COVID isolation not needed if you’re ‘getting better,’ CDC says. What does that mean?

In a surprising shift, the Centers for Disease Control and Prevention announced new COVID-19 guidelines that drastically decrease recommended isolation time.

The change, announced March 1, says those who test positive for COVID-19 can stop isolating themselves just 24 hours after a positive test if they don’t have a fever and are “getting better overall.”

But the vague language of the recommendation has health experts outside of the agency concerned about the future of cases in the United States.

Here’s how to navigate the new guidelines.

CDC cuts isolation time

People experiencing symptoms that “aren’t better explained by another cause” should isolate themselves from others, the CDC says in the new recommendation.

These symptoms include, but are not limited to, fever, chills, fatigue, cough, runny nose and headache, the agency said, many of which overlap with other respiratory illnesses circulating this winter and spring.

The recommendation suggests people should make their own determination on whether they think their symptoms could be attributed to illnesses like the flu or RSV, or if they may have been exposed to COVID-19.

If you think you have COVID-19, or you’ve taken a test that has come back positive, that is when isolation should begin.

If you do not have a fever for at least 24 hours without a fever-reducing medication and your symptoms are “getting better overall,” the CDC says you can stop isolating.

The CDC only explicitly says to test for COVID-19 if you expect you will be around other people.

“Keep in mind that you may still be able to spread the virus that made you sick, even if you are feeling better,” the CDC says.

The agency also notes in the guidelines that you can start to feel worse again even after a period of improvement, and if a fever returns if your symptoms worsen, you should go back into isolation until again you feel better and have gone 24 hours without a fever.

Once you have ended your isolation, the CDC says you should continue to social distance, wear a mask around others and do additional testing for the next five days.

Why are some health experts worried?

Though the CDC director, Mandy Cohen, said the changes to isolation time represent “the progress we have made in protecting against severe illness from COVID-19,” many health experts are raising concerns about the ambiguous nature of the guidelines and the reliance on self-diagnoses.

“Fever is obviously a symptom, but fever itself is not a perfect indicator of transmissibility,” Eric Feigl-Ding, epidemiologist and chair of the department of public health at the New England Complex Systems Institute, told McClatchy News. “We’ve known, there are lots of studies out there that up to 50% of all cases are transmitted asymptomatically, which means fever is not the relevant thing here.”

Feigl-Ding, who also serves on the COVID-19 mortality expert committee for the World Health Organization, said many patients never develop a fever at all during a COVID-19 infection.

This means if they are feeling kind of sick but don’t have a fever, they may not isolate at all based on the new CDC recommendations and may spread the virus to others.

Feigl-Ding said the guidelines are “wishy washy” at best and require people to self-diagnose due to the absence of a multi-virus test that could determine if an illness was COVID-19, the flu, RSV or something else entirely.

“Feeling better is subjective, right? What is ‘feeling better’ to one? If you have symptoms that aren’t better explained by another cause, we don’t have the testing for other causes. And what is ‘better explained’? All these things are just so nebulous and undefinable,” Feigl-Ding said. “It’s not a guideline. A guideline is like ‘do this, if that,’ and it’s a very clear criteria, these are not actual criterias.”

Feigl-Ding also said the data used to warrant the change from the CDC, shared during meetings of the Advisory Committee on Immunization Practices on Feb. 28 and 29, completely ignored one of the serious concerns of the virus continuing to circulate: long COVID.

Long COVID forgotten in new recommendations

“The vast majority of all long COVID will come from these mild cases,” Feigl-Ding said.

Long COVID, defined by the CDC as a COVID-19 infection that lasts longer than one month, can cause patients to have debilitating symptoms for years even if they only had a mild infection initially.

Because vaccines and boosters can’t prevent all infections, instead working to prevent severe infections, it allows those with mild infections to continue to spread the virus to others and could increase the number of those suffering from long COVID in the future, experts say.

Epidemiologists weren’t the only ones to notice this gap in the CDC recommendations.

“We understand that there is a serious controversy with trying to equate COVID with symptoms. There’s biomedical damage happening in the body, and there is asymptomatic infection. A lot of these things, they cannot be seen or described by their symptoms, and people could be infectious,” Joshua Pribanic, founder of the Long COVID Action Project and a long COVID patient, told McClatchy News.

Pribanic said those experiencing long COVID can have waves of improvement, followed by worsening symptoms over time as the virus continues to live in their bodies.

“‘Getting better overall’ is ensuring that the virus is no longer lingering in your body. And right now, the only way to determine really for you or myself or anyone who could be better is to have antivirals that ensure our immune system can remove that virus from our body,” Pribanic said. “That’s the real problem here is that we don’t have that.”

Pribanic, who is trans and uses ki/kin pronouns, said ki had a pretty mild case of COVID-19 in 2021, but 30 days later, kins health took a drastic turn and it felt like poison was coursing through kins body.

Since then, ki has continued to experience autoimmune symptoms, gastrointestinal symptoms and other long-lasting issues.

“You follow the CDC guidelines, you walk out the door, you think you’re better. But there’s ongoing, invisible damage happening in your body. And you accelerate that damage, because you follow these guidelines, and you go to the gym and you go work out or you go for a run,” Pribanic said. “And the next thing you know, you’ll never go for another run again because you’ve gone over that cliff, and you’ve allowed for the virus to take its toll.”

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