Covid is here to stay. How will we know when it stops being special?
The plan to further loosen isolation guidance when the science around infectiousness has not changed is likelyto prompt strong negative reaction from vulnerable groups, includingpeople older than 65, those with weak immune systems and long covid patients, CDCofficials and experts said.
Doing so“sweeps this serious illness under the rug,” said Lara Jirmanus, a clinical instructor at Harvard Medical School and a member of the People’s CDC, a coalition ofhealth-careworkers, scientists and advocates 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. As many as 7 percent of Americans report having suffered from a slew of lingering Covid symptoms, including fatigue, difficulty breathing, brain fog, joint pain and ongoing loss of taste and smell, according to the CDC.
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The new isolation recommendations would not apply to hospitals and other health-care settings with more vulnerable populations, CDC officials said.
While the coronavirus continues to cause serious illness, especially among the most vulnerable people, vaccines and effective treatments such as Paxlovid are available. The latest versions of coronavirus vaccines were 54 percent effective at preventing symptomatic infection in adults, according to data released Feb. 1, the first U.S. study to assess how well the shots work against the most recent coronavirus variant. But CDC data shows only 22 percent of adults and 12 percent of children had received the updated vaccine as of Feb. 9, despite data showing the vaccines provide robust protection against serious illness.
Coronavirus levels in wastewater indicate that symptomatic and asymptomatic infections remain high. About 20,000 people are still hospitalized — and about 2,300 are dying — every week, CDC data show. But the numbers are falling and are much lower than when deaths peaked inJanuary 2021 when almost 26,000 people died of covid each week and about 115,000 were hospitalized.
The lower rates of hospitalizations were among the reasons California shortened its five-day isolation recommendation last month, urging people to stay home until they are fever-free for 24 hours and their symptoms are mild and improving. Oregon made a similar move last May.
California’s state epidemiologist Erica Pan said the societal disruptions that resulted from strict isolation guidelines also helped spur the change. Workers without sick leave and those who can’t work from home if they or their children test positive and are required to isolate bore a disproportionate burden. Strict isolation requirements can act asa disincentive to testwhen testing should be encouraged so people at risk for serious illness can get treatment, she said.
Giving people symptom-based guidance, similar to what is already recommended for flu, is a better way to prioritize those most at risk and balance the potential for disruptive impacts on schools and workplaces,Pan said. After Oregon made its change, the state has not experienced any disproportionate increases 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 masksindoors when they are around others for 10 days after testingpositive — even if they have no symptoms — or becoming sick. “You may remove your mask sooner than 10 days if you have two sequential negative tests at least one day apart,” the California guidance states.
It’s not clear whether the updated CDC guidance will continue to recommend masking for 10 days.
Health officials from other states told the CDC last week that they are already moving toward isolation guidelines that would treat the coronavirus the same as flu and RSV, with additional precautions for people at high risk, said Anne Zink, an emergency room physician and Alaska’s chief medical officer.
Many other countries,including the United Kingdom, Denmark, Finland, Norway and Australia, made changes to isolation recommendations in 2022. Of 16 countries whose policies California officials reviewed, only Germany and Irelandstill recommend isolation for fivedays, according to a presentation the California public health departmentgave health officials from other states in January. The Singapore ministry of health, in updated guidance late last year, said residents could “return to normal activities” once coronavirus symptoms resolve.
Even before the Biden administration ended the public health emergency last May, much of the public had moved on from covid-19, with many people having long given up testing and masking, much less isolating when they come down with covid symptoms.
Doctors say the best way for sick people to protect their communities is to mask or avoid unnecessary trips outside the home.
“You see a lot of people with symptoms — you don’t know if they have covid or influenza or RSV — but in all three of those cases, they probably shouldn’t be at Target, coughing, and looking sick,” said Eli Perencevich, an internal medicine professor at the University of Iowa.