Respiratory virus guidelines

Last content update: 3/14/25

Every year, respiratory viruses including COVID-19, influenza (flu), and respiratory syncytial virus (RSV) cause serious illness, hospitalizations, and deaths in Santa Clara County. This webpage includes recommendations for responding to respiratory virus cases and exposures in both healthcare and non-healthcare settings.

If you have questions about what guidance your facility should follow, contact the Public Health Department’s Communicable Disease Program at (408) 885-4214.

If your facility is experiencing an outbreak, refer to the Report infectious diseases webpage for information on how to report the outbreak to Public Health.

Please note: In the workplace, employees are subject to either the Cal/OSHA COVID-19 Prevention Non-Emergency Standards or the Cal/OSHA Aerosol Transmissible Diseases (ATD) Standard. Employers should consult those regulations for additional applicable requirements.

Isolation and post-exposure recommendations table

Isolation and post-exposure recommendations for individual cases and exposures are organized in the table below by facility type and population (staff or residents).

Individuals who do not fall into the categories below may refer to the Public Health Department’s Preventing spread of respiratory viruses guidelines or the Centers for Disease Control & Prevention (CDC) Respiratory Virus Guidance.

Facility type	Guidance for staff	Guidance for patients or residents
Healthcare delivery facilities, including: Acute Care Hospitals Skilled Nursing Facilities (SNFs) Portions of Long-Term Care Facilities (LTCFs) that deliver healthcare and nursing care	Staff with a suspected or confirmed respiratory virus, regardless of whether testing is performed, guidance (from AFL 25-01): Staff should isolate until at least three days have passed since symptom onset (or positive test, if asymptomatic) and at least 24 hours have passed with no fever (without use of fever reducing medicines), and symptoms are improving Staff should wear a mask for 10 days after symptom onset (or positive test, if asymptomatic) After returning to work, staff should perform frequent hand hygiene, especially before and after each patient encounter or contact with respiratory secretions	COVID-19 Guidance: Follow CDC’s Infection Control Guidance: SARS-CoV-2: COVID-19 positive patients should isolate for at least 10 days from symptom onset (or positive test, if asymptomatic) AND at least 24 hours have passed with no fever (without use of fever reducing medicines), and symptoms are improving Close contacts should test three times (immediately, on Day 3 and on Day 5) For influenza/RSV/other respiratory viruses: Follow CDC’s Infection Prevention and Control Strategies for Seasonal Influenza in Healthcare Settings: Patients with a suspected or confirmed non-COVID respiratory virus, should isolate for at least 7 days from symptom onset AND at least 24 hours have passed with no fever (without use of fever reducing medicines), and symptoms are improving Patients should wear a mask for 10 days after symptom onset (or positive test, if asymptomatic)
Outpatient, Ambulatory, Dental and Optometry Healthcare Settings	Staff with a suspected or confirmed respiratory virus, regardless of whether testing is performed, guidance (from AFL 25-01): Staff should isolate until at least three days have passed since symptom onset (or positive test, if asymptomatic) and at least 24 hours have passed with no fever (without use of fever reducing medicines), and symptoms are improving Staff should wear a mask for 10 days after symptom onset (or positive test, if asymptomatic) After returning to work, staff should perform frequent hand hygiene, especially before and after each patient encounter or contact with respiratory secretions	N/A
Non-healthcare congregate settings, including: Long-Term Care Facilities that do not provide or offer healthcare services Supportive Housing, including Congregate Shelters	Staff with a suspected or confirmed respiratory virus, regardless of whether testing is performed, should follow the below guidance (adapted from AFL 25-01): Staff should isolate until at least three days have passed since symptom onset (or positive test, if asymptomatic) and at least 24 hours have passed with no fever (without use of fever reducing medicines), and symptoms are improving Staff should wear a mask for 10 days after symptom onset (or positive test, if asymptomatic) After returning to work, staff should perform frequent hand hygiene, especially before and after each patient encounter or contact with respiratory secretions	Residents with a suspected or confirmed respiratory virus, regardless of whether testing is performed, should follow the below guidance (adapted from AFL 25-01): Residents should isolate until at least three days have passed since symptom onset (or positive test, if asymptomatic) and at least 24 hours have passed with no fever (without use of fever reducing medicines), and symptoms are improving Residents should wear a mask for 10 days after symptom onset (or positive test, if asymptomatic)
Schools and Childcare Settings	Send home anyone with fever, cough, sore throat, or other acute respiratory illness symptoms in accordance with CDPH symptom guidance or your facility’s protocol. Individuals can return to school/childcare once they are fever-free for 24 hours without medication, symptoms are getting better overall, and they can meaningfully participate in routine activities. Refer to the Public Health Department’s Preventing spread of respiratory viruses guidance. For more information, refer to the Disease reporting and exposure notices for schools and childcare webpage.	Send home anyone with fever, cough, sore throat, or other acute respiratory illness symptoms in accordance with CDPH symptom guidance or your facility’s protocol. Individuals can return to school/childcare once they are fever-free for 24 hours without medication, symptoms are getting better overall, and they can meaningfully participate in routine activities. Refer to the Public Health Department’s Preventing spread of respiratory viruses guidance. For more information, refer to the Disease reporting and exposure notices for schools and childcare webpage.
Emergency Medical Services	May follow CDPH AFL 25-01: Staff should isolate until at least three days have passed since symptom onset (or positive test, if asymptomatic) and at least 24 hours have passed with no fever (without use of fever reducing medicines), and symptoms are improving Staff should wear a mask for 10 days after symptom onset (or positive test, if asymptomatic) After returning to work, staff should perform frequent hand hygiene, especially before and after each patient encounter or contact with respiratory secretions	N/A

