CDC drops 5-day isolation guidance for COVID-19, moving away from key strategy to quell infections

People who test positive for Covid-19 no longer need to routinely stay away from others for at least five days, according to new guidelines from the US Centers for Disease Control and Prevention issued Friday.

The change ends a strategy from earlier in the pandemic that experts said has been important to controlling the spread of the infection.

The agency says it's updating its recommendations for Covid-19 to bring them in line with its advice for other kinds of respiratory infections, including influenza and RSV. Offering a single set of unified guidance will make people more likely to follow it, agency experts said in a news briefing on Friday.

Namely, the CDC now says people who have Covid-19 should stay home until they've been fever-free without medication for at least 24 hours or their symptoms have been improving for 24 hours.

After that, it's fine to resume regular activities, agency experts say. But they recommend that people take additional precautions for the next five days - including improving ventilation, masking and limiting close contact with others - to lower the risk of spreading the virus.

These enhanced precautions are particularly important for people who are around vulnerable individuals, such as those who are elderly or have immune function that's been blunted by medication or an illness, like cancer.

Changing impact of Covid-19 in the US

CDC Director Dr. Mandy Cohen said the agency is changing its guidance because most of the US population has some immunity against Covid and, as a result, the country is no longer seeing large waves of infections, hospitalizations and deaths from the coronavirus. Instead, these have turned into smaller, more predictable bumps in transmission in the summer and winter as the nation reaches a kind of steady state with the virus.

And importantly, the agency says, despite these wavelets of illness, severe outcomes like hospitalizations and deaths have been dropping since 2020 and 2021.

In 2021, at their peak, there were 2.5 million hospitalizations for Covid-19, and in 2023, that number dropped 60% to 900,000 hospitalizations.

The decrease in deaths has been even bigger. In 2021, there were 450,000 deaths from Covid-19; in 2023, that number declined 83% to about 75,000 deaths.

Covid has dropped from the third leading cause of death in the US in 2020 and 2021 to the 10th leading cause of death in preliminary data from 2023, the CDC noted.

That's still a far higher toll than the nation typically sees from the flu. In the 2022-23 season, which the CDC said was similar to some pre-pandemic flu seasons, the agency estimates that there were 360,000 flu-related hospitalizations and 21,000 deaths.

"Today's announcement reflects the progress we've made in protecting against severe illness from COVID," Cohen said in a news briefing on Friday. "We're in a different situation, but we must use the tools that work to protect against respiratory virus. That's why our updated guidance emphasizes some core prevention actions to protect against severe illness," Cohen said, emphasizing that first and foremost, people need to stay up-to-date on their vaccines.

She said she anticipated than an updated Covid-19 vaccine would be available in the fall, and that people should make plans now to get it. Earlier this week, the CDC recommended people age 65 and older get another shot of the current Covid-19 vaccine before the fall.

Cohen noted it's also important to stay home when you're sick, seek testing, and get treatment to lower the chance of severe illness.

The announcement doesn't mean all viruses act the same or have the same impact, Cohen noted. Instead, she said that having a set of uniform recommendations to limit the spread of respiratory infections makes them easier to follow and more likely to be adopted. Symptom-based recommendations also mean people don't need to test for infection, something many people already don't do.

"In a recent CDC survey, less than half of people said they would use an at-home test for Covid If they had new cough or cold symptoms. And this is one of the main reasons that we're targeting this guidance to respiratory viruses and illnesses as a group," said Dr. Brendan Jackson, who leads respiratory virus response at CDC's National Center for Immunization and Respiratory Diseases.

The CDC says its updated guidance will include specific considerations for people who are at higher risk from respiratory illnesses, such as adults over 65, those who are immunocompromised, people with disabilities or those who are pregnant or have recently been pregnant.

The agency also says the new guidance applies only to community settings. There's no change in recommendations to prevent the spread of Covid in clinics, hospitals and other health care settings.

The new guidance only applies to common respiratory infections, the CDC said. It shouldn't take the place of specific guidance for pathogens that require special containment measures, such as the measles.

Asked whether the change in guidelines might lead to more people being sick at work, particularly if they don't have paid leave, Cohen said she hoped that employers would continue to allow and encourage employees to stay home when they are ill.

"We think that options for remote work and paid leave opportunities are an important component of this," Cohen said. She also said she'd like to see more employers offering Covid vaccines alongside flu shots in their at-work clinics.

"The bottom line is that when people follow these actionable recommendations to avoid getting sick, and to protect themselves and others if they do get sick, it will help limit the spread of respiratory viruses, and that will mean fewer people who experience severe illness," said Dr. Demetre Daskalakis, director of the CDC's National Center for Immunization and Respiratory Diseases, in the news release. "That includes taking enhanced precautions that can help protect people who are at higher risk for getting seriously ill."

Daskalakis said that if symptoms rebound after resuming normal activities, they should start the precautions over.

"So if people start to feel ill again, they go back to square one, which is, stay home until you feel better for 24 hours, or your fever has resolved if you have one, then add strategies, enhanced strategies, for five additional days so that you reduce the risk of transmission," Daskalakis said.

Some experts disagree on Covid-19 guidance change

It's reasonable to want to treat Covid-19 like other respiratory viruses, said Dr. Ellie Murray, an assistant professor of epidemiology at Boston University's School of Public Health, "but you can't just discard the science."

"It's not good science. It's not good public health. It doesn't provide people with accurate information," she said.

Murray notes that we've learned a lot about how respiratory diseases spread and how best to control them during the pandemic. But instead of applying those lessons to help protect people from other infections like the flu, she says, this rolling back of precautions is sending a harmful message.

"It's undermining the whole rest of the public health system," she said. "Because what people are hearing is, 'Actually, diseases aren't as bad as we'd said they were, and we don't actually need to do anything. It's not actually that bad if some people die.'"

While some public health experts have argued that it's time to end "Covid exceptionalism" - treating Covid-19 differently than other respiratory infections - others believe the move is wrongheaded.

"I completely disagree with the idea there is no Covid exceptionalism," Dr. Eric Topol, founder and director of the Scripps Research Translational Institute said in an email to CNN. "The overwhelmingly abundant evidence for this virus over the past 4 years tells us that it is a far more dangerous pathogen than flu, which lacks seasonality, is still evolving, has induced Long Covid in tens of millions of throughout the worlds, and cannot be 'FLU-ified.' "

The CDC also noted that states and countries that have already shortened recommended isolation periods have not seen increased hospitalizations or deaths from Covid-19.

The five-day isolation period has had critics on all sides.

It was seen as onerous by employers in industries struggling with worker shortages, like health care and hospitality. Some parents also considered it unnecessarily disruptive to school and child care.

At the same time, people at higher risk of severe infection viewed the five-day guideline as too short, pointing out that people often continue to test positive on rapid tests long after that and are probably still contagious while they do. To them, the guideline has been inadequate and unscientific.

"I think this is, you know, an effort to try to create guidance for the public that is easy to follow. And that doesn't require a tremendous amount of thinking or referencing. And also at the same time, an effort to try to get to language that isn't polarizing," said Lori Tremmel Freeman, chief executive officer for the National Association of County and City Health Officials. Freeman acknowledged that dropping terms like quarantine and isolation "for long-time public health people, it doesn't feel that great. But there's also a recognition of the time that we're in, and we'd rather have people understand what to do to easily address their illness. You know, rather than fight with them about it."

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