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Concernsamong medically vulnerable people are growing as the Centers for Disease Control and Prevention prepares to dropits long-standing recommendation that those with covid isolate for five days.
People with compromised immune systems worry that co-workers will return to the office while they’re still contagious. At the same time, the few remaining policies guaranteeing paid leave for employees with covid are largely coming to an end. New York, the only state that still requires paid leave for covid isolation, is considering ending that benefit this summer.
Even as many cheer loosening isolation guidance, othersare troubled by federal health officials’ latest move to stop treating covid as a unique respiratory viral threat.
The forthcoming change,first reported by The Washington Post, sayspeople could return to school and work if they have been fever-free for at least 24 hours without the aid of medication andthey have mild and improving symptoms.
This would be similar to the guidance for people with influenza and respiratory syncytial virus (RSV). Supporters, including prominent physicians and public health experts, say it’s the right move,reflectingthe reality that many people with covidare not isolating and the threat ofsevere illness has dimmed as a result of vaccination, prior infections and antiviral treatment. But critics say covid should not be treated like other respiratory viruses because it currently hospitalizes and killsmore people than fluandcaninflict long-term complications that scientists are still trying to understand.
“I feel like I’m on an island by myself,” said Lisa Savage, a 60-year-old retired nonprofit fundraiserin Charleston, S.C., who has several autoimmune diseases that keep her bodyin a constant state of inflammation.
Savage said the CDC’s proposed changes scare her. When she hears people say it’s time for the country to move on, she thinks: “Lucky for you. Those of us with compromised immune systems don’t have that luxury.”
The CDC is expected in April to release the proposed revisions to the isolation guidance and seek public feedback.
The science around infectiousness and transmission have not changed. Someone who tests positive for covid can still be infectious beyond five days. People without symptoms or fever can transmit the virus very early in their illness. What’s not known, experts say, is how closely people have followed the five-day isolation recommendation and whether loosening the guidelines will impact community transmission rates.
Oregon got rid of its five-day isolation requirement for covid in May 2023 and told people to stay home until they recovered — similar to other respiratory illnesses — while avoiding vulnerable people for 10 days and wearing a mask around others. The state did not experience any disproportionate increases in community transmission or severity compared with California, which kept its five-day isolation recommendations in place until January 2024, according to data shared last month with the national association representing state health officials.
Loosening the isolation recommendations will increase the risk to people who are immunosuppressed, said Walid Gellad, a physician and professor of medicine at the University of Pittsburgh. But he said those risks must be weighed against the downsides of a lengthy isolation, including people missing work and school. “It really is a different world now,” he said.
Katelyn Jetelina, an epidemiologist who follows covid-19 policy closely, said health policy is complex and needs totake into account trade-offs that change over time fora U.S. population of330 million people with different priorities, risk factors,behaviors and beliefs.“We ultimately need guidance that is protective and actionable and feasible,” she wrote in her most recent weekly newsletter.
Public health experts say it’s also reductive to cast revised guidance as sacrificing the immunocompromised and elderly to minimize economic disruptions. They say there is a middle ground between living in fear and ignoring the virus.
Paul Offit, a pediatric infectious-disease specialist at Children’s Hospital of Philadelphia, said high-risk people would benefit if Americans focus more on isolating while sick rather than which virus they have.
“I think people have this notion that if they don’t have covid, they’re good,” Offit said. “But all of these viruses can cause people to be hospitalized or go to the intensive care unit or die … so therefore stay home when you’re sick, even if you’re not in a high-risk group.”