Facility type

Guidance for staff

Guidance for patients or residents

Healthcare delivery facilities, including:

Acute Care Hospitals
Skilled Nursing Facilities (SNFs)
Portions of Long-Term Care Facilities (LTCFs) that deliver healthcare and nursing care

Staff with a suspected or confirmed respiratory virus, regardless of whether testing is performed, guidance (from AFL 25-01):

Staff should isolate until at least three days have passed since symptom onset (or positive test, if asymptomatic) and at least 24 hours have passed with no fever (without use of fever reducing medicines), and symptoms are improving
Staff should wear a mask for 10 days after symptom onset (or positive test, if asymptomatic)
After returning to work, staff should perform frequent hand hygiene, especially before and after each patient encounter or contact with respiratory secretions

COVID-19 Guidance: Follow CDC’s Infection Control Guidance: SARS-CoV-2:

COVID-19 positive patients should isolate for at least 10 days from symptom onset (or positive test, if asymptomatic) AND at least 24 hours have passed with no fever (without use of fever reducing medicines), and symptoms are improving
Close contacts should test three times (immediately, on Day 3 and on Day 5)

For influenza/RSV/other respiratory viruses: Follow CDC’s Infection Prevention and Control Strategies for Seasonal Influenza in Healthcare Settings:

Patients with a suspected or confirmed non-COVID respiratory virus, should isolate for at least 7 days from symptom onset AND at least 24 hours have passed with no fever (without use of fever reducing medicines), and symptoms are improving
Patients should wear a mask for 10 days after symptom onset (or positive test, if asymptomatic)

Outpatient, Ambulatory, Dental and Optometry Healthcare Settings

Staff with a suspected or confirmed respiratory virus, regardless of whether testing is performed, guidance (from AFL 25-01):

Staff should isolate until at least three days have passed since symptom onset (or positive test, if asymptomatic) and at least 24 hours have passed with no fever (without use of fever reducing medicines), and symptoms are improving
Staff should wear a mask for 10 days after symptom onset (or positive test, if asymptomatic)
After returning to work, staff should perform frequent hand hygiene, especially before and after each patient encounter or contact with respiratory secretions

N/A

Non-healthcare congregate settings, including:

Long-Term Care Facilities that do not provide or offer healthcare services
Supportive Housing, including Congregate Shelters

Staff with a suspected or confirmed respiratory virus, regardless of whether testing is performed, should follow the below guidance (adapted from AFL 25-01):

Staff should isolate until at least three days have passed since symptom onset (or positive test, if asymptomatic) and at least 24 hours have passed with no fever (without use of fever reducing medicines), and symptoms are improving
Staff should wear a mask for 10 days after symptom onset (or positive test, if asymptomatic)
After returning to work, staff should perform frequent hand hygiene, especially before and after each patient encounter or contact with respiratory secretions

Residents with a suspected or confirmed respiratory virus, regardless of whether testing is performed, should follow the below guidance (adapted from AFL 25-01):

Residents should isolate until at least three days have passed since symptom onset (or positive test, if asymptomatic) and at least 24 hours have passed with no fever (without use of fever reducing medicines), and symptoms are improving
Residents should wear a mask for 10 days after symptom onset (or positive test, if asymptomatic)

Schools and Childcare Settings

Send home anyone with fever, cough, sore throat, or other acute respiratory illness symptoms in accordance with CDPH symptom guidance or your facility’s protocol.

Individuals can return to school/childcare once they are fever-free for 24 hours without medication, symptoms are getting better overall, and they can meaningfully participate in routine activities. Refer to the Public Health Department’s Preventing spread of respiratory viruses guidance.

For more information, refer to the Disease reporting and exposure notices for schools and childcare webpage.

Send home anyone with fever, cough, sore throat, or other acute respiratory illness symptoms in accordance with CDPH symptom guidance or your facility’s protocol.

For more information, refer to the Disease reporting and exposure notices for schools and childcare webpage.

Emergency Medical Services

May follow CDPH AFL 25-01:

Staff should isolate until at least three days have passed since symptom onset (or positive test, if asymptomatic) and at least 24 hours have passed with no fever (without use of fever reducing medicines), and symptoms are improving
Staff should wear a mask for 10 days after symptom onset (or positive test, if asymptomatic)
After returning to work, staff should perform frequent hand hygiene, especially before and after each patient encounter or contact with respiratory secretions

N/A

Related resources
COVID-19 information
Influenza (flu) information
RSV information
Report infectious diseases
Health data for Santa Clara County
Public Health Orders
Get help finding health insurance and applying for financial assistance

Isolation and post-exposure recommendations table

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