CDC officials acknowledged during internal discussions and during a briefing last week with state health officials how much the covid-19 landscape has changed since the virus first appeared four years ago, killing nearly 1.2 million people in the United States and shutting down businesses and schools. The new reality — with most people having developed some level of immunity to the virus due to prior infection or vaccination — warrants a shift to a more hands-on approach, experts and health officials say .
“Public health must be realistic,” said Michael T. Osterholm, an infectious disease expert at the University of Minnesota. “In making recommendations to the public today, we must try to make the most of what people are prepared to do. … You can be absolutely right in science and yet accomplish nothing because no one will listen to you.
The CDC plans to recommend that people who test positive for coronavirus use clinical symptoms to determine when to end isolation. Under the new approach, people would no longer need to stay home if they have been fever-free for at least 24 hours without the aid of medication and their symptoms are mild and improving, according to three agency officials who spoke on condition of anonymity. to share internal discussions.
Here are the current CDC guidelines on isolation and precautions for people with covid-19
The federal recommendations follow similar actions taken by Oregon and California. THE The White House has not yet approved guidance that the agency is expected to release in April for public comment, officials said. An agency official said the timeline could “change a little bit” until the guidance is finalized.
Working on the revision isolation guidelines have been in place since last August, but were suspended in the fall as covid cases increased. CDC Director Mandy Cohen sent staff a memo in January that listed “Pan-resp-April guidance” as the focal point of the agency’s 2024 priorities.
Officials said they recognized the need to give the public more practical covid-19 guidelines, recognizing that few people are following isolation guidelines that have not been updated since December 2021. At the time, health officials reduced the recommended isolation period for people with asymptomatic coronavirus from 10 to five days because of concerns that essential services would be hampered by the highly transmissible coronavirus variant. ‘omicron, which caused an increase in infections. The decision was praised by business groups and criticized by some labor leaders and health experts.
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Plan to further relax isolation guidelines while science around contagiousness has not changed is likely provoke strong negative reactions from vulnerable groups, including people over 65, those with weak immune systems, and long-term patients, CDC officials and experts said.
In doing so “Sweep this serious illness under the rug,” said Lara Jirmanus, a clinical instructor at Harvard Medical School and a member of People’s CDC, a coalition of health care workers, scientists and advocates have focused on reducing the harmful effects of covid-19.
Public health officials should treat covid differently from other respiratory viruses, she said: because it’s deadlier than the flu and increases the risk of developing long-term complications. Up to 7 percent of Americans report having suffered from a series of ongoing problems. covid symptoms including fatigue, difficulty breathing, brain fog, joint pain, and continued loss of taste and smell, according to the CDC.
The new isolation recommendations would not apply to hospitals and other health care settings with more vulnerable populations, CDC officials said.
As the coronavirus continues to cause serious illness, especially among the most vulnerable, effective vaccines and treatments like Paxlovid are available. The latest versions of coronavirus vaccines were 54% effective at preventing symptomatic infection in adults, according to data released Feb. 1, the first U.S. study to evaluate the effectiveness of vaccines against the newest variant of the coronavirus . But CDC data shows that only 22 percent of adults and 12 percent of children had received the updated vaccine as of Feb. 9, despite data showing that vaccines provide strong protection against severe disease.
Coronavirus levels in wastewater indicate that symptomatic and asymptomatic infections remain high. Around 20,000 people are still hospitalized – and around 2,300 are dying — every week, CDC data shows. But the numbers are falling and are much lower than the peak of deaths in 2017. January 2021, where almost 26,000 people died from covid each week and around 115,000 were hospitalized.
Lower hospitalization rates are one reason California shortened its isolation recommendation by five days last month, urging people to stay home until they run out of fever for 24 hours and their symptoms are mild and improving. Oregon made a similar decision last May.
California State Epidemiologist Erica Pan said societal disruption resulting from strict isolation guidelines also helped spur change. Workers without sick leave and those who cannot work from home if they or their children test positive and are required to isolate bear a disproportionate burden. Strict isolation requirements can act as a deterrent to be tested while testing should be encouraged so that people at risk of serious illness can receive treatment, she said.
Giving people symptom-based advice, similar to what is already recommended for the flu, is a better way to prioritize those most at risk and balance the potential for disruptive impacts on schools and communities. work places. Pan said. After Oregon made its change, the state saw no disproportionate increase in community transmission or severity, according to data shared last month with the national association representing state health officials.
California still recommends people with Covid wear masks indoors when around other people for 10 days after testing positive – even if they have no symptoms – or they get sick. “You may remove your mask before 10 days if you have two sequential negative tests at least one day apart,” the California guideline states.
It is unclear whether the updated CDC guidance will continue to recommend masking for 10 days.
Health officials in other states told the CDC last week that they are already moving toward isolation guidelines that would treat the coronavirus the same as the flu and RSV, with additional precautions for people at high risk, said Anne Zink, Alaska’s emergency physician and chief. doctor.
Many other countries, including the United Kingdom, Denmark, Finland, Norway and Australia, changed their isolation recommendations in 2022. Of the 16 countries whose policies California officials reviewed, only Germany and Australia ‘Ireland I always recommend isolation for five hours days, according to a presentation from the California Department of Public Health » Health officials from other states said in January. Singapore’s Ministry of Health, in updated guidelines late last year, said residents could “return to normal activities” once coronavirus symptoms resolved.
Even before the Biden administration ended the public health emergency last May, much of the public had given up on covid-19, with many people having long since given up on testing and mask-wearing, and still less to isolate themselves when they present symptoms of covid.
Doctors say the best way for sick people to protect their communities is to wear a mask or avoid unnecessary travel outside the home.
“You see a lot of people with symptoms – you don’t know if they have covid, flu or RSV – but in all three cases, they probably shouldn’t be at Target, coughing and looking sick” , Eli said. Perencevitch, professor of internal medicine at the University of Iowa.
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