The CDC has capitulated to the "urgency of normal" crowd with its new COVID guidelines.
I — and others — object particularly to some of these points in their new guidance.
Eric Topol, MD, expressed frustration that the new guidance doesn't take into account issues that he's raised previously:
He stresses that community transmission levels should be the measure for taking action, not community levels.
Community levels are indicators of hospital strain, defined by CDC as "(1) new COVID-19 hospital admissions per 100,000 population in the last 7 days; (2) percent of staffed inpatient beds occupied by patients with confirmed COVID-19 (7-day average); and (3) new COVID-19 cases per 100,000 population in the last 7 days."
Community transmission levels, on the other hand, refer to the presence and spread of SARS-CoV-2 and may be much higher than hospitalizations. With Omicron, community levels are low even though there is widespread transmission of the virus going on in the community.
Community transmission levels are currently high in 94% of counties, while community levels are high in only 40%.
So, if you focus on community levels, as CDC does now, you will be drastically underestimating the extent of COVID in the community. And how will we even know by how much, since surveillance for COVID is now frowned upon? This stance fits nicely with the let's-pretend-there-is-no-problem crowd.
Ellie Murray, ScD, MSc, MPH (@EpiEllie), and Julia Raifman, ScD, MSc (@JuliaRaifman), both from Boston University, argue that delays in recommending masking until community levels are high are too long, and will fuel preventable illness, hospitalizations, and death. Omicron is the prime example, being a more highly transmissible variant. Overall, it has also led to fewer hospitalizations and is therefore undercounted by the focus on community levels.
The CDC no longer requires students to test negative to return to school. They are prioritizing keeping children in school (and parents working). But Michael Mina, MD, PhD, from the Harvard T. H. Chan School of Public Health, and others have shown that many people shed virus long past 5 days. President Biden tested positive (a sign of shedding virus and infectivity) on day 16.
So, this policy could lead to school outbreaks, said Anne Sosin, MPH, a public health researcher at Dartmouth College. "[W]ishful thinking is not the strategy for getting [to a stable school year]", she told Medical Xpress.
And now, people with COVID can end isolation if they are fever-free for 24 hours without the use of medication and they are without symptoms or their symptoms are improving — don't bother with those pesky tests. (Though if you do test, the CDC now recommends three, rather than the former two, rapid antigen tests over 2 or 3 days to rule out infection, since the tests have more false negatives with this variant.)
According to the CDC, quarantining at home after a close exposure to someone with COVID is no longer necessary. And there is no difference in recommendations for those who are unvaccinated.
The threshold for masking is community levels, which provides little guidance for an individual. The CDC does say that "at medium and high COVID-19 Community Levels, persons at high risk for severe illness and their contacts should consider wearing well-fitting masks or respirators." Still, they offer little guidance as to what those are except noting that: "Loosely woven cloth products provide the least protection, layered finely woven products offer more protection…" and that OSHA-approved respirators (including N95s) offer the highest level of protection.
In their specific recommendations for schools and ECEs (early childhood education centers, aka daycare), the CDC says, "Anyone who chooses to wear a mask or respirator should be supported in their decision to do so at any COVID-19 Community Level, including low…[programs] should consider flexible, non-punitive policies and practices to support individuals who choose to wear masks regardless of the COVID-19 Community Level."
Consider non-punitive policies for kids who wear masks? That's mighty kind of them! Is this the best they can do?
Working While Sick
Saying people only need to isolate for 5 days will likely soon be translated by employers to require employees to be back after 5 days. And, as Katelyn Jetelina, PhD, MPH, notes, this will drive inequities, as poorer folks will not be able to stay home, with predictable effects on COVID transmission.
The guideline urges schools to allow for "flexible, non-punitive and supportive" paid sick leave policies, and for excused absences when students are ill.
"Avoid policies that incentivize coming to school while sick, and support children who are learning at home if they are sick," they add.
This is a problem for the children's parents if they have to stay home with their sick kids. How many people have any sick leave, let alone paid leave for a sick child? For example, hospitals I've worked in always had policies that punished staff that took sick leave. Certainly, this is a problem for others, such as blue-collar workers, who have minimal leave, let alone paid leave.
These are my initial reactions to the new CDC guidance.
Any precautions become "personal responsibility," a convenient way of absolving both the government and businesses of any responsibility to keep their workers and community safe. This is no longer public health and is an abdication of the CDC's historic responsibility.
We can — and the CDC must — do better.
She survived 25 years in solo practice in rural Cumberland, Maryland, and now works part-time. She especially loves writing about ethical issues and advocating for social justice. Follow her at drjudystone.com or on Twitter @drjudystone.
© 2022 WebMD, LLC
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Judy Stone. CDC Abdicates Responsibility: New COVID Guidelines Are a Travesty - Medscape - Aug 18, 2022.