REGIONAL- The Centers for Disease Control is reportedly considering changing its COVID isolation guidelines so that infected people would no longer need to stay home if they’ve been fever free for 24 hours without the aid of medication, and their symptoms are mild and improving.
The Washington Post broke the news about two weeks ago that CDC officials were having internal discussions about modifying the COVID isolation guideline that’s been in place since 2021, based on an understanding that the majority of people have developed some level of COVID resistance due to vaccination or prior infection.
The Post quoted noted Minnesota infectious-disease expert Michael Osterholm. “Public health has to be realistic,” Osterholm said. “We have to try to get the most out of what people are willing to do. You can be absolutely right in the science and yet accomplish nothing because no one will listen to you.”
The CDC has not yet formally announced new guidelines, but in anticipation of the change Osterholm used his regular Feb. 22 Center for Infectious Disease Research and Policy podcast to discuss the change in greater detail.
“This is a very nuanced issue, and I want to be clear that these guidelines are not about giving up, but are instead about adapting our policies and recommendations so they can be as impactful as possible, preventing as many potential serious illnesses, hospitalizations, and deaths as possible,” he said,
Osterholm said the science surrounding COVID transmission hasn’t changed significantly since the first recommendation of ten days of isolation after being diagnosed or exhibiting symptoms. Yet he acknowledged that there is still much left to understand about when and how much COVID viral shedding occurs to propagate the spread of the virus. Constant mutations of the virus have contributed to keeping the picture uncertain.
“We don’t really understand fully what the science is today,” he said. “This virus has changed and the data we have is two years old or older. We need to find an approach to isolation guidelines that will meet the public where they’re at and in terms of both willingness and their ability to comply.”
Putting the decision for isolation in the hands of those who may be suffering from COVID has been met with opposition from some health providers, but while Osterholm notes their reservations, he appears to believe the change is warranted to gain greater acceptance for some level of isolation from the general public.
“This is not bending to the will of the public at their convenience,” he said. “This is about reality, to meet people where they are. That’s what public health is all about, and that’s what prevention research is all about. You can have 100-percent effective intervention, but if nobody uses it, you have zero impact. You can have a 15-percent effective intervention, but if more than half the people are using it, you may really reduce and prevent some serious illness.”
Osterholm also described the change as an equity issue by providing a recommendation that more people can realistically choose.
“Some of us have the ability to stay home for ten days or more after showing symptoms or testing positive for COVID because we have the paid time off, ability to work from home, flexibility or a lack of caregiving responsibilities and frankly, financial flexibility to be able to do so,” he said. “But a lot of people in this country don’t have those things. In fact, 23 percent of Americans have zero paid sick leave. Among those who do, half of them have less than ten days of sick leave. Over half of Americans have caregiving responsibilities, whether they be for children, elderly adults or other adults that have high support needs due to medical conditions or disabilities. Many of these individuals simply cannot isolate for five days. They just can’t. And so, they don’t get tested, and therefore they don’t have access to Paxlovid, and they end up at higher risk of experiencing serious illness, dying, or having long COVID. The current isolation guidelines may work for those with the interest and privilege to be able to follow the five-day isolation, but it leaves many people behind.”
California already has modified its isolation guidelines, and Osterholm pointed out two recommended practices that he concurs with that go beyond the change in isolation.
“They say mask when you are around other people indoors for ten days after you become sick or test positive,” Osterholm said. “Right now, we have a standard recommendation for that, but no one’s following it and they haven’t followed it for several years. They say avoid contact with at-risk people for severe COVID-19 for ten days. I think that’s really important, particularly for those who are in those age groups where they’re more likely to develop serious illness. The California recommendations say if you have symptoms, particularly if you’re at higher risk for severe COVID-19, speak to a health care provider immediately. You are likely eligible for antiviral medications or other treatments for COVID.”
Situation update
Hospitalizations, deaths, and COVID viral load in wastewater, the three remaining indicators of community COVID levels, continued to decrease in Minnesota last week, with only six counties on the southern and western borders having an elevated level of COVID activity according to the CDC.
Minnesota Department of Health data reports eight COVID deaths in St. Louis County over the past month, with six of those coming in the first week of the four-week reporting period. MDH notes that there is typically a lag period between the time a death from COVID occurs and when it is reported to MDH.
Only 16 new hospital admissions were reported last week by the CDC in the St. Louis County health service area, including most of the Arrowhead region. The rate of 4.2 admissions per 100,000 is well below the rate of 10 that triggers an elevated COVID activity warning.
Viral levels in wastewater plunged by 27 percent last week, another indicator that the winter peak is likely subsiding.
Vaccine mandates
For future pandemics, state and health officials may need to reconsider how they promote vaccinations in light of a recent study showing that COVID vaccination mandates were ineffective.
Researchers Stephen Rains of the University of Arizona and Adam Richards of Furman University analyzed state-level vaccination data from the CDC to compare rates in states that imposed vaccination mandates and those that prohibited government mandates.
The pair discovered that requiring COVID vaccinations through mandates did not affect the overall uptake of vaccines.
An additional unintended consequence of state mandates was that smaller proportions of eligible people received either COVID booster shots or seasonal flu vaccines compared to states that left it up to citizens to make their own decisions about vaccinations. These effects were magnified when initial COVID vaccination was low.
“The data from this project indicate that people responded to the limitation to their freedom that stems from vaccination mandates by being less likely to adopt COVID-19 boosters and influenza vaccines relative to states banning vaccination requirements,” the pair concluded. “These findings provide evidence to support the concerns of scholars and practitioners that selective vaccination mandates can have harmful—or at least unintended—consequences for public health, which need consideration when creating such policies.”