CDC isolation guidance challenged as cases rise

In the week since the Centers for Disease Control and Prevention released new guidance shortening the isolation period for asymptomatic people with COVID-19, public health officials in Connecticut have expressed concern that the move could lead people to return to work or socializing when they are still contagious.

The new guidance is flawed, some health officials say, because it does not include a requirement that people test negative before leaving isolation. Others have critiqued it for relying too much on people to assess their own symptoms.

“Ending isolation of COVID cases in five days without testing negative is the noseout-of-mask of COVID-19 policies,” Dr. Saad Omer, director of the Yale Institute for Global Health, said in a post on his personal Twitter page a day after CDC came out with the updated guidance.

Since the CDC’s announcement last week, the nation reported a pandemic-high in daily infections and is now averaging more than 300,000 new cases per day. In Connecticut the situation is also worsening with the state on Monday reporting 21.52 percent of tests came back positive over the long weekend and 1,452 patients hospitalized — a level well above last winter’s wave of infections.

The new CDC guidelines shorten isolation time from 10 days to five days for infected people who are asymptomatic, and for people whose symptoms are resolving and who haven’t had a fever within 24 hours. People should wear a mask when around others for five days after leaving isolation, the CDC said.

The agency similarly shortened the time that close contacts need to quarantine.

“I’m concerned because it’s a blanket one-size-fits-all and we know that the disease doesn’t behave that way,” said Dr. Albert Ko, professor of epidemiology at the Yale School of Public Health.

Dr. Anthony Fauci, the chief medical adviser to President Joe Biden, signaled in a televised interview over the weekend that updates to the recently revised guidance could be coming. U.S. health officials, aware of the pushback to the shortened isolation period, are now weighing whether to include a requirement for a negative test, Fauci said.

This comes as the nation is facing a widespread testing shortage with many Americans waiting in line for hours at testing sites around the holidays as athome tests fly off the shelves.

The CDC has defended its decision, pointing to growing evidence showing people are most contagious two days before they develop symptoms and three days after.

“What we do know is about 85 percent to 90 percent of viral transmission happens in those first five days, which is why we really want people to stay home during that period of time,” Dr. Rochelle P. Walensky, CDC director, said in an interview last week on CBS Mornings.

Ko, who was co-chairman of Gov. Ned Lamont’s 2020 reopening committee, sees a flaw in that logic. With a variant as highly transmissible as omicron, “that 10 percent can represent a significant public health risk.”

He added, “The five-day rule is a balance between days of work lost and the risk of being infectious.”

Fauci said the CDC took into account both public health data and worker shortages.

Walensky also defended the CDC’s decision not to include a testing requirement, saying PCR tests can detect the virus for weeks, even after someone is no longer contagious, and at-home antigen tests might not be effective at detecting if someone can transmit the virus during the end of an infection.

Still, Omer, at Yale, said the agency could have advised testing for larger employers and universities or in high-risk congregate settings. Another option would have been to cut the isolation period from 10 days to seven, as some hospital systems have done, he suggested.

“It would have been more appropriate to at least have some nuance on the guidance,” he said.

But he acknowledged the CDC was in a “tough position” to come up with revised rules to combat a fast-spreading variant in the midst of the holidays while also balancing the need to keep essential services running.

The risk of transmission becomes very low after five days of isolation for people without symptoms, Dr. Manisha Juthani, the Connecticut public health commissioner, said last week, explaining the state’s support for the guidance.

“The calculation that always happens with a respiratory virus is, when do you get to the point where you think your chances of infecting somebody else are low enough— not zero — that you can go out and see other people?” she said.

While the risk of spreading the virus “goes down further and further” after five days, “it’s not zero,” said Juthani, a Yale School of Medicine faculty member. That’s why the CDC recommends people wear a mask for five days after leaving isolation.

But some public health experts said that recommendation relies on strict mask adherence and people wearing high quality masks such as N95 or KN95 masks, not cloth face coverings.

The Lamont administration plans to follow the new guidance for state workers who become infected or are exposed to COVID. “We’ve consistently followed CDC guidelines and we’re going to do the same thing here,” Max Reiss, the governor’s director of communications, said last week. “When it comes to isolation and quarantines, they’re looking at data that we don’t have.”

Lamont notably broke from CDC recommendations last year with the state’s vaccine rollout, prioritizing age, not medical conditions or front-line workers, except for teachers, first responders and health care workers.

Public health experts including Omer have urged the CDC to publish the data it used to make the five-day determination. Omer also called for more resources to be spent on public health messaging to communicate to people of varying vaccination status what to do if they become exposed or infected.

Employers in Connecticut are still making sense of the changes and weighing whether to implement them.

Scott Dolch, executive director of the Connecticut Restaurant Association, said the “vast majority” of calls he received in the days since the CDC’s announcement were from restaurant owners seeking clarification on whether the state would follow it.

Many of them wanted to ensure they wouldn’t have problems at the local level if they adhere to the new guidelines, Dolch said. He added that in conversations with state public health officials, he was told further information would be published on the state website in the coming days.

“I think we’re building the plane while we’re flying it at the same time, because this is still new experiences,” he said. “Even the CDC is changing the guidelines.”

Staff writers Ginny Monk and Dan Haar contributed to this report.