Rethinking Covid-19 Isolation Guidance

Does a 5-day isolation period for Covid-19 still make sense?

For much of the pandemic, the CDC advised anyone infected with Covid-19 to isolate for 10 days (or longer in some cases). Then in late December 2021, near the peak of the initial Omicron wave, the CDC announced that they were shortening isolation times to 5 days, followed by 5 days of masking. This update was welcomed by many, but infuriated many others. The change was met with a lot of debate about whether or not to require a negative test before ending isolation. In the end, the CDC recommended that people who wanted could take an antigen test before ending isolation, but that it wasn’t necessary.

Source: CDC Isolation and Precautions for People with COVID-19

It’s now been more than 16 months since the isolation timeframe was shortened, and the public health emergency has ended, but the CDC’s isolation guidance still stands. And as far as I know, there is no indication that the CDC intends to update their current isolation guidance now that the emergency has ended. However, one state did announce this week that they are no longer recommending a five-day isolation period for those infected with Covid-19. Was it Ron DeSantis and Joseph Ladapo in the “Free State of Florida”? Or Georgia, home of the “experiment in human sacrifice”? Maybe another Covid minimizing state like South Dakota, Missouri, Iowa, or Texas?

Shockingly, no — it was Oregon! That’s right, Oregon, a state that enforced many stringent Covid restrictions over the past three years, is the first state I’m aware of that has dropped recommendations to isolate after testing positive for Covid-19. The Oregon Health Authority announced recently that they “believe widespread population immunity…means many COVID-19 infections are now likely asymptomatic or mildly symptomatic, and the five-day isolation period is doing little to reduce transmission.” This makes a lot of sense. Most people stopped testing a long time ago, and with so many mild cases plus three years of built-up immunity, there’s simply no reason to think that isolating the few people who bother testing would have any meaningful impact on the spread of the virus.

Oregon public health officials are now recommending that people “stay home until fever free for 24 hours and symptoms are improving” and “avoid contact with individuals at increased risk for severe disease.”

Source: Oregon Health Authority News Release

I am shocked but thrilled that a state like Oregon was bold enough to update their recommendations in this way. The next step is to spread the word and encourage other state public health departments to follow suit, and not wait on the CDC.

While isolation is no longer mandated by law in many (most?) states, Oregon is the only state I’m aware of that is explicitly ending the 5 day isolation period for Covid, opting instead to treat it like any other common respiratory illness. Every state health department website that I checked either followed and/or linked to CDC guidance. (Technically, Oregon Health Authority still hasn’t updated their main website to reflect their new guidance, so maybe there are some other states flying under the radar.) It’s also worth noting that Florida varies slightly from the CDC by not recommending masking for 5 days after 5 days of isolation.

I did find some news articles about the change in Oregon’s recommendations, so it’s gotten some publicity within Oregon at least. But when I searched Google and Twitter for stories of any other states lifting pandemic measures, I couldn’t find anything about other states dropping their isolation guidance. If you know of any other states ending their isolation protocols, please tell me!

In a recent Washington Post op-ed, doctors Shira Doron, Elissa Perkins, and Westyn Branch-Elliman, argued for the CDC to end the Covid isolation protocols and switch to a “stay home when sick” policy, just like Oregon has done. I’m sure they’ll be glad to see Oregon health officials seem to agree with them.

Source: Washington Post, April 12, 2023 “It’s time to end the five-day isolation guidance for covid”

Many other countries and Canadian provinces have ended their Covid isolation guidance already. As with most Covid protocols, the CDC is behind much of the world in this regard. Below is a list of several countries that have updated Covid isolation guidance, along with links and quotes from their official websites:

• Denmark
  “If you test positive for covid-19 and feel ill, you are recommended to stay at home until you feel well again. If you test positive for covid-19 and don’t feel ill there is no need to stay at home. You don’t have to notify your close contacts.”

• Sweden
  “Stay home from work, school, preschool, and other activities if you feel ill and have symptoms that could be due to COVID-19…. Children and adults can go back to work, school, preschool and other activities when they feel well and are in a general good condition.”

