Sunday, June 16, 2024

Opinion | The Checkup With Dr. Wen: The CDC needs to change its covid guidance

Opinion | The Checkup With Dr. Wen: The CDC needs to change its covid guidance


You’re reading The Checkup With Dr. Wen, a newsletter on how to navigate covid-19 and other public health challenges. Click here to get the full newsletter in your inbox, including answers to reader questions and a summary of new scientific research.

The end-of-summer increase in covid-19 infections has brought renewed attention to the Centers for Disease Control and Prevention’s isolation guidance. These outdated recommendations must be revised, as they disincentivize testing, sow confusion and fail to achieve the most important objective of protecting vulnerable individuals.

This suggestion is not new. In April, three health experts wrote in The Post that the CDC should retire the existing policy and treat covid like it does influenza and other viral illnesses. Other countries have long since pivoted to this approach. Denmark has removed isolation requirements specific to covid. Britain no longer requires testing for symptomatic individuals and recommends that kids with covid stay home for just three days.

To me, the most compelling reason for the CDC to change its recommendations is that they are not being followed, even by conscientious people. Robert from Virginia wrote that he just contracted covid. “I stayed in my apartment alone for five days,” he told me. “Now, can I drive my mother (87-years old) to her dialysis appointments? Do we still need to wear masks in the car, since we are having dinner together after the dialysis?”

Elizabeth from New York is a single mom of two boys. One of her children just tested positive for covid through his school’s screening program, though he has no symptoms. “Should I really keep him home until he tests negative?” she asks. “When I had covid, I was positive for two weeks. It makes me wish I never agreed to test him.” She adds that she is not testing herself or her other child because she can’t afford to miss more work.

These two situations exemplify the need for improved clarity and specificity. A common misunderstanding, which Robert articulated, is that, after five days, people with covid are no longer contagious. That’s not the case. A large 2022 study published in Lancet Respiratory Medicine found that 65 percent of individuals are still shedding the virus five days after symptoms emerge. While the viral load is lower than earlier in their illness, they could still transmit it to others.

The CDC acknowledges this, which is why its guidance states that those with mild cases should stay away from others for the first five days following diagnosis. Then, for five days after that, they can be around others, but must wear a well-fitting, high-quality mask the entire time.

That means Robert could drive his mother to the appointment, but they should both wear masks — ideally N95 or equivalent. They could further reduce risk by opening car windows. They should not have dinner indoors together.

The CDC says people can stop wearing masks 10 days after their positive covid test. It can also end sooner, if the individual has two negative tests spaced 48 hours apart. I don’t think this is well-understood or followed. Many people think one negative test is sufficient.

Yet another problem is that some people test positive beyond 10 days, as Elizabeth referenced. If this results in more missed work and school, people will be less likely to take the tests.

Adding to the challenge of interpreting the current guidance is that it only applies to people who are asymptomatic or who have mild symptoms. Those with moderate illness — defined as any shortness of breath — are supposed to isolate for a full 10 days. Once again, this adds to complexity and is not likely followed by much of the public.

I think the recommendations can be simplified by shifting the focus from a blanket isolation policy for any individuals with covid to tailored guidance based on who these individuals interact with. Robert’s 87-year-old mother with kidney failure is at high risk for severe outcomes if she were to contract covid. Robert should keep masking around her until he consistently tests negative for covid, which might take more than 10 days.

On the other hand, Elizabeth’s kids are not in this high-risk group. It’s not unreasonable to treat covid as they do other respiratory illnesses: Don’t go to school if they have a fever or serious symptoms, but otherwise they shouldn’t miss more class time.

Moreover, the testing protocol should change. Instead of routinely testing for covid, people should test before they visit vulnerable people, such as an elderly grandparent or a friend receiving chemotherapy.

The Biden administration recently announced it will issue another round of free covid-19 home tests. That’s terrific, and I hope people take advantage of them. Those vulnerable to severe outcomes should take tests if they are symptomatic because they need early antiviral treatment if they are infected. And those around these high-risk individuals should have ample tests to help prevent transmitting the virus to their loved ones.

Accepting that covid-19 is endemic requires adjusting our approach to it. The path forward must emphasize safeguarding the vulnerable while minimizing societal disruption. Changing isolation guidance is a crucial component, along with targeting boosters and treatments for high-risk individuals.



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