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High-risk patients alarmed by CDC’s plan to ease covid isolation guidance

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Concerns among medically vulnerable people are growing as the Centers for Disease Control and Prevention prepares to drop its long-standing recommendation that those with covid isolate for five days.

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People with compromised immune systems worry that co-workers will return to the office while they’re still contagious. At the same time, the few remaining policies guaranteeing paid leave for employees with covid are largely coming to an end. New York, the only state that still requires paid leave for covid isolation, is considering ending that benefit this summer.

Even as many cheer loosening isolation guidance, others are troubled by federal health officials’ latest move to stop treating covid as a unique respiratory viral threat.

The forthcoming change, first reported by The Washington Post, says people could return to school and work if they have been fever-free for at least 24 hours without the aid of medication and they have mild and improving symptoms.

This would be similar to the guidance for people with influenza and respiratory syncytial virus (RSV). Supporters, including prominent physicians and public health experts, say it’s the right move, reflecting the reality that many people with covid are not isolating and the threat of severe illness has dimmed as a result of vaccination, prior infections and antiviral treatment. But critics say covid should not be treated like other respiratory viruses because it currently hospitalizes and kills more people than flu and can inflict long-term complications that scientists are still trying to understand.

“I feel like I’m on an island by myself,” said Lisa Savage, a 60-year-old retired nonprofit fundraiser in Charleston, S.C., who has several autoimmune diseases that keep her body in a constant state of inflammation.

Savage said the CDC’s proposed changes scare her. When she hears people say it’s time for the country to move on, she thinks: “Lucky for you. Those of us with compromised immune systems don’t have that luxury.”

The CDC is expected in April to release the proposed revisions to the isolation guidance and seek public feedback.

The science around infectiousness and transmission have not changed. Someone who tests positive for covid can still be infectious beyond five days. People without symptoms or fever can transmit the virus very early in their illness. What’s not known, experts say, is how closely people have followed the five-day isolation recommendation and whether loosening the guidelines will impact community transmission rates.

Oregon got rid of its five-day isolation requirement for covid in May 2023 and told people to stay home until they recovered - similar to other respiratory illnesses - while avoiding vulnerable people for 10 days and wearing a mask around others. The state did not experience any disproportionate increases in community transmission or severity compared with California, which kept its five-day isolation recommendations in place until January 2024, according to data shared last month with the national association representing state health officials.

Loosening the isolation recommendations will increase the risk to people who are immunosuppressed, said Walid Gellad, a physician and professor of medicine at the University of Pittsburgh. But he said those risks must be weighed against the downsides of a lengthy isolation, including people missing work and school. “It really is a different world now,” he said.

Katelyn Jetelina, an epidemiologist who follows covid-19 policy closely, said health policy is complex and needs to take into account trade-offs that change over time for a U.S. population of 330 million people with different priorities, risk factors, behaviors and beliefs. “We ultimately need guidance that is protective and actionable and feasible,” she wrote in her most recent weekly newsletter.

Public health experts say it’s also reductive to cast revised guidance as sacrificing the immunocompromised and elderly to minimize economic disruptions. They say there is a middle ground between living in fear and ignoring the virus.

Paul Offit, a pediatric infectious-disease specialist at Children’s Hospital of Philadelphia, said high-risk people would benefit if Americans focus more on isolating while sick rather than which virus they have.

“I think people have this notion that if they don’t have covid, they’re good,” Offit said. “But all of these viruses can cause people to be hospitalized or go to the intensive care unit or die … so therefore stay home when you’re sick, even if you’re not in a high-risk group.”

Public health officials have justified easing measures to limit covid transmission by pointing to sharp declines in hospitalizations and death since the pandemic began. The CDC issued an update Friday on the “changing threat” of covid, noting that while community transmission continues to surge periodically, hospitalizations have decreased by more than 60 percent from their peak in 2021 - falling from over 2.5 million that year to around 900,000 in 2023. The decline in covid-associated deaths has also dropped; in 2021, over 450,000 deaths were associated with covid-19; that number fell to roughly 75,000 in 2023.

But long-covid activists have maintained doing so neglects how the virus can cause lingering, sometimes debilitating, symptoms with no clearly defined cure.

“All along the CDC has been part of misleading the public about viewing this crisis as an acute crisis, not as something that has a huge chronic impact,” said JD Davids, co-director of Long COVID Justice. “It furthers this dangerous idea that we are supposed to all just be sick all the time transmitting illnesses to others and just keep working.”

