The CDC cuts recommended isolation periods for COVID infections
The CDC cuts recommended isolation periods for COVID infections
NPR's Steve Inskeep talks to Dr. Ashih Jha, dean of Brown University's School of Public health, about revised guidelines for asymptomatic people who test positive for COVID-19.
STEVE INSKEEP, HOST:
Hours before the Centers for Disease Control and Prevention reduced the recommended period of isolation for people with coronavirus, we put this question to Dr. Anthony Fauci.
(SOUNDBITE OF ARCHIVED NPR BROADCAST)
INSKEEP: Is five days enough?
ANTHONY FAUCI: I believe it will be, Steve. You need the health care workers. And when you have them out for the full 10 days and you do that over a wide swath of people, you can have a situation where you really do not have enough health care workers.
INSKEEP: When the announcement came out, the CDC went beyond just health care workers. All people who test positive can wait just five days if they show no symptoms. Needless to say, if you're sick, you should stay away probably longer. The drop from 10 days amid the omicron explosion did cause a widespread one-word reaction - what? So let's work through the change with Dr. Ashish Jha, who is dean of the Brown University School of Public Health. Welcome back.
ASHISH JHA: Good morning. Thanks for having me back.
INSKEEP: Why is this a good idea now?
JHA: Well, it probably was a good idea even a while back. I think we've known for a while that people are most contagious a couple of days before symptoms, so - and then usually in the first two or three days after symptoms. And so asking people to isolate for 10 days when after about five days they really are not very contagious at all, it just was excessive and unnecessary. And now with millions of Americans getting infected, asking a lot of people to isolate when they're not contagious makes even less sense. So I'm really happy to see the CDC make this change.
INSKEEP: Do you think that it is more likely, then, that people will follow the guidance since it's a little bit easier to follow?
JHA: Absolutely. I mean, imagine the person who feels totally well, hourly wage worker who misses getting paid if they don't go to work - asking them to test themselves and then isolate for 10 days when they feel well is a huge burden, especially when we know that they're not contagious beyond those sort of first five days. So I think - my hope is that this will actually create an incentive for more people to get tested and more people to follow isolation guidelines because it's easier to do, and it's more consistent with the science.
INSKEEP: Is there, though, a risk of confusion because you're telling people stay home for five days if they're asymptomatic and also wear a mask after the five days, but if you show any symptoms, it'd be a different period of time?
JHA: Yeah, absolutely. I mean, any time you have any policy that's at all complex, it can cause confusion. I think the key point for people here to understand is that those first five days are really critical. That's the most contagious time period, and so people staying home during that time is essential. What happens after that, I think - I agree with CDC's guidance to wear a mask for the five days that follow because there is the rare case of somebody who is still contagious beyond that. But I agree. I mean, it'd be easier if we just say five days for everybody and nothing else, but we have to have a little bit of nuance in the context of an evolving pandemic.
INSKEEP: Now, you said the science supports this change. We've had some experts who questioned that. And our reporter Pien Huang spoke with Jessica Malaty Rivera. She's an epidemiologist and adviser at the Pandemic Prevention Institute. And she pointed out that, normally, the CDC would give the science. They would publish a paper. They would say why they're doing what they're doing. And that didn't happen this time. Let's listen.
JESSICA MALATY RIVERA: And so, like, let's see it. Let's see the papers that talk about the incubation period, the viral loads, the rate of infection. I need to see all that so that we can justify this and make people feel confident in this redirection.
INSKEEP: Why do you think the CDC did not publish the science?
JHA: Yeah, that's a very good question. And I wish they had. I mean, just - I think what they're doing is they're relying on the data that's already out there. There have been studies over the last year on all of those questions, obviously not with omicron but with delta, with prior variants. And so I think they were relying on all of that evidence. But I agree; it would be better if we had more recent data and if they could have shown all of this. But I think most experts I'm speaking to, certainly, also agree with my assessment that this really is pretty consistent with everything we've seen out there. So I don't think the CDC is going beyond the science, but it's always helpful to have more data.
INSKEEP: So you're telling me that if someone came to you, faced you and said, show me the science, you could spend a couple of minutes on your laptop and bring it up.
JHA: Yeah. And actually, one of the reasons I've called for this change for many, many days and if not weeks is because, actually, I've been looking at the data, as many of us have, and think that this is the right place to land. So I was actually happy to see it, and I think we can show people what justifies this decision-making.
INSKEEP: It did seem to be driven in a sense by politics. Asa Hutchinson, the governor of Arkansas, said that President Biden supported this change at the request of governors who wanted a little more flexibility to deal with this crisis. I'm curious if you think this is political and also if that's OK.
JHA: Yeah, it sort of depends on what - how you define political. I mean, look; omicron is already causing a huge strain on our society, and it is going to cause a substantially bigger strain on our society over the next month. In that context, we do want to look at the data and ask the question, what's reasonable in terms of asking people to isolate? And I think those pressures should absolutely be part of our decision-making. I mean, functional society - a functional health system is part of public health. And so if that's politics, that's fine. In my mind, what you have is a situation where there are a lot of external forces also pushing on us to look at the data here more carefully and ask, do people really need to be isolated for 10 days? And I think the evidence is they probably don't.
INSKEEP: Let me ask about one other matter that is huge as the omicron wave sweeps over the country, and that's the large percentage, the large minority, of Americans who are not vaccinated and the even larger number of people who have not gotten booster shots. What is appropriate at this point to nudge, persuade, force people to do that? What is one step you would take that you would think would be productive rather than counterproductive?
JHA: Yeah, at this point, we have tried almost everything, Steve, to try to cajole people. The one thing that works consistently is mandates for vaccines and, I think, clear messaging for boosters. But I think mandates are going to be the way that we're going to get a lot more Americans vaccinated, and that's how we're going to get out of this pandemic.
INSKEEP: Dr. Fauci was talking about mandates to get on an airplane. Would that make sense?
JHA: I think from a science point of view, it does. And I've actually called for that as well, and I think that would be helpful.
INSKEEP: Dr. Ashish Jha, dean of the Brown University School of Public Health. Always a pleasure talking with you. Thank you so much.
JHA: Thank you.
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