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It’s a real Goldilocks debate: a week after the Centers for Disease Control and Prevention (CDC) updated their COVID-19 isolation and quarantine guidelines – reducing isolation time – health professionals continue to discuss the changes you’re “inconsiderate.” “, and at least one expert says they are” right in the middle “.
The controversy may lead to further updates. On Sunday, Anthony Fauci, MD, chief medical advisor to President Joe Biden, said in the state of the nation on CNN he expected further clarification of the guidelines soon.
Ignited most of the debate: infected people are not asked to test themselves before leaving isolation, vaccinated and unvaccinated people who are exposed receive some of the same advice, and the mask recommendations are not specific enough.
As issued on December 27, the guidelines recommend to the general public:
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Anyone who tests positive should stay home and isolate themselves for 5 days (instead of 10), and if the person has no symptoms or symptoms subside after 5 days, leaving is okay. A mask should be worn around others for another 5 days. If the fever occurs, the person must stay at home until it subsides.
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If someone has been exposed to someone infected with COVID-19 and received a booster vaccine, completed the Pfizer or Moderna primary series within the last 6 months, or completed the Johnson & Johnson primary series within the last 2 months, they should wear a mask for 10 days and test on the 5th day if possible. However, if symptoms develop, they should get tested and stay home.
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If someone is exposed to someone infected with COVID-19 and is unvaccinated, or more than 6 months after the second dose of the Pfizer or Moderna vaccine (or more than 2 months after the J&J vaccine) and not boosted, they should take Quarantine for 5 days and then wear a mask for an additional 5 days. If quarantine is not possible, a mask should be worn for 10 days. A test on day 5 is recommended whenever possible. If symptoms do occur, the person should be quarantined and tested.
Public health experts voiced a range of views on social media and in interviews with Medscape Medical News.
A tweet from Eric Topol, MD, Editor-in-Chief of Medscape, posted the day after the new guidelines were released, had a blank box saying, “The data supporting the new 5-day @CDCgov isolation period with no negative test. “
The data that supports the new @CDCgov 5 day isolation period without a negative test pic.twitter.com/eRIwgGFd01
— Eric Topol (@EricTopol) December 28, 2021
In a tweet on Sunday, Ashish K. Jha, MD, MPH, dean of Brown University School of Public Health, said, “To hear the CDC is considering adding testing to isolation guidelines. That would be great while these serial negative antigen tests give a lot of confidence that someone is not contagious. “
https://twitter.com/ashishkjha/status/14777754603785576450
Michael Mina, Dr [people] Remaining contagious for 3 days, some 12. There is no way I want to sit next to someone who has transformed [positive] 5 days ago and did not test Neg. Test Neg to get out of isolation early is just smart. “
CDC’s new guidance to drop isolation of positives to 5 days without a negative test is reckless
Some ppl stay infectious 3 days,Some 12
I absolutely don’t want to sit next to someone who turned Pos 5 days ago and hasnt tested Neg
Test Neg to leave isolation early is just smart
— Michael Mina (@michaelmina_lab) December 27, 2021
Paul Offit, MD, director of the Vaccine Education Center at Children’s Hospital of Philadelphia and an infectious disease specialist, disagrees. Usually, he said, an infected person sheds viruses for 7 days.
“If you’re asymptomatic, the chances that you’ll shed a significant amount of the virus are very, very small,” he told Medscape.
In the debate
Testing: While many public health experts say it needs a recommendation to test before leaving isolation, CDC Director Rochelle Walensky, MD stated that testing before leaving isolation was not recommended because PCR testing up to 12 Weeks after a person’s first infection can stay positive for COVID-19.
When asked why there was no recommendation for a rapid antigen test before leaving isolation, Walensky told CNN that it was not known how these tests would fare at the end of the infection and that the tests for this purpose were not approved by the US -American Food and Drug Administration are approved.
And while the guidelines suggest that those who are exposed – whether they have been boosted, vaccinated or not – should test on day five if possible, that recommendation should be stronger, some said. “I recommend at least taking a test on those who can,” Topol said.
But making that recommendation is difficult when experts know how difficult it is for people to get tests now, William Schaffner, MD, professor of preventive medicine and an infectious disease specialist at Vanderbilt University in Nashville, told Medscape.
“I’m sure that was discussed intensively,” said Schaffner of the test recommendation.
Vaccination Status Categories: Amesh Adalja, MD, Senior Scholar at the Johns Hopkins Center for Health Security, Baltimore, Maryland, questioned the scientific basis for treating fully vaccinated subjects (with two mRNA or one J&J vaccine) who exposed “as an equivalent” are the unvaccinated with the quarantine obligation, since the fully vaccinated are protected against the essentials. “
Topol agreed. Guidelines “should be different for vaccinated and unvaccinated people.”
The recommendations for those exposed should definitely be simpler, Offit said. “I think it would be a lot easier just to say, ‘If you are exposed, mask yourself for 10 days'” regardless of vaccination status.
Is it perfect No. Is it carefree? No, it’s right in the middle
Masks: The guidelines should also describe the types of masks in more detail, Topol said. You should spell out the masks must be N95 or KN95, he said.
Science-driven or business-driven? Have the guidelines been changed due to economic concerns rather than scientific information on infections and transmissions? “That was it,” said Topol.
Adalja sees it differently. “While this updated guide will help the economy, it is scientifically based and should have been published much earlier than before.”
Difficult choices
The agency is treading a tightrope, Schaffner said, adding that he generally agrees with the CDC’s efforts. “There is a tightrope walk between the ideal of public health and trying to determine what is acceptable,” he said.
The revised guidelines are more practical than before, others said. “The goal is harm reduction, and many people just don’t isolate themselves when faced with a 10-day grace period,” Adalja said.
Before the new guidelines were published, the CDC looked at the accumulating science and also considered the pressures on the health system and other factors, Schaffner said. “Is it perfect?” Schaffner said about the new directive. “No. Is it carefree? No. It’s in the middle of it.”
Schaffner thinks that the messages about the new recommendations and their decision-making could have been communicated better and more comprehensibly. For example, some experts cited business and the need to return to work and school when explaining the guidelines, and then brought up the science behind the revisions.
This order should have been reversed, said Schaffner.
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