The last major revision in CDC isolation guidance, from 10 to five days in December 2021, prompted a flurry of companies pulling back on paying employees to stay home when infected with covid-19, including Walmart, Amazon, CVS and Walgreens. Now far fewer employers offer any sort of paid leave for covid and instead require workers to use traditional sick time benefits, if they even offer them. Others say employees must return to work when asymptomatic or fever-free, or even while still sick.

“I would imagine that employers that want to scale back [paid leave] would use the CDC guidance as the rationale for doing so,” said Vicki Shabo, a senior fellow who focuses on paid leave policy at New America, a left-leaning think tank. “But what I hope employers understand is ensuring their workers can stay home when they are highly contagious … is better for business, better for morale and better for productivity.”

Almost 1 in 4 workers do not have even a single paid sick day, according to the Bureau of Labor Statistics.

When the coronavirus swept the world in 2020, the United States required businesses with 50 to 499 employees to offer paid time off to workers with covid. The rule lifted at the end of that year, prompting some states and cities to enshrine similar protections that have now expired.

New York Gov. Kathy Hochul (D) has proposed ending the nation’s only state law requiring paid leave for covid isolation. Business groups in the state say ending paid covid leave is long overdue, especially when New York has a broader law mandating paid sick leave.

“It’s time to wind down these special covid benefits out there, and this is the last remaining one,” said Frank Kerbein, director of the center for human resources at the Business Council of New York. “We don’t have a tuberculosis paid leave program.”

Covid isolation policies have been especially challenging for health-care systems that have dealt with staff shortages but must also protect patients from infectious disease.

Northwell Health, New York’s largest health-care system, offers five days of covid leave in line with state guidance and requires workers to wear masks for another five days when they return. In the first week of February, 123 of the more than 80,000 employees were isolating, according to the hospital system. But Northwell leaders also believe a 24-hours fever-free approach as planned by the CDC makes sense as a threshold for determining contagiousness for workers.

“When health-care workers no longer have that need to stay in isolation because they are no longer in a contagious state, we need them,” said Peter Silver, senior vice president for Northwell.

CDC officials have told The Post the new isolation recommendations would not apply to hospitals and other health-care settings with more vulnerable populations.

Activists have organized to preserve New York’s covid leave policy, saying its repeal would hurt low-wage earners and people at risk of severe illness.

“We know that covid is not done altogether, and it would be too soon to make this big of a change when we still see some spikes,” said state Sen. Jessica Ramos (D), who leads a labor committee and has opposed the governor’s attempt to sunset the paid leave law. “Making sure that workers are as safe as they can be should be one of our number one missions.”

Proponents of easing the isolation guidance say the existing recommendation creates a dilemma for some: Rather than face onerous - and potentially costly - isolation for a mild illness, people may instead embrace ignorance as bliss and not test for covid.

Atlanta pediatrician Reshma Chugani often has parents declining a coronavirus test for sick children because they don’t want their kids to miss school for five days, resulting in parents having to skip work, if the test is positive. Plus, she said, there is no treatment for most children, since the antiviral Paxlovid is approved only for people 12 and older.

Many schools, which rely on attendance for funding, have increased pressure on parents who keep children out of school for extended periods of time, sending letters home flagging the number of absences, even when they are sick with covid.

That has put pediatricians “in a pickle from a public health standpoint,” Chugani said.

“We run the risk of exposing vulnerable people by sending sick kids to school,” she wrote in an email. “On the other hand, children missing school is a real problem as we saw with learning loss, isolation, mental health issues during the height of the pandemic.”

Her college-age son caught covid for the first time last week and had to isolate in his dorm for five days, per school policy. He had no fever, and because there were no remote options, he had to miss four days of class, emerging in time to attend a Super Bowl party.

Andrew Franks, a Boston-area consultant who has a 2-year-old daughter, said he takes the virus seriously as a leading cause of death but is frustrated employers don’t offer more incentives to isolate when sick. His wife has only seven sick days a year. His daughter has to wait at least five days and a negative test result to return to day care if she tests positive, and he would need to take off work to care for her.

“One covid case spreading throughout our entire household could very easily drain all of our sick time,” said Franks, 37.

He said he understands why many parents are no longer testing for covid when their children fall ill.

“If I test her and she tests positive, she has to stay home for as long as two weeks,” Franks said. “But if I don’t test her and she never spikes a fever, life can go on. It’s really perverse incentives.”

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Video: The new guidance, which is expected in the spring, would bring covid-19 in line with recommendations for other respiratory viruses, like the flu. Health reporter Lena Sun explains.(c) 2024 , The Washington Post

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