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Navigating the CDC's Updated COVID Isolation Guidelines

Last week, the CDC shortened its isolation guidelines for those infected with COVID-19 from five days to 24 hours without a fever. Jessica Malaty Rivera, Science Communication Advisor at the de Beaumont Foundation explains the shift in policy, how COVID-19 compares to the flu and other common respiratory viruses, and how to stay safe when official guidelines miss the mark.

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Brian Lehrer: Brian Lehrer on WNYC. So last week, did you hear this? The Centers for Disease Control announced new COVID guidelines dropping the long recommended five-day isolation period after you test positive or have symptoms. According to the CDC, you can return to work or school after being fever-free for just 24 hours, much like you would after any other common respiratory infection like the flu or other things. Fever-free is the new standard, no longer a negative test or five days from first symptoms.

Should COVID be treated like the flu? At the start of the decade, the virus killed over a million people in the United States alone. Vulnerable people are still dying from COVID infections, more than 2,000 a week in January, more than 500 last week according to The New York Times' COVID tracker, and many amongst us are living with long COVID symptoms after that initial infection. Is it really in the public interest to send contagious kids to school, contagious adults to the workplace after just 24 hours fever-free as the only measure?

Joining us now to explain further the CDC's updated COVID-19 isolation recommendations and react to them is Jessica Malaty Rivera, science communication advisor at the public health-oriented de Beaumont Foundation. Jessica is an infectious disease epidemiologist, which means she studies the spread of diseases. That's what epidemiologists do. Jessica, great to have you again. Welcome back to WNYC.

Jessica Malaty Rivera: Thanks, Brian, for having me back.

Brian Lehrer: I gave the headline version of the CDC's new guidelines. Is there more to it than that?

Jessica Malaty Rivera: There's not too much to it except for the fact that a lot of us in the public health community are not surprised. If you saw weeks before this announcement came out, states like California and Oregon had quietly done the same thing. It had made some headlines and there were whisperings about if it would become a nationwide type of guideline.

For a number of weeks, the CDC was saying nothing had changed, nothing had changed. There was this brewing suspicion that this was coming, mostly because we've been seeing this trend of streamlining, as the CDC says, guidelines for respiratory viruses and respiratory illnesses in the lumping together for data of RSV, influenza, and COVID, and now the lumping together of preventative guidelines.

It is an effort, I think, to make things easier for the CDC to manage. Sadly, we're watching this happen in the absence of evidence to justify this, because as we know of today, the way the virus is transmitted has not changed. The science of infection is still the same, and the science of infectiousness has not made it so that this risk change would be acceptable. It is quite disappointing to see this shift.

Brian Lehrer: Why is fever the only symptom that they mentioned? Let's say we know we have COVID, but then we're fever-free for a day, it's only been a few days, and we're still coughing a lot, spreading those germs like projectiles each time we cough in a room full of other students or our co-workers. Why is fever the only measure?

Jessica Malaty Rivera: That's such a great question, Brian. I'm a mom of three kids, and fever is often the thing that even the schools are looking for as a measure of whether or not somebody is infectious. It is a great tool among many tools and many signals that somebody is experiencing an active infection, and when they're feverish, they're likely able to spread whatever they are carrying.

Unfortunately, though, COVID has continuously demonstrated that fever doesn't always exist in an infection. Some people can have very mild symptoms, some people can have no symptoms. Even still, the probably best proxy that we have for infectiousness is a positive rapid antigen test. If you are positive on one, if you see those two lines, it is safe to assume that you're still contagious to others.

Brian Lehrer: Listeners, we can take a few phone calls or texts with your questions about the new CDC guidelines for isolating if you have COVID. 212-433-WNYC for epidemiologist Jessica Malaty Rivera. 212-433-9692, call or text. Yes, I think to something you just said, listen or text. Not everyone with COVID even has a fever makes zero sense. That, of course, was the reason for all the testing that-

Jessica Malaty Rivera: Exactly.

Brian Lehrer: -we've been doing the last few years, right, because there are a lot of asymptomatic people out there who can spread it to more vulnerable people without even realizing that they have COVID.

Jessica Malaty Rivera: That's exactly right. There are a number of reasons why COVID is not like the flu, and that is one of them. People can be asymptomatically infected and asymptomatically infectious to others. People can be fever-free throughout the duration of their illness, and people can remain positive, AKA infectious to others, for several days. I struggled even when it was just five days for isolation because I know probably on one hand I can count the number of people who tested negative after five days, unless they were on Paxlovid.

For the most part, it can take 10 to 14 days sometimes to clear that virus. I understand, I recognize how difficult that is for both students in school and employees at companies to be out that long, but we should probably call it what it is, that we don't really have the infrastructure that can manage people being out sick for that long.

Brian Lehrer: The CDC is basically saying, go forth and risk spreading the disease much more than-

Jessica Malaty Rivera: In so many words, yes.

Brian Lehrer: -you did before. Should I assume that more masking would be recommended for those people who may be just barely 24 hours fever-free but may have other symptoms or may only be a few days in?

