Regardless of how done you are with COVID, COVID isn’t necessarily done with you.
However, you wouldn’t know that from the new CDC guidelines, which have triggered a social media outcry among doctors and other public health experts who say that the changes could lead to even more infections and cases of potentially disabling long COVID.
On Wednesday, the CDC announced a major overhaul of the agency after an in-depth analysis showed the COVID response was “confusing and overwhelming,” according to the New York Times.
An external review suggested that the CDC’s COVID efforts were being hampered by its focus on publishing scientific studies instead of urgent action and will be reorganized to give promotions based on public health efforts, not study publications. Officials will also remain in key positions for at least six months to reduce confusion and delays, rather than rotate out after a few months.
“For 75 years, CDC and public health have been preparing for COVID-19, and in our big moment, our performance did not reliably meet expectations,” CDC Director Rochelle Walensky said in a statement.
Some of the major guidance updates released last week include:
- People who have been exposed to COVID, regardless of vaccination status, no longer have to quarantine if they aren’t showing symptoms, including in schools.
- Infected people who choose to use rapid tests can end their isolation after day five, even if they still test positive, if symptoms are improving.
- COVID screening tests used to catch asymptomatic infections are no longer recommended “in most community settings.”
- People are no longer recommended to stay 6 feet away from others to avoid infection.
The changes to the CDC’s recommendations, which were released on Aug. 11, come at a time when more than 400 people continue to die from the disease every day. (A polite reminder that we are simultaneously battling a monkeypox outbreak and serious polio threat, in addition to the COVID pandemic.)
The CDC says it's OK to relax COVID-prevention measures given that there are vaccines, boosters, and treatments that reduce the likelihood that people will develop severe disease and die compared to earlier in the pandemic. “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,” the agency said in a news release last week.
Experts beg to differ. Some say the CDC’s move reflects what Americans want and are already doing, but that the virus couldn’t care less about what we prefer.
Although these are just recommendations, businesses and schools use the CDC’s guidance to determine how they’ll navigate the ongoing pandemic.
“The CDC’s new guideline looks like a gamble to me. Note that I used the term gamble, as opposed to ‘calculated risk.’ To make a calculated risk, one must do calculations,” Dr. Jeremy Faust, an emergency physician at Brigham and Women’s Hospital and an instructor at Harvard Medical School, wrote in an Aug. 11 blog post for Inside Medicine. “If that work has been done, nobody has shown their work, as far as I can determine. So, [the] guidelines leave me puzzled, curious, and uneasy, rather than impressed.”
Experts are also frustrated that the CDC continues to consider people “fully vaccinated” after receiving two doses of either the Pfizer or Moderna vaccines, or one dose of the Johnson & Johnson shot. Studies show at least three doses are really needed to offer adequate protection against Omicron and other variants that can dodge defenses built up from previous infections and vaccinations that better protect against the Delta variant.
Instead, the CDC says you are “up to date with your COVID vaccines” once you have received all doses in the primary series and all recommended boosters for your age group. (People 5 and older should get one booster after their primary vaccinations and people 50 and older, and those who are 12 and older who are immunocompromised, should get two boosters, according to the CDC.)
Here are some more details, as well as expert commentary, on the updated CDC guidelines.
If you know you’ve been exposed to COVID, you no longer have to quarantine, aka stay away from others. Instead, the CDC suggests you wear a high-quality mask like an N95 for 10 days around other people when indoors and then get tested on day five. (Day one is the first full day after your last exposure.)
You should get tested before day five if you have symptoms, the agency says.
The previous guidance said only unvaccinated people had to quarantine after exposure, but the CDC has now leveled the playing field.
Many experts actually agree this change is warranted. Faust wrote that “exposures are too frequent for routine quarantine to be workable” and that the update “acknowledges where the science is and what the public can be reasonably asked to do.”
If you have COVID, you still need to isolate yourself from other people for at least five days and wear a “well-fitting” or high-quality mask or respirator if around others (like an N95 mask).
Infected people, regardless of vaccination status, can leave isolation after five days (when you’re likely to be most contagious) only if they haven’t had a fever for over a day without the use of medications and other symptoms have improved. The same guidance applies even if someone never experienced symptoms.
A mask should be worn around others at home and in public until day 10.
People should also isolate themselves if they suspect they are sick but are waiting for their COVID test results.
Here’s the controversial part. The CDC says infected people who “choose to use testing to determine when to discontinue masking” can leave isolation after day five even if they still test positive on a rapid test.
Experts say this is horrible advice because evidence shows many people are still positive on rapid tests after day five, and that this means they are still contagious, even if they don’t have symptoms. (If you are positive on a rapid test, then you are contagious. If you keep testing positive on a PCR test for weeks, however, you aren't necessarily contagious because those tests are way more sensitive.)
The CDC suggests these people continue to wear a well-fitting or high-quality mask at home and in public until they receive two consecutive negative rapid tests taken two or more days apart. This means some people should keep wearing a mask for more than 10 days after their symptoms start.
The agency also emphasizes that infected people should avoid individuals at high risk of severe disease until at least day 11, which some experts argue is impossible to do successfully because there’s no way to tell if someone around you is immunocompromised.
People with weakened immune systems should isolate for the full 10 days, the CDC says, and consult with their doctor before going out in public again.
The CDC now says “it may not be practical” to stay away from someone who has COVID, so it may make more sense to practice other preventive measures such as washing your hands, wearing a mask, improving ventilation, and “keeping your distance when possible.”
The closer you are to a large number of people, the higher your chances of becoming exposed to COVID, the agency says, so “you may want to avoid crowded areas,” too.