How Long Should You Isolate With COVID-19? Experts Are Split
Since 2021, people with COVID-19 have been told to isolate themselves for at least five days to avoid spreading the disease. But that practice may soon join most mask mandates as relics of the peak pandemic era.
The U.S. Centers for Disease Control and Prevention (CDC) is said to be weighing a new, symptom-based approach to isolation for the general public, the Washington Post reported on Feb. 13. Under that potential approach, which may be rolled out for public feedback this spring, people could leave home when their symptoms are mild and improving and they’ve been fever-free for at least 24 hours without medication, according to the Post.
That possible shift, which echoes similar moves in California and Oregon, would bring the CDC’s recommendations for COVID-19 in closer step with its guidance on the flu. When people are sick with the flu, the CDC recommends they stay home until at least 24 hours after their fever has broken naturally, or until other symptoms clear—which the agency says can take up to five days.
A CDC representative did not confirm or deny the Post’s report when asked by TIME. The agency has “no updates to COVID guidelines to announce at this time,” the representative wrote in an email. “We will continue to make decisions based on the best evidence and science to keep communities healthy and safe.”
While the shift is not yet official, experts have previously predicted that 2024 will bring a further relaxation of COVID-19 policy. “The guidance becomes lighter and lighter over time, and that actually makes sense as people build up more immunity,” Dr. Ashish Jha, dean of the Brown University School of Public Health and the Biden Administration’s former COVID-19 response coordinator, said in a January interview with TIME. “I do expect that some of those guidances will dissipate.”
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The virus itself has not evolved to become less contagious. But people’s tolerance for public-Health precautions has plummeted. Many people in the U.S. haven’t paid attention to COVID-19 guidance in a long time, says Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “You have to face reality,” he says.
Meeting people where they are may encourage them to take at least some precautions, he says. Some people who are unwilling or unable to isolate for five full days might be open to staying home for a shorter period of time when they’re acutely ill, for example.
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Not all experts are as optimistic. Lucky Tran, a Science communicator at Columbia University, called the potential end of five-day isolation periods “a reckless anti-public-Health policy that goes against Science, encourages disease spread, and puts everyone at risk. The bare minimum we should have learned from this devastating pandemic that has killed and disabled millions is that we should stay home when sick.” The rumored adjustment “would completely ignore the continued suffering” of people who are immunocompromised, chronically ill, disabled, or otherwise at heightened risk of severe COVID-19, Tran adds.
Eleanor Murray, an assistant professor of epidemiology at the Boston University School of Public Health, says it would be “really strange” for the CDC to relax its current guidance, given that even a five-day isolation period isn’t always long enough to stop the spread. Studies have shown that a significant portion of people who catch COVID-19 test positive, and thus potentially remain contagious, for longer than five days. (The CDC currently recommends that people with COVID-19 wear a high-quality mask, such as an N95 or KN95, around others for at least 10 days after getting sick; it’s not clear whether that suggestion would remain in place if the guidelines change this spring.)
The absence of symptoms also isn’t a guarantee that someone is no longer infectious, Murray says. Research has long suggested that pre-symptomatic or asymptomatic people can spread the virus, although they may not be as contagious as people who are sicker. At-home tests aren’t a perfect measure either, although they can provide some information about potential contagiousness.
Even still, Dr. Tara Bouton, an assistant professor at the Boston University Chobanian and Avedisian School of Medicine who has researched COVID-19 isolation periods, feels it's reasonable to loosen isolation guidance at this stage of the pandemic, when fewer people who get infected die or become hospitalized. That's in large part because lengthy isolation periods disproportionately penalize people whose income depends on working in person, Bouton says. “The ability to isolate is a privilege,” Bouton says, and public-health policy needs to balance the costs and benefits of asking people to do it.
Murray, however, fears that relaxing isolation guidance will make it easier for businesses to deny their employees time off to recover. If the CDC removes its current guidance—which, Murray notes, is a recommendation rather than a mandate—it would be “providing information that is not evidence-based and is not going to help people make informed decisions, but will probably be used to limit paid leave.”
So what would the experts do if they got sick with COVID-19?
Even though Bouton feels that a blanket five-day isolation recommendation is no longer necessary, she says she would stay home around that long because she’s able to—and because working as an infectious-disease doctor puts her in contact with lots of immunocompromised patients, who remain at increased risk of severe disease if they get infected.
Murray says she would stay home until her symptoms cleared up and wait until she’d gotten two consecutive negative test results, spaced out by at least a day, before exiting isolation. (Often, that approach requires more than five days of isolation, since people can test positive on at-home rapid tests for more than a week.)
Tran says he’d go even further: he’d stay home for 10 days, self-test multiple times before ending isolation, and wear a mask—as he usually does anyway—upon returning to public spaces.
Osterholm, too, says he’d stay home for five days and continue to wear an N95 in the immediate aftermath of his illness. Efforts like those are important, he says—but they’re also not everything. He’d like the public-Health community to devote more attention to encouraging vaccination among vulnerable older adults, many of whom have not gotten the latest shot, and streamlining Paxlovid access for high-risk patients.
Those efforts, Osterholm says, could save lives at a time when most COVID-19 deaths occur among people who are elderly or otherwise at high risk—and at a time when Americans are moving on from COVID-19, whether official guidance tells them to or not.
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