Covid isolation halved to 5 days in CDC revision
Five states, Puerto Rico log caseloads at pandemic high
NEW YORK — U.S. health officials Monday cut isolation restrictions for Americans who catch the coronavirus from 10 to five days, and similarly shortened the time that close contacts need to quarantine.
Centers for Disease Control and Prevention officials said the guidance is in keeping with growing evidence that people are most infectious in the two days before and three days after symptoms develop. The decision also was driven by a recent surge in cases propelled by the omicron variant.
Early research suggests omicron may cause milder illnesses than earlier versions of the virus. But the sheer number of people getting infected — and therefore having to isolate or quarantine — threatens to crush the ability of hospitals, airlines and other businesses to stay open, experts say.
CDC Director Rochelle Walensky said the country is about to see a lot more omicron cases.
“Not all of those cases are going to be severe. In fact, many are going to be asymptomatic,” she said Monday. “We want to make sure there is a mechanism by which we can safely continue to keep society functioning while following the science.”
Last week, the agency loosened rules that had called on health care workers to stay out of work for 10 days if they tested positive. The new recommendations said workers could go back to work after seven days if they tested negative and didn’t have symptoms. And the agency said isolation time could be cut to five days, or even fewer, if there were severe staffing shortages.
Now, the CDC is changing the isolation and quarantine guidance for the general public to be even less stringent.
The change is aimed at people who are not experiencing symptoms. People with symptoms during isolation, or who develop symptoms during quarantine, are encouraged to stay home.
The isolation and quarantine guidance has confused the public, and the new recommendations are “happening at a time when more people are testing positive for the first time and looking for guidance,” said Lindsay Wiley, an American University public health law expert. Nevertheless, the guidance continues to be complex.
The isolation rules are
for people who are infected. They are the same for people who are unvaccinated, partly vaccinated, fully vaccinated or boosted.
They say:
■ The clock starts the day you test positive.
■ An infected person should go into isolation for five days, instead of the previously recommended 10.
■ At the end of five days, if you have no symptoms, you can return to normal activities but must wear a mask everywhere — even at home around others — for at least five more days.
■ If you still have symptoms after isolating for five days, stay home until you feel better and then start your five days of wearing a mask at all times.
The quarantine rules are for people who were in close contact with an infected person but not infected themselves. For quarantine, the clock starts the day someone is alerted they may have been exposed to the virus.
Previously, the CDC said people who were not fully vaccinated and who came in close contact with an infected person should stay home for at least 10 days. Now the agency is saying only people who got booster shots can skip quarantine if they wear masks in all settings for at least 10 days.
That’s a change. Previously, people who were fully vaccinated — which the CDC has defined as having two doses of the Pfizer or Moderna vaccine or one dose of the Johnson & Johnson vaccine — could be exempt from quarantine.
Now, people who got their initial shots but not boosters are in the same situation as those who are partly vaccinated or are not vaccinated at all: They can stop quarantine after five days if they wear masks in all settings for five days afterward.
Suspending both isolation and quarantine after five days is not without risk.
A lot of people get tested when they first feel symptoms, but many Americans get tested for other reasons, such as seeing whether they can visit family or for work. That means a positive test result may not reveal exactly when a person was infected or give a clear picture of when they are most contagious, experts say.
When people get infected, the risk of spread drops substantially after five days, but it does not disappear for everyone, said Dr. Aaron Glatt, a New York physician who is a spokesman for the Infectious Diseases Society of America.
“If you decrease it to five days, you’re still going to have a small but significant number of people who are contagious,” he said.
That’s why wearing masks is a critical part of the CDC guidance, Walensky said.
The new guidance is not a mandate; it’s a recommendation to employers and state and local officials. Last week, New York state said it would expand on the CDC’s guidance for health care workers to include employees who have other critical jobs that are facing a severe staffing shortage.
It’s possible other states will seek to shorten their isolation and quarantine policies, and the CDC is trying to get out ahead of the shift. “It would be helpful to have uniform CDC guidance” that others could draw from, rather than a mishmash of policies, Walensky said.
Given the timing with surging case counts, the update “is going to be perceived as coming in response to pressure from business interests,” Wiley said. But some experts have been calling for the change for months, because shorter isolation and quarantine periods appeared to be sufficient to slow the spread, she said.
PANDEMIC HIGHS
Some places are reporting their worst caseloads of the pandemic. Delaware, Hawaii, Massachusetts, New Jersey, New York and Puerto Rico have reported more cases in the past week than in any other seven-day period, data show.
The numbers point to the ease with which omicron is spreading across the country, even as some studies from overseas suggest that the variant might cause less severe illness. Experts warn that the surge of infections, combined with the fact that tens of millions of Americans remain unvaccinated, could still create a severe strain on the U.S. health system and lead to many more deaths.
On Friday, before holiday interruptions to data reporting, the seven-day national average of new daily cases surpassed 197,000, a 65% jump over the past 14 days. Deaths also increased by 3% during that time, to a seven-day average of 1,345, according to a New York Times database.
The national record for average daily cases is 251,232, set in January during a post-holiday surge.
Hospitalizations are up, too, although not as much as cases. Nearly 71,000 Americans are hospitalized with covid-19, 8% more than the previous week though still well below previous peaks.
