Is it safe to follow CDC’s new guidance on COVID isolation? Experts aren’t convinced
(Tribune News Service) — Here we go again.
The Centers for Disease Control and Prevention updated its isolation guidance amid the mess the omicron variant is causing, including worker and COVID-19 test shortages across the nation.
Now, if you test positive for COVID-19, you can isolate yourself for five instead of 10 days — regardless of vaccination status. The new recommendation applies to people who don’t have symptoms, as well as those who have symptoms that are “resolving.” A negative COVID-19 test is not needed to end isolation.
The caveat: you should continue to wear a face mask around others for another five days, preferably a medical grade one like an N95, experts say.
The CDC says its new guidance is “motivated by science” that shows the majority of coronavirus spread occurs the first two days before symptoms appear and two to three days afterwards.
But many health experts aren’t convinced the shortened isolation period is safe, arguing that the science used to back the CDC’s update is based on pre-omicron data. Emerging evidence shows vaccination status plays a significant role in how long and how easily a person can spread the virus.
In general, studies show vaccinated people are less likely to spread the coronavirus to others — although it’s still possible — and they can clear the germ from their system faster than the unvaccinated.
Unfortunately, the CDC’s decision can’t only focus on the science, experts say. Hospitals are overwhelmed; businesses are struggling to operate; and COVID-19 test supplies are harder to find. Shortening isolation periods could alleviate some of the stress.
“Well, let’s be honest, folks, #omicron is everywhere, and our economy is going to shut down if everyone has to isolate for 10 days,” Dr. Megan Ranney, an emergency room doctor and the Academic Dean for the Brown University School of Public Health, wrote on Twitter.
“On the one hand: I’m all for following the science for the vaccinated & asymptomatic. No reason to keep people home unnecessarily,” Ranney wrote. “On the other hand: the data shows a RANGE of infectiousness. Requiring a rapid test before ending isolation (esp for folks like, say, healthcare workers) would be far, far, far safer.”
But at the top of Ranney’s concerns is the country’s honor system.
“Haven’t we already shown that those who are unvaxxed, are unlikely to wear masks? The devil’s in the details, my friends,” she wrote.
CDC guidance may benefit from adding extra recommendations
Dr. Walid Gellad, an internal medicine doctor and professor of medicine at the University of Pittsburgh, is butting heads with one particular detail in the CDC’s new guidance: the shortened isolation period also applies to people whose symptoms are still present but resolving.
“Just like in the summer with CDC mask guidance, this seems created to allow some amount of Covid transmission to happen. Fine,” Gellad wrote on Twitter. “My personal advice is not to take this as your own personal guidance on what might be safe for you or people close to you, like grandma.”
Many experts agree the CDC’s new guidance could make sense if they add some testing or upgraded face mask recommendations.
“CDC recommendations are reasonable IF PAIRED with rapid antigen testing to come out of isolation. Why? People are infectious for a wide range of time. Some for a couple days. Others, for over a week,” Dr. Celine Gounder, an infectious disease expert and an attending physician at Bellevue Hospital in New York, wrote on Twitter.
Gounder referenced two studies that reveal how inconsistent coronavirus spread can be.
One study published in May 2020 in the early days of the pandemic found many people with COVID-19 were no longer contagious by about seven days after their symptoms appeared, but many others were still infectious two or more weeks out.
A more recent study published Dec. 23 shows infected vaccinated people take an average of 5.5 days to clear the coronavirus (omicron variant not included in the data) from their system, while it takes unvaccinated people an average of 7.5 days. This suggests unvaccinated people may need to isolate or wear masks for longer periods to lower transmission risks.
Even the experts who think the CDC made the right decision feel the new guidance could’ve used some tweaks.
“This is terrific — consistent with the evidence and data for contagiousness. And exactly what our country needs right now,” Dr. Ashish Jha, a physician and the third dean of the Brown University School of Public Health, wrote on Twitter.
Jha said the “new CDC isolation guidelines are reasonable,” but he would have preferred if the agency required a negative rapid antigen test after five days, issued different recommendations for people depending on vaccination status and specified on the use of higher quality face masks.
Issues with new CDC isolation guidelines go beyond the science
Some experts acknowledge the difficulty in setting public health guidelines as the virus we are trying to control mutates so quickly. But many cannot wrap their heads around the fact recommendations are led by data collected before the omicron variant emerged and by test shortages that appear to be avoidable.
“CDC’s new guidance to drop isolation of positives to 5 days without a negative test is reckless,” Dr. Michael Mina, a former assistant professor of epidemiology at Harvard T. H. Chan School of Public Health, wrote on Twitter.
What “hurts” Mina the most is that it appears the CDC did not require people who test positive to test negative before leaving isolation because there are not enough tests in the U.S., “which is obviously a massive problem in its own right but one that is EASILY changed.”
“We CAN get the tests. We CAN. Many countries are getting these and more,” Mina wrote. “This doesn’t have to be a hard decision.”
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