Shifts in pandemic-related policies and recommendations have become part of the new normal, as data involving the coronavirus evolve, and a Montgomery County, Maryland, public health expert wants to give people perspective about decisions involving when to end isolation after testing positive for COVID-19.
Current guidance from the Centers for Disease Control and Prevention recommends that members of the general population who have tested positive for the coronavirus isolate for five days, upon which “if they have no symptoms or symptoms are resolving,” they can leave the house while continuing to wear a mask around others for an additional five days.
The American Medical Association is among groups and individuals criticizing the recent change in the guidance from 10 to five days.
“These are guidelines — guidance. Because there’s some individuality that has to be applied to these. This is not a one size fits all recommendation,” the county’s Assistant Chief Administrative Officer Earl Stoddard said.
Stoddard has a doctorate in cell and molecular biology and has a graduate degree in public health from the Johns Hopkins Bloomberg School of Public Health.
Stoddard said the changes in isolation recommendations are not public health recommendations, but instead they are social changes designed to keep society operating.
The omicron variant has a shorter incubation period and most coronavirus transmission occurs early in the course of infection states: “Spread of the omicron variant has the potential to worsen staffing shortages and increase supply chain challenges, which jeopardize industry, education, and other systems that are essential to maintain a functioning society and economy,” the CDC said.
Stoddard said that society functioning is a very different thing from whether people should feel comfortable going to visit immunocompromised loved ones five days after a positive COVID-19 test.
“You should be making some decisions that are a little bit more stringent when it comes to people who are immunocompromised or otherwise in a condition where they could have a severe outcome from COVID-19,” he said.
Stoddard’s comments, during a virtual COVID-19 briefing on Wednesday, resulted from a reporter’s question about using rapid antigen tests as a barometer of whether it would be appropriate to end quarantine. The rapid tests are only 95% effective in detecting the presence of disease.
“Rapid tests are a lot better than a personal assessment of whether you’re doing better with symptoms. The CDC’s own data says that after five days, roughly 31% of people are still going to be infectious. Rapid test would help us narrow that number from 31% to a much lower number on the back end [of isolation], and that’s why we’re encouraging it,” he said. “That’s why actually the CDC says it is the ‘best approach’ to include a rapid test on the back end.”
The Food and Drug Administration has not approved rapid tests for that type of narrow utilization. But, Stoddard emphasizes that both the CDC and Montgomery County officials agree it’s a helpful way to proceed.
“We’ve attempted to go with best approaches throughout the pandemic,” Stoddard said. “And so this is a case where it is absolutely a better approach to tie a rapid test on the back end of an isolation period when you tested positive earlier and you’re trying to get out of it. Because again, 31% of people at day five are still infectious.”
The CDC said that after day five, “modeling data suggest that close to one-third of persons remain infectious after day 5 and can potentially transmit the virus.”
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