Since January, Californians diagnosed with COVID-19 are no longer required to quarantine for five days. A person with symptoms of the new coronavirus can go out in public within 24 hours after the fever has subsided. Asymptomatic people do not need to isolate, but masks are still recommended when indoors and around other people.
This is a big change. To understand how health officials came to this decision, I spoke with California epidemiologist Erica Pan.
Pan, who is also a pediatric infectious disease expert, stressed that the coronavirus continues to cause severe illness in vulnerable populations. But thanks to vaccination, immunity from past infection, and effective antiviral treatments, the population-level impact of the virus is well below the peak of the pandemic.
“If you look at this season compared to last season and the seasons before that, we have a lot less hospitalizations and a lot less deaths,” Pan said. Top-down requirements such as mask mandates and forced quarantines were necessary when the population’s immunity was low and the virus was straining the health system. But now, “we’re really recognizing the devastating effects of some of these policies, especially in schools and workplaces,” she explained.
Another important factor in California’s decision-making is the fact that coronavirus infections can have mild or no symptoms, and many people are not testing every time they have a runny nose. was. “We wanted to remind people that multiple respiratory viruses are circulating,” she said. This is why they switched to a symptom-based approach. That means you should stay home if you have a fever or respiratory symptoms, regardless of the virus you’re infected with.
Pan points to other countries that have made similar changes. Denmark no longer considers the coronavirus to have special status over other diseases, and there is no need to isolate after testing positive. Norway and the UK advise people to stay home if they are sick, but there is no set quarantine period. In fact, these countries only recommend testing for symptomatic people who are eligible for treatment. Even Australia, which had some of the strictest mitigation measures during the pandemic, ended mandatory quarantine more than a year ago, asking people with symptoms to wear masks and avoid being around high-risk people. .
I also learned that California has practical reasons not to wait for the CDC to change its guidelines. In many states, public health recommendations are simply suggestions that workplaces and individuals can choose to follow or not. But in California, public health policy is tied to workplace regulation. This was also the case in Oregon, where health officials similarly ignored the CDC’s five-day quarantine period.
Opponents of changing guidance often argue for fairness because those at risk of severe disease will suffer the most if virus infections increase. (I’ve written previously about how the CDC is mitigating this risk.) But there are also equity arguments in favor of relaxing quarantine requirements.
As Pan explains, quarantine requirements favor people who have desk jobs and can continue working from home without losing wages. This is not true for people who must work in-person, a disproportionate share of whom are minorities and lower-income workers. Well-intentioned public guidance should not impose additional burdens on essential workers or exacerbate economic hardship.
Changes in quarantine policies in no way mean state health officials are “minimizing the coronavirus,” as some advocates have suggested. Pan highlighted the many efforts his team is making to keep people up to date on vaccines, improve ventilation and increase access to treatment. She agrees with me that we need to adjust the tools available to us based on our personal risk and the risk of those around us.
For example, before going to dinner with her elderly parents, she tests herself and her children. And vulnerable people like her parents must use close-fitting N95 masks or equivalent masks when in public.
At the end of the day, “it’s all about balancing your priorities,” Pan says. Policymakers and the public must recognize that interventions that were appropriate early in the pandemic may no longer be appropriate. The focus has shifted from infection prevention to mitigating severe outcomes while reducing disruption to work, school and social activities.
Getting the balance right is difficult and there will always be naysayers. But as Pan and her colleagues have well illustrated through thoughtful decision-making, this is the work of public health. Government guidance must always be based on science, but there is rarely a straight line from science to policy. Health authorities need to better communicate the complexity and the challenge of determining priorities and why.