CDC’s Updated COVID Isolation Guidelines: Realistic or Relaxed?

On Friday, March 1, 2024, the United States Centers for Disease Control and Prevention (CDC) issued a press release revealing that it no longer recommends that individuals with COVID-19 isolate for five days after testing positive or symptom onset. Instead, the organization notes that individuals can return to normal activities if they are fever-free for 24 hours without taking medications and if their symptoms have been improving for 24 hours.

These guidelines resemble isolation guidelines for other common respiratory diseases, such as influenza.

Additionally, the organization advises that all eligible patients stay current on vaccinations, including COVID-19, influenza, and RSV. Other recommendations include practicing good hygiene by cleaning frequently touched surfaces, washing and sanitizing hands often, and covering coughs and sneezes. Finally, the public health entity advises everyone to take steps for cleaner air.

“Today’s announcement reflects the progress we have made in protecting against severe illness from COVID-19,” said CDC Director Mandy Cohen, MD, MPH, in the CDC press announcement.  “However, we still must use the commonsense solutions we know work to protect ourselves and others from serious illness from respiratory viruses — this includes vaccination, treatment, and staying home when we get sick.”

“The bottom line is that when people follow these actionable recommendations to avoid getting sick and to protect themselves and others if they do get sick, it will help limit the spread of respiratory viruses, and that will mean fewer people who experience severe illness,” added National Center for Immunization and Respiratory Diseases Director Demetre Daskalakis, MD, MPH.

Despite claims by public health leaders at these government organizations and the widespread acceptance of these guidelines for other respiratory diseases, some individuals are alarmed by these updated changes because of the severity of COVID-19.

“It’s something that is likely to draw a wide array of opinions and perhaps even conflicting opinions,” Faisal Khan, MD, Seattle’s director of public health, told NBC News. “But [the CDC’s] rationale is sound in that the pandemic is now in a very different phase from where it was in 2021 or 2022 or 2023.”

Beyond changes in COVID-19 treatment and prevention, some experts note that this shift in isolation guidelines is an attempt by the CDC to be more realistic in its recommendations. Michael T. Osterholm, PhD, an infectious disease expert at the University of Minnesota, told the Washington Post that while making public health recommendations, experts must consider what the broader population would be willing to do.

Additionally, some experts, including California’s state epidemiologist Erica Pan, MD, MPH, note that these changes are a way to minimize “societal disruptions” caused by the isolation guidelines, which disproportionally impact workers who cannot work remotely.

On the reverse side, some experts are concerned that the relaxed recommendations downplay the dangers of COVID-19, implying to the public that the condition is not as severe as it can be. Lara Jirmanus, MD, a clinical instructor at Harvard Medical School and a member of the People’s CDC, a coalition of healthcare workers, scientists, and advocates focused on reducing the harmful effects of COVID-19, told the Washington Post that new recommendations sweep the condition under the rug.

Ellie Murray, ScD, an assistant professor of epidemiology at Boston University’s School of Public Health, voiced her disagreement with these updated recommendations in a statement to CNN Health, saying, “It’s not good science. It’s not good public health. It doesn’t provide people with accurate information.”

Echoing Murray’s concerns, Eric Topol, MD, founder, and director of the Scripps Research Translational Institute, implied in an email to the media outlet that these updated recommendations do not account for COVID exceptionalism, which he believes is supported by evidence and data from the past four years.

Regardless of public opinion, it appears that these new guidelines will become the public health standard as many states have already transitioned to the same or similar guidelines. However, researchers and investigators should continue to monitor how these changes impact public health.