By Landon Gray

The CDC released updated and streamlined COVID-19 guidelines for the U.S. public, marking a major shift in recommendations made during the early days of the pandemic from protecting against infection to mitigating serious disease.

According to the CDC, high levels of vaccine- and infection-induced immunity, along with the availability of effective treatment and prevention tools, have significantly reduced the risk for severe acute illness and associated hospitalizations and deaths (MMWR Morb Mortal Wkly Rep 2022 Aug 11. http://dx.doi.org/10.15585/mmwr.mm7133e1).

“We’re in a stronger place today as a nation, with more tools—like vaccination, boosters and treatments—to protect ourselves, and our communities, from severe illness from COVID-19,” said Greta Massetti, PhD, MPH, the branch chief of the CDC’s Field Epidemiology and Prevention Branch, who served as first author of the new guidance. “We also have a better understanding of how to protect people from being exposed to the virus, like wearing high-quality masks, testing and improved ventilation. This guidance acknowledges that the pandemic is not over, but also helps us move to a point where COVID-19 no longer severely disrupts our daily lives.”

The new guidance excludes some of the main pandemic-era precautions, such as social distancing and quarantining after exposure to COVID-19. Instead, the CDC now recommends that physical distance is only one component of protection, and that risk is relative to the setting. Also, once a person has been exposed to COVID-19, that individual should wear a high-quality mask for 10 days and get tested on day 5, instead of quarantining.

The CDC also now recommends the following:

• People with weakened immune systems should take tixagevimab+cilgavimab (Evusheld, AstraZeneca), if prescribed to prevent COVID-19 “before” exposure.
• If exposed, instead of quarantining, a person should wear a high-quality mask for 10 days and get tested on day 5.
• In the instance of a positive COVID-19 test result, the infected person should stay at home for at least five days while isolating themselves from others—a person is most likely infectious during the first five days—and wear a high-quality mask when around other people.
• After five days, if an infected person is fever-free for 24 hours without the assistance of medication and improvement in symptoms have been observed or never had symptoms, that person may end isolation.
• After a COVID-19 infection, individuals should wait at least 11 days before coming into contact with someone who is at high risk for severe illness related to COVID-19.
• In cases of moderate illness—those who experience shortness of breath or difficulty breathing¬—or severe illness, such as hospitalization, due to COVID-19 or a weakened immune system, isolation is recommended though day 10.
• Consult with a doctor before ending isolation in instances of severe disease or a weakened immune system.
• Testing is no longer recommended for asymptomatic people without a known exposure.
• Physical/social distancing is no longer a main objective, but be aware of the surroundings in particular settings, including local COVID-19 community levels and proper ventilation systems when assessing risk.
  

“Updated recommendations from the [CDC] on masking and isolation post-COVID-19 infection are a positive sign that advances in vaccines and treatments have significantly lowered the risk of severe illness, hospitalization and death from the disease. However, with much of the country experiencing higher than 20% transmission rates, we cannot let our guard down,” said Daniel P. McQuillen, MD, FIDSA, the president of the Infectious Diseases Society of America (IDSA), in a statement responding to the CDC’s new recommendations.

“The changes in the recommendations are thanks in large part to the work of infectious diseases physicians, scientists and other frontline health care and public health workers and demonstrate the powerful effects of vaccination. As the pandemic continues to evolve, it is critical that we continue to protect ourselves and others around us by isolating and masking when appropriate,” he added.

Both the CDC and IDSA continue to recommend vaccination and staying up to date on boosters against COVID-19 as the most essential way to remain protected from COVID-19.