Four years after the Covid-19 pandemic swept through the United States, forcing lockdowns and killing 1. 1 million people, the United States is one of the lax measures that can cement the prestige of Covid like any other virus, similar to the flu or RSV: instead of putting forward an era of isolation for those who test positive for Covid, The U. S. Centers for Disease Control and Prevention (CDC)U. S. officials plan to introduce a symptom-based system, anonymous company officials recently told the Washington Post. If a user has not had a fever for 24 hours and other symptoms improve, they will be free to leave isolation; It can be assumed that those who do not have symptoms or fever will never self-isolate, even if they are positive. This may simply be one component of a new, broader “pan-respiratory guidance,” a topic that CDC Director Mandy Cohen has said. allegedly addressed last fall.
While the public’s appetite for Covid news is low, experts say the stakes in communication about respiratory illnesses are deceptively high. An ongoing bird flu outbreak and a small but deadly swine flu outbreak in Colombia this year have public fitness experts worried about another flu pandemic. to have virtually confidence in the coming years. As government officials have downplayed Covid, flu and other deadly viruses in recent years, shortening Covid isolation times and lifting restrictions, misinformation about measles, some other respiratory illness, has proliferated. A measles outbreak is ravaging Europe lately, and Florida has now reported cases at just one school. State officials who have appeared on the map by opposing Covid measures have said that the two hundred unvaccinated students who have been exposed do not want to be quarantined.
Then there’s the risk of new viruses appearing; Dangerous new coronaviruses have emerged every seven to nine years for the past two decades, which means we may soon see another. Meanwhile, Covid continues to hospitalize and kill people, even with the rules in place; The situation can also get worse when other people are asked to move more freely while still being contagious.
In theory, we are more prepared than ever to counter those threats. “Covid has a greater amount of access, information and awareness than we have [of] seasonal respiratory viruses,” said Erin Sorrell, a senior researcher at the Johns Hopkins Center. Covid has taught us that those viruses you breathe in can be airborne, that other asymptomatic people can still infect others, and that the time it takes to prevent the loss of the virus can vary widely; We’ve also learned what we can do to mitigate those challenges.
The CDC has yet to make the proposed adjustments public, or even verify the Post’s report. When I reached out to the company for comment on this article, a spokesperson responded that there were “no COVID rule updates to announce at this time” and that the company “will continue to make more productive evidence- and clinical-knowledge-based decisions to keep communities healthy and safe. But the rules laid out through the Post’s three resources would run counter to available studies on Covid and other respiratory illnesses. — possibly with the aim of satisfying economic and political interests. The consequences, whether on contagion or public trust, if the company were to come up with such plans, could simply be severe.
Symptoms, which school and painting policies depend on, are a strangely bad way to estimate whether you may be contagious. In January 2020, a family member was hospitalized with RSV and I began researching how long I deserved to stay home if I had it too. . The CDC says that other people with RSV can be contagious for 3 to 8 days. But symptoms can persist for weeks, while other people have only minor symptoms, making the agency’s recommendation to “stay home when sick” impenetrable. (Some young children and others with weakened immune systems can transmit the virus for up to a month, even if symptoms go away, researchers say. )In general, the sicker you are with RSV, the more contagious you are. But RSV only manifests as a fever. Fever usually lasts two to four days in very young children, while adults are less likely to have a fever, making recommendations based on symptoms difficult.
Similarly, the flu is contagious about a day before symptoms appear, if any, and five to seven days after, according to the CDC. Usually, the viral load peaks around the second day of symptoms, which, if you have a fever, is also the time when the fever rises. But only two-thirds of people with the flu have increased symptoms. And there are stark differences between influenza A and influenza B; Only 7. 5% of patients with influenza B have a fever, compared to about 40% of patients with influenza A, and the viral load and symptoms are much more similar to those of influenza A than those of influenza B.
Above all, the symptoms of Covid do not seem to correspond to the contagiousness. “Interestingly, from the beginning of the pandemic we knew that asymptomatic Americans could simply shed the virus and transmit it to others,” Sorrell said. With omicron, only 22% of other vaccinated people had a fever, and this is even less unusual among those who had won a booster dose; Despite this, according to one study, 80% of patients were still positive after five days. About 40% of young people remain contagious once symptoms have disappeared; A quarter are contagious after seven days and 10% are still contagious after 10 days.
About two-thirds of people with Covid are still contagious after five days, according to another study; The authors recommended a policy of ending isolation only after a negative test for two days. Now that more people are immune, viruses don’t peak until the fourth day of symptoms, according to a new study, compared to the onset. of the pandemic, when symptoms tended to appear just when the viral load was at its peak. This means that symptoms may simply improve just as patients manage to reach their peak contagious period. In some other recent, albeit small, preprint, Covid patients exhaled gigantic amounts of virus. In their breath for 8 days, and even those with mild and moderate symptoms had high exhalation levels, the others severely ill exhaled more virus (probably because they coughed or sneezed).
