Post by Nadica (She/Her) on Jul 19, 2024 1:00:51 GMT
3 COVID Experts on Why the CDC’s Isolation Guidelines Are Bad for Public Health - Published March 7, 2024
On March 1, the CDC announced a change to its COVID-19 recommendations, effective immediately: It no longer advises people with the virus to isolate themselves for five days before returning to work or school. Instead, it suggests that if you have COVID (or the flu or RSV—the guidance groups COVID together with these respiratory illnesses), you can resume daily activities if you’ve been fever-free for 24 hours (without the aid of fever-reducing medications) and your symptoms are improving. The guidelines mention testing as “an additional prevention strategy that you can choose to assist in making decisions to further protect yourself and others,” rather than a determinant of whether to leave isolation, as it once was. This change in the CDC’s messaging around COVID comes after an initial reduction in recommended isolation time from 10 to 5 days in 2022.
Three COVID experts tell SELF that these bare-bones isolation guidelines will likely make more people sick—and that this approach increasingly places the burden of public health on individual people, which is dangerous for everyone, but especially for those at a higher risk of complications from the virus. Here’s why the experts we spoke with think the new suggestions are a bad idea.
COVID hasn’t become less transmissible—and you can still give it to other people even if you’re feeling better and are fever-free.
Speaking to reporters about the thinking behind the new guidance on March 1, the CDC’s director, Mandy Cohen, said, “Our goal here is to continue to protect those at risk for severe illness, while also reassuring folks that these recommendations are simple, clear, easy to understand and can be followed,” noting decreases in COVID-related hospitalizations and deaths this winter.
While COVID-related hospitalizations were down in the most recent winter surge, transmission rates were the second-highest (after the initial omicron wave during late 2021 and early 2022) of the entire pandemic. Though the peak of this winter’s surge is receding, wastewater analysis data suggests there are still more than 760,000 new cases of COVID a day in the US—meaning roughly 1 in 63 people are actively infectious. Based on his analysis of this data, Michael Hoerger, PhD, MSCR, an associate professor of psychology and medicine at Tulane University in New Orleans, tells SELF, “There is no evidence to suggest that these waves are becoming smaller on average over time, or that we're having fewer waves.”
Given that COVID is still very contagious, Lara Jirmanus, MD, MPH, a clinical instructor at Harvard Medical School and fellow at the FXB Center at the Harvard T. H. Chan School of Public Health, says the newest guidelines are more confusing—and that they’re even misleading. She tells SELF that the CDC’s messaging implicitly communicates two falsehoods: that COVID has “ceased to be a threat,” and that it “stops being transmitted when people stop having a fever.” According to Dr. Jirmanus, infectiousness has little to do with specific symptoms, since you can be sick (and contagious) without a fever and with few, mild, or even no symptoms at all. And if you’re testing positive on rapid tests, you’re very likely still able to infect others, even if you feel fine.
The period of being contagious with COVID is highly variable. Some research suggests that five days of isolation may not be even enough, since about two thirds of people continue to shed the virus five days after they first feel sick. Data from 2023 suggest that how infectious a person is has a median peak around day four, meaning that under the new guidance many people will go back to their daily lives at the point that they’re most likely to transmit the virus, so long as they don’t have a fever and are feeling better than they did when they first felt sick.
“Shortening isolation below five days supports economic interests and is not in the interest of protecting health, as the contagious period can vary with current variants,” Kaitlin Sundling, MD, PhD, director of cytology at Wisconsin School of Medicine and Public Health and member of the People’s CDC, tells SELF. She believes that the CDC’s updated recommendations are moving in the wrong direction. “COVID isolation should be expanded, not reduced or eliminated. There is no change in the scientific evidence around COVID transmission that would support reducing the recommended isolation period below five days,” she says. “Extending isolation beyond five days would be a safer approach, both to prevent viral spread and to allow people adequate time to recover.”
Despite what the CDC guidelines say, Dr. Sundling’s advice is to isolate for 10 to 14 days, if you have that option, and take two rapid tests with negative results at least 24 hours apart before going about your daily life as usual again. (Because Americans do not have universal paid sick leave, Dr. Sundling recognizes that many people will have to return to work or other responsibilities earlier than this. In that case, she says, people should be “wearing a well-fitting respirator and limiting in-person activities only to what is essential.”)
There’s still a lot we don’t know about long COVID.
Dr. Jirmanus stresses that SARS-CoV-2 is still a very new virus, and that eliminating preventative public health measures before we fully understand its long-term effects can have potentially devastating consequences. “None of us have a crystal ball. None of us know what COVID will be doing in five to seven years, what it even will mean for a person who is infected now, and what long COVID could look like,” she says.
“Every time you get infected with COVID, it increases your risk of having heart problems, strokes, blood clots, and many other issues,” says Dr. Jirmanus—for instance, an increased risk of diabetes, new-onset asthma, ME/CFS, POTS, MCAS, and a plethora of post-viral symptoms and chronic conditions, some of them very serious, that fall under the long COVID umbrella, including POTS, MCAS, brain fog, difficulty breathing, joint paindiarrhea, and post-exertional malaise, among other issues.
