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  • Dr. Bow Tie

COVID-19 CDC Guideline Update: "We're Tired of Arguing, Do Whatever You Want"

The CDC released updated guidelines this weekend regarding COVID-19. They are...frustrating. Dr. Leana Wen, former public health leader-turned-gaslighter, states that the CDC is just “meeting people where they are”, reflecting how people actually are “living with the virus” because they’re “done with the pandemic” and frustrated with protective measures. Just because people are fed up doesn’t mean we stop trying to CONTROL the spread of disease, though. *Sigh*...let's state the guidelines first.



The Community Levels (the sugar-coated, capitalism-driven depictions of COVID-19 spread used to make things seem better than they are) are remaining the same. Not like we really did much based on those, anyway.

If you test positive for COVID-19, you must still isolate.

  • If asymptomatic or mildly symptomatic (no shortness of breath, difficulty breathing, or increased oxygen requirements), isolate for five days; if 24 hours fever-free by that time (without medication) (or never had symptoms), you can exit isolation and wear a well-fitting mask around other people for the next 5 days

  • If you have moderate or severe symptoms, isolate through 10 days (and if you required hospital services, talk to your doctor before exiting)

  • If feasible, stay at home, do not go anywhere, and if possible isolate from COVID-negative family members during isolation

  • Wear a mask if you need to be around anyone during isolation, and through day 11 even after leaving isolation

  • If you have symptoms, they end, and then they restart - your isolation restarts

Exposure to COVID-19:

  • No quarantine required anymore, just wear a mask for 10 days

  • Test on Day 5 and again if you develop symptoms

No Longer Recommended:

  • No longer recommending screening of asymptomatic people without known exposures in most settings

  • Physical distancing (“consider the risk in a particular setting”)

These do not apply to hospitals, nursing homes and other congregate settings, or travel.


Why I Disagree:

We literally just witnessed the President of the United States test positive for COVID-19 and he was still positive until day 7 (and unfortunately are about to watch the First Lady go through the same). If he left isolation at day 5, that would be two days of exposing those around him, even with a mask (Republican leaders would have had a field day even though they don't care in most other contexts). Test-to-exit is a strategy that makes sense! We know that rapid antigen tests are probably more reliable from a community transmission standpoint because they are a better reflection of when you are most infectious. When they turn negative after being positive, you can feel confident that you are no longer infectious!


We also know that asymptomatic or presymptomatic transmission of COVID-19 is very real and very common, so stopping screening and asymptomatic testing (for example, when you're about to go gather with friends) will only serve to promote further transmission. Even some hospitals have stopped testing patients who get admitted without respiratory symptoms, resulting in small outbreaks.


We also know that ventilation is insufficient in most work places and schools, and not enough corrective construction has been made to amend that. This begs the question of why we feel abandoning physical distancing is now safe? If we really cared about the well-being of children, the government would allocate money to that.


Further, we have stalled hard in vaccination rates. 67% of Americans have received two doses, but only 32% have received their boosters. The fact that so many people are still getting infected with COVID-19 is NOT an indication that vaccines don't work. It's an indication that we did not vaccinate widely enough (nationally or globally), and the virus found human hosts in unvaccinated folks where it could replicate, spread, and evolve to escape vaccines. Despite what so many anti-vaccine pundits keep trying to falsely portray, we never actually stated that vaccines would be perfect or some miracle pandemic exit, because they never have been, especially not individually - they work en masse. However, we need more people to actually take them (and we also should start boosting people under 50 sooner rather than later).


Some people are trying to say that the CDC is finally acknowledging “natural immunity.” First of all, all immunity is natural, because it's still YOUR immune system. Infection-induced immunity vs. vaccine-induced immunity is still YOUR immune system. As Regina George would say, "stop trying to make 'natural immunity' happen." It's a fake phrase used to create a false dichotomy.



Unfortunately, infection-induced immunity continues to be less reliable, lower in duration, and sometimes at too great of a cost compared to vaccine-mediated immunity. Vaccines are still protective and, at the very least, reduce the severity of illness and likelihood of hospitalization. However, because not enough people are vaccinated, the collective protection has some serious holes in it, which puts everyone at risk, whether vaccinated or unvaccinated.


The Lancet: Infectious Diseases published a study utilizing modeling based on COVID-19 deaths which showed that vaccines averted anywhere from 14 to 20 MILLION deaths worldwide, but that it also could have prevented so many more - with better uptake both in the United States and in other countries, we could have prevented 1 in 5 of the excess deaths that actually did occur.

So many we could have prevented. So many we could still prevent if we layer protections including vaccines, distancing, ventilation, screening/testing, and...masks.


Thankfully, the CDC is still emphasizing the importance of masking because we know those work. I've posted many times with multiple articles showing that a well-fitting mask (preferably KN95, KF94, or N95 in the Omicron era, but emphasis on well-fitting) really does prevent spread (not 100%, nirvana fallacy enthusiasts). The latest, linked below, shows how N95 and other respirator masks helped healthcare workers with direct exposure reduce COVID-19 infections by 40%.


And finally, I have not even discussed the less immediate, but still worrisome, specter that is Post-Acute Sequelae of COVID-19, or "Long COVID." More and more, my colleagues and I are seeing people with persistent shortness of breath, oxygen requirements, new heart conditions, brain fog and memory issues, nerve damage (headaches, long-lasting pain, loss of smell/taste, etc.) and other symptoms - not due to the vaccine, but to the COVID-19 viral infection. I'll link to the CDC MMWR that shows an increase in those conditions and others in children, including blood clots, renal failure, and (just like other viral infections can trigger in kids) diabetes. Remember when people kept trying to hype up fears about long-term effects of vaccines? We now have millions of doses given, proving that none of the vaccine remains in your body while your immune system works, meaning it can’t cause delayed effects beyond 8 weeks. On the other hand, we do not know how long these Long COVID symptoms will remain in people (some have had problems for over a year now), or what others we may discover. Not to mention Long COVID is difficult to diagnose because you have to rule out other causes and it's not always directly noticed after infection. Further, insurance companies may choose not to cover treatments for it or may see it as a preexisting condition. It's worth taking precautions and layering protections to avoid these consequences, and there is a way to do that while still enjoying our lives!


"Meeting people where they are" doesn't mean caving into misguided pressures. Leading doesn't mean following disinformation. Public health is NOT "individual risk and measures." I have had my disagreements with the Center for Disease Control's recommendations from time to time. Unfortunately, the main problem now is political pressure, from an administration that wants to declare a win in time for midterm elections, and corporate pressure, from companies like Delta Airlines writing to demand that they be allowed to exploit workers again. I worry about how this focus on "individual protections" will leave us open to yet another wave in the fall once schools reopen and winter sends us indoors.


I don't believe in masking forever, but I believe there is a time and place based on transmission rates and public/community risk. I believe in layering these protections. I recommend continuing to wear masks indoors when infections/transmission rates are high (like they are now), installing better ventilation in workplaces and schools, testing frequently (and making it cheaper/free/easier than just insurance reimbursement, Biden administration!) before gatherings, and getting vaccinated/boosted.


As always, I welcome your questions.


https://www.nytimes.com/interactive/2020/us/covid-19-vaccine-doses.html

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00320-6/fulltext

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2795150

https://www.cdc.gov/mmwr/volumes/71/wr/mm7131a3.htm

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