On Thursday, August 11th, the CDC released a new set of guidelines regarding COVID. These guidelines loosen some of the previous guidelines, especially around isolation and quarantine. The reason is that the severity of the epidemic is lessening in terms of the number of people getting seriously ill, requiring hospitalization or who are dying. There are several factors that are coming together to make this so. First, the current variant, omicron, causes a less serious illness. Second, a high percentage of the population has at least some degree of immunity either through vaccination, prior infection or both. Lastly, treatments such as Paxlovid are available to help prevent progression to serious illness in people who are most vulnerable.
In the official press release that announced the changes, Greta Massetti, of the CDC’s publication MMWR, was quoted as, “We’re in a stronger place today as a nation, with more tools—like vaccination, boosters, and treatments—to protect ourselves, and our communities, from severe illness from COVID-19. We also have a better understanding of how to protect people from being exposed to the virus, like wearing high-quality masks, testing, and improved ventilation. This guidance acknowledges that the pandemic is not over, but also helps us move to a point where COVID-19 no longer severely disrupts our daily lives.”
Before we get into the changes found in the new guidelines, let’s clarify the difference between quarantine and isolation. Quarantine is for people who have been exposed to an infectious illness, but are not yet positive and may not have contracted the illness. A person is placed in quarantine to give enough time to see if they subsequently come down with the illness. Isolation is for people who are known to have the illness. Also, here is a reminder of the definition of exposure: within 6 feet for 15 minutes or more of someone who is known to have COVID and neither person was wearing a mask. So, your kid, playing with the neighbor’s kid, whose mother just tested positive does not mean you have an exposure. Nor does your child unless they were exposed to the mom. With that out of the way, let’s look at the changes.
Quarantine is no longer required for people with a known exposure to COVID. Previously, people were asked to quarantine for 10 days after an exposure. The new recommendation is that a person who is exposed simply wear a high-quality mask for five days and then test on day five, where the day of exposure is counted as day zero. This makes sense as the incubation period is about 4 days, so tests won’t turn positive until around the fifth day after an exposure. Also, during the four days of incubation, people are generally not contagious. If the person tests negative on day five, then there is no need to do anything special after that. Using an antigen test that is available over the counter is recommended. Medical PCR testing should be reserved for people with significant symptoms.
Isolation is shortened for people who have only mild cases of COVID. If a person tests positive, the recommendation is to isolate at home for five days. If the person is without a fever for 24 hours and their symptoms are improving, then that person can be out of isolation after day five, but must wear a medical grade mask or an N-95 when in public or around others for the next five days. This is less than the previous guideline that required 10 days of isolation. The shortening of the period of isolation is supported by the fact that people are most contagious in the first five days of symptoms. The spreading of virus rapidly diminishes after that to essentially zero by day 10 as the immune system knocks down the infection. These guidelines regarding isolation have also been simplified by making them pertain equally to vaccinated and unvaccinated persons.
For people with COVID who have moderate (e.g. significant shortness of breath) or severe (e.g. needed hospitalization) symptoms, then the isolation period remains 10 days. Ten days is also the recommendation if the person has a weak immune system regardless of severity of symptoms because they may not clear the virus as quickly.
General “surveillance” screening of the public is no longer recommended.
The guidelines continue to encourage people to get vaccinated as an effective means of avoiding serious illness from COVID. The guidelines also restated the benefit of wearing a “high-quality mask” and maintaining social distancing in crowds. More emphasis than in previous guidelines was placed on the benefit of ventilation in public spaces.
The guidelines did not address questions pertaining to returning to work or healthcare settings. Therefore, the previous guidelines set out in January still stand. Specifically, people who have COVID can return to work after 10 days from onset of symptoms if they are without a fever for 24 hours and their symptoms are improving. Testing is not recommended to return to work.
In an interview with USA TODAY, CDC spokesperson Tom Skinner stated that the CDC is in the process of revising its guidelines for elementary schools, healthcare facilities, and travel. Hopefully, these come out soon.
We should keep in mind that CDC guidelines do not replace state or local health department requirements. However, I think it is reasonable to expect that the California Department of Public Health (CDPH) will follow CDC’s lead in the weeks to come and put out some of their own revised guidelines. Likewise, county health departments should be expected to follow what CDPH has to say and issue new public health orders that are more relaxed.
Miller Report for the Week of August 15th, 2022; by William Miller, MD
You can access all previous Miller Reports online at www.WMillerMD.com.
Dr. Miller is a practicing hospitalist and the Chief of Staff at Adventist Health Mendocino Coast hospital in Ft. Bragg, California. The views shared in this weekly column are those of the author and do not necessarily represent those of the publisher or of Adventist Health.
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