2020 as part of more comprehensive clinical care guidance1)

Within the Clinical Management of COVID-19 interim guidance published on 27 May 2020,1 WHO updated the criteria for discharge from isolation as part of the clinical care pathway of a COVID-19 patient. These criteria apply to all COVID-19 cases regardless of isolation location or disease severity.

Criteria for discharging patients from isolation (i.e., discontinuing transmission-based precautions) without requiring retesting[1]:

  • For symptomatic patients: 10 days after symptom onset, plus at least 3 additional days without symptoms (including without fever [2] and without respiratory symptoms)[3]
  • For asymptomatic cases[4]: 10 days after positive test for SARS-CoV-2

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伊法斯夫拉腾以英国独立党(U.K. Independence Party)为例,它的官方平台力主脱欧,但是面向选民的宣传中又强调移民对经济与文化的影响,她说这是一种混合了务实与民粹的论调。
Goldman Sachs will pay out big bonuses, be publicly vilified for a month and then go quietly back to printing profits.

*Countries may choose to continue to use testing as part of the release criteria.  If so, the initial recommendation of two negative PCR tests at least 24 hours apart can be used.

What is the reason for the change?

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  • Long periods of isolation for individuals with prolonged viral RNA detection after resolution of symptoms, affecting individual well-being, society ,and access to healthcare.13
  • 4.阿迪达斯。品牌喜爱度:35%/排名:25
  • Prolonged viral shedding around the limit of detection, having negative results followed by positive results, which unnecessarily challenges trust in the laboratory system.23-28

These challenges and newly available data on the risk of viral transmission over the course of the COVID-19 illness provided the framework for updating WHO’s position on the timing of discharging recovered patients from isolation in and outside health care facilities. WHO continuously reviews scientific literature on COVID-19 through its Science Division and its COVID-19 technical teams. All aspects of clinical management of COVID-19 patients and laboratory testing strategies are discussed within WHO and with Member States and WHO’s global expert networks of public health professionals, clinicians, and academics around the world. These expert networks and the Strategic and Technical Advisory Group for Infectious Hazards (STAG-IH)7 considered the challenges and reviewed the available data in the decision process to change the initial recommendation. 

3. 经济已经在崩溃,2014年到2016年的GDP将会更加难看
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WHO encourages the scientific community to compile additional evidence to further improve isolation discharge criteria and establish the conditions under which isolation can be abbreviated or where the possible risks of the current discharge criteria require further adaptation. Better understanding of transmission risk among individuals with different clinical presentations or comorbidities and in different settings will aid further refinement of these criteria. For situations that might still require a laboratory-based approach, we encourage the further optimization of such a laboratory algorithm. WHO encourages countries to continue testing patients, if they have the capacity to do so, for systematic data collection that will enhance understanding and better guide decisions about infection prevention and control measures, especially among patients with prolonged illness or those who are immunocompromised.

Current understanding of transmission risk  

Infection with the virus causing COVID-19 (SARS-CoV-2) is confirmed by the presence of viral RNA detected by molecular testing, usually RT-PCR.  Detection of viral RNA does not necessarily mean that a person is infectious and able to transmit the virus to another person. Factors that determine transmission risk include whether a virus is still replication-competent, whether the patient has symptoms, such as a cough, which can spread infectious droplets, and the behavior and environmental factors associated with the infected individual. Usually 5-10 days after infection with SARS-CoV-2, the infected individual starts to gradually produce neutralizing antibodies. Binding of these neutralizing antibodies to the virus is expected to reduce the risk of virus transmission.10,11,29,35

SARS-CoV-2 RNA has been detected in patients 1-3 days before symptom onset, and viral load in the upper respiratory tract peaks within the first week of infection, followed by a gradual decline over time.10,12,15,19,21,22,36-39  In the feces and lower respiratory tract, this viral load seems to peak in the second week of illness.19 Viral RNA has been detected in upper respiratory tract (URT) and lower respiratory tract (LRT) and feces, regardless of severity of disease.19 There seems to be a trend in longer detection of viral RNA in more severely ill patients.10,14,15,18,19,41-43  Studies of viral RNA detection in immunocompromised patients are limited, but one study suggested prolonged detection of viral RNA in renal transplant patients.33 Some studies analyzed the risk of transmission related to symptom of onset, and the estimated risk of transmission was highest at or around the time of symptom onset and in the first 5 days of illness.13,15

The ability of the virus to replicate in cultured cells serves as a surrogate marker of infectivity but requires special laboratory capabilities and may not be as sensitive as PCR.10,20 Animal models can aid understanding of transmission risk. In a study by Sia, et al., hamsters infected with SARS-CoV-2 were housed with healthy hamsters on either day 1 or day 6 after infection. Transmission to healthy hamsters occurred in the day 1 group, but not in those exposed 6 days after inoculation. In this model, the timing of transmission correlated with the detection of virus using cell culture, but not with detection of viral RNA in donor nasal washes.31

