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AMA Update
Are there new CDC guidelines for COVID and how did the bubonic plague start in Oregon?
Feb 21, 2024
Featured topic and speakers
Featured topic and speakers
Has the CDC updated COVID guidelines? How long do you have to quarantine? Can adults catch measles? Is the bubonic plague still around? More on: CDC 5 day isolation, measles transmission, Oregon bubonic plague case, plus Alaskapox virus. Out guest is AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia, JD, MPH. AMA Chief Experience Officer Todd Unger hosts.
Speaker
- Andrea Garcia, JD, MPH, vice president, science, medicine & public health, American Medical Association
Unger: Hello and welcome to the AMA Update video and podcast. Today, we have our weekly look at the headlines with the AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia. I'm Todd Unger, AMA's chief experience officer. Andrea, welcome back.
Garcia: Thanks, Todd. It's great to be here.
Unger: Well, a lot has happened in the last week. Let's begin with the headline that the CDC is considering a change to its isolation guidance for COVID. Andrea, tell us more about that.
Garcia: Yeah, Todd. And I just—I want to be very clear from the outset that as of now, nothing has changed, and we've not seen anything directly from the CDC on this possible change in the guidance. But it is being reported in a number of news outlets, including the Washington Post and the New York Times, that the CDC is considering updating its isolation recommendations for COVID.
And that would be for the first time since 2021. And that's when they scaled down their recommended isolation period from 10 to 5 days. Both the Washington Post and the New York Times are citing "people familiar with the discussions" as their sources for these stories.
Reportedly, under these proposed changes to the guidance, those who test positive for COVID would no longer need to stay home from work or school for five days. Instead, they could return to their routines if they've been fever free for at least 24 hours without medication and their symptoms are mild and improving. This would put COVID isolation guidance in line with the guidance for flu and RSV and other respiratory infections.
It's being reported that the CDC is expected to release this guidance in April for public feedback, but the White House also has yet to sign off on it. So, the timing could move around a bit until that guidance is finalized.
Unger: Really interesting. Andrea, what's the thinking behind making a change like this right now?
Garcia: Well, it's being reported that CDC has been working on revising the isolation guidance since last August. But obviously, the fall, as we saw those COVID cases start to rise again, wasn't a good time. So, it was put on pause. I think one reason people feel like this makes sense is because the COVID landscape has changed. The virus emerged four years ago, and the CDC has acknowledged that most people have some level of immunity from the virus, either because of prior infection or vaccination.
We've seen experts like Michael Osterholm, who's an infectious disease expert, point out that public health has to be realistic. And in making recommendations to the public today, we have to get the most out of what people are willing to do. You can be absolutely right in the science and yet accomplish nothing because no one will listen to you. And this approach would be in line with recently revised isolation guidance that some states like Oregon and California are already moving toward.
Unger: Andrea, I'm curious about what those who wouldn't support a change like this would say.
Garcia: Yeah. So some experts definitely feel like this is a missed opportunity to change how we respond to and prevent illness. We should be focused on things like guaranteed paid sick and family leave so people can stay home when they're sick, as well as things like clean indoor air to prevent the spread of infections. These officials worry that removing the isolation period sends the wrong message about COVID and people will take it to mean that it's no longer a threat.
As we know, this past winter, we were still losing about 1,500 lives a week. We know that a COVID infection can still lead to long COVID. And in adults older than 65, those deaths from COVID have been two to four times as common as those from flu. This shift could impact everyone, for sure, but we need to realize the implications for those who are older or immunocompromised.
CDC officials have said these recommendations would not apply to hospitals or other health care settings with more vulnerable populations. I think it's also unclear where this new guidance would land on masking. Right now, it certainly feels like a balancing act, though, having that practical guidance that people will follow but also making evidence-based recommendations that protect people's health. And as we saw over the course of the pandemic, that balance is not always easy.
Unger: No, that is not easy to do at all. It's something that we'll continue to follow, of course. Stay tuned. Andrea, COVID wasn't the only headline last week. Measles is also back in the news. We talked about this a few weeks ago. What's happening right now?
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Garcia: Last time we talked, we noted that there could be a lot more cases and that's certainly starting to happen. As of February 15, we now have had 20 measles cases reported in 2024, and those cases have been reported by 11 jurisdictions. And just as a reminder, measles was eradicated in 2000 thanks to an effective vaccine program.
It's highly contagious and can spread quickly through the general public if people aren't vaccinated. And when we talked about this last, CDC had just issued a health alert to warn the public about the growing number of cases. On a global level, we certainly continue to see large outbreaks in Asian, Middle Eastern, African and European countries.
Unger: Andrea, what about in the U.S.? Do we have an outbreak here?
