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A simple guide to understanding the CDC's exasperating COVID-19 rules

·6 min read
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  • Rochelle Walensky
    American medical scientist
dr rochelle walensky cdc director
Centers for Disease Control and Prevention Director Rochelle Walensky on November 4, 2021.Chip Somodevilla/Getty Images
  • The new CDC guidance on COVID-19 isolation and quarantine is confusing.

  • The guidance says people can come out of isolation after day 5.

  • Buried in the fine print: you still need to wear a mask and act like you're infectious for 10 days.

If you're confused about the new Centers for Disease Control and Prevention's new guidelines, you're not alone.

The agency published a press release December 27 saying people who contract or are exposed to COVID-19 only need to isolate for 5 days.

The advice triggered huge backlash from reporters, citizens, and scientists, who had questions about how the new guidelines work — why is there no testing component at the end? What's the science behind this? Are there exceptions?

Even the nation's doctors were at a loss. The American Medical Association released an uncharacteristically critical statement on the CDC's guidelines January 5 arguing that the new recommendations are "not only confusing, but are risking further spread of the virus" at a time when it's already spreading faster than it ever has yet.

On Friday morning, CDC Director Rochelle Walensky held the agency's first media telebriefing since July 2021 to address the confusion.

"This virus has changed and is constantly throwing us curveballs," Walensky said. "As this virus changes, the science changes."

Here's how to follow the new guidelines the right way.

The CDC changed its guidelines to keep society running

rapid covid test
Aaron Salvador swabs his nose with a COVID-19 rapid antigen test kit in Washington, DC on December 29, 2021.Tom Williams/CQ-Roll Call, Inc/Getty Images

The CDC's new guidance was originally rolled out on December 23, 2021, and at that time it was exclusively for healthcare workers, who were already struggling to staff hospitals, with many doctors and nurses out sick.

The CDC director said she worried that, given how rapidly Omicron was spreading, those December staffing shortages in hospitals were but "a harbinger of other things to come, in our pharmacists, in our essential workers, in our police force and our ambulance force, and in many other sectors."

And she wasn't wrong.

Across the country, airlines are unable to staff thousands of flights, schools are missing teachers, garbage handlers and plow operators are in short supply, and managers are subbing in for sick employees. The Wall Street Journal estimates 5 million people in the US may be calling out sick this week, which is roughly 3% of the nation's workforce.

If you have COVID, or were exposed, you should isolate for 5 days

The CDC says "people with COVID-19 should isolate for 5 days," but it should really be considered a 6 day rule, since the CDC considers your first day of illness (or exposure) "day 0." Start counting from the day you are exposed, feel symptoms, or test positive for COVID-19.

Some of the most common COVID symptoms being reported right now include a sore throat, cough, fatigue, congestion, and a runny nose.

You can stop isolating after 5 days — but only if you no longer have symptoms

The 5-day isolation rule is meant only for people who no longer have COVID symptoms after their first five days of illness.

Say you started feeling symptoms on Monday, that is "day 0," per the CDC. That means your day 5 is Saturday. If you're feeling fine on Saturday, you can venture out to perform essential chores and work. But you should still be careful for the next five days, until the following Wednesday, which is 10 full days after you first fell ill.

"If on day five, you don't have symptoms anymore, then we can talk about, you know, coming out of isolation, with a mask on," Walensky said. "You should not leave isolation if you're still symptomatic."

That advice runs counter to how some institutions have been interpreting the guidelines. In New York City, for example, teachers are being told they can return to the classroom while still mildly symptomatic, as long as they're not "coughing up phlegm."

Act like you're infectious for 10 days. Wear a good mask, don't travel, don't visit grandma.

covid christmas
With one member of a family testing positive for the rapidly spreading Omicron variant of COVID, a household under quarantine spends a quiet Christmas trying to remain socially distant while opening their presents on December 25, 2021 in Brooklyn, New York.Andrew Lichtenstein/Corbis via Getty Images

The CDC is still sticking to the idea that COVID-infected people — and people exposed to COVID — should be careful for a full 10 days, no matter what.

That means wearing a well-fitted medical mask, staying in well-ventilated areas, avoiding crowds and unmasked gatherings with friends and family, not eating or drinking with other people, not hanging out with people who are especially vulnerable to COVID-19, and just generally acting like you could still transmit the virus. Because the truth is, you could.

"Day six through 10, you should really wear a mask and anticipate that you might have some residual contagion in you," Walensky said. "Wear your mask all the time. Don't go to restaurants. Don't go to traveling. And also avoid your family members or others who might be immunocompromised, avoid visiting grandma or our nursing homes."

This idea that people can potentially still be infectious after five days was one of the major reasons that the AMA was so critical of this guidance.

"According to the CDC's own rationale for shortened isolation periods for the general public, an estimated 31% of people remain infectious five days after a positive COVID-19 test," the medical association said. "With hundreds of thousands of new cases daily and more than a million positive reported cases on January 3, tens of thousands—potentially hundreds of thousands of people—could return to work and school infectious."

Note: None of this relaxed guidance is based on how Omicron behaves

The CDC director said the agency based this new strategy on "a scientific review of dozens of papers regarding the infectiousness of SARS-CoV-2" — the technical name for the novel coronavirus.

But the data doesn't capture what's going on right now with Omicron — it included studies of the original "wild type" virus from two years ago, as well as other variants including Alpha and Delta. That's because these kinds of "detailed laboratory studies" that the agency relied on to craft the guidance "can take weeks to do," Walensky said.

"We are unlikely to have detailed data for Omicron in exactly the same way for weeks to come," she added.

Even with a negative test after 5 days, you could be infectious a little longer

With previous variants, people were (generally) most contagious from about a day or two before symptoms start until two to three days after those symptoms began.

But even before Omicron, not everyone remained infectious for the same amount of time, and that's likely still the case.

That's why it's crucial to continue being careful for at least an additional five days, even if you're testing negative, experts say.

"A negative antigen test doesn't necessarily mean that there's an absence of virus," Dr. Henry Walke, who directs the center for preparedness and response at the CDC said during the agency's Friday briefing. "Regardless of the test result, wearing a well-fitting mask after those five days of isolation is still recommended."

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