Politics

Why the CDC modified its Covid-19 quarantine coverage

The Centers for Disease Control and Prevention suggested on Wednesday that some people exposed to Covid-19 could be quarantined for less than two weeks.

The agency said a 14-day quarantine, where people stay at home and don't interact with others, is still the safest option when in close proximity with someone who has Covid-19 within 6 feet for at least 15 minutes Get in touch. Anyone who actually becomes infected with the disease should self-isolate for at least 10 days after symptoms begin and only leave isolation after the fever has cleared for at least 24 hours.

However, the CDC has updated its guidelines – recommendations, not legal requirements – to offer "alternatives". People who have been in close contact with someone with Covid-19 should continue to be quarantined. However, this quarantine can end after 10 days without a coronavirus test. Or it can take seven days for someone to get a negative test result, which they should have received by the fifth day of quarantine. People should watch out for symptoms for 14 days after quarantine.

Public health experts cited the change as a harm reduction step: cutting down their quarantine time isn't ideal for people. However, if the change quarantines more people for a period of time, this could be better overall.

"The new guidelines are an example of an approach to harm reduction or an approach that takes into account the challenges individuals may face in reducing risk," said Jen Kates, director of global health and HIV policies at Kaiser Family Foundation. “My main concern, however, is the potential for confusion and the need for strong, clear messaging. CDC continues to recommend a 14-day quarantine – that shouldn't be lost here. "

The CDC pointed this out, pointing to the possibilities of "economic hardship" and "stress on the public health system" due to 14-day quarantines.

"CDC continues to advocate quarantine for 14 days and recognizes that any quarantine shorter than 14 days offsets a lower burden for a low possibility of the virus spreading," the agency said.

The incubation period for Covid-19 can be up to two weeks – in rare cases even longer – suggesting that people cannot say they are fully aware until a 14-day quarantine has expired.

But for most people it is now believed that the incubation period "has moved towards the shorter end of that 14-day window," said Harvard epidemiologist William Hanage. Therefore, most people can likely cut their quarantine period without putting others at risk.

The change comes at a particularly disastrous time. Cases in the US continue to rise and consistently break records. Hospital admissions topped 100,000 for the first time this week. The daily death toll is now regularly above 2,000 – deaths have not been recorded since the first spring outbreaks.

And it's sure to get worse. Thanks to the incubation period of the virus and the fact that most people may be sick weeks prior to hospitalization or death, we still haven't seen the effects of Thanksgiving gatherings last week. The U.S. could see record-breaking Covid-19 cases, hospitalizations, and deaths as people congregate for Christmas and New Years – further fueling the spread of the virus in lingering, intimate settings. In the meantime, a vaccine is likely months away for most Americans.

The CDC's new quarantine policy is an attempt to get Americans to do something, even if many of them refuse to take the other steps requested by the agency. If it works, it could help combat how bad things get in the next few weeks.

The reduced quarantine time is all about harm reduction

In public health, harm reduction means recognizing that people take risks but still try to make their behavior as safe as possible. People could eliminate their risk of sexually transmitted infections by, for example, not having sex at all. Given that people are going to have sex, public health officials are trying to encourage people to do it safely by using condoms and having fewer partners.

As we have received more evidence of the spread of the coronavirus and the public has grown tired of the pandemic and more resilient to tougher action, health officials have increasingly taken a harm reduction approach to combating Covid-19.

"While we'd like to envision that we can stop the entire broadcast immediately, we are really working to prevent as much as possible, which can sometimes lead to compromises," Hanage said.

While it is better not to socialize with people from different households – since any interaction carries a risk of transmission – officials have tried to encourage people to engage in safer interactions in outdoor environments where the virus cannot spread easily. The same impulse drives the urge to wear masks: maybe people shouldn't have their hair cut at all if they want to rule out the risk of Covid-19, but if they do, they can at least reduce the risk of transmission with Masks.

At a press conference announcing the new recommendations, it was clear to CDC officials that they would prefer to quarantine people 14 days after exposure. Given the limitations people can face, including the need to work, and the recent evidence that the incubation period for most people might not be two weeks, the CDC is now trying to provide some flexibility.

"We can safely shorten the quarantine length, but accept that there is a small residual risk that a person who leaves the quarantine prematurely will be transferred to another person in the event of an infection," said John Brooks, CDC Chief Medical Officer Covid-19 Answer said.

It's not perfect. With the CDC's new guidelines, some coronavirus infections are likely to prevail that could have been prevented by a 14-day quarantine. However, if the guidelines stop more infections overall by quarantining more people, even for an imperfect amount of time, there is still a net benefit in reducing transmission.

In other words, it's about finding a balance between the ideal steps to stop Covid-19 and people's willingness to actually follow those steps.

There are still risks associated with a shortened quarantine

A major risk in guiding the CDC is that we still don't know much about Covid-19. We are still learning many basics about the coronavirus and the disease it causes, from the duration of the incubation to the wide range of symptoms to its long-term effects. It is still not certain how much transmission is controlled by people who never experience symptoms, and this could pose a challenge to the CDC's leadership if it turns out that many people are leaving their quarantine early – for example at the new 10 – day cutoff -. but are able to unwittingly spread the virus to others.

On the other hand, there are also studies that show that people may not be infectious for as long as previously thought. So it might turn out that the CDC's new guidelines are too lax, just as it might also be that the agency's guidelines in general are still too strict.

Some experts were critical of the CDC's guidelines and asked for more clarity or improvements to the recommendations. Saskia Popescu, an infectious disease epidemiologist, told me she was concerned that the agency said people could get a test as early as the fifth day of quarantine and use the test results to end the quarantine after the seventh day. "I would have liked to see tests on the sixth or seventh day and then the end of the quarantine if the result is negative," said Popescu.

Still, experts were overall open to the change, with Popescu noting that "it can help improve quarantine compliance". However, she cautioned that the CDC and other officials should be aware of the restrictions and the continued need for other steps, such as social distancing when possible and masking.

The big risk for now is that the US is still in the middle of a massive Covid-19 outbreak – one of the worst in the world. In this environment, every single interaction outside of your home is a potential transmission risk. There is just too much virus out there, which makes it easy for people to spread it.

Despite these circumstances, health authorities also had to grapple with the fact that people are not listening. For weeks, experts and officials advised people not to travel for Thanksgiving. Then the country set records for air travel out of the pandemic last week.

The same thing now seems likely to happen again with Christmas and New Years Eve, bringing with it new, widespread events as the country faces record highs for cases, hospitalizations and deaths.

Given this reality, the CDC is trying to meet people where they are: when individuals are doing things that officials prefer not to do, they can at least take some action – even a shorter quarantine period – to slow the spread as much as possible. It's not perfect, but this is where the land is.

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