Should COVID isolation guidelines change? Experts weigh in amid reports of potential shift

Should there be a change in COVID guidelines and protocols for those who test positive for the virus?

According to a recent report, plans are in the works for the Centers for Disease Control and Prevention to update its isolation guidance, and the new recommendations could mean the removal of the five-day isolation period.

But is that the best move?

A new report from The Washington Post, citing "four agency officials and an expert familiar with the discussions," states that the U.S. health agency is preparing to loosen its COVID isolation recommendations for the first time since 2021.

According to the report, multiple sources said the CDC plans to recommend that those who test positive for the virus can base their isolation time on symptoms, with the new guidance allowing those who have been fever-free for at least 24 hours without medication and who have mild symptoms that are improving to end isolation. Some exceptions could still see longer isolation requirements, however, particularly for those in health care settings or who work with vulnerable populations.

The CDC told NBC Chicago there were "no updates to COVID guidelines to announce at this time."

"We will continue to make decisions based on the best evidence and science to keep communities healthy and safe," spokesperson Dave Daigle said.

But some experts say the move wouldn't be unexpected.

"I think this is expected because they're trying to give guidelines that are going to be reasonable that people will follow," Dr. Jonathan Pinsky, the director of infection control at Edward Hospital, told NBC Chicago. "We already have guidelines for other viruses like influenza about how long people need to stay at home, so they wanted to kind of get in line with those guidelines and give people a reasonable instructions about how to behave."

The Washington Post report notes that the new guidance is not yet finalized and changes could still be made. Initial timing was expected to see the new protocols released for public feedback in April, though that timing could also change.

"My reaction was, 'It's about time,' you know? We're going to have some changes in terms of these quarantines as we get year to year to year into our COVID pandemic because it is becoming, for many people, a more mild illness and it's time we sort of treat it and approach it like other respiratory viruses that we commonly see in the fall- influenza RSV - more typical durations of contagiousness and durations of isolation," said Dr. Mia Taormina, infectious disease chair at Duly Health & Care.

The current guidance has been in place since 2021, though reports of potential updates had surfaced last fall before respiratory viruses began surging in the colder months.

Last month, California announced new isolation guidelines similar to the potential update from the CDC.

There, a person who tests positive for COVID and has no symptoms does not need to isolate, according to new state health guidelines. People who test positive and have mild symptoms, meanwhile, can end isolation once their symptoms improve and they’ve been fever-free for 24 hours without medication — even if that point arrives in less than five days.

"We are now at a different point in time with reduced impacts from COVID-19 compared to prior years due to broad immunity from vaccination and/or natural infection, and readily available treatments available for infected people," the California Health Department said in a news release.

"Our policies and priorities for intervention are now focused on protecting those most at risk for serious illness, while reducing social disruption that is disproportionate to recommendations for prevention of other endemic respiratory viral infections," it added.

Experts predict the potential CDC changes that could come out this spring will likely mirror those changes seen in California and Oregon.

"We’re sort of anticipating that what may come down - again, not until April or later - from the CDC, after the viral season is over, is going to be in line with states like California and Oregon who have already reduced that quarantine time but encourage 10 days of mask wearing ... The important part here is that nothing has changed in terms of the science of this virus," Taormina said. "We still know that folks are contagious for five, six, seven days, they may still be testing positive on home tests for quite a while."

In Illinois, however, state health officials said they are "aware of the CDC’s consideration of new COVID-19 guidelines and are continuing to evaluate our own statewide guidelines."

"As we work with our federal partners to provide the most appropriate recommendations to our residents moving forward, IDPH continues to emphasize the importance of using all preventative tools to protect yourself and your loved ones from COVID-19," the Illinois Department of Public Health said in a statement. "Especially for those with certain underlying conditions, COVID-19 even today poses a more serious risk of severe health outcomes than RSV or flu. The lessons we learned during the pandemic continue to remain valuable for COVID-19 and other respiratory diseases.  This means washing your hands frequently if you have a cough/cold/respiratory symptoms and even considering wearing a mask to prevent the transmission of those germs to others. You should also get tested if you are experiencing symptoms, as it can help you access time sensitive treatments for Flu and Covid-19.  And, let’s not forget vaccinations. Vaccinations continues to remain the most effective tool to protect you from serious illness from these respiratory infections."

