Medical Examiner

The CDC’s Confusing New Guidance for the COVID-Positive Is Actually Kind of a Relief

A COVID rapid test with two tell-tale lines.
Photo by Rod Long on Unsplash

The Centers for Disease Control and Prevention released new guidance on Thursday on how to live with the coronavirus. One of the recommendations in particular was surprising (OK, a lot were, but this one stood out): If you’re infected with COVID-19, you should isolate yourself for five days. Then, if you no longer have symptoms, you’re free to go out into the world, as long as you wear a mask—even if you are still testing positive on an antigen test.

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Yes, really. Here’s what the guidance says: if after five days “your antigen test results are positive, you may still be infectious.” And so, to prevent spreading the virus? “You should continue wearing a mask.”

“New CDC guidance effectively ends test to exit,” is how ER physician Jeremy Faust put it.

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This is not strictly in line with the biology of the virus, Faust points out. Nor does it square with the reality of masking, which can cut down on but not eliminate transmission, especially if not everyone is doing it (hats off to other non-medical professionals who have figured out how to get a perfectly tight seal on their KN95s; mine always let at least a little air leak through no matter what I do). And while leaving isolation at day five then masking was already on the menu of CDC-sanctioned options (in part because tests were hard to come by), the fact that the agency is saying it’s OK to be out and about while you know you’re personally infectious is a notable departure.

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Relaxing COVID rules like this is the wrong move for the agency, some are arguing: “The CDC sets the bar on what should happen, like a speed limit,” public health expert Julia Raifman told the Washington Post. Basically, it is the CDC’s role to outline the very best practices for what you should do when you are sick with COVID, including the steps that you should follow to avoid spreading it to other people. That way if you slack off a little—well, at least you were starting from an airtight place. More importantly, the CDC’s guidelines are what you can hold up to your employer to say: Hey, I’m not officially cleared to come back into work yet.

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It’s also worth noting that the latest CDC guidance is an ever-more-complex tangle of options, and wild-card plays. For example, after five days, you have the option to go into the world (masked) but keep testing; if your test comes up negative sooner than day 10, you can remove your mask. But if COVID symptoms pop back up after five days, you need to go back into isolation, and restart the countdown clock to day zero. Also, none of this is relevant if you have shortness of breath: in that case, you should isolate for the full 10 days. At that point you might also need to distinguish between shortness of breath due to light panic from all the instructions, versus COVID itself.

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The messaging here should perhaps just be: “You need to try to isolate for 10 days, unless you have a specific exception,” in big neon letters. Maybe, on a personal level, these exceptions could include flying home from a foreign country (people are doing it). Still, your boss should not be able to require you to clock back into work before then.

Even if they seem to be a mess of choices, not everyone hates the spirit of the new CDC guidelines. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security, told the New York Times that the new set of guidance, which also removes quarentine periods if you’re exposed to the virus, is “a welcome change.” Jennifer Nuzzo, an epidemiologist, wrote on Twitter: “I’m sure there will be protest about this, but these revised guidelines seem to track with how people are actually living in the face of a virus that 1) is not disappearing and 2) seems to be finding even the most cautious among us.” If COVID is going to keep spreading anyway, why should the government-suggested burden be on individuals to keep it from spreading, even when they are infected?

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The real problem here is not these guidelines; it is the lack of support and incentive available for people to take the steps necessary to avoid spreading the virus; it is the broad dropping of mask mandates, even as the virus surges. Staying at home for up to 10 days—or isolating in place, wherever you may find yourself—can be a huge financial burden. The CDC is suggesting that in an expanded number of instances, people do not necessarily have to do this, so long as they wear a mask. This might not be the best advice for a speed-limit setting agency to provide. Or maybe—maybe—guidance that is more in line with how people are living will engender trust from people who have come to see a lot of advice around COVID precautions as scold-y and out of touch with reality. As someone who has spent the pandemic in the rule-follower camp, it is hard for me personally not to read the new CDC guidance and feel a little bit of relief.

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