Two very strong and polarized reactions have swamped Twitter over the CDC’s new loosened COVID-19 guidelines. The comments are slinging from citizens, scientists, and medical practitioners.
One camp is happy “it’s finally over.” They post dancing gifs and applaud the new guidelines published Thursday, which recommend that infected individuals isolate for 5 days, and exposed individuals get a test (in 5 days) and wear a mask (for 10 days), and send kids to school as long as they do not have symptoms. Mask wearing and social distancing otherwise are not recommended, but rather, individuals are encouraged to understand their risk level and take action accordingly.
But not everyone was dancing. Those who believe the rules should remain more restrictive also flooded Twitter, name-calling the CDC and saying the guidelines were unscientific. “Utter insanity.” “Just ridiculous.” “Took me 20 days to test negative after I got a breakthrough case. I don’t think it would have been wise for me to go back to work after 5 days, do you?” One tweet highlighted a recent study in the New England Journal of Medicine that showed continued virus shedding more than 5 days after positive tests.
One health policy expert said people need to accept that transmission is not the center of the public health problem anymore, that the new variant requires a new approach. “BA.5 is very contagious, but has milder disease; in part because of population immunity,” William Schaffner, MD, of Vanderbilt University Medical Center in Nashville, told MedPage Today in a phone interview.
“We’re in a changed environment,” he said. “What we did months ago is not applicable to what we do now.”
He says the new CDC guidelines are in sync with the current environment. The CDC is focusing on what has become the primary health goal for COVID-19, he said: “To keep people out of the hospital — notice I did not say minimizing transmission.”
Transmission is not stoppable, he asserted. “I don’t think we can do that. This virus is spreading so rapidly, it affects both people who are vaccinated and have had COVID-19 before. A focus on transmission is misguided.”
The new variants of the virus are so infectious they are “both escaping our protection and our testing,” Schaffner pointed out. “We can talk about masks, and that will be relevant on a personal level, but not on a population level anymore.”
Georges Benjamin, MD, executive director at the American Public Health Association, told MedPage Today that more testing could have been encouraged in the guidelines. “I think that we should rationally do much more testing to offer assurance that you’re not infected.” He said the timeline of 5 days after exposure is good, “but I personally think we have to do more liberal testing.”
“It’s still free,” he added. “Why not do it?”
The CDC guidelines do not recommend testing negative before going back to normal business, with which Benjamin also took mild issue. “If you had it, you’re feeling great — you should still wear your mask — but take a test to make sure you’re negative,” he said.
If you’ve taken two or three tests and still have positive results after a week, “check in with [your] doctor to see what it means.”
Still, for the vast majority of people who are recovering, “they are shedding so little virus after 5 days, and not showing any signs of illness, they don’t require a test of negativity.”
As for the CDC guidelines, he said it’s important people understand that they are just that, guidelines. “The challenge with federal policy is it’s supposed to provide guidance, not a firm policy. It has to be adjusted to local needs,” Benjamin pointed out. The guidance on testing could be more robust, he said, but ultimately high-risk communities have to make decisions based on their circumstances.
“If you’re in an older school with bad ventilation [in a community in a ‘red’ zone] you might want to do more testing,” he said. “If you’ve got nice vents and older kids with a lower prevalence of disease, you’re going to be more lenient.”
The most important part is the community prevalence piece, Benjamin said. “If you’re in a community that’s green, these guidelines are working well. In a red zone, you need a whole lot more testing and handwashing.”
The elimination of test-to-stay in schools really needs to be evaluated depending on the school and the community.
Schaffner said the issue around what to do in schools has a simple, straightforward, and clear solution: “Vaccinate every child who goes to school. End of story.”
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