February 23, 2024 – Is shorter higher? Or simply more practical? The CDC will reportedly shorten its COVID-19 isolation recommendations from 5 days to 24 hours starting in April.
The agency appears to be walking a high-quality line between reductions Covid transmission, including the JN.1 variant, and the fact that many individuals find it difficult to miss work or school for days at a time.
The agency is anticipated to recommend 24 hours under two conditions: so long as the person stays fever-free for twenty-four hours and their symptoms are mild and improving. But what about keeping those at higher risk for more serious COVID outcomes? Why wait until April? And has the science around COVID modified or simply our behavior?
We turned to some experts for answers.
It stays to be seen whether individuals are more prone to be isolated for twenty-four hours, or whether doing so will send an unintended message concerning the severity of COVID.
“I worry that people will stop taking isolation seriously when it's so short,” said Purvi Parikh, MD, an immunologist at Allergy & Asthma Network, a nonprofit advocacy group for individuals with these conditions based in Fairfax, VA.
Eyal Oren, PhD, professor of epidemiology at San Diego State University School of Public Health, said, “The science around COVID really hasn’t changed. COVID is just as contagious, and one could even argue that the JN.1 variant is more contagious,” he said
One danger is that individuals will interpret the change to mean that COVID is less severe, he said. It could give the misunderstanding that “something has suddenly changed.”
In addition, it could not at all times make sense to base isolation on fever. You could be contagious for twenty-four hours with out a fever, said Parikh, who can also be contagious clinical assistant professor within the departments of medication and pediatrics at New York University Langone School of Medicine in New York City.
Someone who tests positive for COVID is probably going still contagious after five days, Oren said.
“We are still seeing around 1,500 COVID-related deaths every week in the United States. This is still a virus that hospitalizes and kills many more people than the flu,” he said. COVID is “not as bad as it was, but 1,500 people a week – or more than 200 a day – is a lot.”
If the CDC moves forward with the advice, Bruce Farber, MD, chief public health and epidemiology officer at Northwell Health in New York, hopes they continue to be flexible because COVID is unpredictable. “If the situation changes and there is a big peak in the fall… that should be reconsidered.”
The move “ignores the increased risk this change poses to the most vulnerable,” said Brian Koffman, MDCM. In 2005, he was diagnosed with chronic lymphocytic leukemia (CLL) blood cancer and is considered one of the virtually 7% of individuals with a weakened immune system.
“These changes will reinforce the need for me and other immunocompromised people to continue avoiding crowds, wearing a mask indoors and practicing careful hand hygiene,” he said. “This makes restaurants and other indoor events even riskier.”
“Many – myself included – will find the risk prohibitive and will choose to stay home.”
Protecting these higher-risk populations from COVID might help reduce the chance to the larger population, Koffman said. “We have clear evidence that new variants often arise in infected people with weakened immune systems, so protecting them protects everyone.”
A matter of timing
Because many individuals are testing for COVID at home and never reporting their results, it’s harder to find out overall case and transmission numbers. But of those that have been officially tested, almost 10% are currently positive CDC COVID Tracker Numbers reveal.
COVID isn't the one virus on the market this winter respiratory season either, as RSV and the flu proceed to make people sick.
The CDC could also be taking a break to beat a COVID surge related to the winter months. “They are waiting until April because RSV season will be over and COVID numbers will most likely be significantly lower than they were in the winter months,” Farber said.
In addition, the pandemic isn’t any longer what it was two years ago, he said. “There is a lot of immunity to COVID.”
There can also be the sensible query of what number of individuals are there Covid symptoms or who test positive for COVID will actually remain in isolation for five full days. Although “I don't think anyone would argue that it's not safer to wear a mask and isolate for five days … the reality is that most people don't follow those rules,” Farber said.