CNN: Is CDC Really Ending Quarantine? This seems like an important step. Dr. Leana Wen: Quarantine for people exposed to Covid-19 has essentially ended. I agree, this is a major change in recommendations. The new guidance says that someone exposed to a person with Covid-19 no longer needs to self-quarantine at home, away from others. They can go to work, attend school, and be in other environments around people as long as they wear a well-fitting, high-quality mask — ideally an N95 or equivalent. People should cover up for 10 days after exposure. They should also be tested at least five days after exposure. If it’s positive, they have Covid-19 and must go into isolation. If negative, they must continue to cover for 10 days. CNN: Can you remind us of the difference between quarantine and isolation? Wen: Quarantine applies to someone who has been in close contact with a person infected with the coronavirus. Close contact, according to the CDC, means you were within 6 feet of someone with Covid-19 for a total of 15 minutes or more in a 24-hour period. Earlier in the pandemic, recommendations were that those exposed to Covid-19 should be quarantined from others and not be in public. That’s how someone in need of “quarantine” was defined — someone who hasn’t been diagnosed with Covid-19 but has significant exposure. Now, someone with known exposure no longer needs to quarantine, but must have a 10-day coverage period. On the other hand, someone should be in isolation if they have been diagnosed with Covid-19. Isolation is defined as being physically separate from others in order to prevent transmission of the virus during the infectious period. CNN: Are there still people who should take extra precautions, despite the guidelines lifting the quarantine? Wen: Yes. The CDC says exposed people should take extra precautions when around people who are more likely to get very sick from Covid-19. What I take it to mean is that you should be extra careful if you’re visiting, say, an elderly grandparent. If your spouse currently has the virus and you and your children do not, you could go to work and your children to school with a mask, but consider postponing travel to see medically frail relatives until after your period of 10 days. If you live in the household with vulnerable people, keep your distance during the 10-day period after your exposure and make sure everyone is covered indoors around each other. CNN: What should people know now about isolation? Wen: Here, the new CDC guidance is a bit complicated. The basic condition is that people diagnosed with Covid-19, whether symptomatic or asymptomatic, must be isolated for at least five days. These first five days are the period when you are most likely to be contagious. The CDC emphasizes that you should try to stay home and separate from others if possible. Do not travel or go to places where you cannot wear a mask, such a restaurant where you will eat. If you have no symptoms, or if you have symptoms and they improve and you remain fever-free for at least 24 hours, you can end the isolation after five days. For the next five days, you must wear a mask while in public. So you can go to work, but still cover up at work and make sure you wear a mask while on the train or bus there. There are some caveats here. First, CDC guidance says that if you’ve had moderate illness, defined as shortness of breath or difficulty breathing, or if you require hospitalization or are immunocompromised, you should isolate until day 10. This makes sense, because you have more severe illness or have A weakened immune system suggests that you could have a higher viral load that takes longer to clear. Second, the CDC is once again emphasizing caution to people who are likely to get very sick from Covid-19. If you’ve just had Covid-19, you should wait at least until day 10 to visit medically frail family or friends. I would also like to add here, that you should test negative with a rapid antigen test before seeing vulnerable people indoors. This is not something the CDC recommends, but I think the negative test adds more reassurance to protect high-risk people. Third, speaking of tests, the new guidance also says you could end your 10 days of coverage early if you take two rapid tests 48 hours apart. Let’s say on day five, your rapid test is negative. You could do another test on the seventh day, and if it’s negative, you don’t need to mask anymore after that. I think that makes sense, and I really wish the CDC would be even more clear with their recommendation to clear testing-based isolation. There are some people who will still be positive on day 11. Here I am only referring to the home rapid antigen test, as the PCR test could remain positive for much longer. I think it would be even safer to say that you should be negative before being around vulnerable people, even if it’s been, say, 12 or 13 days. CNN: What about people who start to test positive again after first testing negative — the so-called “rebound” effect? Is the clock reset for them? Wen: Good question, and yes. This “rebound” effect is often associated with taking the antiviral Paxlovid, but it can happen in people who are not taking treatments. CDC guidance says that if someone tests positive again, the clock resets and the day they test positive the second time is day zero again. This means they still have to go through five days of isolation and mask until the 10th day, just like they did the first time. CNN: Why were these changes made? Has the science changed or is the CDC responding to public pressure? Wen: I think there are two factors. One is the admission that Covid-19 is here to stay. We will likely live with this virus for the rest of our lives and the lives of our children and beyond. As this is the case, the focus must be on resuming normality, which means cutting out policies that disrupt everyday life. The other factor is that public health must respond to where the public is. Most Americans have returned to many aspects of life before the pandemic. The CDC’s guidelines seem to meet people where they already are — and, for some, don’t go far enough — for example, they still recommend a mask in high-transmission areas even though most people don’t. For public health to be credible, it must be seen as relevant, and if guidance from the CDC is too far removed from people’s everyday behavior, it will not be credible. Implicit here is that there is no new research leading to change. Quarantine is not lifted because Covid-19 has become less contagious. However, circumstances have changed, including the fact that we have many more tools that reduce the chance of serious illness from the coronavirus. Overall, I think the CDC made the right call. Easing restrictions now preserves the credibility of public health officials later if stricter guidelines need to apply due to a new, more dangerous variant.
