Can Someone Please Explain What's Up with the CDC's New Isolation Guidelines?

Here, exactly what the updates entail if you've been exposed to or test positive for COVID-19 — plus, why they seem to be so controversial.

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Photo: AdobeStock / Design by Jo Imperio

While the Centers for Disease Control and Prevention has solidified a seemingly permanent place in headlines since March 2020, the public health agency has been receiving plenty of added attention over the past week after it significantly modified its isolation guidelines for people who test positive for COVID-19.

On December 27, CDC officials shortened the recommended isolation period for those infected with COVID-19 to just five days. The organization continued in a media statement, "...and if they are asymptomatic or their symptoms are resolving (without fever for 24 hours), follow that [isolation period] by 5 days of wearing a mask when around others to minimize the risk of infecting people they encounter." For context, the CDC had been previously recommending people who tested positive for COVID-19 and/or were experiencing symptoms isolate for 10 days from the start of symptoms or positive test result. (BTW, here's what to do if you have asymptomatic COVID-19.)

After several days of shock from most, backlash from some, and memes from what felt like everywhere and everyone, the CDC tweaked its updates once again — this time to include a testing component. On Tuesday, January 4, the agency added guidance on how people should respond to a test result, if they choose to take a test after five days of isolation or quarantine, according to CNN. Now, the CDC recommends that if you test positive for COVID-19 after isolating for five days, you should then continue isolation until 10 days after your symptoms started, not necessarily from the day in which you received a positive result. If your test is negative, however, you can leave your house as long as you wear a mask around other people at least until day 10. During this time, you should also avoid places where you can't wear a mask (e.g. gym or restaurant), according to the CDC.

New CDC COVID Guidelines and Recommendations

First, here's a breakdown of the new CDC COVID-19 isolation guidelines:

CDC Isolation Guidelines

  • Stay home for five days.
  • If you're fever-free to 24 hours without using fever-reducing medication and other symptoms have improved, you can leave your house.
  • Wear a mask around other people for the five additional days (it's also a good idea to wear a mask around anyone you might live with if you can't stay clear of them altogether).
  • If you continue to have fever or other symptoms haven't improved, continue isolation until you're fever-free for at least 24 hours sans-meds and other symptoms imrpve.
  • Do not travel during the five-day isolation period. After you end isolation, avoid travel until 10 days after your first day of symptoms.
    • If you must travel, wear a well-fitting mask for the duration of your travel.
    • If you can't wear a mask, then do not travel until after the 10 day mark.
  • Do not go to places where you're unable to wear a mask (e.g. gym, restaurant) until 10 days after exposure.

If you have access to a COVID test and want to give it a go, the CDC recommends using an antigen COVID test at the end of your five-day isolation period — just make sure you wait until to wait until you're fever-free for 24 hours without using fever-reducing meds and your other symptoms have improved to do so. If you test positive, continue to isolate for at least another five days. If your result is negative, you can end isolation but continue to wear a mask until, at least, day 10. (Related: What You Need to Know About False Positive COVID-19 Test Results)

The CDC also updated its quarantine guidance. (These apply to those who might've been exposed to someone with COVID-19 and may or may not have been infected, as well as people who are unvaccinated or who have not gotten a booster shot):

CDC Quarantine Guidelines

The CDC recommends that if you come into close contact with someone with COVID-19, you should quarantine if you are in one of the following groups:

  • You are ages 18+ and completed the primary series of recommended vaccine, but hvae not received a recommended booster shot when eligible.
  • You received the single-dose Johnson & Johnbson vaccine (completely the primary series) over two months ago and have not yet received a recommended booster shot.
  • You are note vaccinated or have not completed a primary vaccine series.

Now, for the guidelines:

  • Stay home and away from people for at least five days after your last contact with a person infected with COVID-19.
  • If you develop symptoms over the course of 10 days after exposure, get tested immediately and isolate until you receive test results. If you test positive, follow isolation guidelines.
  • If you do not develop symptoms, get tested at least five days after exposure.
    • If you test negative, you can leave your home. Wear a mask around others for five additional days — at least until 10 days after exposure.
    • If you test positive, isolate for at least five days from the date of your positive test (even if you do not have symptoms).
  • If you're unable to get a test five days after exposure, you can leave your home after five days — as long as you haven't experienced symptoms during this time period. Wear a mask for at least 10 days after your date of close contact when around others and in public.
  • Do not travel during the five-day quarantine period. Make sure to test negative before traveling. If you don't get tested, delay travel until 10 days after exposure, if possible.
  • Do not go to places where you're unable to wear a mask (e.g. gym, restaurant) until 10 days after exposure.

If you're unable to quarantine, the CDC says it's "imperative" that you wear a well-fitting mask at all times when around other people for 10 days post-exposure.

Why Did the CDC Shorten the Isolation and Quarantine Periods?

The CDC explained in the December 29 statement that the change was "motivated by science demonstrating that the majority of SARS-CoV-2 transmission occurs early in the course of illness generally in the one to two days prior to [the] onset of symptoms and the two to three days after." Meaning, you're more likely to spread COVID-19 during the first five days after being infected — no matter when you test positive.