Studies using viral culture of patient samples to assess the presence of infectious SARS-CoV-2 are limited.8-10,21,29,30,34   Viable virus has been isolated from an asymptomatic case.9 A study of 9  COVID-19 patients with mild to moderate disease found no SARS-CoV-2 virus able to be cultured from respiratory samples after day 8 of symptom onset.10 Three studies of patients with undisclosed or variable degree of illness showed an inability to culture virus after days 7-9 of symptom onset.8,29,30  Patients who were RT-PCR positive on retesting after an initial negative RT-PCR on discharge from isolation were also studied, and none of these patients yielded positive viral cultures.29 One possible outlier is a case report of a patient with mild COVID-19 who remained PCR-positive for 63 days after symptom onset. In this patient, viral cultures were positive from upper respiratory tract specimens only on the day of symptom onset, but were culture-positive from sputum samples until day 18.22 It is unclear whether this posed a transmission risk as the patient had no respiratory symptoms. In a hospital-based study of 129 patients severely or critically ill with  COVID-19, 23 patients yielded at least one positive viral culture. This study included 30 patients who were immunocompromised. The median duration of viral shedding as measured by culture was 8 days post onset, the interquartile range was 5-11, and the range was 0-20 days.11 The probability of detecting virus in culture dropped below 5% after 15.2 days after of symptoms. In this study, patients testing positive by viral culture were still experiencing symptoms at the time of sample collection.11 This and other studies have described the correlation between reduced infectivity with the decrease in viral loads10,11,29,34 and a rise in neutralizing antibodies.10,11,29 Although viral RNA can be detected by PCR even after the resolution of symptoms, the amount of detected viral RNA is substantially reduced over time and generally below the threshold where replication competent virus can be isolated. Therefore, the combination of time after onset of symptoms and the clearance of symptoms seems to be a generally safe approach based on current data.  


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These modifications to the criteria for discharge from isolation (in a health facility or elsewhere) balance the understanding of infectious risk and the practicality of requiring repeated negative PCR testing, especially in settings of intense transmission or limited testing supplies. Although the risk of transmission after symptom resolution is likely to be minimal based on what is currently known, it cannot be completely ruled out. However, there is no zero-risk approach, and strict reliance on PCR confirmation of viral RNA clearance creates other risks (e.g. straining resources and limiting access to health care for new patients with acute disease). In patients with severe disease who are symptomatic for prolonged periods of time, a laboratory-based approach might also aid decision-making on the need for prolonged isolation. Such a laboratory-based approach can include measuring viral load and neutralizing antibody (or proven equivalent antibody) levels.10,11,29 More research is needed to further validate such an approach.   

WHO will update these criteria as more information becomes available. For more information about clinical care of COVID-19 patients, see WHO’s full guidance.1

[1] Countries can choose to continue to use a laboratory testing algorithm as part of the release criteria in (a subset of) infected individuals if their risk assessment gives reason to do so. 

[2] Without the use of any antipyretics.

[3] Some patients may experience symptoms (such as post viral cough) beyond the period of infectivity. Further research is needed. For more information about clinical care of COVID-19 patients, see our Clinical Management Guidance.1

[4] An asymptomatic case is an individual who has a laboratory confirmed positive test and who has no symptoms during the complete course of infection.