• Norway
  “…there are no longer any rules or recommendations to quarantine or isolate. If you feel ill and experience respiratory symptoms, you should stay home until you feel better. You can go about life as normal if you are not experiencing any symptoms.”

• Finland
  “Currently, official quarantine or isolation is only imposed extremely rarely because they no longer effectively prevent the spread of coronavirus infections.

  Coronavirus infections can be prevented by the same means as other respiratory tract infections.”
  “If you experience symptoms of a respiratory tract infection, you can treat them like other sudden respiratory tract infections. It is a good idea to stay at home when you are ill until the symptoms have clearly decreased.”

• Netherlands
  “If you test positive for COVID-19, you no longer have to self-isolate. The guideline for self-testing if you have symptoms has also been discontinued as of 10 March 2023.”
  “The coronavirus SARS-CoV-2 is a constant presence in the Netherlands, but it is less likely to cause serious illness at this point. This is known as the endemic stage. Even in an endemic stage, there are still vulnerable people who have a higher risk of serious illness from an infection involving SARS-CoV-2 or another respiratory virus. For that reason, it is still important to take them into account. Follow these recommendations if you have symptoms.”

• UK
  “Try to stay at home and avoid contact with other people if you or your child have symptoms and either:

  • have a high temperature

  • do not feel well enough to go to work, school, childcare, or do your normal activities

  You can go back to your normal activities when you feel better or do not have a high temperature.”

  “You are no longer required to do a COVID-19 rapid lateral flow test if you have symptoms.”

• France
  “…if you have suggestive symptoms or test positive for COVID-19, you no longer have to self-isolate.” They do have some recommendations to mask, distance, “avoid contact with frail persons,” among other things.

• Czech Republic
  “Isolation due to covid-19 is no longer automatically ordered based on a positive test result.”
  “The general basic recommendations that significantly reduce the risk of further spread of any respiratory disease still remain valid.

  1. If I am sick, I stay at home and try to avoid contact with elderly or immunocompromised people.

  2. I follow respiratory hygiene.

  3. I wash my hands regularly with soap.

  4. I ventilate enough.

  5. I cover my airways when I sneeze or cough.”

Even some countries known for taking very serious measures against Covid have updated their isolation guidance to be more flexible:

• Australia
  “It is no longer a legal requirement for people diagnosed with COVID-19 to isolate.”
  “For the 7 days following your positive test result, you may consider additional precautionary measures to protecting the health of your loved ones, and those most at risk from severe COVID illness in the community.”

• Hong Kong

  “Symptomatic persons should stay at home for rest and avoid going out, while asymptomatic persons can go out on their will or go to work. To protect the young, students who have tested positive should not attend schools until they have tested negative by RATs. Infected persons should wear well-fitting surgical masks, KF94, KN95 masks, or respirators (such as N95 masks) during the first five days after testing positive.”

• Canada left isolation guidance up to the provincial health departments. Most (if not all) provinces dropped mandatory isolation, and recommended isolation guidance varies by province. The Ontario Ministry of Health recommends the following for anyone with symptoms of Covid-19:
  “Stay home and self-isolate until all of the following apply:

  • your symptoms have been improving for at least 24 hours (or 48 hours if you had nausea, vomiting and/or diarrhea)

  • you do not have a fever

  • you have not developed additional symptoms”

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What Can Be Done?

Unfortunately, I doubt that the CDC will update their current isolation guidance anytime soon, especially with CDC Director Walensky leaving in a month — so I recommend working at the state level. Contact your local department of health and ask if they will follow Oregon’s lead and update Covid isolation guidance to treat Covid like any other illness. Given Oregon’s history of strict Covid mitigations, it will be hard for anyone to argue that the Oregon Health Authority is being reckless and “not taking the virus seriously.” You can even send them this article to show all the other countries that have already updated their guidance. I will certainly be sending an email along with this article to Georgia DPH and Governor Kemp’s office.