CDC director Rochelle Walensky, M.D., also cited the now-dominant Omicron variant and new data as reasons for the modified guidelines. "The Omicron variant is spreading quickly and has the potential to impact all facets of our society," she said. "CDC's updated recommendations for isolation and quarantine balance what we know about the spread of the virus and the protection provided by vaccination and booster doses. These updates ensure people can safely continue their daily lives." (Related: Everyone Age 16+ In the U.S. Is Now Eligible for a COVID Booster Shot)

It's important to note that although people tend to use the words "quarantine" and "isolation" interchangeably, they're actually not the same. Quarantine is defined by the CDC as a strategy used to prevent transmission of COVID-19 by keeping people who've been in close contact with someone with COVID-19 apart from others. In other words, quarantining does not mean you've tested positive for the virus and, for the most part, applies to those who've been exposed to COVID-19 and are vaccinated but not yet boosted or not "fully" vaccinated.

Isolation is used to separate people with confirmed cases of symptoms of COVID-19 from those without the virus, according to the CDC. In other words, you should isolate if you're experiencing symptoms of COVID-19 and are waiting for test results or have not yet been tested or if you've received a positive test for COVID-19 (even if you're asymptomatic). When you're in isolation, it's best to stay away from other people in a specific "sick room" or area and use a separate bathroom from others, if you can.

So, Why All the Controversy Around the New CDC COVID Guidelines?

Given the surge of COVID-19 cases across the globe thanks to the now-dominant Omicron variant as well as the still-lingering Delta variant, the recent reduction of days in isolation has left many citizens and health pros confused and frustrated. Take a quick look on social media, and you'll see a collection of commentary from people criticizing the CDC's updated recs as being too short.

Public health officials have also acknowledged that staffing issues played a role in the decision, which hasn't helped with the controversy surrounding the modified guidelines. "With the sheer volume of new cases that we are having and that we expect to continue with Omicron, one of the things we want to be careful of is that we don't have so many people out," Anthony Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases, told CNN of the new guidelines.

Other health officials point out that it's been hard enough to get people to wear a mask, even when they don't have COVID-19, and allowing people to break their isolation early who may not mask up could put others at risk of infection. There is also a concern that some will feel pressured to return to work, even when they don't feel well enough to do so.

But some doctors uphold that the recent modifications simply reflect where society's at with the pandemic. "It makes a breakthrough COVID infection and any COVID infection less disruptive," says infectious disease expert Amesh A. Adalja, M.D., a senior scholar at the Johns Hopkins Center for Health Security. "We learned that many people weren't complying with the previous isolation guidelines because they were too long, and some people were refraining from getting tested just because they didn't want to have to deal with the implications of a positive test."

The new guidance "covers the bulk of the contagious period," which is through day five after infection, says Dr. Adalja, adding, "you can't let perfect be the enemy of good. You have to have public health guidance that people will actually follow."

The CDC is in a "difficult position" with isolation guidance, says William Schaffner, M.D., infectious disease specialist and professor at the Vanderbilt University School of Medicine. "They're having to walk the tightrope between safety for the majority of people as well as permitting our economy and social and cultural events to continue to function," he says. "In the health care industry, we are pushed for personnel because some of them are out on isolation or quarantine. It's the same thing for airlines and even college and professional sports." (Related: The Compounding Impact of the COVID Pandemic On Black Women)

Dr. Adalja admits that there is "some level of risk" in shortening the isolation guidance but adding rapid tests to ending isolation periods as they become more readily available will also help people make better-informed decisions. Meaning, a testing element may eventually be added to the isolation guidance wherein people will need to get a negative COVID test before they can break their isolation. It's just difficult to require that right now when tests are so scarce, he explains.

COVID-19 isn't going away and, with that, guidance needs to evolve, stresses Dr. Adalja. "For influenza, we tell people they can go back to being around others 24 hours after their fever is over — we don't test people to see if they're negative," he says. "We've got to start treating COVID like other respiratory viruses, especially in people who are vaccinated."

"The 10-day rule was too much," agrees Dr. Schaffner. "We as a society are moving beyond that."

What Should You Do If Infected or Exposed?

Dr. Adalja points out that a "small portion" of transmission of the virus can happen after day five, although wearing a mask around others should help.

If you have COVID-19 and are concerned about infecting others past the five-day mark, he recommends taking a rapid test — if you can actually find one at your local drugstore or online — to see if you still test positive. And, if you do, you can extend your isolation period until it's been 10 days since you originally tested positive or developed symptoms. You can also (and always, for that matter) take extra safety precautions, such as staying home as much as possible and making sure you actually wear your mask in all situations around others. (See also: FDA-Authorized At-Home COVID-19 Tests That'll Save You from Waiting In Line)

It's also not a bad idea to try to steer clear of vulnerable people in your life — think: anyone who's immunocompromised, older than 65, etc. — as much as possible until the 10 days have passed, adds Dr. Schaffner. "The general agreement is that, after 10 days, the likelihood of being able to spread this virus to others has gone down to a minuscule chance," he says.

The information in this story is accurate as of press time. As updates about coronavirus COVID-19 continue to evolve, it's possible that some information and recommendations in this story have changed since initial publication. We encourage you to check in regularly with resources such as the CDC, the WHO, and your local public health department for the most up-to-date data and recommendations.

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