It’s About Time: CDC Changes COVID Isolation Guidelines

At Long last. The CDC has updated its guidelines with respect to Covid isolation. This has been a long time coming, and many in our field are relieved that the CDC finally changed its guidance with respect to how long people should isolate if they test positive for COVID-19.

First, the guidance itself removes a specific reference to COVID-19 and groups it together with other respiratory viruses, such as influenza and RSV. This, in and of itself, is a significant change. And the new guidance says that if you do not have a fever for 24 hours and are feeling better, you do not have to isolate for five days and can continue normal activities.

As far as I’m concerned, this is a big deal. In many settings, especially in healthcare settings, if one or more staff members have to isolate at home for five days if they test positive for Covid, this can cause significant staffing difficulties. Now, the CDC finally recognizes that common sense needs to prevail.

That common sense includes the fact that, if you are sick, you need to stay home. This is true whether it is the flu, Covid, RSV, or any other illness. Once you’re feeling better, then you can resume normal activities.

Now, it is true that Covid can spread to other people even if the carrier does not have any symptoms. And so, again, common sense needs to prevail: if you are around people who are at high risk for severe illness with Covid, you should wear a mask around them. And, when you are sick, you should stay away from them completely. This is proper “virus etiquette” that more of us need to develop. It is the same as coughing or sneezing into one’s elbow.

The reason I am so excited about this change is because, today, the COVID-19 virus is a completely different pathogen. In the very beginning, COVID-19 caused severe illness in a great number of people. In the United States, it killed over 1 million people. That is a lot. I myself came down with COVID-19 in November 2020, and I have never had a viral illness like that one. It was unlike anything I have ever experienced. Now, however, for many people, COVID-19 is simply a bad cold.

It has been several months, if not years, that I have seen a life-threatening case of Covid ARDS in my ICU. Recently, I had a patient who tested positive for Covid and had severe lung infiltrates. It turns out that those were due to severe heart failure and not Covid. In fact, many of the patients we see in the hospital with Covid have other conditions that brought them in, and the Covid was simply a bystander.

That said, this does not mean that Covid cannot cause severe illness at all. The elderly, the frail and weak, and those with compromised immune systems are still at high risk for life-threatening illness, even with the current variant of Covid. They, of course, need to remain vigilant and careful. And those of us who are not at high-risk need to be cognizant of this and, again, have proper virus etiquette.

All of this having been said, this is a great change. I disagree with the those who say that this new guidance will make people dismiss Covid as a significant disease. People have already moved beyond Covid, and this is because the COVID-19 of 2024 is substantially different than the COVID-19 of 2020. This is reality, and I am very happy that the CDC has finally acknowledged this reality.

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