With Covid, “fever has never been a marker of contagion. Honestly, if we are, right now, we’re just making things up,” said Lara Jirmanus, a clinical instructor at Harvard Medical School and a member of the People’s CDC. , an organization that provides fitness recommendations and policies.
Still, the established recommendation for keeping young people in poor health at home after school or daycare is to wait 24 hours after the fever has appeared on its own; If they don’t have a fever, they can still attend. When there are recommendations for workplaces, they are more or less the same: if you don’t have a fever, it passes.
The symptom-based formula was born out of a lack of resources, in addition to a lack of available evidence. You can’t take your child to the doctor every time he or she wakes up with a stuffy nose.
But the Covid-19 pandemic has revolutionized home checks. “One of the things that has drastically replaced is the ability to do self-tests that tell you with some certainty if you’re positive,” said Adolfo Garcia-Sastre, a professor of microbiology at the Icahn School of Medicine at Mount Sinai. “If you’re positive, you’re positive, whether it’s for the flu, RSV or Covid, regardless of symptoms. This is the ultimate vital point you need other people to know: “A positive check means you have the virus; Even if you don’t have symptoms, you have the virus and as long as you’re positive, you can spread it. Antigen controls, that is, those received in a humble home. “Home control was the most productive marker of Covid infection, than symptoms or PCR tests, according to a study.
Rapid checks aren’t just for Covid; they also exist for RSV and influenza. In the U. S. , those checks are almost done in doctors’ offices, yet in other countries, a single affordable home check can detect all those respiratory viruses at once. at-home test in the U. S. The U. S. is looking for Covid and the flu, but its value is prohibitive. )The FDA can simply allow affordable at-home respiratory breathing tests to be used; By now, many of us are familiar with the procedures. And it’s possible that government projects will simply make controls, as well as vaccines and treatments, less difficult to locate and more affordable. “We have things available, but are they accessible?” Sorrell asked.
CDC rules may also include “a flowchart or resolution tree of communication strategies,” Sorrell said. “If you meet those kinds of criteria, here’s what we recommend,” because it’s not a one-size-fits-all approach, but it should be transparent and concise. And you want to think about how to provide the data and at the same time make it accessible, and you want to see accessibility to vaccines and at-home testing.
Masks are another proven way to prevent the spread of not only Covid, but also the flu and RSV, the rates of which dropped dramatically as masks and other precautionary measures became more prevalent. “If masks are recommended for Covid, then masks are also recommended. “for the flu,” Garcia-Sastre said. This is where consistent rules for all three diseases come into play. “If you’re looking to compartmentalize diseases under other masking rules, especially now with the public’s appetite for public fitness rules, it can be very tricky,” Sorrell said.
“If I were the head of the CDC, I would also propose to the U. S. government to require paid leave for people in poor physical condition, because it benefits all staff,” Jirmanus said. And the rules should be consistent with existing laws, such as the Americans with Disabilities Act, he said. People with chronic illnesses or physical condition situations that put them at risk of serious illness or disability due to Covid infection will be provided with suitable hotels to reduce the risk of getting sick.
And any guidance also reminds the public that some people are more vulnerable than others. Babies under six months, for example, cannot be vaccinated against Covid or flu, and monoclonal antibodies against RSV are rare, making younger children one of the most vulnerable. “If I have RSV, I probably wouldn’t come into contact with a newborn. Here’s something I want to clarify: If you have RSV, “Don’t come into contact with a newborn, because it’s one of the very high-risk groups,” Garcia-Sastre said.
But it’s not enough to advise other people in poor health to stay away from other vulnerable people. This assumes that those Americans can still be identified, or that they feel comfortable disclosing their status, or even that they know they might be vulnerable. Forget that we’re all connected: what about younger siblings or older grandparents at home, pregnant people, transplant recipients, or cancer patients?back of combat.
Above all, it’s imperative that the CDC’s recommendations for breathing viruses (and everything else) be evidence-based and update guidance as we refine our knowledge about those diseases, not because the economy needs workers. “Talk about more than science to the American public?” asked Jimanus. When CDC fails to provide intelligent data, it shapes public opinion and modifies other people’s opinions,” which can simply “undermine other people’s autonomy to make their own decisions, because then other people don’t have the data they want to make decisions independently. ” Make decisions that are consistent with your own values.
Everyone I’ve talked to has said the same thing: You want to have rules that are undeniable enough for everyone to understand, from the school administrator who gets panicked emails from parents to your boss telling you whether or not you should come to work. But as science evolves, recommendations need to be updated regularly. And barring the effects of new studies, you can’t replace science just because other people are tired.
CDC makes recommendations, not mandates or laws. Other federal agencies, states, local entities, employers, and Americans must abide by the rules and how to do so. But if the CDC undermines the science from the start, bona fide actors have no way to do it. orientate. After years of discord and accusations of bias, issuing rules that forget everything we’ve learned from Covid would be a devastating goal.
Melody Schreiber is a journalist and editor-in-chief of What We Didn’t Expect: Personal Stories About Premature Birth, in November 2020.