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Some Health Experts Surprised by CDC Isolation Change Given Omicron Unknowns

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Health experts are divided over the new CDC guidance that shrinks the isolation period for certain people with COVID-19: Some view the policy shift as a nod to reality, while others see it as confusing and even irresponsible. Federal health officials on Monday halved the recommended 10-day isolation period for many infected Americans, saying those without symptoms—or whose symptoms are improving and who do not have a fever—can now stop isolating after five days as long as they continue to wear masks around others. “I’m a little surprised at them cutting it in half without having a testing requirement associated with it or based on vaccine status,” Joseph Fauver, a genomic epidemiologist at the University of Nebraska Medical Center, told The New York Times about the shift, which he called “remarkable.” Epidemiologist Michael Mina went further, saying that the CDC allowing people to leave isolation early without requiring a negative test result is “reckless,” given that studies have found variation in how long people stay infectious.

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The change, according to the CDC, “is motivated by science demonstrating that the majority of SARS-CoV-2 transmission occurs early in the course of illness, generally in the 1-2 days prior to onset of symptoms and the 2-3 days after.” The update comes amid a massive surge in infections fueled by the omicron variant, which, while highly transmissible, appears to cause less-severe infections. The new guidelines “balance what we know about the spread of the virus and the protection provided by vaccination and booster doses,” CDC director Rochelle Walensky said in a statement, to “ensure people can safely continue their daily lives.” Pfizer board member and former FDA commissioner Scott Gottlieb underscored that point in The Washington Post, saying, “the new guidance reflects a growing reality that we’re going to have to learn to live with Covid as a persistent risk, and can’t let it shut down society.” Airlines, restaurants, and health care systems are among the industries that have been most hit by omicron-related staff shortages in recent weeks. Some suspect the economic burden is at least partly behind the CDC’s policy shift. 

“We know those who are vaccinated, and those who were previously infected and vaccinated, are more likely to shed virus for shorter periods of time,” Gottlieb pointed out. But for some health experts, given the swirling unknowns around omicron, particularly for those who are unvaccinated, the policy shift feels abrupt. Megan Ranney, Brown University’s associate dean of public health,  told CNN that “for the unvaccinated, the data doesn’t really back up that they become noninfectious at five days.” Health officials should be updating their recommendations as more is learned about the virus, Ranney said, but she wished the CDC had done so “in a way that rewarded the vaccinated, and didn’t put the rest of us at risk.” (She also noted that she’s “a little nervous” about the CDC saying people should wear masks for an additional five days: “You and I both know how often the unvaccinated are wearing masks out in public right now,” Ranney told CNN’s Jake Tapper.)

Unvaccinated people are five times as likely to test positive, and 14 times as likely to die of COVID-19, compared with fully vaccinated people, per the CDC. In a widely circulated Twitter thread about his recent shifts working in the ER, Columbia University Medical Center’s Craig Spencer pointed out that “every patient I’ve seen with Covid that’s had a 3rd ‘booster’ dose has had mild symptoms” and no difficulty breathing or shortness of breath. And those who have had two doses of either Pfizer or Moderna have been “a little more miserable overall” compared with boosted patients, but still no shortness of breath or breathing trouble, he observed. But it’s a different story for those who have not had any dose of the vaccine. “Almost every single patient that I’ve taken care of that needed to be admitted for Covid has been unvaccinated,” Spencer wrote. 

While The Washington Post also reports that, according to international studies and early data from several U.S. hospitals, healthy vaccinated individuals, and especially those who have been boosted, are apparently unlikely to end up hospitalized because of omicron, while the effect of the newest variant on older, at-risk populations remains to be seen. “In some ways, this is almost like a calculus problem. It’s got a lot of moving parts to it and we’re trying to figure it out,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. Among the factors that could determine someone’s risk level include their age, vaccination or booster status, and underlying health issues, Osterholm told the Post. “I think it’s tricky, because they’re trying to prepare for a crisis situation,” virologist Jeremy Kamil told the Times of the federal health officials’ altered guidance. “There are so many unknowns.” 

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