"Not the flu": CDC's change in COVID guidance could misrepresent risks of virus, experts warn

Last Friday, the Centers for Disease Control and Prevention (CDC) made a major change to its COVID-19 quarantine guidance. The public health agency stated that as long as an infected person is fever-free for 24 hours (without using fever-reducing medicine), and other symptoms have improved, people no longer have to isolate themselves from school and work for five days. 

Before the change in guidance, the CDC recommended that when someone tested positive for COVID-19, to stay home for at least five days to reduce the chances of spreading the virus to others. News about the potential change leaked a couple of weeks ago, and was quickly criticized by many. As Salon previously reported, there was a concern that it could perpetuate America’s problematic "work-while-you're-sick" culture. At the time of the leak, the CDC said there were no updates to its guidance to be announced. Today, we know the full story, including the background data that informed the agency’s decision and the additional steps they recommend people to take to prevent spreading their infections to others once they’ve resumed their usual activities.  

There are critics on both sides of the debate: those who agree with the CDC’s change and others who are extremely concerned about the potential impact it may have on spread of a virus that still hospitalizes and kills thousands of Americans per week. Regardless, it's clear the CDC is attempting to treat COVID-19 like other common respiratory viruses, such as flu and RSV.

“This guidance provides practical recommendations and information to help people lower risk from a range of common respiratory viral illnesses, including COVID-19, flu and RSV,” the CDC states. But some public health experts tell Salon they’re concerned about this misrepresentation and that it could be a bit misleading.

Dr. Syra Madad, an infectious disease epidemiologist at Harvard's Belfer Center for Science, told Salon crafting a public health policy is both “an art and a science.” The idea is to create something that the public will follow, which is likely why the agency took a more unified approach. However, from a long-term public health policy perspective, she said it does a “disservice” to public health. 

“Lumping them all up from a better science communication perspective makes sense,” Madad said. “But at the same time, all three are distinct infectious diseases and COVID certainly does carry a higher burden of illness.” 

While hospitalizations and deaths have declined, COVID-19 is still in the top 10 leading causes of death in the United States. Both the flu and RSV aren’t in the top ten. 

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“I don't want people to think that COVID is on par with flu, because it's not on par with the flu,” Madad said. “You're seeing many more hospitalizations and deaths with COVID.”

Madad added that the U.S. population isn’t exactly a healthy one either compared to other countries. Notably, the U.S. has the highest death rates for avoidable or treatable conditions. Obesity, diabetes, and chronic cardiac disease, are associated with a higher risk of having more severe COVID-19 infections, too.

Dr. Rajendram Rajnarayanan, of the New York Institute of Technology campus in Jonesboro, Arkansas, told Salon he isn’t “totally happy with the guidelines.”

“This is an effort to simplify respiratory virus guidance so people can understand the rules and follow the rules for prevention — but then the question here is not really about simplifying disease or minimizing a disease,” he said. “COVID-19 is not the flu.” 

COVID-19 and flu should not be used in the same sentence in a guideline, he emphasized, in part because the guidelines treat COVID-19 like a disease that only spreads when people exhibit symptoms. But it’s estimated that more than half of COVID-19 transmission happens among asymptomatic or pre-symptomatic people — people who feel fine, in other words.

This doesn’t go unnoticed by the CDC, which included this data in their background summary. For this reason, the CDC justifies its decision by suggesting that exposure to infected people in a community is already a common occurrence. Regardless, Rajnarayanan said increased exposure in a community is a major concern. 

“You’re probably going to see more long COVID — because if more COVID is spreading, the risk for long COVID increases,” he said, referring to a condition in which COVID symptoms last for months or even years. “In an effort to simplify, they may actually spread it to a lot of more people and that could become problematic.”

Dr. Kaitlin Sundling, a physician-scientist, pathologist and member of the advocacy group the People’s CDC, told Salon the new guidance “makes the situation worse,” adding that in her opinion, the five-day guidance it is replacing wasn’t sufficient enough. Sundling said she recommends isolating for 10 to 14 days.

“This new guidance really has a great risk of putting people into their daily lives and daily activities while they are still contagious,” she said, adding there is a lot of variation in regards to how long someone is contagious with a COVID-19 infection, citing an article highlighting current variants and the variability of the contagious period. “It is very concerning that this reflects an overall approach to minimizing the impact of COVID when we are learning more and more every day about how COVID is harmful and that we should be protecting ourselves from infection.”

Sundling added that members of the public and employers look to the CDC and other state public health authorities for guidance and support. The change in guidance could send the message to people that they don’t have to rest when they have COVID-19 or worry about spreading it to other people. 

“Nobody wants to get other people around them sick,” she said. “They may come in contact with a large number of other people, including people who may be disabled, elderly and immunocompromised, which may be an even more devastating infection for those people.”

Appropriate paid time off would have been a nice complement to the change in guidance, all experts agreed. While it’s not the CDC’s authority, Madad said the agency could “certainly be better advocates for it.” 

“They can say, 'well, we can't build a public health policy that eliminates the five day isolation period when we don't have paid sick leave,'” Madad said. 

On a less critical note, Rajnarayanan said he strongly urges people to read the guidance themselves to understand what it is and what it isn’t. For example, as previously noted, the guidance includes data on what influenced the agency’s decision. It also encourages people to take extra steps to prevent spreading the infection once their usual activities have been resumed — such as getting vaccinated, washing hands frequently and using air filtration systems. 

“It doesn’t say if you have COVID-19 today, go back to the workforce right away,” Rajnarayanan said. “It does recommend staying at home until the fever clears, and any other major symptoms. If you have a cough, please make sure that you stay home and then once the symptom clears, I would recommend to wear a good quality mask, if you really have to go to congregate settings.”