Revisiting the guidelines for ending isolation for COVID-19 patients

Jeong, Yong Dam; Ejima, Keisuke; Kim, Kwang Su; Iwanami, Shoya; Bento, Ana I; Fujita, Yasuhisa; Jung, Il Hyo; Aihara, Kazuyuki; Watashi, Koichi; Miyazaki, Taiga; Wakita, Takaji; Iwami, Shingo; Ajelli, Marco

Since the start of the COVID-19 pandemic, two mainstream guidelines for defining when to end the isolation of SARS-CoV-2-infected individuals have been in use: the one-size-fits-all approach (i.e. patients are isolated for a fixed number of days) and the personalized approach (i.e. based on repeated testing of isolated patients). We use a mathematical framework to model within-host viral dynamics and test different criteria for ending isolation. By considering a fixed time of 10 days since symptom onset as the criterion for ending isolation, we estimated that the risk of releasing an individual who is still infectious is low (0–6.6%). However, this policy entails lengthy unnecessary isolations (4.8–8.3 days). In contrast, by using a personalized strategy, similar low risks can be reached with shorter prolonged isolations. The obtained findings provide a scientific rationale for policies on ending the isolation of SARS-CoV-2-infected individuals.