CDC considers ending the five-day isolation period for Covid

The Centers for Disease Control and Prevention is considering relaxing its recommendations on how long people should isolate after testing positive for the coronavirus, another reflection of changing attitudes and norms as the pandemic wanes.

Under the proposed guidelines, Americans would no longer be advised to isolate for five days before returning to work or school. Instead, they could return to their routines if they have been fever-free for at least 24 hours without medication, the same standard applied to the flu and respiratory syncytial viruses.

The proposal would bring the CDC's advice in line with revised isolation recommendations in Oregon and California. The shift was previously reported by The Washington Post but is still under consideration, according to two people with knowledge of the discussions.

The CDC last changed its isolation policy in late 2021, when it reduced the recommended period from ten to five days. If adopted, the new approach would signal that Covid has taken its place alongside other routine respiratory infections.

But by focusing on Covid isolation policies, for example, the agency is squandering an opportunity to promote better public health policies, several experts said.

“From a long-term public health perspective, I think this really sets an unfortunate precedent,” says Dr. Syra Madad, senior director of the special pathogens program at NYC Health + Hospitals.

She urged the CDC to “seize this opportunity to truly change the way we respond to deadly epidemics and pandemics and advocate for national, guaranteed paid sick and family leave rather than succumbing to the easier option to abolish the isolation period.”

Some researchers worried that Americans would interpret the new advice to mean that Covid was no longer a threat. At its peak this winter, Covid was claiming around 1,500 lives a day. In adults over 65, deaths from Covid are two to four times as common as those from the flu.

“There are still a lot of people getting Covid and dying from Covid in the US,” says Dr. Boghuma Titanji, an infectious disease physician at Emory University in Atlanta.

“If you're making a public health recommendation, it shouldn't be based on what people are already doing,” she said. Instead, she added, the advice should be based on evidence.

Even people who have only mild illness can develop long-term Covid-19 illness, for which there is no treatment yet, added Dr. Titanji to it.

The proposed recommendations also don't appear to take into account older Americans, or people who have weakened immune systems or are otherwise at risk of serious outcomes from Covid, said Jennifer Nuzzo, director of the Pandemic Center at Brown University School of Public Health.

Dr. Nuzzo said she has an aunt with cancer who contracted Covid twice in a long-term care facility. “I sympathize with the people who now feel even less protected,” she said.

At a minimum, the CDC should recommend that people who end their isolation after one fever-free day should also wear N95 masks or the like when leaving their homes, she added.

“Let's not pretend that you are suddenly no longer contagious,” said Dr. Nuzzo after one day. “We need to be very clear and transparent about that – to say that we think there is still a risk.”

Masking remains a highly controversial topic in the United States. But many people avoid masks just because they're afraid of drawing attention or vitriol, said Dr. Jay Varma, chief medical officer at Siga Technologies and former deputy health commissioner for New York City.

Over time, sick people wearing masks could become the norm, such as wearing condoms to prevent HIV infections or helmets to prevent head injuries, he said.

“A strong group of people are now against wearing masks, but that has not been resolved in time,” he added. “People change, people die out, children become adults.”

CDC officials declined to discuss the proposed changes. “We will continue to make decisions based on the best evidence and science to keep communities healthy and safe,” the agency said in a statement.