Per CDC guidance, a time and symptom-based strategy for discontinuation of transmission-based precautions is preferred over a test-based strategy. While some patients may continue to test positive by SARS-CoV-2 PCR for weeks to months after an initial diagnosis, data support that these patients do not transmit the virus to other people. Repeat testing for these patients who are not thought to be at risk for person-to-person transmission leads to inefficiencies in testing, unnecessary use of PPE, and may result in delays in patient care.

The duration of transmission-based precautions is determined by a patient's severity of illness and level of underlying immunosuppression, based on reports that critically ill or those who are highly immunocompromised may shed viable virus longer than those with milder disease.

Valley is adopting a time and symptom-based strategy rather than a testing-based strategy​ as follows to discontinue Transmission-Based Precautions:

Patients who are COVID recovered who had mild to moderate illness and did not require hospitalization:

• ​At least 10 days have passed since COVID-19 test date AND
• ​At least 24 hours have passed since last fever without the use of fever-reducing medications AND
• ​Symptoms (e.g., cough, shortness of breath) are improving
• ​Note: For patients who did not have symptoms throughout their infection, TBP may be discontinued when at least 10 days have passed since the date of their first positive viral diagnostic test.

Patients who are COVID recovered who needed to be hospitalized or who are moderately immunocompromised:

• ​At least 20 days have passed since COVID-19 test date AND
• ​At least 24 hours have passed since last fever without the use of fever-reducing medications AND
• ​Symptoms (e.g., cough, shortness of breath) are improving​
• ​Note: For patients who are highly immunocompromised we will still use a test based strategy. In addition to time and symptoms, one negative COVID-19 PCR test. Do not obtain follow-up tests earlier than 20 days​. ​

When to retest after discontinuation of transmission-based precautions​
Patients who meet the above criteria for discontinuation of transmission-based precautions should NOT be re-tested for at least 90 days after onset of infection because positive PCR during this time likely represents persistent shedding of non-viable viral RNA rather than reinfection. If such a person remains asymptomatic during this 90-day period, then any re-testing is unlikely to yield useful information, even if the person had close contact with an infected person.​

Repeat testing should be guided by clinical symptoms compatible with COVID. For persons who develop new symptoms consistent with COVID-19 during the 3 months after the date of initial symptom onset, if an alternative etiology cannot be identified by a provider, then the person may warrant retesting; consultation with infectious disease and/or infection control experts is recommended.​

What is the role of serologic testing in determining precautions?
Serologic testing should not be used to establish the presence or absence of acute SARS-CoV-2 infection or reinfection.​

Resources

CDC Discontinuation of Transmission-Based Precautions and Disposition of Patients with COVID-19 in Healthcare Settings (Interim Guidance): https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-hospitalized-patients.html ​