CDC Drops Quarantine Recommendation for Those Exposed to COVID

Instead of quarantining if you’re exposed to COVID-19, wear a high-quality mask for 10 days and get tested on or after day 5, irrespective of vaccination status, the CDC suggested in revised COVID guidelines issued Thursday.

“In light of high population levels of anti–SARS-CoV-2 seroprevalence, and to limit social and economic impacts, quarantine of exposed persons is no longer recommended, regardless of vaccination status,” Greta Massetti, PhD, of the CDC COVID-19 Emergency Response Team, and colleagues wrote in Morbidity and Mortality Weekly Report.

In addition, “CDC now recommends case investigation and contact tracing only in healthcare settings and certain high-risk congregate settings,” the authors wrote. The updated guidelines no longer mention the “test to stay” strategy previously recommended for school students who had a potential exposure.

The agency developed the revised guidance because “high levels of vaccine- and infection-induced immunity and the availability of effective treatments and prevention tools have substantially reduced the risk for medically significant COVID-19 illness (severe acute illness and post–COVID-19 conditions) and associated hospitalization and death,” Massetti and co-authors indicated.

“These circumstances now allow public health efforts to minimize the individual and societal health impacts of COVID-19 by focusing on sustainable measures to further reduce medically significant illness as well as to minimize strain on the healthcare system, while reducing barriers to social, educational, and economic activity,” they added.

“CDC’s public health recommendations change in response to evolving science, the availability of biomedical and public health tools, and changes in context, such as levels of immunity in the population and currently circulating variants,” the authors continued. “CDC recommends a strategic approach to minimizing the impact of COVID-19 on health and society that relies on vaccination and therapeutics to prevent severe illness; use of multicomponent prevention measures where feasible; and particular emphasis on protecting persons at high risk for severe illness.”

The agency reiterated in a press release, however, that people should isolate from others if they have COVID-19, and that “you should also isolate if you are sick and suspect that you have COVID-19 but do not yet have test results.” Once test results come back, if they’re positive, patients should comply with full isolation recommendations; if the results are negative, patients can end their isolation.

“COVID-19 remains an ongoing public health threat; however, high levels of vaccine- and infection-induced immunity and the availability of medical and nonpharmaceutical interventions have substantially reduced the risk for medically significant illness, hospitalization, and death from COVID-19,” the authors wrote.

“As transmission of SARS-CoV-2 continues, the current focus on reducing medically significant illness, death, and healthcare system strain are appropriate and achievable aims that are supported by the broad availability of the current suite of effective public health tools,” they added.

“Rapid identification of emergent variants necessitating a shift in prevention strategy makes continued detection, monitoring, and characterization of novel SARS-CoV-2 variants essential,” the authors noted. “Incorporating actions to mitigate the impact of COVID-19 into long-term sustainable routine practices is imperative for society and public health.”

The updated recommendations for those who test positive include:

• Stay home for at least 5 days and isolate from others in your home. You are likely most infectious during these first 5 days.
• Wear a high-quality mask when you must be around others at home and in public.
• If, after 5 days, you are fever-free for 24 hours without the use of medication, and your symptoms are improving, or you never had symptoms, you may end isolation after day 5.
• Regardless of when you end isolation, avoid being around people who are more likely to get very sick from COVID-19 until at least day 11.
• Wear a high-quality mask through day 10.
• If you had moderate illness (if you experienced shortness of breath or had difficulty breathing) or severe illness (you were hospitalized) due to COVID-19 or you have a weakened immune system, you need to isolate through day 10.

Daniel McQuillen, MD, president of the Infectious Diseases Society of America, applauded the revised guidelines in a statement, calling them “a positive sign that advances in vaccines and treatments have significantly lowered the risk of severe illness, hospitalization and death.”

However, “with much of the country experiencing higher than 20% transmission rates, we cannot let our guard down” and should continue to isolate and mask when appropriate, McQuillen added.

The CDC’s recommendations come a little more than a week after a study published in JAMA Network Open found that a substantial proportion of COVID-19 patients who continue to test positive on a rapid antigen test after 5 days may still be infectious. Of 17 patients who were tested for viral culture on day 6, 12 still had a positive antigen test, and six of these patients had culturable virus, a proxy for infectiousness, reported Lisa Cosimi, MD, of Brigham and Women’s Hospital in Boston, and colleagues.

On Thursday, the FDA recommended that people who use rapid antigen tests for COVID perform a repeat test in order to avoid a false negative result. “At-home COVID-19 antigen tests are less likely to detect the SARS-CoV-2 virus than molecular tests, such as polymerase chain reaction (PCR) tests,” the agency noted. “Today, the FDA is highlighting the continued need for repeat, or serial testing when people get a negative result with an at-home COVID-19 antigen test, including recommending additional testing over a longer period of time.”

“Over the course of the COVID-19 pandemic, public health scientists have continued to learn about the SARS-CoV-2 virus and the impact of variants on diagnostic tests that detect SARS-CoV-2,” the FDA said. “Today’s recommendations are based on the latest study results from people with likely Omicron infection showing that repeat testing after a negative at-home COVID-19 antigen test result increases the chance of an accurate result.”