Why the nation needs clear advice on COVID-19 isolation

Andis Robeznieks , Senior News Writer

What’s the news: With the pandemic’s death toll topping 830,000 in the U.S. and with one new SARS-CoV-2 strain of concern following another filling hospital intensive-care units with COVID-19 patients, the public deserves clear guidance from the Centers for Disease Control and Prevention (CDC) on when it’s safe to leave home after getting sick with COVID-19 or testing positive for SARS-CoV-2.

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Instead, the agency has issued recommendations that includes shortening quarantine-and-isolation periods and a matrix of suggested actions regarding testing and mask-wearing. The quarantine recommendations, which apply to those individuals who have been in close contact with someone with COVID-19, depend on a person’s vaccination status at the time of exposure or onset of symptoms.

The isolation guidance, which applies to people with confirmed or suspected COVID-19, does not depend on an individual’s vaccination status. The guidance states that people can end isolation after five full days if they are fever-free for 24 hours without the use of fever-reducing medication and other symptoms have improved. However, individuals should continue to wear a well-fitting mask around others for five additional days after the five-day isolation period. Some activities, such as travel and eating in restaurants, are to be avoided for 10 days.

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“Nearly two years into this pandemic, with Omicron cases surging across the country, the American people should be able to count on the CDC for timely, accurate, clear guidance to protect themselves, their loved ones, and their communities,” said AMA President Gerald E. Harmon, MD.

“Instead, the new recommendations on quarantine and isolation are not only confusing, but are risking further spread of the virus,” added Dr. Harmon, a family physician in South Carolina.

Why it’s important: The CDC says the new recommendations—which shorten the isolation time after testing positive from 10 days to five—are “motivated by science” showing that most COVID-19 transmission occurs one to two days prior to the onset of symptoms and up to two to three days after.

Yet, Dr. Harmon noted, “according to the CDC’s own rationale for shortened isolation periods for the general public, an estimated 31% of people remain infectious 5 days after a positive COVID-19 test.”

Potentially hundreds of thousands of Americans “could return to work and school infectious if they follow the CDC’s new guidance on ending isolation after five days without a negative test,” Dr. Harmon said.

“Physicians are concerned that these recommendations put our patients at risk and could further overwhelm our health care system,” he added. “A negative test should be required for ending isolation after one tests positive for COVID-19. Reemerging without knowing one’s status unnecessarily risks further transmission of the virus.”

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“Test availability remains a challenge in many parts of the country, including in hospitals, and we urge the administration to pull all available levers to ramp up production and distribution of tests,” Dr. Harmon said. “But a dearth of tests at the moment does not justify omitting a testing requirement to exit a now-shortened isolation.”

President Joe Biden has pledged to increase production of rapid COVID-19 tests so that 500 million free tests will be available to those who request one. In the meantime, his administration has worked with Google so that interested persons can locate an available test by searching for “COVID test near me.”

Learn more: Visit the AMA COVID-19 resource center for clinical information, guides and resources, and updates on advocacy and medical ethics.