Q&A: CDC's new COVID-19 guidance 'reflects how far we've come'

Key takeaways:

• The CDC’s updated COVID-19 guidelines relax previous strategies and no longer require unvaccinated individuals to quarantine after an exposure.
• The new guidance comes as the CDC says there is a much lower risk for severe illness and death, unlike earlier in the pandemic.
• It is unlikely that the new recommendations will affect infection prevention measures in health care settings, an expert told Healio.

The CDC has updated its COVID-19 guidance, streamlining recommendations and relaxing previous prevention measures, noting “there is significantly less risk of severe illness, hospitalization and death compared to earlier in the pandemic.”

The guidelines were published last week in Morbidity and Mortality Weekly Report.

“High levels of immunity and availability of effective COVID-19 prevention and management tools have reduced the risk for medically significant illness and death,” Greta M. Massetti, PhD, branch chief of the CDC’s Field Epidemiology and Prevention Branch, and colleagues wrote in the report.

They further noted that significant illnesses, deaths and strain on the health care system can be limited with “vaccinations and therapeutics to prevent severe illness, complemented by use of multiple prevention methods to reduce exposure risk and an emphasis on protecting persons at high risk for severe illness.”

The updated recommendations are a departure from previous guidance in that schools and businesses no longer have to require unvaccinated individuals to quarantine after SARS-CoV-2 exposure. The CDC now recommends that if an individual is exposed to SARS-CoV-2, regardless of vaccination status, they get tested after 5 days and wear a high-quality mask for 10 days.

The previously recommended contact tracing and testing of asymptomatic people without known exposure was also dropped “in most community settings,” according to the CDC.

Further, the new recommendations emphasize that “physical distance is just one component of how to protect yourself and others,” a change from the previous guidance that suggested social distancing of 6 feet.

If an individual tests positive for SARS-CoV-2, the CDC recommends that they stay home for a minimum of 5 days and isolate from others. Regardless of when one ends isolation, they should avoid being around people “more likely to get very sick from COVID-19” until the 11th day, according to the guidance.

Healio spoke with Amesh A. Adalja, MD, an infectious disease, bioterrorism and emergency medicine specialist and senior scholar at the Johns Hopkins Center for Health Security, about the new recommendations and their implications.

Healio: What are your overall thoughts on the new guidance?

Adalja: I am very supportive of the updated guidance, which I think accurately reflects how far we’ve come during this pandemic to make COVID-19 a much more manageable infection. As more tools such as vaccines, rapid tests, monoclonal antibodies, antivirals and booster vaccines have become available, guidance has to reflect the decreasing risk that COVID-19 poses. I think this guidance goes a long way toward treating COVID-19 like other respiratory infections, which I believe to be completely justified based on the progress we have made.

Healio: What are the most notable changes?

Adalja: The most notable changes are that post exposure, one does not have to quarantine but can go about life wearing a mask.

Healio: Is there anything that you don’t agree with in the new guidance? If so, what would you change?

Adalja: One area where I think there could be more guidance would be for individuals younger than 2 years of age, who cannot wear a mask. If they are exposed, we don’t want to be in a situation where daycare centers are contemplating closing or in a situation where they don’t have a way to operate.

Healio: What are the implications for primary care clinicians? Should this update affect infection prevention measures in their offices?

Adalja: The guidance isn’t really applicable to health care settings, so for the most part that should remain the same.

Healio: How likely do you think it is that COVID-19 cases will significantly increase to the point where it necessitates another shift in guidance? How do you think the public would react to a return to stricter guidelines?

Adalja: COVID-19 cases are going to ebb and flow, new variants will arise, there will be new hotspots. Future increases of cases will be occurring in an environment that is characterized by: rapid home test, vaccines, booster vaccines, antiviral drugs, monoclonal antibodies, in a population that has strong immunity against severe disease. The ups and downs of cases was always going to be the case with a virus that cannot be eradicated, efficiently spreads via the respiratory route, and is a member of a family of viruses that cause about 30% of our common colds. The goal has always been to make COVID-19 more manageable. I don’t see any need for future stricter guidance without COVID-19 being able to prompt havoc in hospitals the way it once could.

References:

• CDC streamlines COVID-19 guidance to help the public better protect themselves and understand their risk. https://www.cdc.gov/media/releases/2022/p0811-covid-guidance.html. Published Aug 11, 2022. Accessed Aug 12, 2022.
• Summary of Guidance for Minimizing the Impact of COVID-19 on Individual Persons, Communities, and Health Care Systems — United States, August 2022. https://www.cdc.gov/mmwr/volumes/71/wr/mm7133e1.htm?s_cid=mm7133e1_w. Accessed Aug. 12, 2022.