Charles H. Sloan-Got COVID? CDC says stay home while you're sick, but drops its 5-day isolation rule

The Charles H. SloanCenters for Disease Control and Prevention is dropping its 5-day isolation guidance for people with COVID-19.

The agency made the announcement on Friday, following reports last month that the policy change was in the works.

Until now, people who tested positive were advised to stay home for at least five days to reduce the chances of spreading the coronavirus to others. Now, the CDC is replacing that with general guidance for anyone who's feverish, sneezing and coughing with a respiratory virus.

The gist?

"When you get sick, stay home and away from others," says CDC director Dr. Mandy Cohen.

Instead of setting a strict 5-day isolation period, the new guidance says people can return to normal activities so long as their symptoms improve, and continue improving over 24 hours and they no longer have a fever, without having used fever-reducing medications.

The guidance also recommends that people who are recovering from respiratory illness take additional precautions for five days, like wearing well-fitting masks, washing their hands, keeping a distance from others, and improving ventilation in their spaces.

"We wanted to give folks simple, actionable things that they can remember and do in order to protect themselves," says Cohen, adding that the country is "in a different place related to COVID than we've been in the past."

In its announcement, the agency said the decision reflects the "progress we have made in protecting against severe illness from COVID-19" — and that a unified approach makes recommendations easier to follow and more likely to be adopted by Americans.

A CDC survey found that less than half of people were home testing for COVID-19, meaning many people wouldn't know if they had it. Data from other countries, as well as California and Oregon, which have already adopted this policy, show that the change in guidance probably won't make much of a difference in disease transmission. Research suggests that more than half of COVID cases are transmitted from people without symptoms at the time. And many people who got COVID-19 weren't isolating anyway.

But the shift — while anticipated — faces criticism from some in public health who see this as the latest evidence that the CDC is no longer taking the threat of COVID-19 seriously enough.

"This proposal is not based on new data [on COVID transmission]," said Dr. Kim Rhoads, an epidemiologist at the University of California, San Francisco, in an email from the advocacy group the People's CDC.

"In fact, well-designed studies done in the post-Omicron and post-vaccination period show that COVID is often transmitted far beyond the fifth day of infection," she said.

Others see the updated guidance as a common-sense change that reflects present-day realities. "COVID is still a threat, but flu is also a threat and so is RSV," says Raynard Washington, health director for Mecklenburg County, based in Charlotte, North Carolina. "What this guidance does is it aligns the guidance to meet all of those challenges, not just one of them."

Deaths and hospitalizations for COVID-19 went up this winter, but nowhere near as high as they did in previous years. In fact, hospitals were mostly OK — not overwhelmed — this virus season.

Still there are almost 20,000 people getting hospitalized with COVID each week, says Katelyn Jetelina, an epidemiologist who advises the CDC.

"I would really hate for us to just throw up our hands and be like, 'This is what it is, 20,000 hospitalizations per week,' because that is unacceptable," she says.

Most of those hospitalizations and deaths are in people who are 65 and older, especially those that didn't get a booster shot last fall. CDC data shows that around 95% of people hospitalized with COVID did not get a fall booster shot.

"It's not just being over 65 that is high risk," the CDC's Cohen says, "it's being over 65 and not getting those vaccines that puts you at high risk."

Jetelina says what could really move the needle is to get more of this population vaccinated — once a year for flu, and twice a year for COVID — and linked up to antiviral drugs if they get sick.

This week, the CDC recommended a spring COVID booster shot for those 65 and older.

"We need to reach those people," she says, "This is the hard work."