- End isolation if symptoms are resolving
- Wear a mask around other people for five more days
Testing at the end of the five days of isolation with a rapid antigen test is optional.
So what should I do? I suggest a simple and effective strategy that is based on both tests and clinical symptoms, distinguishes between those who are vaccinated or not, and still allows a quick return to normal life if you are well.
Let’s tackle the CDC guide one by one.
Stay home for at least five days
However, on day five, the end of the CDC period of isolation, a significant percentage of people (31%) are still contagious. By the seventh day, the percentage of people who are still infecting is halved, to about 16%.
End isolation if symptoms are resolving
Wear a mask around other people for five more days
Optional rapid antigen test around day five
The latest CDC guidance says that an isolated person can take an antigen test towards the end of the five-day isolation period, if they have access to a test and want to take one.
Making these tests optional has been the biggest source of confusion in the new guidelines. It undermines its value in identifying when it is contagious and does not seem to consider all the evidence.
“With hundreds of thousands of new cases daily and more than a million positive cases reported on January 3, tens of thousands – potentially hundreds of thousands of people – could return to work and school contagious if they follow the new CDC guidance. to end isolation after five days without a negative test, “warned Harmon, president of the AMA.
“A negative test should be required to terminate isolation after a positive test for COVID-19. Reemerging without knowing one’s status risks further transmission of the virus.”
So what should the clearest and most evidence-based isolation guide look like? Given the paucity of evidence, it would be both an evidence-based and symptom-based policy that reflects real-world data on someone’s level of contagion at any given time. It would also consider the vaccination status of the person.
Consider this approach that we have chosen to take at my home institution, Emory Healthcare, where I am a practicing neurosurgeon.
Vaccinated employees may end up with isolation:
- By day 5, if an antigen test is negative and symptoms are resolving (including no fever for 24 hours, no fever-reducing medications such as acetaminophen)
- Or on day 7, if symptoms are resolving; no proof required
Employees who are not vaccinated can end up with isolation:
- By day 7, if an antigen test is negative and symptoms are resolving (including no fever for 24 hours, no fever-reducing medications such as acetaminophen)
- Or on day 10, if symptoms are resolving; no proof required
While it is true that vaccinated people can sometimes be just as contagious as unvaccinated people, there are two important points to remember:
- Those vaccinated are five times less likely to be infected in the first place.
- If a vaccinated person becomes infected, the contagion time is shorter.
It goes without saying that if you are sick, you should stay home, no matter what day it is. These rapid antigen tests are most useful in people who have Covid-19 or who have recently been exposed but are feeling fine, describing many of the people who are currently isolated or quarantined.
But sadly, the CDC has downplayed the value of these rapid antigen tests by making them optional. Dr. Thomas Tsai of Harvard’s TH Chan School of Public Health says the ideal strategy would be to use these rapid tests every day, which can take a lot of guesswork out.
“We rely on symptoms to indicate how infectious you are, compared to antigen test data to tell whether or not you are infectious, regardless of your symptoms,” Tsai said.
The reason rapid antigen tests are often discarded is because they can give a negative result at the same time that a PCR test is positive. Most PCR tests take longer and require a laboratory; they are very sensitive and can detect the presence of the genetic material of the virus long after someone is no longer contagious. Rapid antigen tests can be done at home and detect certain virus proteins, when the viral load is high enough.
The differences in the tests seem like a subtle point, but it is an important distinction.
If antigen testing were ubiquitous, everyone could get tested regularly in the morning and find out if they are currently contagious and should continue to isolate themselves.
The real problem with this strategy, however, is incredibly frustrating: Two years after this pandemic, these tests are still hard to find.
Yet here we are.
I think Tsai best describes America’s relationship with evidence: “The course of the pandemic has always been documented rather than altered.”
“Test deliveries from manufacturers to the United States government will begin over the next week. Americans will begin receiving free testing in the coming weeks,” White House Covid-19 response coordinator Jeff Zients said during a briefing on Wednesday.
If you have Covid-19, it is worth reducing your risk of spreading it by really thinking about how you will get out of isolation. I support a strategy that considers your symptoms, vaccination status, tests, and the best data about your infection at any given time.
I am confident that 2022 will be a year of promise and renewal and that we will get through it together. While Covid-19 is likely to stick around, these simple strategies can help hasten the end of the pandemic.