CDC ends 5-day quarantine guidance for coronavirus, moving away from key strategy to quell infection

CNN
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People who test positive for COVID-19 will no longer have to routinely stay away from others for at least five days, according to new guidelines from the U.S. Centers for Disease Control and Prevention released Friday. The change, experts say, marks the end of an early-pandemic strategy that was critical to slowing the spread of infections.

The agency said it is updating its recommendations for coronavirus disease (Covid-19) to be consistent with recommendations for other types of respiratory infections, such as influenza and respiratory syncytial virus. Agency experts said at a press conference Friday that providing one, uniform guidance makes people more likely to follow it.

In other words, the CDC currently says that people infected with COVID-19 should stay home until they are fever-free and their symptoms have improved for at least 24 hours without taking medication.

After that, it is safe to resume normal activities, agency experts say. However, it is advising people to take additional precautions over the next five days to reduce the risk of spreading the virus, including improving ventilation, wearing masks and limiting close contact with others.

These enhanced precautions are especially important for people who are around vulnerable populations, such as the elderly and people with weakened immune systems due to medications or illnesses such as cancer.

The CDC on Friday launched a detailed section on its website with guidance on respiratory viruses.

CDC Director Dr. Mandy Cohen said most Americans have some level of immunity to the coronavirus, and as a result, the country is no longer seeing large waves of coronavirus infections, hospitalizations, or deaths. , the CDC said it would change its guidance. Rather, these have turned into smaller, more predictable bumps in summer and winter infections as the country reaches a kind of steady state with the virus.

And importantly, despite these waves of illness, severe outcomes such as hospitalizations and deaths have decreased since 2020 and 2021, officials say.

At its peak in 2021, there were 2.5 million people hospitalized due to the new coronavirus, but by 2023 that number had fallen by 60% to 900,000.

The decline in deaths was even greater. In 2021, the number of deaths due to the new coronavirus infection was 450,000. In 2023, that number has decreased by 83%, with approximately 75,000 deaths.

The coronavirus has dropped from the third leading cause of death in the United States in 2020 and 2021 to the 10th leading cause of death in 2023, according to the CDC.

This is much higher than the average national death toll from influenza. 2022-23 season, CDC said to be similar to some seasons During the pre-pandemic flu season, authorities estimate there were 360,000 flu-related hospitalizations and 21,000 deaths.

“Today's announcement reflects the progress we have made in protecting people from serious illness caused by the novel coronavirus,” Cohen said at a Friday briefing. “While our circumstances are different, we must use tools that work to protect us from respiratory viruses. That's why our latest guidance includes core precautions to prevent serious illness. We are emphasizing.”

Cohen stressed that first and foremost, people need to stay informed about vaccines.

He expects the latest coronavirus vaccines to be available in the fall, and said people should start planning to get vaccinated now. Earlier this week, the CDC recommended that people 65 and older get revaccinated with current coronavirus vaccines by the fall.

Cohen said it's also important to stay home when you're sick and get tested and treated to reduce your chances of becoming seriously ill.

The CDC also noted that states and countries that have already reduced recommended isolation periods have not seen an increase in hospitalizations or deaths from COVID-19.

Cohen noted that the announcement does not mean all viruses act the same or have the same impact. Instead, a uniform set of recommendations to limit the spread of respiratory infections would be easier to follow and more likely to be adopted, she said. Symptom-based recommendations also mean there is no need for infection testing, which many people already do not do.

“In a recent CDC survey, fewer than half of people said they would get an at-home coronavirus test if they developed new cough or cold symptoms. “That's one of the main reasons we're targeting respiratory viruses and respiratory diseases as a group,” said Dr. Brendan Jackson, director of the respiratory virus response at the CDC's National Center for Immunization and Respiratory Diseases.

According to the CDC, the latest guidance includes special recommendations for people at increased risk of respiratory illness, including adults 65 and older, people with compromised immune systems, people with disabilities, and people who are pregnant or have recently become pregnant. It is said that considerations will be included.

The agency also said the new guidelines apply only to community settings. There are no changes to our recommendations for preventing the spread of coronavirus in clinics, hospitals, and other healthcare settings.

The CDC said this guidance applies to common respiratory infections and should not replace specific guidance for pathogens that require special containment measures, such as measles.

Asked if the change in guidelines would result in more people getting sick at work, especially if they don't have paid time off, Cohen said it would be easier for employers to force employees to stay home when they're sick. He said he hopes to continue to allow and encourage this.

“We believe options for remote work and paid time off opportunities are key elements of this,” Cohen said. He also said he would like to see more employers offer COVID-19 vaccines alongside flu shots at workplace clinics.

“In short, if people follow these actionable recommendations to avoid getting sick and protect themselves and others if they get sick, it will help limit the spread of respiratory viruses, and that That means fewer people will experience severe illness,” Dr. Demetre Daskalakis, director of the CDC's National Center for Immunization and Respiratory Diseases, said in a news release. “This includes increasing precautions to protect those at high risk of severe illness.”

Daskalakis said people whose symptoms return after resuming normal activities will need to start their precautions all over again.

“So when people start feeling sick again, they go back to square one, which means staying home for 24 hours until they feel better, or if they have a fever, until the fever goes down, and then adding five more strategies. , we will add enhanced strategies “to reduce the risk of infection in the coming days,'' he said at a briefing on Friday.

Dr. Ellie Murray, assistant professor of epidemiology at Boston University School of Public Health, said it's natural to want to treat COVID-19 like any other respiratory virus, but “we can't just throw away the science.” .

“It's not good science. It's not good public health. It doesn't give people accurate information,” she said.

Murray said we've learned a lot about how respiratory diseases spread during the pandemic and how best to control them. But instead of applying those lessons to protect people from other infectious diseases like influenza, she says this rollback of precautions sends a harmful message.

“It's undermining the entire public health system,” she says. “Because what people are hearing is, 'Actually, the disease isn't as bad as we say, we don't actually need to do anything.' In fact, it's that bad that someone dies.” That’s not the point.”

Some public health experts say it's time to end “COVID exceptionalism,” which treats COVID-19 differently than other respiratory infections, a move that is misguided. Some people think it is.

“I totally disagree with the idea that there is no COVID-19 exceptionalism,” he said. Eric Topol, founder and director of the Scripps Research Translational Institute, said in an email to CNN. “The overwhelming body of evidence about this virus over the past four years shows that it is a far more dangerous pathogen than influenza. has caused tens of millions of long-term corona infections, and there is no way to prevent infection.

The five-day quarantine period was criticized from all sides.

This was seen as a nuisance for employers in industries suffering from labor shortages, such as health care and hospitality. Some parents thought it was an unnecessary disruption to school and child care.

At the same time, people who are at high risk of severe infection He said he believed the five-day guideline was too short, noting that people often continue to test positive on rapid tests long after that, and that people are probably still contagious while testing positive. To them, the guidelines were inadequate and unscientific.

“I think this is an effort to create guidance for the public that is easy to understand and doesn’t require a huge amount of thought or reference. And at the same time, “It's an effort to have a less polarizing voice,” said Lori Tremmel Freeman, CEO of the National Association of County and City Health Officials.

Freeman acknowledged that doing away with terms like quarantine and isolation “isn't that great for people who have been working in public health for many years.” But there's also a recognition of the times we're facing, and we want people to understand what to do to easily deal with the disease, rather than fight about it. ”