COVID-19: Longer Time to Isolate After Recovery / Prolonged aPTT / Guidance on Life Support in Children

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM

The CDC has extended the time that recovered COVID-19 patients should remain isolated. In particular, recovered patients should isolate for at least 10 days — rather than 7 — after symptom onset and for at least 3 days after recovery. (The agency defines recovery as the "resolution of fever without the use of fever-reducing medications with progressive improvement or resolution of other symptoms.")

The CDC notes that replication-competent virus has not been cultured more than 9 days after illness onset.

Stricter requirements — such as longer periods of isolation or testing of respiratory specimens for viral burden — may be appropriate for certain patients. These may include people who could transmit the virus to higher-risk individuals (e.g., those with underlying health conditions), those living in retirement homes and other congregate settings, and those who are immunocompromised and may shed the virus longer than others.

In other COVID-19 news:

• Prolonged aPTT: Researchers in the U.K. report that among some 200 patients with severe COVID-19, 20% had a prolonged activated partial-thromboplastin time (aPTT). Of those with prolonged aPTT who had lupus anticoagulant assays, 91% of the assays were positive; none of these patients had clinically significant bleeding. The researchers conclude in the New England Journal of Medicine: "Clinicians should not withhold use of anticoagulants for thrombosis while awaiting further investigation of a prolonged aPTT, nor should they withhold thrombolytic therapy in the face of a high-risk pulmonary embolism on the basis of a prolonged aPTT alone."

• Guidance on life support in children: Several groups, including the American Heart Association and American Academy of Pediatrics, have together issued interim guidance on basic and advanced life support for newborns and children with COVID-19. The document is available free of charge at the third link below.