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The Centers for Disease Control and Prevention on Thursday loosened many of its recommendations to fight the coronavirus, a strategic shift that puts more responsibility on individuals, rather than schools, businesses and other institutions, to limit the spread viral
Schools and other institutions no longer need to screen seemingly healthy students and employees as a matter of course. The CDC is putting less emphasis on social distancing. Their quarantine rule for unvaccinated people is gone. The agency is now focusing on highly vulnerable populations and how to protect them, not on the vast majority of people who now have some immunity to the virus and are unlikely to become seriously ill.
The new recommendations indicate that the Biden administration and its medical advisers have decided that the lower death rate from covid-19 in a heavily vaccinated population allows for a less demanding set of guidelines.
“The current conditions of this pandemic are very different from the past two years,” CDC epidemiologist Greta Massetti said Thursday at a briefing for reporters.
CDC officials have repeatedly pointed to increased protection against the virus due to high levels of vaccine-induced immunity and infection in the country, along with the deployment of effective treatments that have reduced severe disease. A report released Thursday by the agency outlining revisions to the guidance said the more favorable circumstances allow public health officials to focus on “sustainable measures to further reduce medically significant disease as well as minimize the strain on the health system, while reducing social barriers, educational and economic activity”.
But revising the guidance comes with some risk, infectious disease experts say: Another wave of fall and winter cases, or the emergence of a new coronavirus variant, could call into question the wisdom of the CDC’s strategic pivot or hinder the agency’s ability to reimpose tougher guidelines.
Under the new guidance, quarantine procedures have been relaxed: unvaccinated people who have had close contact with someone infected are no longer recommended to go through a five-day quarantine period if they have not tested positive for the virus or have shown symptoms.
Previous CDC guidance said people who had been exposed but were up to date on their coronavirus vaccinations could skip the quarantine period. The new guidance extends this standard to everyone.
The CDC’s updated guidance doesn’t call for abandoning all precautions. For example, people who have been exposed but not confirmed to be infected should still wear a mask and get tested at least five days after exposure.
People who test positive must continue to self-isolate immediately and stay at home for five full days if they test positive. (“Isolation,” as opposed to “quarantine,” covers those known to be infected or symptomatic.)
The CDC did not ask for a negative test before coming out of isolation. Some infectious disease experts have argued that a negative test provides direct evidence of a person’s potential to spread the virus, as opposed to a single timeline. And the five-day standard has been criticized as too short. A recent study found that people continue to test positive for the antigen for eight days, on average, after becoming infected.
As part of the changes, the agency is also dropping its recommendation that people get tested for covid in most settings. This change is likely to affect policies in workplaces, schools and daycare centers.
“When considering whether and where to implement screening for asymptomatic individuals with no known exposure, public health officials may consider prioritizing high-risk congregate settings, such as long-term care facilities term, homeless shelters and correctional facilities, and workplaces that include housing with limited access to medical care,” the CDC wrote in the report explaining the changes.
“I think the question is whether the CDC finally says, ‘Look, we’ve done what we can do to contain the most acute phases of this pandemic,'” said Jeanne Marrazzo, an infectious disease expert and clinical at the University of Alabama at Birmingham. “So they’re finally saying it’s time for us to step back and think about bringing it back to the individual person?”
The more relaxed guidelines are “a concession to realism, to the way a lot of people are managing it,” said William Hanage, an epidemiologist at the Harvard TH Chan School of Public Health. He called the new guidelines “totally reasonable” but added: “My main concern is whether they will continue to be totally reasonable given the unpredictable dynamics of the virus.”
The CDC’s revision of its coronavirus guidance is the agency’s most significant move since last winter’s massive outbreak of omicron infections. Omicron sickened tens of millions of people in a matter of weeks. The CDC had recommended a 10-day isolation period until that point, but omicron quickly decimated the workforce, and the agency abruptly cut the isolation guidance in half.
The CDC is not a regulatory body. Its guidelines do not have the force of law. But many government jurisdictions, businesses, schools and millions of people have tried to adhere to the agency’s guidelines during the pandemic.
Social and not just virological factors have shaped CDC’s approach. The agency’s director, Rochelle Walensky, said the agency wants to offer what practical recommendations they can, and will be followed by a wide range of public. This means considering issues of equity, because people do not have equal access to testing, or the same ability to work remotely or isolate themselves from family members. The agency has said it wants to avoid an unnecessary extension of isolation for people who test positive but are unlikely to still be infectious.
Public health experts, interviewed in recent days about the anticipated easing of restrictions, said the changes reveal the Biden administration’s strategic shift toward a “live with the virus” approach.
Although the latest omicron subvariant, BA.5, has fueled a wave of infections in many parts of the country over the past two months, the vast majority of these cases have not required hospitalization.
“The pandemic is in a very different place” than last year, said David M. Aronoff, an infectious disease expert and physician at Indiana University. “We know that most Americans have some immunity to SARS-CoV-2, either because they are immunized by a vaccine or by infection.”
Many workplaces may use the latest guidance to stop routine testing and may scale back other preventive policies, Aronoff said. But if there is an increase in serious illness and death in the fall, “there needs to be a willingness to increase or dial back our preventive strategies if necessary,” Aronoff said.
Caitlin Rivers, an infectious disease epidemiologist at the Johns Hopkins Center for Health Security, said it made sense to standardize quarantine guidance regardless of vaccination status.
“Vaccines are still protective against serious disease, but the combination of variants and waning [immunity] have eroded their protection against infection,” Rivers wrote in an email. But, he added, “I strongly believe that people who are exposed should wear a mask and get tested between days 5 and 7 to avoid infecting others “.
Rivers said he was sorry to see the agency stop recommending that the test be used to detect the virus, calling it a “useful tool to identify outbreaks early and monitor the burden of disease in a population.” Expense can be a barrier, he said, but “absenteeism and losses in learning or productivity are also costly.”
Julia Raifman, an assistant professor at Boston University’s School of Public Health, said what’s most striking about the guidelines is what’s missing.
“The CDC sets the bar for what should happen, like a speed limit,” Raifman wrote in an email. “Instead, we have the CDC stating that there are no speed limits and it makes it very difficult for state and local governments to establish better policies.”
There is no policy direction “to reduce a bad surge and its health damage, as well as widespread disruption to education and work, by activating a mask mandate and increasing testing,” Raifman said. The CDC should “establish long-term policies for living with less COVID and have policy readiness to make increases less harmful and harmful to health and the economy.”
The new guidance also provides additional information about the reliability of rapid antigen tests and the importance of testing more than once, known as serial testing. It comes amid evidence that many people with symptoms of illness who suspect they have covid are still initially testing negative at home.
The new guidance says that people who have access to antigen tests and decide to use them to determine when they can stop masking should wait to take the first test until at least day 6 and be fever-free for more than 24 hours without medication. Try again in 48 hours, according to the new guide. Two antigen tests more than 48 hours apart provide “more reliable information due to improved test sensitivity,” the guideline said. People should have two consecutive negative tests to stop masking, the guidance said.
A University of Massachusetts research study, published online but not yet published in a peer-reviewed journal, has spurred the government to adopt mass testing. The study showed that two rapid antigen tests performed 48 hours apart were sensitive to 93% of infections detected independently by the much more accurate PCR tests…