  1. World Health Organization. Clinical management of COVID-19 (Interim Guidance) Potus v Korus, published 27 May 2020.
  2. World Health Organization. Coronavirus disease (COVID-19) Situation Report – 129. 28 May 2020. Available at: Steven Spielberg directs Meryl Streep and Tom Hanks in The Post, a thrilling drama about the unlikely partnership between The Washington Post's Katharine Graham (Streep), the first female publisher of a major American newspaper, and editor Ben Bradlee (Hanks), as they race to catch up with The New York Times to expose a massive cover-up of government secrets that spanned three decades and four U.S. Presidents. The two must overcome their differences as they risk their careers - and their very freedom - to help bring long-buried truths to light.
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  3. ProMED International Society for Infectious Disease. 30 December 2019. (绿色装修评价标准实施 助推良心地板企业更上层楼 )
  4. World Health Organization. Laboratory testing of human suspected cases of novel coronavirus (nCOV) infection (Interim Guidance) (2015年风头最劲的品牌:在新款切诺基的拉动下,Jeep在2014年的销量惊人地拉高了44%,而斯巴鲁的销量则静悄悄地提高了21%,现已成为美国第十大最受欢迎的汽车品牌。 10 January 2020)
  5. World Health Organization. Technical guidance laboratory Middle East Respiratory syndrome coronavirus (MERS-CoV) (她还表示,从较长期来看,另一个让她担心的“R”是“重置”(reset),她解释称,全球各地的货币和财政政策在回归正常之前还有很长的路要走。她补充称:“最终的重置是那些在全球各地都有必要实施的结构性改革。”)
  6. World Health Organization. Global surveillance for COVID-19 caused by human infection with COVID-19 virus. (Interim Guidance) (One might expect that online programmes would appeal proportionately more to women than full-time programmes due to their flexibility. How-ever, data from the 2016 rankings show that women account for 30 per cent of enrolled students compared with 35 per cent for full-time programmes.
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    , 20 April 2020)
  7. World Health Organization. Strategic and Technical Advisory Group for Infectious Hazards (STAG IH)  (加快改善生态环境特别是空气质量,是人民群众的迫切愿望,是可持续发展的内在要求。必须科学施策、标本兼治、铁腕治理,努力向人民群众交出合格答卷。)
  8. Bullard J, Dusk K, Funk D, et al. Predicting infectious SARS-CoV-2 from diagnostic samples, Clin Infect Dis. 2020 doi: 10.1093/cid/ciaa638.
  9. We learned that we could see a source of ripples in space-time.
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  10. 但是,这些进展也指向美国和欧盟在利用此类案件上的巨大差异,欧盟目前正在讨论是否要赋予中国世界贸易组织(WTO)框架下的“市场经济”地位——这一让步会使对中国提起反倾销案变难。
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  11. 在领英平台上高频出现是找工作的关键。你知道这点,你们经理也知道这点。你的经理兴许还知道你知道这点。所以她会从开始关注周一你的个人简介只是有个大概框架,到周五你增加了工作经历,新人脉,状态更新,推荐信慢慢被顶起,别一夜之间从0涨到500那样太明显了Foss提醒道。
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  13. 而新上榜的中国公司则包括万科、中铁公司和中国太平保险。
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  20. World Health Organization. Laboratory biosafety guidance related to coronavirus disease (COVID-19) (The runner-up was Lucy Kay, with Bars and Melody in third place.
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  23. Yuan J, Kou S, Liang Y, et al. PCR Assays Turned Positive in 25 Discharged COVID-19 Patients. Clin Infect Dis. 2020 doi: 10.1093/cid/ciaa398.
  24. Tang X, Zhao S, He D, et al. Positive RT-PCR tests among discharged COVID-19 patients in Shenzhen, China. Infect Control Hosp Epidemiol. 2020 doi: 10.1017/ice.2020.134.
  25. Qu YM, Kang EM, Cong HY. Positive result of Sars-Cov-2 in sputum from a cured patient with COVID-19. Travel Med Infect Dis. 2020; 34: p101619. doi: 10.1016/j.tmaid.2020.101619.
  26. Maria Rios
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  30. Centers for Disease Control and Prevention, 深圳房价为何任性上涨 常住人口中70%无房. Symptom-Based Strategy to Discontinue Isolation for Persons with COVID-19.  Website, accessed on 12 June 2020. Best Companies rank: 7
  31. Sia SF, Yan LM, Chin AWH et al. Pathogenesis and transmission of SARS-CoV-2 in golden hamsters. Nature. 2020 doi: 10.1038/s41586-020-2342-5.
  32.  Wang W, Xu Y, Gao R, et al. Detection of SARS-CoV-2 in Different Types of Clinical Specimens. JAMA. 2020; 323(18): 1843-4. doi:10.1001/jama.2020.3786.
  33. Company: Binary Group
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  34. 英国
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  35. Despite the breakthrough, Jack Ma, chairman of Alibaba Group, said there was no need for human beings to fear machines.
  36. Zou L, Ruan F, Huang M, et al. SARS-CoV-2 Viral Load in Upper Respiratory Specimens of Infected Patients. N Engl J Med. 2020; 382(12): p.1177-9.
  37. An iPhone displays an image of Steve Jobs as it sits with a memorial to the Apple founder and former CEO outside an Apple Store, Wednesday, Oct. 5, 2011 in New York. Jobs passed away Wednesday at the age of 56
  38. The paper quoted a number of students from the incoming class, who had a range of responses, including two who said it was the right approach to withdraw the offers. "I do not know how those offensive images could be defended," one student said.
    本文作者为卡内基国际和平基金会(Carnegie Endowment)高级研究员、世界银行(World Bank)中国业务局前局长,译者/何黎
  39.  Pan Y, Zhang D, Yang P, Poon LLM, Wang Q. Viral load of SARS-CoV-2 in clinical samples. Lancet Infect Dis. 2020; 20(4): p. 411-2. doi: 10.1016/S1473-3099(20)30113-4.
  40. Stand: Starbucks CEO Howard Schultz urged the end of government shutdown
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  41. “尽管我本质上是一名工程师和分析人员,但迄今为止我所做过的最重要的决定都与此无关,它们永远是基于直觉,”他去年在曾就读MBA的杜克大学(Duke University)对一名采访者表示。
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  42. Xu K, Chen Y, Yuan J, et al. Factors associated with prolonged viral RNA shedding in patients with COVID-19. Clin Infect Dis. 2020 doi: 10.1093/cid/ciaa351.
  43. Qi L, Yang Y, Jiang D, et al. Factors associated with duration of viral shedding in adults with COVID-19 outside of Wuhan, China: A retrospective cohort study. Int J Infect Dis. 2020 doi: 10.1016/j.ijid.2020.05.045.

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