California and Oregon ease Covid isolation rules, breaking with CDC

Since the start of the Covid-19 pandemic, the doctors’ orders in this country have been: If you’re positive, stay away from other people, even if you don’t have a cough or fever. However, in recent months that rule has been relaxed in two most unlikely places.

Oregon and California, among the most cautious states early in the pandemic, surprised health officials elsewhere by flouting Centers for Disease Control and Prevention guidelines and telling infected workers and school children that, as long as they had no symptoms, they could generally go about their lives.

The a new approach It was met with trepidation by some health experts in the United States, especially as sewage data showed an increase in cases caused by the new strain. But many scientists say that Covid has moved from a public health crisis to a more prominent virus among a range of respiratory risks.

“The emergency is over. Covid-19 is endemic,” said dr. Melissa Sutton, medical director for respiratory viral pathogens at the Oregon Health Authority. “We are in the second phase.”

As vaccinations, antiviral treatments and natural immunity have reduced the death rate from Covid, government officials have looked more closely at the social costs of pandemic restrictions.

Even in states where the health rules have been the toughest, officials say that for asymptomatic people, the benefits of strict isolation no longer outweigh the cost of missing school, missed work and lost income.

“The question is, is the juice worth the squeeze?” said Dr. Shira Doron, chief infection control officer for Tufts Medicine Health System in Massachusetts. “We are not able to contain the virus. So what do we get from this policy?”

Research has shown that people with Covid-19 are most likely to transmit the virus within a few days before and after the development of symptoms.

The CDC originally recommended that patients be isolated for at least 10 days. As of 2021, the CDC recommends that patients with Covid isolate themselves for five days and wear a mask until day 10, even if they have no symptoms. Most states still officially refer their residents to federal guidelines, even in politically conservative places like Arizonawhere enforcement of the pandemic was more laissez-faire than in neighboring California.

In May, Oregon became the first state to break with the CDC by relaxing isolation rules for individuals who tested positive for Covid but showed no symptoms. California officials closely followed Oregon’s experience last year and decided last week that it was safe to let people with Covid continue to attend school and work — as long as they didn’t cough or show other signs of illness.

Like the CDC, Oregon and California continue to advise infected people to mask up indoors in public and stay away from people at high risk for the disease for at least 10 days. But otherwise, both states say people with symptoms can go out in public after they’ve been fever-free for at least 24 hours and have recovered.

Doron said she agreed with the policy change, but was surprised who moved first. “California and Oregon are just not states I would expect to see this from,” she said.

In many states with liberal leaders, rigorous Covid precautions have been treated as key to the social compact and have helped save lives during the worst of the pandemic. But California schools were also among the last in the country to return to in-person classes, and businesses have struggled to recover from prolonged shutdowns and strict state policies requiring isolation, testing and masking.

Covid rules have continued to shape behavior in those states even as rates of serious illness and death have declined. Workers and their employers felt the pressure.

“We had asymptomatic individuals in the workforce who were not on sick pay who were asked to stay out for five days because of infections,” said Dr. Sutton, who helped lead the shift at Oregon last year.

The chief epidemiologist of California, dr. Erica Pan, noted that the previous policy discouraged some workers from even finding out if they had Covid because a positive result would sideline them for days.

National studies have found that attendance has failed to fully recover in schools disrupted by the pandemic, and recently cardboard after the pandemic The Oregon Department of Education found that more than 38 percent of public school students were chronically absent last year.

A variety of factors have been blamed for attendance problems, including disruptions in the relationship between students and their schools during the pandemic and learning losses that have made classroom learning even more daunting for children. But school districts in California and Oregon have had an additional barrier by requiring students to self-isolate after testing positive for Covid.

dr. Sutton noted that some schoolchildren lack “a solid week of school” despite feeling and looking good. In the meantime, she said, Covid won’t go away.

“We knew that the virus was probably the most transmissible known to mankind and that about half of all individuals did not develop symptoms,” she said. “And isolation alone, in the absence of other safeguards, did almost nothing to stop transmission.”

The effectiveness of policy is hard to glean from the natural rise and fall of infections, but Oregon’s death and hospitalization rates have remained in line with national rates — a sign, said Dr. Sutton, that the new system at least did not make things worse. And, she said, asymptomatic people feel less compelled to miss work and skip class, and are more willing to follow other Covid rules.

Encouraged by Oregon’s success, California, the nation’s most populous state at 39 million, has adopted similar guidelines, citing “reduced impacts of COVID-19 compared to previous years.”

The new guidelines have already been implemented by some of the nation’s largest school districts, including those in Oakland, Sacramento and San Diego, and by the state’s workplace regulatory agency.

Some public health experts questioned the change. Jason Salemi, an epidemiologist at the University of South Florida, noted that vulnerable Americans are still dying from Covid, at about 1,500 per week. Some evidence suggests that people infected with the new variants may be most contagious a few days after symptoms appear.

“I don’t want people coming to work and communicating with me if they have the flu and are still contagious, if they have strep throat and are still contagious, and of course if they have Covid-19 and are still contagious,” he said.

dr. Peter Hotez, vaccine expert and author of a forthcoming book, “The Deadly Rise of Anti-Science.” worried that loosening the rules in Oregon and California could further fuel biased attacks on Covid safeguards.

“Guidelines can make sense,” he said. But, he added: “What is their reason for going alone, when it could cause confusion? There’s an inherent danger in that, because Florida’s surgeon general could argue that what California is doing is no different than Florida even though we know there’s a very different political agenda at play.”

A CDC spokesman said the agency “will continue to evaluate the latest data as it considers its recommendations,” but declined to say whether the two West Coast states’ change would affect federal guidelines.

dr. Sutton said she expects other states to follow the lead of Oregon and California, regardless of what federal officials do. Already, she said, she has been invited to make a presentation about her state’s experience later this month to Washington state health officials.

“We need policies that make sense for our population and are evidence-based,” she said. “And arbitrary five-day isolation is not the most evidence-based policy.”

Apoorva Mandavilli contributed to the reporting.

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