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CDC director defends new COVID guidelines reducing isolation period

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Amid criticism from public health officials, Centers for Disease Control Director Rochelle Walensky defended new guidelines released this week that halved the isolation period for people who test positive for COVID-19 but are asymptomatic or whose symptoms are ‘resolving.'

“This virus has proven its ability to adapt quickly and we must adapt with it,” Walensky said Wednesday during a briefing by the White House COVID-19 response team.

The CDC announced the changes Monday, saying they were “shortening the recommended time for isolation from 10 days for people with COVID-19 to five days, if asymptomatic, followed by five days of wearing a mask when around others.”

Dr. Rochelle Walensky and Dr. Anthony Fauci
Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, testifies on Capitol Hill as Dr. Anthony Fauci listens, July 20, 2021. (J. Scott Applewhite/Pool via Reuters)

During Wednesday’s press briefing, Walensky said that “studies show that people are most infectious in the one-to-two days before symptoms develop, and in the two-to-three days after,” with an estimated 85-90 percent of transmission occurring in the first five days of infection with COVID-19.

“After five days, the risk of transmission substantially decreases,” she said.

Walensky also addressed the CDC’s controversial decision not to recommend that people who’ve been infected with COVID-19 obtain a negative test after five days before they stop isolating. She said that the CDC did not know if antigen, or rapid, tests were capable of assessing transmissibility at day five and beyond, while the PCR tests could show a positive result up to 12 weeks after infection — “long after” a person is no longer infectious — limiting their utility in preventing further spread of the virus at that stage.

“Basically, if you test negative or positive we want you to mask,” Walensky said, noting that the new CDC guidance recommends masking for five days after isolation.

“I want to emphasize the critical importance of masking, which we know decreases risk of transmission, and of staying home if you’re sick,” she said, adding, “These recommendations will only work if people follow them.”

Over the last 14 days, the country has seen a 126 percent rise in COVID cases and an 11 percent increase in hospitalizations, per tracking from the New York Times. While the CDC changes were supported by some public health experts, others have been critical, citing the decision not to include testing as a suggested condition for ending isolation after five days.

“Ending isolation of COVID cases in five days without testing negative is the nose-out-of-mask of COVID-19 policies,” Saad Omer, director of the Yale Institute for Global Health, wrote on Twitter Tuesday. “By not including a testing requirement, there will be a lot of infectious people in the workforce transmitting the virus to the others — further increasing the public health risks and likely economic disruptions.”

A man is tested for COVID-19
A man is tested for COVID-19 at a walk-up testing site in Miami. (Rebecca Blackwell/AP)

“Of course, shortage of tests and masks is an issue but increasing supply of tests and high quality masks should be a national priority,” Omer concluded. “We can't have our pandemic control cake and eat it too.”

“It’s frankly reckless to proceed like this. Using a rapid test or some type of test to validate that the person isn’t infectious is vital,” Dr. Eric Topol, founder and director of the Scripps Research Translational Institute, told Reuters, adding, “There’s no evidence, no data to support this.”

The timing of the release of the new guidelines has also been questioned. Last week, the airline industry urged the CDC to shorten the isolation period, arguing that the previous 10-day time frame may “exacerbate personnel shortages and create significant disruptions to our workforce and operations.” The recent rise of coronavirus infections driven by the highly transmissible Omicron variant has forced airlines to cancel thousands of flights amid the busy holiday travel season.

“To address the potential impact of the current isolation policy effectively, we propose an isolation period of no more than 5 days from symptom onset for those who experience a breakthrough infection,” Nicholas Calio, CEO of Airlines for America, a trade association representing several major U.S. airlines, wrote in a letter to Walensky last week. Notably, the airline industry’s proposal also suggested that “those individuals would be able to end isolation with an appropriate testing protocol.”

The Association of Flight Attendants-CWA, which describes itself as “the world's largest labor union organized by flight attendants for flight attendants,” was among the first to speak out against the CDC’s new isolation guidelines after they were announced this week.

"We said we wanted to hear from medical professionals on the best guidance for quarantine, not from corporate America advocating for a shortened period due to staffing shortages,” said Association of Flight Attendants-CWA International President Sara Nelson. “The CDC gave a medical explanation about why the agency has decided to reduce the quarantine requirements from 10 to five days, but the fact that it aligns with the number of days pushed by corporate America is less than reassuring.”

A health worker administers a dose of a Moderna COVID-19 vaccine
A health worker administers a dose of the Moderna COVID-19 vaccine in Norristown, Pa., Dec. 7, 2021. (Matt Rourke/AP)

Dr. Anthony Fauci, President Biden’s chief medical adviser, told CNN Monday that the reason for the change is “that with the sheer volume of new cases that we are having and that we expect to continue with Omicron, one of the things we want to be careful of is that we don’t have so many people out.” Fauci added that “if you are asymptomatic and you are infected we want to get people back to jobs — particularly those with essential jobs to keep our society running smoothly.”

The backlash to the new guidance seems, at least in part, to be the latest side effect of the messaging woes that have plagued the CDC since the early days of the pandemic. As with earlier changes to official guidance on things like mask wearing and booster shots, attempts to explain the CDC’s thinking behind the new isolation protocols have given rise to still more questions.

In an interview with CNN earlier Wednesday, Walensky said that in addition to the scientific evidence regarding when people with COVID-19 are most infectious, the CDC’s new five-day isolation guidelines were also based on an assessment of what “people were willing to adhere to.”

“We’ve seen relatively low rates of isolation for all of this pandemic,” Walensky told the news network. “Some science has demonstrated that less of a third of people are isolating when they need to. So we really wanted to make sure we had guidance, in this moment where we’re going to have a lot of disease, that could be adhered to, that people were willing to adhere to, and that spoke specifically to when people were maximally infectious.”

While explaining the new guidance at Wednesday’s White House briefing, Walensky did not mention the behavioral considerations, but rather emphasized that the change was “standing on the shoulders of two years of science, two years of understanding transmissibility.”

During the briefing, Fauci stressed the importance of vaccinations and boosters during the Wednesday briefing in addition to isolating when you’re sick and masking. Fauci noted that all indications pointed to the Omicron variant being less severe than Delta.

Officials added they were working to increase the amount of testing available to Americans, following a Vanity Fair report that the White House had rejected a plan in October to follow other countries in making rapid at-home tests easily accessible. At a Dec. 6 briefing, press secretary Jen Psaki mockingly dismissed the idea of mailing free tests to all Americans.

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