Government data show that vaccination is still a strong protector against severe illness. Unvaccinated people are five times as likely to test positive and 14 times as likely to die compared with vaccinated patients, according to the CDC.
Still, only 62% of Americans are fully vaccinated, and the nation’s medical infrastructure is dangerously frayed two years into the pandemic as hospitals contend with staff shortages fueled by burnout and early retirements.
NEW YEAR’S RESTRICTIONS
As omicron spreads ever more gloom around the globe ahead of New Year’s Eve, governments are moving at different speeds to contain the scourge, with some reimposing restrictions immediately and others hesitating to spoil the party again.
In Britain, where the variant has sent caseloads soaring to record highs, Health Secretary Sajid Javid said Monday that no further restrictions will be introduced in England before the new year. New daily infections are hovering around 100,000, and hospital admissions were up more than 70% on Christmas from a week earlier.
“When we get into the new year, of course, we will see then if we do need to take any further measures, but nothing more until then, at least,” Javid said.
Elsewhere in the United Kingdom, though, nightclubs have been ordered closed and limits on gatherings imposed in Scotland, Northern Ireland and Wales, leaving the country divided in its approach to the crisis.
The Netherlands, meanwhile, has already shut down all nonessential stores, restaurants and bars and extended the school holidays in what largely amounts to a new lockdown. In Belgium, new measures took effect Monday and over the weekend: Shopping in large groups was banned, and movie theaters and concert halls closed in the middle of the holiday season.
In France, Prime Minister Jean Castex announced a set of restrictions set to kick in next week, after New Year’s. Among them: Big events will be limited to 2,000 people indoors and 5,000 outdoors; eating and drinking will be banned in theaters, at sports venues and on public transportation; and working from home will be mandatory at least three days a week for employees whose jobs make it possible.
Workers should stay away from the office as many as four days a week if possible to help reduce social contacts, Castex said. “In France and in Europe, the health situation is, as you know, extremely tense,” he told reporters.
France reported a daily record of more than 100,000 new cases Saturday fueled by omicron’s rapid spread, mirroring significant infection rates in the U.K. and Italy. More than 16,000 people are currently hospitalized for covid in France, including some 3,300 in intensive care — above the crisis threshold of 3,000 set by health officials.
Also, a bill will be voted on in France next month to create a vaccine pass that will allow only inoculated people to enter public places, including restaurants, bars and movie theaters.
In Greece, authorities announced additional restrictions — also effective after New Year’s — after recording its highest-ever one-day total of new infections, nearly 9,300.
Health Minister Thanos Plevris said that starting Jan. 3, high-protection or double masks will be mandatory at supermarkets and on public transportation, entertainment venues will close at midnight, and capacity will be cut to 10% at soccer stadiums, among other measures.
In Poland, a nation of 38 million where the daily death toll now often tops 500, nightclubs will be allowed to reopen on New Year’s Eve, with the government unwilling to go against the will of the many voters opposed to restrictions and mandatory vaccinations.
And despite the highest death toll in Europe, Russia will ring in the new year with few if any restrictions. Many precautions will be lifted during the holiday period that runs for 10 days starting New Year’s Eve. Russia also will not impose any additional travel curbs.
The official Rosstat statistical agency estimated that between April 2020 and October 2021, Russia had 537,000 virus-related deaths.
4TH-SHOT STUDY
An Israeli hospital Monday began a study to test the safety and effectiveness of a fourth dose of a covid-19 vaccine, as health officials continued to deliberate over rolling out fourth shots for vulnerable people nationwide.
Officials at Sheba Medical Center, near Tel Aviv, said their study was the first of its kind and involved administering an additional shot to 150 medical personnel who had received a third dose of the Pfizer-BioNTech vaccine at least four months ago.
The moves in Israel, an early leader in vaccinations, are being closely watched as governments worldwide struggle with how to confront the omicron variant. A panel of medical experts advising the Israeli government recommended last week that health officials offer a fourth shot to people 60 and older, those with weaker immunity and medical workers.
The proposal is awaiting approval from the Ministry of Health, but questions have been raised about whether the recommendation was premature given the lack of data on the effects of a fourth shot. It was unclear whether the ministry would wait for the results of the hospital study to make its recommendation.
The advisory panel acknowledged uncertainty over the effects of omicron but pointed to evidence of decreased immunity in people who were among the first to receive a third dose in August. Israeli data showed a doubling of the rate of infection from the delta variant, then dominant, among the 60-plus age group within four or five months of the third shot.
Israel, a relatively small country of 9 million with an efficient public health system, was a leader in introducing the first round of vaccinations and later in giving booster shots, putting it in position to assess early how effective the shots are and how quickly the protection wears off.
Most of Israel’s population has received at least two doses, but about 1 million eligible citizens have not yet received a booster shot.
Information for this article was contributed by Mike Stobbe, Raf Casert, Zeke Miller, Colleen Barry, Sylvia Hui, Sylvie Corbet, Molly Quell, Geir Moulson, Jari Tanner, Uliana Pavlova and Vanessa Gera of The Associated Press; by Benjamin Mueller, Isabella Grullon Paz, Andrew Jacobs and Isabel Kershner of The New York Times; and by Gaspard Sebag and Samy Adghirni of Bloomberg News (WPNS).