Concerns Grow as CDC Prepares to Drop Covid Isolation Recommendation
As the Centers for Disease Control and Prevention (CDC) prepares to change its long-standing recommendation that those with Covid isolate for five days, concerns are growing among medically vulnerable individuals. The potential drop in isolation guidelines has raised worries among people with compromised immune systems, who fear that their co-workers will return to the office while still contagious. Additionally, the few remaining policies guaranteeing paid leave for employees with Covid are coming to an end, further exacerbating the concerns of vulnerable individuals. New York, the only state that still requires paid leave for Covid isolation, is considering ending that benefit this summer.
The forthcoming change in isolation guidelines, which was first reported by The Washington Post, suggests that people can return to school and work if they have been fever-free for at least 24 hours without the aid of medication and if they have mild and improving symptoms. This guidance aligns with recommendations for other respiratory viruses like influenza and respiratory syncytial virus (RSV). Supporters of this change argue that it reflects the reality that many people with Covid are not isolating and that the threat of severe illness has diminished due to vaccination, prior infections, and antiviral treatment. However, critics argue that Covid should not be treated like other respiratory viruses because it currently hospitalizes and kills more people than the flu and can cause long-term complications that scientists are still trying to understand.
The proposed changes by the CDC have left medically vulnerable individuals feeling isolated and concerned about their well-being. Lisa Savage, a 60-year-old retired nonprofit fundraiser in Charleston, S.C., who has several autoimmune diseases, expressed her fears about the CDC’s proposed changes. She believes that those without compromised immune systems do not understand the challenges faced by individuals like her. Savage said, “Lucky for you. Those of us with compromised immune systems don’t have that luxury.”
The CDC is expected to release the proposed revisions to the isolation guidance in April and seek public feedback. While the science around infectiousness and transmission has not changed, experts acknowledge that people can still be infectious beyond five days after testing positive for Covid. People without symptoms or fever can also transmit the virus early in their illness. The impact of loosening the guidelines on community transmission rates remains unknown.
To gain insights into the potential impact of loosening isolation recommendations, experts have looked at the experiences of Oregon and California. Oregon eliminated its five-day isolation requirement for Covid in May 2023 and instead advised people to stay home until they recovered, similar to other respiratory illnesses. Data shared last month with the national association representing state health officials showed that Oregon did not experience any disproportionate increases in community transmission or severity compared to California, which kept its five-day isolation recommendations in place until January 2024.
While some argue that easing isolation guidelines poses increased risks to immunosuppressed individuals, others believe that the downsides of lengthy isolation, such as missing work and school, must also be considered. Dr. Walid Gellad, a physician and professor of medicine at the University of Pittsburgh, acknowledges the increased risk to immunosuppressed individuals but believes that the changing landscape of the pandemic necessitates a different approach. “It really is a different world now,” he said.
The complexity of health policy and the diverse priorities, risk factors, behaviors, and beliefs of the U.S. population further complicate the decision-making process. Epidemiologist Katelyn Jetelina emphasizes the need for guidance that is protective, actionable, and feasible for a population of 330 million people.
Public health experts argue that revising the isolation guidance does not mean sacrificing the immunocompromised and elderly to minimize economic disruptions. They believe that there is a middle ground between living in fear and ignoring the virus. Dr. Paul Offit, a pediatric infectious-disease specialist, suggests that focusing on isolating when sick, regardless of the virus, would benefit high-risk individuals. He emphasizes the importance of staying home when sick, even for those who are not in a high-risk group.
While public health officials justify easing measures based on declines in hospitalizations and deaths, long-Covid activists argue that this neglects the long-term impact of the virus. JD Davids, co-director of Long COVID Justice, criticizes the CDC for viewing the crisis as an acute one rather than recognizing its chronic impact. He believes that this perpetuates the dangerous idea that individuals should continue to be sick and transmit illnesses to others.
The previous revision in CDC isolation guidance, reducing the isolation period from 10 to five days in December 2021, led to many companies no longer offering paid leave for Covid. Walmart, Amazon, CVS, and Walgreens were among the companies that pulled back on paying employees to stay home when infected with Covid-19. Currently, far fewer employers offer any sort of paid leave for Covid and instead require workers to use traditional sick time benefits or return to work while still sick.
The lack of paid sick