Estimates about the rates of long COVID vary, but one recent analysis suggests that each COVID infection carries a 10 to 20% risk of the chronic condition, most often after mild acute illness. Dr. Hoerger estimates that, in the US, between 38,000 and 152,000 people will develop long COVID every day this week, based on wastewater analysis. These are staggering figures, and each case represents a person with one or more of the above symptoms and conditions, all of which can have significant impacts on their quality of life.
To reduce the isolation period is to communicate that these serious outcomes are not a concern to the CDC, and shouldn’t be a concern to the American public—many of whom have opted not to receive new boosters for their years-old vaccines—which provide protection from severe acute illness, but only limited protection from long COVID.
High-risk people continue to be deprioritized by the CDC—even though they’re the most impacted by these changes.
Science-backed public health precautions are so important because they protect the most vulnerable. The experts who spoke with SELF emphasize the especially negative impacts of the new CDC isolation guidance on high-risk people. About “4 out of 10 Americans have chronic diseases that put them at higher risk of COVID,” Dr. Jirmanus says.
She points out that the new CDC recommendations seem targeted toward non-disabled or -immunocompromised people. This is evident in the way that the guidance page is set up on the CDC’s website: It offers overarching guidance for the majority, with individual pages dedicated to those who are disabled or immunocompromised. In those sections, the agency recommends individualized precautionary measures, rather than prioritizing robust public health infrastructure to protect those vulnerable groups. (And the stripping-away of public resources aimed at preventing the spread of COVID is ongoing, including the suspension of the USPS’s free rapid test delivery program, which ends tomorrow.)
The CDC’s emphasis on individual precautions, such as one-way masking, in its new guidelines puts the onus on vulnerable people to protect themselves, forcing them to ask for protection from doctors, family members, and co-workers, when the impetus should be on the government to provide guidance that minimizes the risk of transmission. “Life will be harder and more isolating for people with known risk factors” under the new isolation guidance, says Dr. Hoerger. As he points out, “Anyone can have a known or unknown vulnerability to COVID,” meaning it’s nearly impossible to identify who might be high-risk without their self-identifying (which is unlikely to come up at the grocery store or on public transportation). The new CDC recommendations mean it’ll be even more difficult for high-risk people to be safe in public.
In the absence of science-informed policies that account for how quickly COVID-19 spreads, how it can lead to disabling and otherwise serious health complications, and how to protect especially vulnerable people: Experts say we’re likely to face more long-term risks from COVID, at higher rates, that could have been avoided if public health was the agency’s first priority.
On March 1, the CDC announced a change to its COVID-19 recommendations, effective immediately: It no longer advises people with the virus to isolate themselves for five days before returning to work or school. Instead, it suggests that if you have COVID (or the flu or RSV—the guidance groups COVID together with these respiratory illnesses), you can resume daily activities if you’ve been fever-free for 24 hours (without the aid of fever-reducing medications) and your symptoms are improving. The guidelines mention testing as “an additional prevention strategy that you can choose to assist in making decisions to further protect yourself and others,” rather than a determinant of whether to leave isolation, as it once was. This change in the CDC’s messaging around COVID comes after an initial reduction in recommended isolation time from 10 to 5 days in 2022.
Three COVID experts tell SELF that these bare-bones isolation guidelines will likely make more people sick—and that this approach increasingly places the burden of public health on individual people, which is dangerous for everyone, but especially for those at a higher risk of complications from the virus. Here’s why the experts we spoke with think the new suggestions are a bad idea.
COVID hasn’t become less transmissible—and you can still give it to other people even if you’re feeling better and are fever-free.
Speaking to reporters about the thinking behind the new guidance on March 1, the CDC’s director, Mandy Cohen, said, “Our goal here is to continue to protect those at risk for severe illness, while also reassuring folks that these recommendations are simple, clear, easy to understand and can be followed,” noting decreases in COVID-related hospitalizations and deaths this winter.
While COVID-related hospitalizations were down in the most recent winter surge, transmission rates were the second-highest (after the initial omicron wave during late 2021 and early 2022) of the entire pandemic. Though the peak of this winter’s surge is receding, wastewater analysis data suggests there are still more than 760,000 new cases of COVID a day in the US—meaning roughly 1 in 63 people are actively infectious. Based on his analysis of this data, Michael Hoerger, PhD, MSCR, an associate professor of psychology and medicine at Tulane University in New Orleans, tells SELF, “There is no evidence to suggest that these waves are becoming smaller on average over time, or that we're having fewer waves.”
Given that COVID is still very contagious, Lara Jirmanus, MD, MPH, a clinical instructor at Harvard Medical School and fellow at the FXB Center at the Harvard T. H. Chan School of Public Health, says the newest guidelines are more confusing—and that they’re even misleading. She tells SELF that the CDC’s messaging implicitly communicates two falsehoods: that COVID has “ceased to be a threat,” and that it “stops being transmitted when people stop having a fever.” According to Dr. Jirmanus, infectiousness has little to do with specific symptoms, since you can be sick (and contagious) without a fever and with few, mild, or even no symptoms at all. And if you’re testing positive on rapid tests, you’re very likely still able to infect others, even if you feel fine.
