The US Centers for Disease Control and Prevention (CDC) has revised its Covid isolation guidelines that reduced quarantine period for asymptomatic patients to five days. The CDC has now clarified that the person should have no fever for 24 hours before ending Covid isolation.

Earlier, the CDC guidelines mandated 10-day isolation for Covid-19 patients.

The first update was notified on December 27, when the CDC said Covid-19 patients could end their isolation after five days if they were asymptomatic. The CDC had not elaborated what “asymptomatic” implied in the updated guidelines.

The move was criticised on social media and in 48 hours, the CDC revised its guidelines on December 29 to say, “People with Covid-19 should isolate for 5 days and if they are asymptomatic or their symptoms are resolving (without fever for 24 hours), follow that by 5 days of wearing a mask when around others to minimize the risk of infecting people they encounter.”

Here, “without fever for 24 hours” was specifically mentioned to explain being asymptomatic for ending Covid isolation after five days.

In both updates, the CDC recommended such patients to continue wearing a mask for the next five days, throughout when among other people. The revision of guidelines was made without an official announcement.

In the hours since it was recommended, the CDC had to defend this decision many times. In an interview to the American media, Dr Anthony Fauci, advisor to US President Joe Biden said, “The reason is that 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, as he explained why CDC changed Covid isolation guidelines.”

“How can you get people to function in a society, not with a zero risk, but with a diminished risk?” said Dr Fauci, in TV interviews to the US media.

CDC FACED HEAVY CRITICISM

Those criticising the CDC move on Twitter and other social media platforms alleged that the revision of Covid isolation guidelines was made to ensure that a large number of people did not go on sick leave that extended to 10 or more days.

The revision of Covid isolation guidelines in the US come at a time when the country is witnessing huge surge in cases. This is likely to see a sizeable workforce go on sick leave, leading to under-staffing in several offices. Some of the critics of the revised guidelines called the move a “corporate propaganda” to cut sick leave pay.

CDC MADE IT WORSE—The @CDCgov is so out of whack right now—@CDCDirector quietly **without any notice** revised the unscientific 5-day isolation press release from just “asymptomatic” to “or symptoms are resolving”. Plus “resolving” is even more useless & dangerously vague— https://t.co/BILjmuJrqr pic.twitter.com/zOsCdKKzNn

— Eric Feigl-Ding (@DrEricDing) December 30, 2021

The move was criticised for being “unscientific” as experts felt there was no science backing this decision. In a series of tweets, Dr Eric Feigl-Ding said, “CDC MADE IT WORSE—The @CDCgov is so out of whack right now—@CDCDirector quietly **without any notice** revised the unscientific 5-day isolation press release from just “asymptomatic” to “or symptoms are resolving”. Plus “resolving” is even more useless & dangerously vague (sic).”

“Yesterday I warned that this vague language will definitely enable if not encourage people to skirt the isolation rules. This will only cause more infections! (sic)”

On December 29, he tweeted, “People will definitely abuse that vagueness to be blasé and ignore isolation. Businesses will abuse it too— to the detriment of public health. Meanwhile, here is how UK rightfully sets clear cut isolation guidelines with 2 negative tests on top! (sic)”

“Tell me what’s wrong with this @CDCgov rule—besides zero testing for early isolation exit—it says you can simply leave the house if “your symptoms are resolving”. In what universe is that considered a clear guideline? It’s dangerously muddy @CDCDirector! (sic)”
‘UNSCIENTIFIC GUIDELINES’

Indian experts have heard the possibilities before. “Even in 2020, there were discussions about shortening the period of isolation for asymptomatic people with who had tested positive.” said Dr Rajeev Jayadevan, clinical researcher and member of the Covid task force in Kochi, Kerala.

Isolation refers to an already infected person. Quarantine applies to a person who has been exposed, and stays away as a precaution.

REASON FOR SHORTENING ISOLATION IS TWO-FOLD

There is tremendous loss of productivity when a person who is otherwise asymptomatic sits at home for 10 days, when other people are expected to cover the same amount of work. This is difficult in an already strained healthcare system. The UK, for example, is already experiencing health care worker shortages because of such isolation protocols.

The argument to shorten the isolation period from 10 to five days by the CDC was conditional upon the person being symptom free, and wearing a mask afterwards, which would decrease the risk of the spread of the virus.

Secondly, we know that most of the spread would have already occurred by the time the person tested positive, that is, within the first few days of illness.

In other words, isolating people in the second half of the 10 day period will not yield much in terms of stopping viral spread.

This risk is further diminished by wearing masks, and also when the person is delegated to taking care of already infected patients, to whom there is obviously no additional risk.

“In a global emergency like this, there are no perfect answers. However, we have to continue to upgrade our guidelines based on experience and best judgment,” said Dr Rajeev Jayadevan.

NOT AN OPTION FOR INDIA

In India, those testing positive for Omicron are being admitted in hospitals, whether symptomatic or asymptomatic. When asked, Union health ministry’s joint secretary Lav Agarwal said, “India is taking a cautious approach. It is best to isolate or hospitalise such cases. Contacts are traced and tested as well. At this time, India will maintain a cautious approach.”

Dr Swapniel Parikh, clinical researcher and author of the book ‘Coronavirus’ said, “USA’s decision to reduce isolation period without testing had been made to reduce staff shortages and testing has not been included as there is a huge shortage of tests in the USA.”

“I do think it is possible to reduce isolation periods safely with testing and this is something we should explore in India. The isolation period also depends on the baseline level of infection risk in the community.”

“As the risk of community infection increases, the benefit of longer isolation decreases. For example, at the peak of a wave, the risk of infection in the community may be much higher than the residual transmission risk from a person who ends isolation on Day 5 or Day 7. We can’t and shouldn’t follow what the USA is doing. Our approach should be tailored to our setting and transmission levels.”

Dr Shuchin Bajaj, founder-director, Ujala Cygnus Group of Hospitals, said, “The CDC has recommended that you shorten your quarantine period to five days, if you are asymptomatic and double vaccinated because the current virus Omicron has a much shorter incubation period and goes up faster as well as you turn negative much faster in contrast to the Delta version, where people were turning negative in 11 to 15 days.”

“In Omicron, they’re turning negative in 5-7 days. So that is what CDC has recommended. Of course, if you continue to have symptoms, then you must isolate yourself for longer, then you should not finish your isolation within five days.”

“So, India, I don’t think is quite ready to follow that right now. But hopefully with more and more data coming in from India on Omicron, we will see that most people will be turning negative in five days and so we can reduce that isolation period, of course, provided there are no symptoms.”

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