CDC recommits to isolation and quarantine guidelines without tests

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After days of criticism over new isolation and quarantine guidelines, the Centers for Disease Control and Prevention on Tuesday doubled down on its policy, pointing to data that it says supports its guidance that Americans who contract Covid-19 or have not been boosted and are exposed to the virus can return to normal life after five days if they wear a mask.

The recent guidance, updated Dec. 29, said individuals who test positive for Covid-19 and whose symptoms are resolving need only isolate for five days as long as they continue to wear masks for an additional five days. And for individuals exposed to the virus who are unvaccinated or are not yet boosted, the CDC recommended that they quarantine for five days and wear masks for another five days. The CDC also said boosted Americans could return to work after exposure but that they should wear a mask for 10 days.

Public health officials and scientists criticized the agency’s decision not to recommend Americans receive a negative test before emerging from isolation and quarantine, saying testing could limit transmission post infection. Since then, top Biden administration health officials, including Anthony Fauci, the president’s chief medical officer, have hinted that the CDC was considering adding a testing recommendation to the guidelines.

But the CDC ultimately decided against it, with scientists pointing to data that shows individuals are less likely to transmit the virus after five days. The agency updated its isolation and quarantine instruction webpage Tuesday with language that clarifies the science behind its decision.

"Accumulating evidence demonstrates the majority of transmission occurs during the early periods of infection," the CDC said, adding that the agency also took into consideration "societal impact" when deciding to shorten the time period for isolation and quarantine. "Spread of the Omicron variant has the potential to worsen staffing shortages and increase supply chain challenges, which jeopardize industry, education and other systems that are essential to maintain a functioning society and economy."

The CDC also noted that studies suggest that only 25 to 30 percent of people isolated for the full 10 days previously recommended by the agency.

Tuesday’s move comes after weeks of deliberations inside the CDC and among White House Covid-19 officials about how to handle the recent surge in Omicron and Delta cases, and hospitalizations, according to two senior Biden health officials. As the winter surge has intensified, officials have debated whether to invoke stricter public health guidelines to keep case counts down and whether it is safe for Americans who tested positive to return to normal life more quickly than in previous surges, those officials said.

In meetings about whether to add a testing recommendation to the CDC guidelines, agency officials said they discussed the practicality of recommending individuals obtain a negative test before breaking isolation and quarantine. Americans across the country are still struggling to get a hold of Covid-19 tests, some waiting hours in lines for swabs. With limited supply, public health officials worried about the ability of Americans finding a test to take before returning back to normal life on day six.

In its updated language, the CDC mentioned testing only to say that if people want a test and have access to one, they should use an antigen test toward the end of the five-day isolation or quarantine period but cautioned that "a negative antigen test does not necessarily indicate the absence of transmissible virus." If Americans receive a positive test, the CDC recommends individuals isolate until the end of the 10-day period.

"Tests for [Covid-19] … are not authorized by the U.S. Food and Drug Administration (FDA) to evaluate duration of infectiousness," the CDC added. "Some people may remain positive … long beyond the period of expected infectiousness."

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