CDC ending five-day COVID isolation guidance

The Centers for Disease Control and Prevention (CDC) is no longer recommending Americans stay home from work or school for five days after testing positive for COVID-19, a major shift in policy that comes as much of the country has moved on from the height of the pandemic.

The new guidance aligns COVID recommendations with other respiratory viral illnesses such as flu and RSV.

The simplified guidance recommends that even if they don’t know what virus is causing the illness, people should stay home when they are sick and symptomatic and resume normal activities if their symptoms have been improving and they are fever-free for at least 24 hours without any medication.

People who are at higher risk for severe illness who start to feel sick should seek health care right away, the agency said.

CDC officials said the change recognizes that the COVID-19 landscape has changed dramatically since the start of the viral outbreak in 2020 when businesses and schools ground to a halt and people stayed home.

It is still an important health threat, the agency said, but it is no longer the emergency it once was.

“Today’s announcement reflects the progress we have made in protecting against severe illness from COVID19,” CDC Director Mandy Cohen said in a statement. “However, we still must use the commonsense solutions we know work to protect ourselves and others from serious illness from respiratory viruses—this includes vaccination, treatment, and staying home when we get sick.”

Weekly emergency department visits and hospital admissions for COVID-19 have been decreasing since late December, and they are down more than 75 percent from the peak of the initial Omicron wave in January 2022.

Though the virus is still killing around 2,000 people on average every week, deaths are down by more than 90 percent from the omicron peak, the agency said.

In 2022, COVID-19 accounted for more than 245,000 deaths. Last year, that number was around 76,000. 

Symptoms are an easy way to know when someone should use prevention strategies. These strategies, like staying home, can be done without a test, the agency said.

While at-home testing is widely available for COVID-19, most infections likely go undiagnosed. The agency pointed to a recent survey where less than half of people said they would do an at-home test for COVID-19 if they had cold or cough symptoms, and less than 10 percent said they would get tested at a pharmacy or by a healthcare provider.

The CDC last updated its isolation policy in 2021, when it decreased the recommended period to five days from the initial 10. That move was praised by business groups but slammed by unions and some public health experts.

Some health advocates also slammed Friday’s announcement as a move catering to big business that goes against medical science. They said the CDC is putting the burden on employees, especially essential workers, to negotiate sick time to recover and try to not infect other people.

“The CDC is again prioritizing short term business interests over our health by caving to employer pressure on COVID guidelines. This is a pattern we’ve seen throughout the pandemic,” said Lara Jirmanus, a clinical instructor at Harvard Medical School and a member of the People’s CDC, a coalition of public health practitioners, healthcare workers and advocates focusing on reducing the harmful impacts of COVID-19.

Jirmanus and others at People’s CDC said it’s inappropriate to treat COVID-19 like the flu. COVID is infectious before symptoms begin, which is not typical of the flu. COVID-19 is also not seasonal, and cases surge multiple times a year, they said.

The updated guidelines don’t apply to health settings, CDC said.

Other public health experts and officials said the new guidelines make sense because the message is simple.

“What we’ve seen is that flu hospitalizations have exceeded COVID hospitalizations this winter. So I think it’s really important that people stay home when they’re sick and can leave when they get better, and not just think about positive or negative if they have COVID,” said David Margolius, public health director for the city of Cleveland.

The change is more realistic than asking people to isolate for five days, said Georges Benjamin, executive director of the American Public Health Association.

“We do make a lot of broad decisions in health care, because we know how people are going to behave,” Benjamin said. “Medicine is both an art and a science. So in many ways, they’re [CDC] following the art component of this.”

Margolius said the widespread availability of effective vaccines and treatments like Paxlovid, as well as underlying population immunity from prior infections, will make the change easier.

“We’ve always been dependent on what people will choose to do, and I think we’re lucky at this point, with widespread immunity from vaccines and prior protection, that we can simplify the guidance,” Margolius said.

Still, CDC said the percentage of the population reporting COVID-19, influenza, and RSV vaccines remains low for children and adults.

Only 22 percent of adults and 13 percent of children had received the updated vaccine as of March 1, despite data showing the vaccines provide robust protection against serious illness.

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