CDC Clarifies New COVID-19 Isolation Protocol, Outlines Efforts to Protect Children

In the wake of skyrocketing COVID-19 cases across the country and confusion regarding a controversial new isolation protocol for those infected with COVID-19, CDC officials Friday sought to clarify the agency’s recent changes to its COVID-19 guidance and outline steps it is taking to keep the country’s children safe.

In what was the first direct press call with reporters in months, CDC Director Rochelle Walensky, MD, MPH, came under scrutiny for the agency’s poor communication of late and vowed to increase transparency in the future.

“We're in an unprecedented time with the speed of Omicron cases rising and we are working really hard to get information to the American public and balancing that with the reality that we're all living with,” Walensky said. “Scientists across CDC have worked every day to stay current in our recommendations, incorporating the latest science into work and partnering with state and local public health to provide recommendations that are most feasible and can be implemented in communities across the country.”

In late December, the CDC announced those with confirmed infections of COVID-19 would only need to isolate for 5 days following symptom onset, as opposed to the initially recommended 10 days. The first day of symptoms is considered day 0, and, if after 5 additional days, an infected individual is symptom-free, they may exit isolation but are recommended to wear a well-fitted mask for another 5 days when around others. Individuals who are still symptomatic at day 5 are encouraged to continue isolating.

The update was based on data showing most transmission occurs 1 to 2 days prior to symptom onset and 2 to 3 days afterwards. Although data are based in part on research conducted on other variants, officials noted it will still be weeks until detailed data on Omicron—like that reported for other variants—become available.

The previously recommended 10-day isolation period also put a strain on a number of businesses and health care systems as more and more individuals succumbed to the transmissible variant and were thus prohibited from working for 10 days. The officials stressed that unlike prior waves in the pandemic, the current issue facing the health care system is not a shortage of beds, but a shortage of staff.

Importantly, the agency also distinguished its definitions of isolation versus quarantine, noting “you quarantine when you might have been exposed to the virus and may or may not have been infected,” and “you isolate when you are sick or when you have been infected with the virus, even if you don’t have symptoms.”

Following last month's announcement of the halved isolation period, some experts publicly questioned why the guidance did not recommend a negative test after the 5 days of isolation to better justify its ending.

“The significance of a negative antigen test late in the course of illness, after you've become positive, it's unclear what that means,” said Henry Walke, MD, MPH, the co-lead of the expanding testing and diagnostic work group for the COVID-19 response, during the call. “A negative antigen test doesn't necessarily mean that there's the absence of a virus. Regardless of the test result, wearing a well-fitting mask after those 5 days of isolation is still recommended.”

Polymerase-chain reaction (PCR) tests have been described as the gold standard for COVID-19 because they can detect even small amounts of the virus in the nostrils. But individuals who were infected with COVID-19 and may not still be contagious could test positive for weeks or months after recovery.

Conceiving of, implementing, and clearly explaining new guidance based on fluid information and data has posed a challenge for the agency. “This is hard and I am committed to continue to improve as we learn more about the science and to communicate that with all of you,” Walensky said.

During the call, Walensky, along with Walke and Greta Massetti, PhD, principle deputy incident manager for the CDC’s COVID-19 response, also stressed the importance of keeping schools open and protecting children under the age of 5 who are not yet eligible for a COVID-19 vaccine.

This includes surrounding these children with vaccinated adults and peers, and while in school, wearing masks, increasing ventilation, and testing, Walensky said. However, vaccination remains the best tool to protect children from COVID-19.

The announcements come after new data detailed increased rates of hospitalizations in children throughout the United States. For those under the age of 5, hospitalization rates stand at over 4 in 100,000 compared with 1 in 100,000 for those aged between 5 and 17, the Associated Press reports.

“While children still have the lowest rate of hospitalization of any group, pediatric hospitalizations are at the highest rates compared to any prior point in the pandemic,” Walensky said. This could be due to a myriad of factors, including more cases of COVID-19 in the country overall and increased rates of routine screening.

Compounding these stark figures are new preliminary data that also indicate rapid COVID-19 antigen tests—which many sectors have come to rely on for their accessibility and quick turn-around times—may be less effective at detecting the Omicron variant in those infected early in their disease course.