Nationally, COVID-19 illnesses seem to have peaked alongside flu, data showed, though experts cautioned that things could change on a regional level. CDC data indicates coronavirus-caused hospitalizations haven’t hit the same levels they did at the same point during the last three winters, but COVID-19 is putting more people in the hospital than flu.

That's why some experts say while changes may be in the works, it won't mean abandoning guidance to stay home if you're ill and masking will be more important than before.

"It's important to know that once you have COVID or another virus, you can still spread it especially in those first few days. And so it'll still be important to wear a mask to protect other people," Pinsky said. "If you're going leaving your home, especially if it's only after a day or two of infection, you're still going to be infectious. So it's important to wear the mask to protect other people for full 10 days."

"We're not saying that this is any less contagious, that we can go out and about - it's just for people that are having improvement in their symptoms. otherwise healthy hosts, they are less likely to be meaningfully contagious once those fevers are gone and their symptoms are getting better," Taormina said. "So with some mask wearing and picking and choosing your activities, we should be in a better place ... the messaging stays the same. If you're not feeling, well stay home."

Taormina even added that it could make things safer in some cases.

"I'd rather have folks staying home for a day or two, going back to work or to their usual activities on day three or four if they're feeling better, as opposed to not testing at all because they don't want to be hung up on this mandatory five days away from work away from their activities," she said.

Here's a look at the current guidelines and where things stand:

What are the current COVID protocols?

The guidelines for isolating have not changed since May, according to the Centers for Disease Control and Prevention.

Here are the protocols listed by the agency:

Regardless of vaccination status, you should isolate from others when you have COVID-19, the CDC reports.

You should also isolate if you are sick and suspect that you have COVID-19 but do not yet have test results. If your results are negative, you can end that isolation.

If you test positive for COVID-19, you should stay home for at least five days and isolate from others in your home. The CDC notes that people are "likely most infectious during these first five days."

When you have COVID-19, isolation is counted in days, as follows:

If you had no symptoms:

• Day 0 is the day you were tested (not the day you received your positive test result)
• Day 1 is the first full day following the day you were tested
• If you develop symptoms within 10 days of when you were tested, the clock restarts at day 0 on the day of symptom onset

If you had symptoms:

• Day 0 of isolation is the day of symptom onset, regardless of when you tested positive
• Day 1 is the first full day after the day your symptoms started

Other guidance for those who test positive:

• Wear a high-quality mask if you must be around others at home and in public.
• Do not go places where you are unable to wear a mask.
• Stay home and separate from others as much as possible.
• Don’t share personal household items, like cups, towels, and utensils.
• Monitor your symptoms. If you have an emergency warning sign (like trouble breathing), seek emergency medical care immediately.

If you had no symptoms, you can end your isolation after day five, but for those who experience symptoms, that line might be different, the CDC notes.

Those who have mild symptoms can end isolation after day five if they are fever-free for 24 hours, without using fever-reducing medication, but those with more moderate or severe illnesses will need to wait until day 10.

Those who have mild symptoms that are not improving should also wait until those symptoms are improving and they are fever-free for 24 hours.

Those with more severe illness may also want to consult with their doctor before ending isolation and could need a viral test to end their isolation period.

Despite ending isolation, those who test positive should continue to avoid people and mask through at least day 11, according to the CDC guidelines.

What to know about testing?

Those who have symptoms are urged to take a COVID test as soon as possible, though officials continue to caution that a negative at-home test may not be as reliable as a positive one.

"If your antigen test is negative, take another antigen test after 48 hours or take a PCR test as soon as you can," the CDC states.

Those who don't have symptoms but may have been exposed should wait five days after exposure to take a test, according to the CDC guidance.

While many Americans may have unused tests in their homes, it's important to check the expiration dates, experts say.

The Food and Drug Administration has extended the expiration dates of many popular at-home test products, which means some such kits may still be safe to use, CNBC reports. You can check expiration dates for each brand using a page on the FDA's website.

Public health experts have continued to urge people to test, particularly as numbers rise.

But beyond the at-home test kits, lab PCR tests have become more challenging to access - and in some cases more expensive - since the national public health emergency ended in May.

Antigen and PCR testing is still available at major pharmacies, like Walgreens, for example, but out of pocket costs could apply, depending on your insurance provider.