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The CDC Dropped Its COVID-19 Isolation Guidelines. Experts Are Split

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Updated: | Originally published:

On March 1, the U.S. Centers for Disease Control and Prevention (CDC) dropped its long-standing recommendation that people with COVID-19 should isolate themselves for at least five days to avoid spreading the disease.

Instead of the five-day rule, the CDC now recommends that people stay home until they've been fever-free for at least 24 hours without medication and their symptoms are generally improving. Once they’re feeling better, they can resume normal life—though the agency recommends taking extra precautions for five days after leaving home, including limiting close contact with others, moving activities outside, and wearing a mask around others. If someone’s symptoms worsen or their fever returns, they should revert to staying home.

That shift, which echoes similar moves in California and Oregon, streamlines the CDC’s recommendations for COVID-19 and other respiratory illnesses. The agency’s website now lists the same advice for people sick with respiratory illnesses including COVID-19, the flu, and RSV, and its page on COVID-19-specific isolation has been archived.

Even before the shift in guidance became official, experts predicted that 2024 would bring a further relaxation of COVID-19 policy. “The guidance becomes lighter and lighter over time, and that actually makes sense as people build up more immunity,” Dr. Ashish Jha, dean of the Brown University School of Public Health and the Biden Administration’s former COVID-19 response coordinator, said in a January interview with TIME.

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The virus itself has not evolved to become less contagious. But people’s tolerance for public-health precautions has plummeted. Many people in the U.S. haven’t paid attention to COVID-19 guidance in a long time, says Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “You have to face reality,” he says.

Meeting people where they are may encourage them to take at least some precautions, he says. Some people who are unwilling or unable to isolate for five full days might be open to staying home for a shorter period of time when they’re acutely ill, for example.

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Not all experts are as optimistic. Lucky Tran, a science communicator at Columbia University, called the end of five-day isolation periods “a reckless anti-public-health policy that goes against science, encourages disease spread, and puts everyone at risk. The bare minimum we should have learned from this devastating pandemic that has killed and disabled millions is that we should stay home when sick.” Loosening isolation recommendations “ignores the continued suffering” of people who are immunocompromised, chronically ill, disabled, or otherwise at heightened risk of severe COVID-19, Tran adds.

Eleanor Murray, an assistant professor of epidemiology at the Boston University School of Public Health, says it's “really strange” for the CDC to relax its guidance, given that even a five-day isolation period isn’t always long enough to stop the spread. Studies have shown that a significant portion of people who catch COVID-19 test positive, and thus potentially remain contagious, for longer than five days.

The absence of symptoms also isn’t a guarantee that someone is no longer infectious, Murray says. Research has long suggested that pre-symptomatic or asymptomatic people can spread the virus, although they may not be as contagious as people who are sicker. At-home tests aren’t a perfect measure either, although they can provide some information about potential contagiousness.

Even still, Dr. Tara Bouton, an assistant professor at the Boston University Chobanian and Avedisian School of Medicine who has researched COVID-19 isolation periods, feels it's reasonable to loosen isolation guidance at this stage of the pandemic, when fewer people who get infected die or become hospitalized. That's in large part because lengthy isolation periods disproportionately penalize people whose income depends on working in person, Bouton says. “The ability to isolate is a privilege,” Bouton says, and public-health policy needs to balance the costs and benefits of asking people to do it.

Murray, however, fears that relaxing isolation guidance will make it easier for businesses to deny their employees time off to recover. Ending the five-day guidance equates to “providing information that is not evidence-based and is not going to help people make informed decisions, but will probably be used to limit paid leave,” Murray says.

So what would the experts do now if they got sick with COVID-19?

Even though Bouton feels that a blanket five-day isolation recommendation is no longer necessary, she says she would stay home around that long because she’s able to—and because working as an infectious-disease doctor puts her in contact with lots of immunocompromised patients, who remain at increased risk of severe disease if they get infected.

Murray says she would stay home until her symptoms cleared up and wait until she’d gotten two consecutive negative test results, spaced out by at least a day, before exiting isolation. (Often, that approach requires more than five days of isolation, since people can test positive on at-home rapid tests for more than a week.)

Tran says he’d go even further: he’d stay home for 10 days, self-test multiple times before ending isolation, and wear a mask—as he usually does anyway—upon returning to public spaces.

Osterholm, too, says he’d stay home for five days and continue to wear an N95 in the immediate aftermath of his illness. Efforts like those are important, he says—but they’re also not everything. He’d like the public-health community to devote more attention to encouraging vaccination among vulnerable older adults, many of whom have not gotten the latest shot, and streamlining Paxlovid access for high-risk patients.

Those efforts, Osterholm says, could save lives at a time when most COVID-19 deaths occur among people who are elderly or otherwise at high risk—and at a time when Americans are moving on from COVID-19.

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Write to Jamie Ducharme at jamie.ducharme@time.com