Oregon and California recently lowered isolation guidelines from five days to only one day if symptoms had improved and the person hadn’t had a fever for 24 hours. The CDC is now following suit. They suggest that people continue wearing masks for five days after resuming normal activities.
The initial isolation for Covid-19 was ten days. This was lowered to 5 days in December 2021 after the Delta Airlines CEO complained about disruptions in airline services. Dr. Lucky Tran, a science communicator at Columbia University, says, “The changes in the CDC guidelines 1709363606 are really a result of political and corporate pressure. It’s a dangerous change that goes against the science, encourages disease spread, and prioritizes corporate interests, making it easier to exploit workers.”
The CDC says, “While every respiratory virus does not act the same, adopting a unified approach to limiting disease spread makes recommendations easier to follow.”
This is likely true, and it eliminates the need for testing for specific respiratory viruses, which is important since tests are expensive and not readily available for RSV in the U.S. However, Covid-19 is not like RSV or influenza, particularly given the long-term organ damage caused by the SARS2-CoV virus. That issue is not addressed by the CDC.
Proponents of the change argue that “we are in a better place,” with much of the population having some immunity from vaccination or prior infection. They also note we have antivirals available. Clearly, immunity is not long-lasting for many, given the number of people reporting recurrent Covid infections, and recurrent infection is considered a substantial risk for long Covid. Partial immunity from vaccinations has markedly reduced the risk of death from Covid-19.
Yes, fewer people are dying from Covid-19—but as of early February, there were still 2000 deaths per week and almost 20,000 people needing hospitalization.
One of CDC’s arguments for reducing isolation is to “meet people where they’re at” and that most of the public objects to masking and isolation. Another is that many infections are transmitted by asymptomatic people.
In terms of this sort of nonchalance, Dr. Jonathan Howard, a New York City psychiatrist, has written about this attitude in We Want Them Infected. Howard explained, “Almost immediately after vaccines arrived at the end of 2020, several prominent doctors from UCSF and Stanford began spreading the message that the pandemic was over, that variants were nothing to “panic” about, that herd immunity was at hand, and that vaccines both stopped viral transmission and essentially eliminated severe COVID outcomes.” Howard added that their innumerable media appearances “certainly contributed to the high level of complacency we see about a virus that is currently killing around 2,000 Americans every week.”
Transmission risk
People can’t judge whether they are infectious or not. Fever is not a good barometer for Covid-19. While most transmission occurs early in the illness, 20 to 40% of people can still transmit COVID after five days, and some even longer. That’s why many experts, such as Boston immunologist Michael Mina, have recommended serial Rapid Antigen Tests to stop isolation. If you have a positive RAT, you can transmit infection. Some people test positive for even two weeks, and occasionally even longer if immunocompromised.
Treatment
In terms of the availability of treatments, Evushield is no longer effective.
Paxlovid is difficult for many to obtain and is underprescribed, given to only 9.7% of those eligible for treatment in a study of more than 1 million health records. It is also now prohibitively expensive for many.
Organ Damage From Covid
The CDC and proponents of reducing isolation don’t mention one critical point—the tissue damage from Covid-19. Ziyad Al-Aly, a long Covid expert at the VA St. Louis Health Care System, had an article in The Conversation this week reviewing the toll of infection on brain health. Sequelae included an increased risk of cognitive deficits. Even with a mild infection, there was evidence that brain cells’ ability to regenerate was impaired. Another new review of infection in those older than 60 found a significant risk of new-onset dementia in those post-Covid. In a new New England Journal of Medicine study, there was a decrease of “only” 3 points in IQ following Covid. While that doesn’t sound like much, Al-Aly estimates “that a three-point downward shift in IQ would increase the number of U.S. adults with an IQ less than 70 from 4.7 million to 7.5 million – an increase of 2.8 million adults with a level of cognitive impairment that requires significant societal support.”
The CDC stresses that rates of long Covid are less than previously and are now down to 3.4%. Tran notes that “Because the virus is so contagious, even if a small percentage of people develop long term [Covid] then there are significant increases in things like cardiovascular disease, diabetes, neurological symptoms. That’s a huge increase in the burden of public health.”
Equity
Major pushback against reducing isolation relates to pressure on employees to return to work despite feeling poorly.
Noha Aboelata, M.D., CEO of Roots Community Health Center, hypothesized that a major driver is “worker shortages in several industries, including bus drivers, teachers, and health care providers.” She criticized the policy on X (formerly Twitter), saying it is “Promoting reckless disregard for everyone.“ She continued, “The message: Presenteeism is encouraged. You don’t deserve to rest & fully recover. You shouldn’t care about the well-being of those around you, or even your own.” She expressed concern that “these types of policies are going to disproportionately impact folks who use public transportation, who live in crowded intergenerational housing, who don’t have time from work.” Covid is “no longer considered something that you should use sick time for,” she added.
Tran concurs, adding, “The CDC guidance isn’t telling people to adequately isolate in a way that prevents the spread of COVID. That’s going to cause frontline workers and marginalized people to be at a lot more risk.
They, and others, say the problem will only be adequately addressed if there is guaranteed sick leave and pay.
Action/Responses
The World Health Network has filed a formal complaint against the California Dept of Public Health and Cal OSHA for reducing the isolation guidance without public comment. Others might follow with complaints against the CDC.
National Nurses United wrote to CDC Director Cohen last week “warning the CDC not to relax Covid isolation guidance. Nurses are disheartened to once again see the CDC weakening protections for public health, which will mean more transmission, illness, hospitalizations, and cases of long Covid. Today’s update comes on the heels of other work to relax infectious disease protections at the CDC—late last year, the CDC’s Healthcare Infection Control Practice Advisory Committee (HICPAC) drafted infection control guidance updates that proposed to lump Covid with other respiratory viruses and set the stage to weaken CDC’s personal protective equipment (PPE) guidance for health care workers.” Jane Thomason, industrial hygienest for NNU, concluded, “It is vital that nurses’ health and safety be protected so that they can care for their patients, especially due to the staffing crisis that many hospitals face.”
Some are suggesting calling the CDC at 800-232-4636 to comment. Others recommend calling your representatives (202 224-3121) and the White House at 202 455-1414.
A protest will also be happening in D.C. on March 15, opposing this decision and asking for more support and action on long Covid.
Further information about proposed changes for hospital infection control through the HICPAC committee are pending.
