CDC eases isolation guidance for Covid and other respiratory illnesses

The Centers for Disease Control and Prevention is “sunsetting” its advice that people sick with Covid-19 isolate themselves for five days. The agency published new guidance Friday for Covid and other respiratory illnesses, suggesting people who are sick should stay at home until they are fever-free for 24 hours and their symptoms have been improving for the same period of time.

The new guidance recommends that in the five days that follow, recovering people should take measures such as masking and keeping a physical distance from others to try to reduce the risk that they will spread their illness.

“Our goal here is to continue to protect those at risk from severe illness while also reassuring folks that these recommendations are simple, clear, easy to understand, and can be followed,” CDC Director Mandy Cohen said during a media briefing outlining the new guidance.

“We are in a different place, both in the level of protection people have against these illnesses and the tools we have available.”

The guidance is for individuals. It does not change the CDC’s advice to health care facilities or nursing homes about how to reduce the risk of disease transmission within their operations.

The public acknowledgement of the new policy came two weeks after the Washington Post revealed that the CDC was about to drop its advice that people with Covid isolate for five days. The new approach has drawn criticism from people who feel that the guidance leaves people who are at highest risk from Covid infection in an even more vulnerable situation.

“The proposal would make workplaces and public spaces even more unsafe for everyone, particularly for people who are high-risk for Covid complications,” Sam Friedman, a research professor of population health at NYU Grossman School of Medicine, said in a press release issued by a group called the People’s CDC. The group is a coalition of health care professionals and researchers who have repeatedly pressed for more aggressive policies to limit Covid transmission.

But Michael Osterholm, director of the University of Minnesota’s Center for Infectious Diseases Research and Policy, said the new guidance makes sense. People with Covid are infectious before they develop symptoms, and some infected people don’t experience symptoms but can transmit the virus. Given those particulars, Covid cannot be contained through testing and isolation, Osterholm said, suggesting more effort should be focused on persuading people who are at high risk of severe disease to update their immunity by getting a Covid shot when they are available.

In outlining the new guidance, CDC officials noted that while the toll of Covid infections remains higher than that of influenza, respiratory syncytial virus, and other respiratory pathogens, the impact of Covid is drawing closer to those other viruses. Covid hospitalizations this winter are down 75% from the rate seen in January 2022, and Covid deaths have declined by 90% from that time.

Brendan Jackson, the CDC’s longtime Covid response manager, noted that where Covid was the third leading cause of death in the United States in 2021, its position on that list fell to the 10th spot in 2023. “Covid-19 is still an important public health threat, but it is not the emergency that it once was,” he said.

While the new guidance unifies the CDC’s advice on what to do when one is infected with a respiratory illness, the 25-page document highlights one important exclusion: measles. It is a respiratory pathogen; measles spreads when a susceptible person breathes in viruses coughed or breathed out by infected individuals. But containment of the highly infectious illness requires special measures, the CDC noted.

Staying home when sick is advice that is easier for some people to follow then others. Not all employers offer paid sick leave. Cohen acknowledged that fact and said the CDC guidance encourages organizations to make it easier for their workers to take care of themselves and reduce the risk they will infect other people while ill. “We recognize that that’s going to require organizations to consider policies such as working from home or paid sick leave,” she said.

In addition to adjusting its recommendations on how long infected people should isolate, the CDC guidance stresses ways to try to protect against becoming infected with Covid, flu, RSV, and other respiratory bugs.

Keeping up to date with vaccinations is critical, Cohen said, noting that over 95% of people hospitalized for Covid this winter had not received the latest Covid booster. The guidance also stresses the utility of handwashing, cleaning high-touch surfaces, and trying to improve indoor air quality.

The guidance also recommends testing when one is sick, because there are drugs for Covid and flu that can shorten the course of illness and lower the risk an individual will go on to develop severe disease. CDC survey data show that fewer than 50% of people who are sick with respiratory symptoms are testing themselves for Covid at this point. Demetre Daskalakis, director of CDC’s National Center for Immunization and Respiratory Diseases, said health officials hope that people will find the new guidance easier to follow and will be more willing to test themselves.

Jackson noted that jurisdictions that have already moved to a less stringent Covid isolation policy — California and Oregon among them — have not seen a rise in emergency room visits for Covid infections.

Correction: An earlier version of this story misstated the year in which Covid-19 was the third leading cause of death in the U.S.