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Special Respiratory Isolation Precaution Removal
Special Respiratory Isolation Precaution Removal

Removing COVID-19 Patients from Special Respiratory Isolation Precautions - Updated 12/1/20

Written by Denver Health
Updated over a week ago

Specialized Respiratory Isolation (SRI) Precautions

❏ Contact precautions (gown and gloves)

❏ Airborne precautions (N95 mask)

❏ Eye protection (face mask or goggles)

When can Specialized Respiratory Isolation be removed?

Test of cure is not indicated to remove SRI for most patients. Instead, SRI may be removed 10 days after the onset of symptoms (symptomatic patients) in patients with mild to moderate illness who are not severely immunocompromised or 10 days after the FIRST positive test (asymptomatic patients) AND ≥24 hours after afebrile without fever-reducing medication and respiratory symptoms improving.

Patients with severe or critical illness OR who are severely immunocompromised may be removed from isolation 20 days the onset of symptoms provided they have been afebrile for ≥24 hours without fever-reducing medication and respiratory symptoms are improving.

For details please see the COVID-19 Testing and isolation algorithm.

How should I handle a negative COVID test in a patient with high clinical suspicion of infection?

If COVID test is negative yet high clinical suspicion remains, then please contact the COVID attending physician (see AMION, Infectious Diseases) to discuss repeat testing. Continue Specialized Respiratory Isolation until the decision is made.

How long do patients shed live COVID-19 virus?

Viable virus has not been found after 9 days of illness though has not been studied extensively for ventilated patients.

How long does COVID-19 PCR remain positive?

Despite absence of viable virus, COVID PCR may be detected for a month or more in some patients. Viral burden in upper respiratory specimens declines after onset of illness. No correlation between the length of illness and shedding of viral RNA has been detected.

What guidance is available for patients who had remote COVID-19 with prolonged viral shedding?

Researchers in South Korea have followed a cohort of “re-positive” COVID cases, meaning that they are PCR-positive after a period of PCR-negative status. Viral cultures plus epidemiologic investigations of 64% of their cohort (285/447) have been performed. No virus has been cultured from these 285 individuals, and no secondary cases of transmission have been attributed to these individuals among close contacts. Based on this data, we do not recommend Specialized Respiratory Isolation for patients with these characteristics.

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