CDC tweaks guidance on ending isolation for anyone who ‘wants to test’
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The CDC tweaked its guidance for people isolating with COVID-19, adding a recommendation for anyone who “wants to test” but stopping short of telling people that they should test.
In updated guidance published last week, the CDC halved the recommended isolation time for people with COVID-19, saying they could leave isolation after 5 days if asymptomatic, followed by 5 days of masking around other people.
The update generated some criticism, including from experts who said it should have included a testing component.
The CDC tweaked that guidance on Monday for both symptomatic and asymptomatic people, saying: “If an individual has access to a test and wants to test, the best approach is to use an antigen test towards the end of the 5-day isolation period.”
“If that test is positive, people should stay home for those extra 5 days,” CDC Director Rochelle P. Walensky, MD, MPH, said Wednesday during a White House press briefing. “If that test is negative, people really do need to understand that they must continue to wear their masks for those extra 5 days.”
For rapid antigen tests, “negative results should be treated as presumptive [and] do not rule out SARS-CoV-2 infection,” the CDC guidance notes. For improved results, it says people should test twice over a 3-day period with at least 24 hours in between tests.
“[The FDA has] said that these tests are for qualitative purposes, not quantitative purposes, meaning we can't tell how transmissible you are based on a positive or negative test,” Walensky said.
The CDC recommends that people leaving isolation or quarantine do not go places where they cannot wear a mask, such as restaurants or some gyms, and not eat around other people at home or at work for 10 days after they tested positive, first had symptoms or were exposed.
Although the initially updated guidance drew criticism for not emphasizing testing, there are experts who agreed with leaving it out.
Daniel Diekema, MD, MS, a clinical professor of infectious diseases and epidemiologist at the University of Iowa Carver College of Medicine, directed Healio to a Twitter thread in which he said it would “be a mistake to add testing to the criteria for isolation duration.”
“We have no test for infectiousness,” Diekema tweeted. “We have tests that we’ve compared to other tests that we think might be associated with infectiousness [and] there are many vagaries with testing: sample adequacy, operator error, interpretation, changing performance as the virus evolves, etc.
“Not to mention disparities (at least in US) w/ test availability. Yes, in a perfect world and all that, but the U.S. is a resource-limited setting with a threadbare [public health] system — those [without] ready access to tests will be subject to prolonged isolation, and potential loss of pay/employment.”
References:
CDC. Quarantine and isolation. https://www.cdc.gov/coronavirus/2019-ncov/your-health/quarantine-isolation.html. Updated Jan. 4, 2022. Accessed Jan. 5, 2022.
CDC. Overview for testing for SARS-CoV-2 (COVID-19). https://www.cdc.gov/coronavirus/2019-ncov/hcp/testing-overview.html. Updated Dec. 28, 2021. Accessed Jan. 5, 2022.
Perspective
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One-size-fits-all isolation periods never made sense when the bulk of transmission was known to occur in the first half of illness.
While I don’t think testing needs to be mandatory — we don’t use testing to end isolation periods for influenza and we have robust case contact data for when transmission risk is maximal — testing can be a way to right-size isolation periods and precision guide them.
Unfortunately, testing supply constraints persist, prohibiting the optimal use of rapid tests. Nevertheless, the current guidance is a bit puzzling to me because it somewhat disincentives testing because it states that if an individual “wants” to test, they can, and if found to be positive, should isolate for an additional 5 days. Many people would not test to avoid an extra 5 days of isolation.
I think a better approach would be to use antigen tests, in a serial fashion, to reduce isolation periods as much as possible gauged on contagiousness — whether that is 4 days for some and 8 days for others, for example.
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CDC. Quarantine and isolation. https://www.cdc.gov/coronavirus/2019-ncov/your-health/quarantine-isolation.html#closecontact. Accessed Jan. 5, 2022.
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