California and Oregon relax Covid isolation rules, breaking with CDC

From the beginning of the Covid-19 pandemic, it has been doctor's orders in this country: If you test positive, stay away from other people, even if you don't have a cough or fever. In recent months, however, that rule has been relaxed in two of the most unlikely places.

Oregon and California, among the most cautious states early in the pandemic, surprised health officials elsewhere by violating Centers for Disease Control and Prevention guidelines and telling infected workers and schoolchildren that as long as they have no symptoms, are generally free to go about their lives.

The New Approach has been greeted with concern by some health experts in the United States, especially as wastewater data shows an increase in cases due to a new variant. But many scientists say Covid has transitioned from a public health crisis to a more distinctive virus among a range of respiratory risks.

“The emergency is over. Covid-19 is endemic,” said Dr. Melissa Sutton, medical director for respiratory viral pathogens at the Oregon Health Authority. “We are in a different phase.”

As vaccinations, antiviral treatments and natural immunity have lowered Covid mortality rates, government officials have paid more attention to the social costs of pandemic restrictions.

Even in states where health rules were the strictest, officials say that for asymptomatic people, the benefits of strict isolation no longer outweigh the costs of missed school, missed work and lost income.

“The question is: Is the juice worth squeezing?” said Dr. Shira Doron, chief of infection control at the Tufts Medicine health system in Massachusetts. “We are not achieving control of the virus. What do we get from this policy?”

Studies have shown that people with Covid-19 are most likely to spread the virus within days before and after developing symptoms.

The CDC initially recommended that patients isolate for at least 10 days. Since 2021, the CDC has recommended that Covid patients isolate for five days and wear a mask until day 10, even if they have no symptoms. Most states still officially refer their residents to the federal guidelines, even in politically conservative places like Arizonawhere pandemic enforcement has been more laissez-faire than in neighboring California.

In May, Oregon became the first state to break with the CDC by relaxing isolation rules for individuals who tested positive for Covid but showed no symptoms. California officials have been closely monitoring Oregon's experience last year and decided last week that it was safe to let people with Covid continue to attend school and work — as long as they don't cough or show other signs of illness.

Like the CDC, Oregon and California still advise infected people to mask up in public indoors and stay away from people at high risk for illness for at least 10 days. But beyond that, both states say individuals with symptoms can go out in the public once they have been fever-free for at least 24 hours and are recovering.

Dr. Doron said she agreed with the policy change but was surprised by who took action first. “California and Oregon are just not the states I expected to see this,” she said.

In many states with liberal leaders, strict Covid precautions were seen as key to the social pact and helped save lives during the worst of the pandemic. But California schools were also among the last in the country to return to in-person learning, and businesses struggled to recover from extended closures and strict state policies requiring isolation, testing and masking.

Covid rules have continued to shape behavior in those states, even as rates of serious illness and death have declined. Workers and their employers have felt the pressure.

“We had asymptomatic individuals in the workforce who did not have sick leave benefits, who were asked to stay away for five days due to infections,” said Dr. Sutton, who helped lead the Oregon service last year.

California's chief epidemiologist, Dr. Erica Pan, noted that the previous policy prevented some workers from even finding out if they had Covid, because a positive result would have sidelined them for days.

National surveys have found that school attendance has not fully recovered in schools disrupted by the pandemic post-pandemic report card Oregon's Education Department found that more than 38 percent of the state's public school students were chronically absent last year.

A variety of factors are responsible for school attendance challenges, including a disruption in relationships between students and their schools during the pandemic and learning losses that made classroom instruction more daunting for children. But school districts in California and Oregon had the added barrier of requiring students to isolate once they tested positive for Covid.

Dr. Sutton noted that some schoolchildren missed “a solid week of school” despite feeling and looking good. Meanwhile, she said, Covid wasn't going away.

“We knew that the virus is probably the most transmissible virus known to man, and that about half of all people do not develop symptoms,” she said. “And isolation alone, in the absence of other protective measures, did almost nothing to stop transmission.”

The effectiveness of the policy is difficult to gauge from the natural rise and fall of infections, but Oregon's death and hospitalization rates have remained consistent with national rates — a sign, said Dr. Sutton, that at least the new system hasn't made things worse. . And, she said, asymptomatic people feel less compelled to miss work and skip classes, and more willing to adhere to other Covid rules.

Encouraged by Oregon's success, California, the nation's most populous state with 39 million residents, adopted similar guidelines, stating “reduced impact of COVID-19 compared to previous years.”

The new guidelines have already been introduced by some of the state's largest school districts, including those in Oakland, Sacramento and San Diego, and by the state agency that regulates workplaces.

Some public health experts are questioning this shift. Jason Salemi, an epidemiologist at the University of South Florida, noted that vulnerable Americans are still dying from Covid, about 1,500 per week. And there is evidence that people infected with new variants may be most contagious a few days after symptoms appear.

“I don't want people coming to work and coming into contact with me if they have flu and are still contagious, if they have strep throat and are still contagious, and of course if they have Covid-19. 19 and they are still contagious,” he said.

Dr. Peter Hotez, a vaccine expert and author of a forthcoming book, “The Deadly Rise of Anti-Science.“Concerned that the relaxation of rules in Oregon and California could further encourage partisan bashing of Covid safeguards.

“The guidelines can make sense,” he said. But he added: “What is their reason for going out on their own when it could cause confusion? There is an inherent danger in doing that because the surgeon general of Florida could argue that what California is doing is no different than Florida, even though we know there is a very different political agenda at play.

A spokesperson for the CDC said the agency would “continue to evaluate the latest data as it considers its recommendations,” but declined to say whether the shift by the two West Coast states would affect the federal guidelines.

Dr. Sutton said she expects other states will follow Oregon and California's lead, regardless of what federal officials do. She said she has already been invited to give a presentation about her state's experience to Washington state health officials later this month.

“We need policies that make sense for our people and are based on evidence,” she said. “And an arbitrary five-day isolation is not the most evidence-based policy.”

Apoorva Mandavilli reporting contributed.