Jessica Malaty Rivera: It's, again, a great question, and this is probably a symptom of where we are in the pandemic. The pandemic is not over, but public health and public health mitigation really falls on states. The CDC is unfortunately not an enforcing agency to mandate anything. They can put up guidelines as these guidelines to have best practices, but even in the bullet points that they mention of staying up to date to vaccination, practicing good hygiene, and taking steps for cleaner air, masking is not one of the four bullets. Yes, it's sometimes mentioned as one of the ways to reduce risk and to reduce the spread of COVID-19, but I don't think mask mandates are in our future either. I think it's an individual choice, and it would actually fall on states and/or companies to create policies related to masking.

Brian Lehrer: Well, mandates are one thing, but CDC recommendations are another because they're not mandating that you go back to work or school after 24 hours fever-free, either. They're saying it's okay. It's a recommendation.

Jessica Malaty Rivera: That's right.

Brian Lehrer: They could take the step of at least recommending masking if you're in that intermediate phase of COVID, but you're telling me they didn't do that.

Jessica Malaty Rivera: Well, they say something to the effect of to reduce the spread for those next five days, you can do things like take steps for cleaner air, enhance hygiene practice, or wear a well-fitting mask and keeping your distance from others. It's falling short in the sense that it's assuming that people that they are infectious, but they should still be out because why else would you wear a mask? Five days is not a magic number when it comes to your ability to spread the disease. The best way to know if you're spreading infectious particles is a test, and testing is what's shockingly missing from this.

Brian Lehrer: Here is Tony in Montclair. You're on WNYC. Hi, Tony. Tony in Montclair, are you there? Hi there.

Tony: Yes, I am there. I just wanted to push back a little bit about the criticism of the CDC guidelines because while the biology hasn't necessarily changed, the state of immunity and the state of public health has. When I was taking care of patients in May of 2020, it was a disaster in the hospital, and I just finished taking care of patients this past month, and we had no serious COVID infections. The guidelines are not--

Brian Lehrer: You yourself, I just want to establish, you told our screener, you yourself are an infectious disease physician, correct?

Tony: Yes.

Brian Lehrer: Good, that's helpful. Go ahead, you can finish your point. Go ahead.

Tony: No, no, that was really just the point. I think that the guidelines are guided not only by the biology, but also by the state of our public health and obviously driven by immunity of the population. While they're not perfect guidelines-

Brian Lehrer: Right.

Tony: -I think that they're good.

Brian Lehrer: Tony, thank you very much. Jessica, what do you think? I guess his main point was for the vast, vast, vast, vast, vast majority of people who get COVID now, as compared with the beginning of the pandemic, it's just not that serious.

Jessica Malaty Rivera: I'm going to push back on the pushback because it's not recognizing the fact that there are a number of people who are suffering with long COVID; a number of people who are immunologically high risk for COVID. Hybrid immunity is not standardized. Yes, we have hybrid immunity from a combination of a series of vaccines and/or multiple or single infections. That is definitely something that gives us an advantage today compared to a few years ago.

We are certainly not seeing the same rate of hospitalizations and deaths as we have, but we are still seeing hospitalizations and deaths, and we are still seeing a alarming number of people suffering from disability and prolonged consequences because of conditions like long COVID. I think we do a disservice to people who rely on their community to reduce the spread of this preventable disease by not prioritizing people staying home when they're sick.

Brian Lehrer: Here's one more testimonial to that from a listener in a text. Person writes, "As an older person who recently spent nearly seven weeks in bed with a 'mild case of COVID', I'm pretty alarmed. My GP, my doctor says that nearly one-third of her patients with the recent COVID strain have had similar long-term fatigue." It brings up a question of, as they put it in an Atlantic Magazine article the other day, why are we still fluifying COVID? Would you say COVID is more serious than the flu? Is that part of the premise of your unhappiness with the CDC?

Jessica Malaty Rivera: I would say it's more serious than the flu for a few reasons. We've never had a flu season as bad as the worst COVID season. When we saw, and I think it's even mentioned in that article, we've had maximum 200,000 hospitalizations went into flu in a really bad season, where we saw that number exponentially higher with COVID at its peak.

Brian Lehrer: Wait, but we're not at its peak.

Jessica Malaty Rivera: We're not at its peak, but it's still not the same thing. We don't see long-term complications from flu in the same way that we do with COVID. Flu is also seasonal, and COVID is not. COVID had surges all throughout the year. We've got a summer surge, a late summer surge, a spring surge. We don't have that seasonality that we can rely on to control the spread of the disease.

Brian Lehrer: Last question, there's a reverse line of thinking that says rather than treat COVID more like the flu, we should learn from the pandemic to be more cautious than we used to be regarding flu and other viruses, personal choices, and public policy both. The flu kills many thousands a year too and we could do better on that with more courteous workplace policies and public health laws or recommendations like making sure you stay home if you're in a contagious phase. Are you in that camp at all? Treat the flu more like we treat COVID rather than the other way around?

Jessica Malaty Rivera: I absolutely agree. I remember one of the first reactions to COVID was, wow, we used to reward people for being very loyal to their jobs by showing up sick and even reward kids with perfect attendance by showing up sick to school. We've downplayed the value of rest and of harm reduction, which are the principles of public health, and to not prioritize people recovering and reducing other people's risk for getting infectious diseases. We've regressed and gone back to the days prior to COVID where we think it's okay to just walk around sick and making other people at risk of getting sick too.

Brian Lehrer: Jessica Malaty Rivera, science communication advisor now at the public health-oriented de Beaumont Foundation. Thanks, Jessica. We always appreciate when you come on.

Jessica Malaty Rivera: Of course, thank you so much.

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