The CDC may be reconsidering its COVID isolation guidance

Caption

Tested positive for COVID and wondering whether you should isolate? The Centers for Disease Control and Prevention may soon change its guidelines. / AP

The Centers for Disease Control and Prevention may soon drop its isolation guidance for people with COVID-19. The planned change was reported in The Washington Post on Tuesday, attributed to several unnamed CDC officials.

Currently, people who test positive are advised to stay home for at least five days to reduce the chances of spreading the coronavirus to others. The unnamed officials told the Post that the agency will advise people to rely on symptoms instead. If a person doesn't have a fever and the person's symptoms are mild or resolving, they could still go to school or work. These changes could come as early as April.

The CDC hasn't yet confirmed the report. In an email, an agency spokesperson wrote that the CDC has "no updates to COVID guidelines to announce at this time. We will continue to make decisions based on the best evidence and science to keep communities healthy and safe."

Some states — California and Oregon — have already implemented similar guidelines.

If this change takes place, it shouldn't be interpreted to mean that COVID-19 is less contagious, says Jennifer Nuzzo, an epidemiologist and director of the Pandemic Center at Brown University School of Public Health.

"The science of COVID has not changed," Nuzzo says. If you test positive for COVID-19, you're likely contagious for a few days at least and risk spreading the coronavirus to others.

The policy change under consideration may be a reflection of the fact that the impacts of spreading COVID-19 are less consequential than they used to be, at least from a public health perspective. Deaths and hospitalizations went up this winter, but nowhere near as high as they did in previous years. In fact, hospitals were mostly OK — not overwhelmed — this virus season.

Changing the guidance may reflect the reality that many Americans aren't necessarily following it. Isolation "is really hard, and it takes a lot of work," says Dr. Anand Parekh, chief medical adviser at the Bipartisan Policy Center. He was on day nine of COVID when he spoke to NPR and had spent the first five days isolating at home. He worked, ate and slept alone to avoid exposing his family members, including three young children.

"For a lot of people, it's not possible — how they live, where they live, how many people are in the household, their jobs — whether they have paid leave, whether they could work virtually," he says.

In addition, testing is more expensive and harder to access than it used to be, so people may not even know they have COVID-19, let alone take steps to isolate, Parekh says.

Still, even if many people ignore the current guidance, Jessica Malaty Rivera, an epidemiologist and communications adviser to the de Beaumont Foundation, says the federal government's public health advice should be guiding people, and not the other way around.

"It's like saying, well, people aren't really wearing a seat belt, so I guess we can say seat belts don't matter," she says. "That kind of defeats the purpose of providing evidence-based information — that's still the responsibility of public health to do that."

And a change in CDC guidance could make a big difference for workplace policies, public health experts say. If the CDC no longer recommends staying home for a week with COVID-19, workers may be forced to go into work while still sick. They might spread the coronavirus to others.

And it makes it harder on people who are especially vulnerable: individuals who are very young, very old, immunocompromised or with underlying medical conditions.

"This could actually increase COVID and long COVID cases and, to a certain extent, probably illness among high-risk individuals and thus hospitalizations and deaths," Parekh says, though he notes that evidence from California and Oregon, both states that have stopped recommending five-day isolation periods, has so far been inconclusive.

If the guidance change goes through, the CDC will be effectively treating COVID-19 more like flu, says Nuzzo. But she and other health experts wonder whether that's the right model, given that the status quo of influenza results in many illnesses and deaths.

"While it may make sense for us to kind of harmonize our policies to not just be COVID specific" and address all respiratory pathogens, Nuzzo says, "it doesn't mean that there aren't still risks to people posed by these pathogens."

Rivera points out that it has never been a good idea to go to work or school with an active flu infection, but it used to be the norm for many people to show their dedication to work. "We didn't value rest and isolation and quarantine," she notes.

Given the risks to vulnerable people and the risk of long COVID, "I think people forget the fact that it's not OK to be moving around when you're infectious," she says. "We can't go back to ignoring those who are immunocompromised, those who are too young or too old and rely on protecting themselves through community protection."