In the new COVID-19 guidelines released on August 11th, the US Centers for Disease Control and Prevention (CDC) made a change in their recommended infection control measures that are geared more towards increasing the focus on individuals understanding their own risk level for developing severe COVID-19 disease, making a personal decision about what level of risk is acceptable to them, and then giving guidance on how to mitigate those risks. We know that COVID-19 is still very much circulating both in the US and globally. Although there has been a shift with recent case surges this summer, in that hospitalization rates and deaths have not come anywhere close to reaching the worst levels as seen with past wave.
It is important to keep in mind that the CDC’s new recommendations are geared more towards streamlining precautions for those who are immunocompetent to help them prevent severe disease, hospitalization, and death. However, serious concerns are raised as to how these measures will affect the immunocompromised who remain at higher risk for severe disease by lessening recommended preventative measures for the public. The question remains, will moving away from broad public health mandates to instead putting emphasis on individual choice lead to increased exposure, illness, and death among society’s most vulnerable?
The CDC appears to have taken on the belief that the nation should move away from preventing infection with restrictive measures such as quarantines and social distancing and instead focus mainly on preventing severe disease. The updated guidelines recommend that COVID-19 prevention practices continue to some degree but are dependent both upon a person’s individual risk of becoming severely ill and on the amount of COVID-19 infection in their community. Individuals are still encouraged to pay close attention to their COVID-19 community level of spread for their jurisdiction.
When COVID-19 community levels are high, the CDC still recommends wearing a KN5 or N95 mask indoors. And they are also continuing to promote the importance of being up to date with COVID-19 vaccinations (although there is no longer any differentiation in the recommendations based on vaccination status). Here is a summary of the recent changes:
- Known Exposure: People who have known exposure to the virus (but have not yet tested positive) no longer need to quarantine, regardless of vaccination status. However, keep in mind that the CDC did say that the purpose of this change was to “limit social and economic impacts.”
- Routine Testing: Utilizing routine testing to screen for COVID-19 in workplaces for individuals who must work in close proximity with others will no longer be recommended for people who do not have COVID-19 symptoms. They did make the exception that this does not apply in certain high-risk settings like nursing homes and prisons.
- Social Distancing: Keeping at least six feet of distance or more from others to reduce the risk of exposure is no longer recommended, which is a big shift from guidance that had been in place since the early days of the pandemic. However, the recommendations put more emphasis on ventilation.
- Contact Tracing: The updated guidelines also say that contact tracing, another hallmark during the pandemic, should be limited to hospitals and certain high-risk group-living situations such as nursing homes. They also de-emphasize the use of regular testing to screen for COVID-19,
- Guidelines for Schools: The test-to-stay protocol has been an alternative to mandatory quarantine for schools to keep children in classrooms if they have had known exposure to a classmate. Testing is no longer required for those who have had known exposure in order to stay in school. The recommendation is now to handle known exposures in schools with masking rather than a quarantine.
- How to Isolate When Infected: Immunocompetent individuals who have tested positive for COVID-19 can stop wearing masks if their symptoms have improved and they test negative twice in a row. Individuals should take a rapid antigen home test initially on day five after their symptoms began, and then again on day seven. (The first day of symptoms is considered day zero).
- Ending Isolation After Infection: Wear a high-quality KN95 or N95 mask and avoid being around people who are more likely to get very sick from COVID-19 until day 10, specifically those who are older, have high-risk factors, and especially those who are immunocompromised. People with moderate symptoms such as shortness of breath and those who required hospitalization should stay home for at least 10 days. The updated guidance from CDC did not recommend a test to end isolation, although many infectious disease specialists are still recommending this approach. The guidance states that if at 5 days, you have been fever free for 24 hours without the use of medication and your symptoms are improving (or you never had symptoms), you can end isolation. However, we know data indicates that a high percentage of people can be infectious beyond day five. Some infectious disease experts still recommend having two negative rapid antigen home tests taken 24 hours apart before ending isolation.
- Masking: When the COVID-19 community level is high (as it currently is in 41% of counties in the US) the CDC continues to recommend that everyone wear high-quality KN95 or N95 masks indoors. The guidance also specifies that those with high-risk factors should wear quality masks when the community level is medium, (as it is now in an additional 39% of counties in the US).
- Rebound Infections: There’s new advice on what to do if individuals experience a rebound of COIVD-19 symptoms. All individuals who have experienced improving symptoms but then symptoms worsen again should start isolation all over again at day zero and talk with their healthcare provider.
- Special Considerations for the Immunocompromised: The updated guidelines did specifically advise people who are at higher risk for severe illness to take additional measures beyond the recommendations, including the use of Evusheld. They also recommended if someone has moderate or severe illness or has a weakened immune system that they should fully isolate through at least day 10, and ALL of those who are immunocompromised should now talk to their doctor about when to end their isolation period after an infection. The CDC also stressed the use of antiviral medications in those who qualify as being high-risk for developing severe disease.
CLL Society continues to urge those with CLL / SLL (who are all considered immunocompromised regardless of treatment status) to practice social distancing, wear a tightly fitted KN95 or N95 mask anytime you are around others outside of your household, avoid large crowds especially indoors, practice good hand hygiene, stay up-to-date with COVID-19 vaccinations, obtain Evusheld as recommended, if you have symptoms test early and often so you can qualify for antiviral therapies, and make sure you have a COVID-19 Action Plan in place that is easily accessible should you ever need it.
Keep learning and stay well.
Robyn Brumble, MSN, RN
Director of Scientific Affairs & Research
CLL Society
