The CDC has new Covid guidelines. This is what went wrong.
For almost two years, U.S. officials have changed recommendations on how to handle the coronavirus. On Monday we had one of the most significant changes yet: infected people, long asked to self-isolate for at least 10 days, now only have to self-isolate for five days if they feel good, regardless of their vaccination status. On one level, this decision by the Centers for Disease Control and Prevention is a welcome nod to science and practicality, as many people are not contagious for such a long time.
But the change is not effectively addressing the reality that fully vaccinated and vaccinated people and unvaccinated people live in two different worlds. The CDC’s guidelines still take a generally one-size-fits-all approach and ignore the use of antigen testing to distinguish between the relative safety and danger of the two groups.
When the pandemic started there were no vaccines, so we all lived in a world where everyone was at the same high risk. The CDC therefore recommended that infected people take shelter for 10 days, as evidence indicated they could be infectious for some time. The CDC also argued that those who were credibly exposed but not yet sick were quarantined for 14 days, as it could take that long for them to become infected and contagious.
However, when vaccinations became widespread, the math changed. Those who were immunized were less likely to be infected and less likely to be as contagious. For this reason, the CDC said this year that immunized people do not need to quarantine if exposed as long as they remain asymptomatic, although it recommended that those people test within days of the test. display to make sure they were safe.
New recommendations go even further. They say that as long as people who test positive for the coronavirus are asymptomatic, they only need to be isolated for five days, whether vaccinated, vaccinated or not.
The recommendations have also changed for quarantine, which uninfected people do if exposed. If they are properly reminded, they only need to be cautious for the next 10 days (i.e., wear a mask when around other people). If they aren’t vaccinated or need a booster, they now only need to be quarantined for five days if they never become symptomatic, then be careful the next five. The recommendations also say that if for these people – even if they are not vaccinated – quarantine “is not feasible”, they can simply mask themselves for 10 days. (The CDC also recommends, if possible, getting tested five days after exposure, whether or not a person is vaccinated and vaccinated.)
These numbers are mostly averages – sometimes the best guesses – of how people react when exposed or infected. They also apply roughly equally to fully vaccinated and unvaccinated people, as if these two populations were the same.
It’s confusing. Covid itself hasn’t changed much for those who aren’t vaccinated. If they are infected, there is no reason to believe that they shouldn’t always follow the original guidelines and self-isolate for 10 days. It is a very contagious disease, and they are in danger not only to themselves but also to those around them. Hospitals are always full of unvaccinated people, and nothing had led us to believe that the danger was over for them.
However, people who have been vaccinated, especially people who have been boosted, have a very low risk of poor results, are less likely to be infected if exposed, and less likely to be infectious for longer periods of time.
It seems that even on this late date, the CDC is trying to appease everyone and therefore not please anyone.
What would be better is a more evidence-based approach. Antigen testing provides us with a way to see if people remain infected, and possibly infectious, over time. My 17 year old son, who is on recall, felt congested last week. Being responsible, we tested him at home with an antigen test, and he was positive.
The next day, however, he felt good. Same the next day. We tested it again, and it was negative. We tested it a day later, and it was still negative.
Of course, this was all possible because we bought a bunch of antigen tests a few weeks ago in case that happened. There is a nationwide shortage of such tests, and their price is out of reach for too many Americans.
Based on his two negative tests, I would say that at present my son is no longer contagious. He’s asymptomatic, he’s been boosted, and he’s tested negative on antigen tests several times. That is why his isolation should end, and not because of a single rule that treats all people and all infections the same.
If, however, he had tested positive for more than five days, even though he was feeling fine, he could still be contagious. How would we know? Many people may feel pressured by their jobs or obligations to ignore symptoms and return to work or life before it is safe. They can minimize lingering symptoms, as five-day isolation becomes the norm. And the unvaccinated might never self-quarantine because it “isn’t feasible” for them to do so. All of these scenarios would be acceptable under the new CDC guidelines, but they all potentially pose a risk for the spread of coronavirus infections.
Covid-19 is becoming endemic. We are even seeing more and more people who receive a booster become infected. We cannot continue to ask people to self-isolate for mandatory periods in the hope that Covid will go away. We need to find ways to live with the coronavirus, from which we recognize that for many it is a mild infection from which they recover quickly. For others, the Covid is a serious disease for which precaution is essential. The biggest difference between these groups is vaccination.
The CDC is expected to develop new guidelines, starting now, that allow those who are vaccinated and recalled to leave isolation as soon as possible after repeatedly testing negative for antigen. The government should do everything possible to make these antigen tests freely and readily available. The efforts of the Biden administration are necessary but not sufficient. They have to go much further and much faster.
Such guidelines would provide another incentive for people to be fully immunized. They could also lead to more people avoiding testing because they fear a mandatory lockdown to be tested, as the implications of a positive test are not as severe.
They would also provide us with a way to shift into a way of thinking that recognizes that Covid is here to stay and that we have to find a way to live with it. Our previous plans were based on a disease that could be controlled through testing, contact tracing, quarantine and isolation, as well as vaccination.
Omicron may not be so controlled; it seems very, very possible to prevent serious illness and death with vaccination, but it may not be possible to prevent transient infections, even with masking. If this is the case, we must redouble our attention to the first and accept the second. Infectious people must isolate themselves while they are infectious, no more and no less, and we need more precise means to make these judgments.
The Covid is changing before our eyes. We have to adapt with it.
The New York Times