Garcia: We're not experiencing a widespread outbreak, but there have been a few small, isolated outbreaks, mostly related to international travelers and children who have not been vaccinated. You may have seen in the news in Florida, health officials are investigating five confirmed cases at an elementary school in Broward County.
We know that vaccination rates have dropped. Many children missed their well visits during the pandemic. CDC is estimating 61 million doses of the measles vaccine were postponed or missed between 2020 and 2022 due to the pandemic. I think that, coupled with the anti-vaccine sentiment which we know is growing, vaccine exemptions which are at an all-time high for kindergartners. So we're seeing the ramifications of that. And really, the best way to fight it is to get vaccinated if you haven't already. We know the MMR vaccine is safe and it's highly effective at preventing measles.
Unger: Well, in the realm of things we thought we'd eradicated but are popping up, a U.S. resident was recently diagnosed with bubonic plague. Andrea, is this something we need to worry about?
Garcia: Well, the Associated Press reported on this last week. And officials in Central Oregon reported a case of bubonic plague in a resident who likely got the disease from a sick pet cat, although that has not been confirmed definitively. Public health officials said the infected resident and the resident's close contact have all been provided with medication, and people in the community are not believed to be at risk. The cat was also treated but unfortunately did not survive.
Unger: Andrea, this has got to be pretty uncommon to see a case like this. Is this unusual?
Garcia: It isn't common, but it's also not unheard of. So we typically see a handful of cases here in the U.S. every year. Based on CDC data, the U.S. has an average of seven cases of human plague each year. It's caused by the bacterium Yersinia pestis, which is carried by rodents and fleas.
According to the CDC, sunlight and drying can kill that plague bacteria on surfaces, and antibiotics are also effective in treating plague. But without prompt treatment, the disease can cause serious illness or death.
Unger: Any particular set of symptoms that people need to watch out for?
Garcia: Well, the symptoms can manifest in a few different ways. Bubonic plague, which is the kind that was contracted by the Oregon residents, happens when the bacteria gets into the lymph nodes. That can cause fever, headache, weakness and painful, swollen lymph nodes. According to the CDC, it usually occurs from an infected flea.
Other forms of plague can be more serious, but all forms are treatable with antibiotics. And people who seek treatment early definitely have a better chance of recovery. People can definitely reduce their risk by keeping their homes and their outdoor living areas less inviting for rodents by clearing brush and junk piles and keeping pet food inaccessible.
Things like ground squirrels, chipmunks and wood rats can carry plague, as well as other rodents. So people with bird and squirrel feeders may want to consider the risk if they live in an area with a plague outbreak. The CDC also says repellent with DEET can help protect people from rodent fleas when camping or working outdoors.
Unger: I'm going to file that under "Thank Goodness for Antibiotics and Reasons I Don't Have a Cat." Andrea, it's hard to believe, but the plague wasn't the only rare disease that made headlines last week. We also saw news about a newer disease called Alaskapox. What do we need to know about that?
Garcia: Yeah. So as its name suggests, this is a rare virus that so far has only been identified in Alaska. It was first seen in a patient in Fairbanks in 2015. And then, since then, six additional cases have been reported in the area. While there have only been a small number of cases so far, it made headlines because we saw the first death from this virus reported. That fatality was in an older adult who did have an underlying medical condition.
Unger: Andrea, what exactly is Alaskapox?
Garcia: So Alaskapox is a Orthopoxvirus, which also includes some other viruses you've heard of, including smallpox and more recently Mpox. It's typically found in small mammals, such as voles and shrews. Symptoms can include small lesions on the skin, muscle and joint aches, and swollen lymph nodes.
This virus is not known to be transmissible from human to human, but it is transmissible from animals to humans. So that means you're probably not going to catch Alaskapox from another person, but you could definitely get it from an infected animal. There have only been seven cases documented in humans so far, and most cases have been mild and resolved after a few weeks.
Unger: Andrea, are there any approved treatments for Alaskapox?
Garcia: So there are not approved treatments at this time. It may be the case that the medications that we use against other Orthopoxviruses like Mpox could prove to be effective against Alaskapox. Given that there is no known human to human transmission, those prevention measures that we focus on include avoiding that direct contact with an infected small mammal.
Health officials are also advising that lesions formed by the virus should be protected with bandages. And if you're—if you do have an infection, you should avoid sharing bedding or clothes or linens with another person. Good hygiene practices, including hand washing are also really crucial to help prevent the spread of the virus. At this point, though, most people don't need to be too concerned about this.
Unger: Well, we'll end on that positive note then. Andrea, thanks so much for being here and keeping us informed. If you found this discussion valuable, please support us and programming like it by becoming an AMA member at ama-assn.org/join.
We'll be back soon with another AMA Update. In the meantime, you can find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. Please take care.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
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