Here’s an article for todays’ New York Times regarding the Center for Disease Control’s update released today on quarantine and isolation in patients who have, or are exposed to, Covid 19.
C.D.C. Eases Covid Guidelines, Noting Virus Is ‘Here to Stay’
The new guidelines eliminate quarantines and put less emphasis on social distancing, routine surveillance testing and contact tracing.
The Centers for Disease Control and Prevention loosened Covid-19 guidelines on Thursday, freeing schools and businesses from the onus of requiring unvaccinated people exposed to the virus to quarantine at home.
The changes are a sharp move away from measures such as social distancing requirements and quarantining, which had polarized much of the country, and effectively acknowledge the way many Americans have been navigating the pandemic for some time. The agency’s action comes as children across the country return to school and many offices have reopened.
“We know that Covid-19 is here to stay,” Greta Massetti, a C.D.C. epidemiologist, said at a news briefing on Thursday. “High levels of population immunity due to vaccination and previous infection, and the many tools that we have available to protect people from severe illness and death, have put us in a different place.
The C.D.C.’s new guidelines come after more than two years of a pandemic in which more than one million Americans have died. With the highly contagious BA.5 subvariant of Omicron spreading, the United States is recording more than 100,000 cases and nearly 500 deaths a day on average.
But many Americans dispensed with practices such as social distancing, quarantine and mask-wearing long ago.
“I think they are attempting to meet up with the reality that everyone in the public is pretty much done with this pandemic,” said Michael T. Osterholm, an infectious disease expert at the University of Minnesota, referring to the C.D.C.
The agency has been working for months on the new guidance, which builds on previous recommendations issued in February, when the agency shortened isolation times for many Americans. The C.D.C. said it is making changes now because vaccination and prior infections have granted many Americans some degree of protection against the virus, and treatments, vaccines and boosters are available to reduce the risk of severe illness.
The changes shift much of the responsibility for risk reduction from institutions to individuals. The C.D.C. no longer recommends that people stay six feet away from others. Instead, it notes that avoiding crowded areas and maintaining a distance from others are strategies that people may want to consider in order to reduce their risk.
And the recommended prevention strategies no longer draw a distinction between people who are up-to-date on their vaccinations and those who are not, streamlining a complicated set of rules that could be difficult for schools and businesses to navigate.
People who are exposed to the virus no longer must quarantine at home regardless of their vaccination status, although they should wear a mask for 10 days and get tested for the virus on day 5, according to the new guidelines. Contact tracing and routine surveillance testing of people without symptoms are no longer recommended in most settings.
Instead of focusing on slowing transmission of the virus, the recommendations prioritize preventing severe illness. They emphasize the importance of vaccination and other prevention measures, including antiviral treatments and ventilation.
The guidelines around masking — which recommend that people wear them indoors in places where community Covid-19 levels are high — have not changed.
And people who test positive for the virus should still isolate at home for at least five days. Those who had moderate or severe illness, or are immunocompromised, should isolate through day 10.
The agency also addressed the rebound infections that some people reported after taking the antiviral treatment Paxlovid; if symptoms return, people should restart the clock on isolation, the C.D.C. said.
Many health experts praised the new guidelines as representing a pragmatic approach to living with the virus in the longer term.
“I think this a welcome change,” said Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security. “It actually shows how far we’ve come.”
The new guidelines will also be easier for the public to follow, he added.
But the pandemic has not ended, experts noted, and more stringent measures may be needed in the event of new variants or future surges.
While nearly all Americans are now eligible to be vaccinated, many are not up-to-date on their shots. Just 30 percent of 5- to 11-year-olds and 60 percent of 12- to 17-year-olds have received their primary vaccine series nationwide. Among adults 65 and older, who are at highest risk of severe illness, 65 percent have received a booster. Critical therapeutics, such as antiviral treatments, remain difficult for many to access.
“Obviously, we have to do more work to make sure that more people avail themselves of the protection that those tools have to offer and that more people can access those tools,” said Jennifer Nuzzo, director of the Pandemic Center at the Brown University School of Public Health. “I do think there’s been an overall dial-back in the ground game that’s needed to get people vaccinated.”
The guidance moves away from sweeping, population-level precautions to more targeted advice for vulnerable populations and specific high-risk settings and circumstances.
For instance, the guidelines note that schools may want to consider surveillance testing in certain scenarios, such as for when students are returning from school breaks or for those who are participating in contact sports.
Unvaccinated students who are exposed to the virus will no longer need to test frequently in order to remain in the classroom, an approach known as “test to stay.” The C.D.C. no longer recommends a practice known as cohorting, in which schools divide students into smaller groups and limit contact between them to reduce the risk of viral transmission.
Health experts said the change in guidance was particularly welcome as students head back to school, a setting in which quarantines had been especially disruptive.
“This really will help to minimize the impact of Covid-19 on education,” said Christina Ramirez, a biostatistician at the University of California, Los Angeles.
