The current guidance, which has not been updated since December 2021, is too restrictive and does not provide enough protection. It says most people who test positive for the coronavirus should stay away from others for five days after symptoms appear. After that, they can go out in public for five days as long as they wear a mask.
Many people misunderstand this guidance, which does not require testing to come out of quarantine, as saying that people are no longer contagious after five days. It’s not true. A 2022 Lancet study found that 65 per cent of infected people were still shedding virus after the fifth day. If we stop quarantining around vulnerable family members too soon, we will be putting our loved ones at risk.
The CDC can and should make its guidance clearer and more specific. This can be achieved by providing three different recommendations based on people’s risk factors and the vulnerability of people in the household.
The first recommendations are for people who are at higher risk of severe disease due to older age or underlying health conditions. These people should get tested as soon as they develop symptoms of coronavirus. If negative, you will need to be tested at least again in the next few days. If you are diagnosed with COVID-19, you should start antiviral treatment as soon as possible. (And of course, these people must be up to date with the coronavirus vaccine. Shockingly, only 40% of nursing home residents have received the up-to-date vaccine.)
How long these people should isolate depends on whether they are around people who are also at high risk. For example, people who live in nursing homes or with other high-risk people should take stricter precautions than those who live with younger, healthier people. In the former case, the CDC should advise people to stay away from other vulnerable people until they test negative.
The second recommendation is aimed at people who are not at high risk themselves but live or work in close contact with people who are. Guidance should state that precautions should be taken around high-risk individuals as long as they are contagious.
For example, health care workers who test positive should stay home early in the illness when they are most likely to transmit the virus to others. To meet staffing needs, you probably won’t be able to come to work until you test negative, but you will be required to wear a mask at all times around patients and other staff.
Similarly, children infected with the coronavirus should not be around their immunocompromised grandparents until their symptoms subside and they no longer test positive.
However, that is not the same as the amount of time a child has to stay home from school. And this brings us to her third guideline. It is for individuals who are not themselves at high risk and have not been in close contact with vulnerable people.
In this regard, the CDC needs to adapt to reality. This group should be given the same advice for coronavirus as it is for other respiratory viruses. Avoid being around other people when you have symptoms.
This is already the standard in much of the United States. Anne Zink, Alaska’s chief medical officer, said in an interview that she was not aware of any school in the state that still required infected students to quarantine for five days.
“The school has gone above and beyond,” she said. “They said we have to prioritize kids going to school.”
This would be a significant change in CDC guidance. Many people avoid testing because they don’t want to be isolated. This change does not mean that a positive test result means you need to stay home from work or school, but that you should avoid close contact with vulnerable loved ones. This shall be clearly stated. Research shows that prolonged contact of an hour or more accounts for the majority of coronavirus infections, so paying extra attention to high-risk family members and friends can save lives.
I would add that anyone who plans to visit a relative in a nursing home or have dinner with a high-risk friend should take a rapid test on the same day. If you are positive, please do not go. If you have coronavirus and live with someone who is susceptible, stay away from that person until you test negative.
In anticipation of the CDC relaxing its guidelines, advocates expressed concern that the new coronavirus remains deadly to immunocompromised people and others. Those people are right; the United States is not doing enough to help the most vulnerable. Much more needs to be done to vaccinate and treat high-risk patients. Universal masking should be maintained in cancer centers, dialysis clinics, and other facilities frequented by vulnerable populations. And we should invest more in long-term COVID-19 research and treatment.
However, continuing with the current confusing and unrealistic quarantine guidance is not the solution. The CDC should adapt its recommendations to the reality of what Americans still want four years into the coronavirus pandemic, while protecting those most at risk. Both are possible.