Time-based and Symptom-based Strategy for Discontinuing Patients’ Isolation and Rejoining the Community

The Philippine College of Physicians and Philippine Society for Microbiology and Infectious Diseases would like to inform the public of the current national criteria for discontinuing patients’ isolation based on recent scientific evidence. It is recommended that patients who tested positive for SARS-CoV-2 on RT-PCR should be released from isolation once the following conditions have been met, without the need for additional antibody or repeat RT-PCR testing:

- For asymptomatic individuals who remain without symptoms, 14 days of isolation have been completed from the time of the original positive result.
- For patients with mild to moderate COVID-19 disease, at least 14 days of isolation have been completed, including resolution of fever without use of antipyretic medications and with improvement of other symptoms for at least 3 days.
- For patients with severe or critical COVID-19 disease, at least 21 days of isolation have been completed including resolution of fever without use of antypyretic medications and with improvement of other symptoms for at least 3 days.

Those patients with immunocompromising conditions, as duly assessed by the attending physicians are not included in the time-based or symptom based strategy. These patients need to be cleared at the discretion of the attending physician, using clinical parameters and the test-based strategy. The period of isolation from time of symptom onset should not be less than 14 days.

Final assessment should always be made by a licensed physician to ensure that the patient has clinically recovered. Patients discharged from isolation are no longer considered contagious and can join the household and the community without significant risk of infecting others. However, using soap and water or alcohol hand rub, cough etiquette, and physical distancing since there is still no definite evidence on the duration of protection and immunity after recovery from COVID-19 disease.

The Department of Health has released guidelines to this effect last May 29, 2020 with Department Memorandum 2020-0258 stating that repeat PCR testing is no longer required to release patients from isolation. These recommendations are based on studies which showed that while RT-PCR can remain persistently positive for up to eight weeks, infectious viruses could no longer be cultured beyond the ninth day of symptom onset. Hence, routine repeat testing is no longer recommended as this approach leads to unnecessary isolation and use of PPE and testing resources.