CDC loosens Covid-19 guidance, signaling strategic shift
THE Centers for Disease Control and Prevention (CDC) on Thursday loosened many of its recommendations for battling the coronavirus, a strategic shift that puts more of the onus on individuals, rather than on schools, businesses and other institutions, to limit viral spread.
No longer do schools and other institutions need to screen apparently healthy students and employees as a matter of course.
The CDC is putting less emphasis on social distancing – and the new guidance has dropped the “six foot” standard.
The quarantine rule for unvaccinated people is gone. The agency’s focus now is on highly vulnerable populations, and how to protect them – not on the vast majority of people who at this point have some immunity against the virus and are unlikely to become severely ill.
The new recommendations signal that the Biden administration and its medical advisers have decided that the lower fatality rate from covid-19 in a heavily vaccinated population permits a less demanding set of guidelines.
“The current conditions of this pandemic are very different from those of the last two years,” CDC epidemiologist Greta Massetti said Thursday in a briefing for reporters.
The virus has killed more than 1 million people in the United States since it arrived in early 2020.
About 42,000 people with Covid-19 are hospitalised and the daily death toll is close to 500, according to a Washington Post seven-day average of daily trends.
Those numbers, though quite a bit higher than in early spring, do not approach the dire figures of last winter, and CDC officials have repeatedly pointed to greater protection against the virus because of high levels of vaccine- and infection-induced immunity, coupled with the rollout of effective treatments that have reduced severe illness.
A report released Thursday by the agency explaining the guidance revisions said the more favourable circumstances allow public health officials to focus on “sustainable measures to further reduce medically significant illness as well as to minimise strain on the health care system, while reducing barriers to social, educational, and economic activity.”
But the revision in guidance carries some risk, according to infectious-disease experts: Another fall and winter wave of cases, or the emergence of a new coronavirus variant, could call into question the wisdom of the CDC’s strategic pivot or hamper the agency’s ability to reimpose tougher guidelines.
As part of the changes, the agency is dropping its recommendation that people be screened or tested for covid in most settings. That change is likely to affect policies in workplaces, schools and day-care centers.
“When considering whether and where to implement screening testing of asymptomatic people with no known exposure, public health officials might consider prioritising high-risk congregate settings, such as long-term care facilities, homeless shelters, and correctional facilities, and workplace settings that include congregate housing with limited access to medical care,” the CDC wrote in the report explaining the changes.
One CDC webpage, titled ‘How to Protect Yourself and Others’, has been extensively revised.
It no longer states, for example, “If possible, maintain 6 feet between the person who is sick and other household members.”
The new language is more nuanced, does not employ the 6-foot rule, and acknowledges that it may be impractical to stay away from a sick person: “In those situations, use as many prevention strategies as you can, such as practicing hand hygiene, consistently and correctly wearing a high-quality mask, improving ventilation, and keeping your distance, when possible, from the person who is sick or who tested positive.”
Under the new guidance, quarantine procedures have been relaxed: Unvaccinated people who have had close contact with someone who is infected no longer are advised to go through a five-day period of quarantine if they have not tested positive for the virus or shown symptoms.
Previous CDC guidance said people who had been exposed but were up to date on their coronavirus shots could skip the quarantine period. The new guidance expands that standard to everyone.
The updated CDC guidance does not call for dropping all precautionary measures. 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 should continue to isolate immediately and stay home for five full days if positive. (“Isolation,” as opposed to “quarantine,” covers those known to be infected or who are symptomatic.)
The CDC did not call for a negative test before exiting isolation. Some infectiousdisease experts have argued that a negative test offers direct evidence of a person’s potential to spread the virus, unlike the one-size-fits-all timeline. And the five-days standard has been criticised as too short.
A recent study found that people continue to test positive on antigen tests for eight days, on average, after becoming infected.
The more relaxed guidelines are “a concession to realism, to the way that a lot of people are handling this,” said William Hanage, an epidemiologist at the Harvard T H Chan School of Public Health.
He called the new guidelines “entirely reasonable,” but added, “My major concern is whether they will continue to be entirely reasonable given the unpredictable dynamics of the virus.”
The revision by the CDC of its coronavirus guidance is the most significant move by the agency since the massive outbreak of infections from omicron last winter.
Omicron sickened tens of millions of people in a matter of weeks. The CDC had been recommending a 10-day isolation period up to that point, but omicron quickly decimated the labour force and the agency abruptly cut 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.