What the CDC’s new COVID guidelines could mean for you

On February 13, the Washington Post reported that the Centers for Disease Control and Prevention (CDC) plans to issue new guidelines that would substantially pull back on recommendations for people infected with Covid-19.

The guidelines, which are expected to drop in April, will reportedly no longer recommend that most Americans infected with the virus stay away from work and school for five days. Instead, they will advise people that they can leave home if they’ve been fever-free for at least 24 hours (without fever-reducing medicine like ibuprofen or acetaminophen) and have mild and improving symptoms. The Post’s story didn’t mention whether or how the new guidelines would recommend using tests to guide decision-making.

“It’s a reasonable move,” says Aaron Glatt, an infectious disease doctor and hospital epidemiologist at Mount Sinai South Nassau Hospital on Long Island. “When you’re doing public health, you have to look at what is going to be listened to, and what is doable.”

Guidelines that adhere to the highest standards of infection control might please purists in public health who don’t have to make policies for the real world. However, guidelines that seem to acknowledge that workers often don’t have paid sick leave and emergency child care, and that social interactions are important to folks, are more likely not only to be followed but to engender trust in public health authorities.

This change likely won’t increase exposure risk for the people most vulnerable to severe Covid-19

It’s important to note that the new recommendations will be aimed toward the broader community and the people who live, work, and go to school in it — not toward hospitals, nursing homes, and other facilities whose residents are both less socially mobile and more vulnerable to the virus’s worst effects.

That means the people who are at higher risk of getting severely ill or dying if they get infected — people who are older and sicker at baseline — will likely be subject to different, more conservative guidelines. Which makes sense, says Glatt: “It’s not the same approach in a 4-year-old kid as it is in a nursing home. It shouldn’t be.”

Covid-19 hospitalization rates among adults 65 and over are at least four times what they are in other age groups, and rates are particularly high among adults 75 and over, according to the CDC. In a study published in October, the agency reported that those 65 and older constituted nearly 90 percent of Covid-19 deaths in hospitals.

The older adults getting hospitalized and dying with Covid-19 now are not the otherwise well people with active work and social lives who were getting severely ill earlier in the pandemic, says Shira Doron, an infectious disease doctor and hospital epidemiologist at Tufts Medicine in Boston. They’re people with severe underlying illness and compromised immune systems — and for many, it’s not even clear Covid-19 is what’s causing their decline. “I’m really struck by how totally different the Covid inpatient population — even the Covid death population that I’m seeing — is from 2020, or even 2021,” she says.

It’s hard to tell exactly how many of the worst-affected adults are infected in facilities like hospitals and nursing homes — in other words, how many of them would be relatively unaffected by a revised set of guidelines. It’s also hard to tell how many older adults, aware of their higher risk, take more measures to protect themselves in public, like wearing masks and gathering outdoors.

However, it’s worth noting the experiences of states that have already loosened recommendations. Since Oregon loosened its guidelines in May 2023, the state has not seen unusual increases in transmission or severity; California made similar changes in January 2024. In revising their recommendations, state officials hoped to reduce the burdens on workers without sick leave and reduce disruptions on schools and workplaces, according to the Post’s reporting.

Doron says the reason loosened isolation guidelines haven’t led to mayhem in Oregon — nor in Europe, where the recommendations changed two years ago — is because isolation never did much to reduce transmission to begin with. “This has nothing to do with the science of contagiousness and the duration of contagiousness. It has to do with [the fact that] it wasn’t working anyway,” she says.

Leaning away from what doesn’t work to reduce the virus’s impact — and toward what does work — is a smarter way forward, she says.

Revising testing guidelines would free up resources for interventions that actually work

Isolation guidelines haven’t been effective for mitigating Covid-19 harms because so many people simply do what they want, regardless of whether they’re sick — and they may avoid reporting symptoms to avoid being forced to comply with an isolation policy.

Imagine a workplace or school policy adheres to the current CDC guidelines, which recommend that people who test positive for Covid-19 infection stay home for at least five days. That policy creates a “perverse incentive” for some people who have symptoms to avoid getting tested, Doron says, because they don’t want to miss school, work, or a social event. Because so many people don’t have paid sick time, acknowledging even mild symptoms can lead to real financial losses when it means missing a week of work.

At the same time, because these guidelines build testing into their protocols, they lead lots of other people — and the federal government — to spend money on at-home tests, which are often inaccurate early in infection. That’s a waste of resources that could save more lives if they were instead spent on providing tests to people likeliest to benefit from Paxlovid and getting them treated, says Doron.

For that reason, she thinks that in addition to changing isolation guidelines, the CDC should change the guidelines around testing. “You should only be testing when it will change something, and that should be because you need Paxlovid or an antiviral,” Doron says. (Clarity and greater focus on who qualifies for Paxlovid would also be helpful, she says — current CDC recommendations are too broad.)

In the long term, CDC guidelines should normalize being considerate

The CDC’s revised guidelines likely won’t be formally released until April at the earliest, and their details are as yet unclear. While they’re recommendations, not requirements, employers and state and local health departments often use them to guide their own policies.

One area where a new set of guidelines could make a big difference is in elevating and normalizing masking, says Jay Varma, an epidemiologist and biotechnology executive with extensive experience in state and federal public health practice. He hopes the new recommendations lean heavily into putting forth masking in public as a matter of routine for people who leave home as soon as they feel well.

“CDC should be thinking of this as a decades-long effort to promote cultural acceptance that being in public with a mask is similar to washing your hands, wearing a condom, or smoking outdoors: It’s a form of politeness and consideration for others,” Varma wrote in an email to Vox.

After all, in the long term, it’s a lot easier to change social norms around masking than it is to get people used to giving up their social lives for days or weeks at a time.

It would also be helpful for public health officials to encourage people to factor in who gets exposed if they leave isolation soon after a Covid diagnosis, says Glatt. It’s hard to build nuance into a one-size-fits-all recommendation, but the guidelines could suggest that, for example, people who have regular social contact with someone they know takes high-dose immunosuppressive medications act differently than people who don’t have that kind of contact.

“That’s something that’s very difficult for a guideline to take into account,” he acknowledges.