Since January, Californians diagnosed with covid no longer need to isolate for five days. Individuals with covid symptoms can be in public 24 hours after their fever subsides. Asymptomatic people do not need isolate, though they are still advised to mask indoors when around others.
This is a major change. To understand how health officials came to this decision, I spoke with Erica Pan, California’s state epidemiologist.
Pan, who is also a pediatric infectious-disease specialist, emphasized that the coronavirus continues to cause severe disease among vulnerable individuals. But the virus’s population-level impact is far below its pandemic peak because of immunity from vaccination and previous infections, as well as effective antiviral treatments.
“If you look at this season compared to last season and prior seasons, our hospitalizations and deaths are much lower,” Pan said. Top-down requirements such as mask mandates and mandatory isolation were needed when population immunity was low and the virus was straining health-care systems. But now, she explained, “we are really recognizing the disruptive impact of some of these policies, specifically in schools and workplaces.”
Another key factor in California’s decision-making was the fact that coronavirus infections can be mildly symptomatic or asymptomatic, and many people are no longer testing every time they have a runny nose. “We really wanted to remind people that there are multiple respiratory viruses circulating,” she said. This is why they switched to a symptom-based approach: People should stay home if they have a fever and respiratory symptoms, no matter what virus they have.
Pan points to other countries that have made similar changes. Denmark no longer considers covid to have special status over other illnesses and does not require isolation after a positive test. Norway and Britain advise people to stay home if ill, but there is no set isolation period; in fact, these countries recommend testing only for symptomatic people who qualify for treatment. Even Australia, which had some of the strictest mitigation measures during the pandemic, ended mandatory isolation more than a year ago in favor of asking symptomatic people to mask and avoid settings with high-risk individuals.
I also learned that California had practical reasons for not waiting on the CDC to change its guidelines. In many states, public health recommendations are just that — suggestions that workplaces and individuals can choose to follow or not. But in California, public health policy is tied to workplace regulations. This is also true for Oregon, where health officials likewise overrode the CDC’s five-day isolation period.
Opponents of the guidance change often invoke equity, because people at risk of severe illness would suffer the most if virus transmission increased. (I have written about how the CDC can mitigate this risk.) But there is an equity argument in favor of relaxing isolation requirements, too.
As Pan explains, isolation requirements favor people who have desk jobs and can keep working from home without losing wages. This is not the case for those who must work in person, a disproportionate proportion of whom are minorities and workers who make less money. Well-meaning public guidance should not impose additional burdens on essential workers and exacerbate economic hardships.
In no way does the change in isolation policy mean that state health officials are “minimizing covid,” as some advocates have suggested. Pan emphasized the many efforts her team is making to encourage people to remain up to date with the vaccines, improve ventilation and increase access to treatment. She agrees with me that people should tailor the tools available to them based on their individual risks and the risks of those around them.
For instance, before going to dinner with her elderly parents, she will test herself and her kids. And vulnerable people such as her parents should use well-fitting N95 or equivalent masks in public settings.
At the end of the day, “it’s all about balancing priorities,” Pan said. Policymakers and the public must recognize that the interventions that were appropriate earlier in the pandemic might no longer be. The emphasis has shifted from preventing infection to reducing severe outcomes while lessening disruptions to work, school and social activities.
The balance is difficult to get right, and there will always be naysayers. But as Pan and her colleagues illustrated well through their thoughtful decision-making, this is the work of public health. The government’s guidance must always be guided by science, but there is rarely a straight line from science to policy. Health officials must do better to communicate complexity and the challenge of determining which priorities take precedence and why.
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