The period of being contagious with COVID is highly variable. Some research suggests that five days of isolation may not be even enough, since about two thirds of people continue to shed the virus five days after they first feel sick. Data from 2023 suggest that how infectious a person is has a median peak around day four, meaning that under the new guidance many people will go back to their daily lives at the point that they’re most likely to transmit the virus, so long as they don’t have a fever and are feeling better than they did when they first felt sick.
“Shortening isolation below five days supports economic interests and is not in the interest of protecting health, as the contagious period can vary with current variants,” Kaitlin Sundling, MD, PhD, director of cytology at Wisconsin School of Medicine and Public Health and member of the People’s CDC, tells SELF. She believes that the CDC’s updated recommendations are moving in the wrong direction. “COVID isolation should be expanded, not reduced or eliminated. There is no change in the scientific evidence around COVID transmission that would support reducing the recommended isolation period below five days,” she says. “Extending isolation beyond five days would be a safer approach, both to prevent viral spread and to allow people adequate time to recover.”
Despite what the CDC guidelines say, Dr. Sundling’s advice is to isolate for 10 to 14 days, if you have that option, and take two rapid tests with negative results at least 24 hours apart before going about your daily life as usual again. (Because Americans do not have universal paid sick leave, Dr. Sundling recognizes that many people will have to return to work or other responsibilities earlier than this. In that case, she says, people should be “wearing a well-fitting respirator and limiting in-person activities only to what is essential.”)
There’s still a lot we don’t know about long COVID.
Dr. Jirmanus stresses that SARS-CoV-2 is still a very new virus, and that eliminating preventative public health measures before we fully understand its long-term effects can have potentially devastating consequences. “None of us have a crystal ball. None of us know what COVID will be doing in five to seven years, what it even will mean for a person who is infected now, and what long COVID could look like,” she says.
“Every time you get infected with COVID, it increases your risk of having heart problems, strokes, blood clots, and many other issues,” says Dr. Jirmanus—for instance, an increased risk of diabetes, new-onset asthma, ME/CFS, POTS, MCAS, and a plethora of post-viral symptoms and chronic conditions, some of them very serious, that fall under the long COVID umbrella, including POTS, MCAS, brain fog, difficulty breathing, joint paindiarrhea, and post-exertional malaise, among other issues.
Estimates about the rates of long COVID vary, but one recent analysis suggests that each COVID infection carries a 10 to 20% risk of the chronic condition, most often after mild acute illness. Dr. Hoerger estimates that, in the US, between 38,000 and 152,000 people will develop long COVID every day this week, based on wastewater analysis. These are staggering figures, and each case represents a person with one or more of the above symptoms and conditions, all of which can have significant impacts on their quality of life.
To reduce the isolation period is to communicate that these serious outcomes are not a concern to the CDC, and shouldn’t be a concern to the American public—many of whom have opted not to receive new boosters for their years-old vaccines—which provide protection from severe acute illness, but only limited protection from long COVID.
High-risk people continue to be deprioritized by the CDC—even though they’re the most impacted by these changes.
Science-backed public health precautions are so important because they protect the most vulnerable. The experts who spoke with SELF emphasize the especially negative impacts of the new CDC isolation guidance on high-risk people. About “4 out of 10 Americans have chronic diseases that put them at higher risk of COVID,” Dr. Jirmanus says.
She points out that the new CDC recommendations seem targeted toward non-disabled or -immunocompromised people. This is evident in the way that the guidance page is set up on the CDC’s website: It offers overarching guidance for the majority, with individual pages dedicated to those who are disabled or immunocompromised. In those sections, the agency recommends individualized precautionary measures, rather than prioritizing robust public health infrastructure to protect those vulnerable groups. (And the stripping-away of public resources aimed at preventing the spread of COVID is ongoing, including the suspension of the USPS’s free rapid test delivery program, which ends tomorrow.)
The CDC’s emphasis on individual precautions, such as one-way masking, in its new guidelines puts the onus on vulnerable people to protect themselves, forcing them to ask for protection from doctors, family members, and co-workers, when the impetus should be on the government to provide guidance that minimizes the risk of transmission. “Life will be harder and more isolating for people with known risk factors” under the new isolation guidance, says Dr. Hoerger. As he points out, “Anyone can have a known or unknown vulnerability to COVID,” meaning it’s nearly impossible to identify who might be high-risk without their self-identifying (which is unlikely to come up at the grocery store or on public transportation). The new CDC recommendations mean it’ll be even more difficult for high-risk people to be safe in public.
In the absence of science-informed policies that account for how quickly COVID-19 spreads, how it can lead to disabling and otherwise serious health complications, and how to protect especially vulnerable people: Experts say we’re likely to face more long-term risks from COVID, at higher rates, that could have been avoided if public health was the agency’s first priority.