Mercedes Carnethon, an epidemiologist at the Northwestern University Feinberg School of Medicine, said that she did not view the changes, even the elimination of quarantines in favor of 10 days of masking, as a loosening of the agency’s guidance.
“We certainly know that wearing a high-quality mask is going to provide some of the strongest protection against spreading it to somebody else, and quarantine is logistically burdensome,” she said. “That could be seen as a relaxing of guidelines, but I think it’s a much more appropriate and targeted solution.”
Joseph Allen, a Harvard University researcher who studies indoor environmental quality, praised the new guidelines for putting more emphasis on improving ventilation.
“Good ventilation is something that helps reduce the risk of transmission that isn’t political and doesn’t require any behavior change,” he said.
Sheryl Gay Stolberg contributed reporting
Emily Anthes is a reporter for The New York Times, where she focuses on science and health and covers topics like the coronavirus pandemic, vaccinations, virus testing and Covid in children.
Here is a link to the new guidelines followed by a summary of them.
Looking for the Quarantine and Isolation Calculator? It’s currently being updated and will be posted here when available.
If you were exposed to COVID-19, you should start taking precautions.
This information is intended for a general audience. Healthcare professionals should see Ending Isolation and Precautions for People with COVID-19. This CDC guidance is meant to supplement—not replace—any federal, state, local, territorial, or tribal health and safety laws, rules, and regulations.
If you have COVID-19, you can spread the virus to others. There are precautions you can take to prevent spreading it to others: isolation, masking, and avoiding contact with people who are at high risk of getting very sick. Isolation is used to separate people with confirmed or suspected COVID-19 from those without COVID-19.
These recommendations do not change based on COVID-19 Community Levels. If you have COVID-19, also see additional information on treatments that may be available to you.
For Healthcare Professionals: Ending Isolation and Precautions for People with COVID-19
Regardless of vaccination status, you should isolate from others when you have COVID-19. You should also isolate if you are sick and suspect that you have COVID-19 but do not yet have test results. If your results are positive, follow the full isolation recommendations below. If your results are negative, you can end your isolation.
If you had no symptoms
- Day 0 is the day you were tested (not the day you received your positive test result)
- Day 1 is the first full day following the day you were tested
- If you develop symptoms within 10 days of when you were tested, the clock restarts at day 0 on the day of symptom onset
If you had symptoms
- Day 0 of isolation is the day of symptom onset, regardless of when you tested positive
- Day 1 is the first full day after the day your symptoms started
If you test positive for COVID-19, stay home for at least 5 days and isolate from others in your home. You are likely most infectious during these first 5 days.
- Wear a high-quality mask if you must be around others at home and in public.
- Do not go places where you are unable to wear a mask, including travel and public transportation settings.
- Stay home and separate from others as much as possible.
- Use a separate bathroom, if possible.
- Take steps to improve ventilation at home, if possible.
- Don’t share personal household items, like cups, towels, and utensils.
- Monitor your symptoms. If you have an emergency warning sign (like trouble breathing), seek emergency medical care immediately.
- Learn more about what to do if you have COVID-19.
End isolation based on how serious your COVID-19 symptoms were.
If you had no symptoms
You may end isolation after day 5.
If you had symptoms
You may end isolation after day 5 if:
- You are fever-free for 24 hours (without the use of fever-reducing medication)
- Your symptoms are improving
If you still have fever or your other symptoms have not improved, continue to isolate until they improve.
If you had moderate illness (if you experienced shortness of breath or had difficulty breathing), or severe illness (you were hospitalized) due to COVID-19-, or you have a weakened immune system, you need to isolate through day 10.
If you had severe illness or have a weakened immune system, consult your doctor before ending isolation. Ending isolation without a viral test may not be an option for you.
If you are unsure if your symptoms are moderate or severe or if you have a weakened immune system, talk to a healthcare provider for further guidance.
Regardless of when you end isolation, avoid being around people who are more likely to get very sick from COVID-19 until at least day 11. Remember to wear a high-quality mask when indoors around others at home and in public and not go places where you are unable to wear a mask until you are able to discontinue masking (see below).
Loss of taste and smell may persist for weeks or months after recovery and need not delay the end of isolation.
After you have ended isolation, when you are feeling better (no fever without the use of fever-reducing medications and symptoms improving),
- Wear your mask through day 10.
OR
- If you have access to antigen tests, you should consider using them. With two sequential negative tests 48 hours apart, you may remove your mask sooner than day 10.
Note: If your antigen test results1 are positive, you may still be infectious. You should continue wearing a mask and wait at least 48 hours before taking another test. Continue taking antigen tests at least 48 hours apart until you have two sequential negative results. This may mean you need to continue wearing a mask and testing beyond day 10.
After you have ended isolation, if your COVID-19 symptoms recur or worsen, restart your isolation at day 0. Talk to a healthcare provider if you have questions about your symptoms or when to end isolation.
[1] As noted in the Food and Drug Administration labeling for authorized over-the-counter antigen tests, negative test results do not rule out SARS-CoV-2 infection and should not be used as the sole basis for treatment or patient management decisions, including infection control decisions.
