Thank you for sharing your perspective. I can’t say I agree with all of it, but I respect you. I know from the research that many, if not most, folks don’t get a fever with COVID. The change in guidance here in CA is only a few months old so I can’t imagine there’s enough data to prove it hasn’t been problematic.
My daughter’s school in CA allows and encourages students with COVID-19 to return to school and does not require them to mask. Both myself and my husband are immunocompromised and my daughter has had classmates with COVID sitting next to her causing her a great deal of anxiety. I have LC and have been disabled by it. I can’t take another infection.
This guidance leaves families like ours feeling abandoned.
People don't mask anymore so they won't be masking even if they have symptoms. I have ZERO confidence or trust that the average person will do what they should in this situation because they have refused to do so for 4 years. People will not follow 'guidence' if it's at all inconvenient for them to do so. They have stopped caring if they ever did at all. Vulnerable communities can no longer safely participate in public life. I no longer see a future where I will ever be comfortable in public spaces again. I'm tired of being told that we have to trust people to do the right thing because they don't. They have proven that time and again. I'm tired of being a hostage in my own home. And I'm tired of the bad messaging and complete lack of accountability from agencies like the CDC for contributing to this problem instead of fixing it.
I think public health professionals should be allowed to say that some policies or experts are anti-public health, ableist, participating in eugenics, and calling for death because they’ve reached different conclusions. I would like to see more of a strong moral conviction towards preserving life in public health experts and professionals - not a the “immuno-compromised will fall by the wayside,” type attitude which is baked into many of these policies. I’d like public health professionals to learn more about eugenics history, how that history is intertwined with public health.
For example, the entire basis of statistics and concepts of the “average” person from the invention of the “mean, median, and mode” are ideas that didn’t exist always in scientific thinking. This idea of “normal” has created a mindset of normal = people who can work and a striving to be “above average.” These concepts are related to eugenics thinking from this mindset. I bring this up only to say, it might feel extreme or hurtful when people begin to bring these concepts to light, but they do have a basis in reality and history and are born from equally important and meaningful research in the disability studies community. Many of these experts (bc I know who she’s talking about here) are also disability history experts or allies to immuno-compromised or disabled people.
Another similarity, sometimes white people get feedback from BIPOC that makes them feel defensive or outraged at the specific wording of the remarks. When white people do not have a basis of understanding about internalized white supremacy or how white supremacy is baked into history and concepts then, when they receive negative feedback from BIPOC people, the white people will then participate in defensiveness and white fragility. BIPOC ppl who shared their opinion are often tone-policed. I think this same pattern of fragility, defensiveness, and tone policing can happen to other groups, such as disability activists, when they share their very real and intimate understanding and knowledge of eugenics thinking in society and their opinions on how our current government structures and experts perpetuate eugenics thinking through policies such as the CDC’s new isolation guidance. Please imagine if this were feedback that someone had named some action that someone had taken as potentially racist, and their reaction among the professionals was “you’re name calling me! We are good people and we got into public health because we have a good heart! How dare you call me racist.” If you know anything about white supremacy and structures, you would know that it is very possible to inadvertently act in racist ways due to ignorance. Take this metaphor and apply it to the disability community and realize how mistaken it is to then say the same lines of defensiveness towards the disability studies and community.
Instead of feeling outraged and defensive, how helpful would it be for public health professionals to be able to pause and reflect on:
-How does the policy affect the safety of the most marginalized among us?
-How does this policy impact immuno-compromised and disabled individuals?
-How can I take care of the big feelings that are coming up inside of me right now in a way that helps me take care of me while supporting my ability to lean into the feedback and learn from it?
-Where can I look for further resources on disability studies and what what steps can I take to advance my own learning on this topic?
All of the above action steps would be more helpful than commenting on hurt feelings because of statements that while the language is strong (just as strong as the concept of racism, deploying the metaphor), but could be true. Anything that serious of an accusation, merits investigation and reflection, not deflection and defensiveness.
Naming eugenics thinking is not the same as name-calling.
My 10-yo tested positive for 16 days last month and only had a fever of 99F for about 1 day! The school said they could come back after 5 days (old CDC guidance) regardless of subsequent positive tests with NO OTHER MITIGATIONS, so I know that the next time they will say it is fine to come back after 1 day. We are privileged enough to be able to keep them home and isolate while practicing effective airborne mitigations (swiss cheese model) and prevented any household spread to the other 5 members of our family, including high risk. Most are not privileged nor properly informed. Schools and employers will absolutely ABUSE this guidance (and continue to ignore all of the "cautionary" advice), which is frankly, NOT INFORMED BY SCIENCE. When the majority of folks aren't testing/reporting, then the stats from California, Oregon and the UK are utter nonsense. Your colleagues are right to call out the abandonment of EFFECTIVE PUBLIC HEALTH GUIDANCE, because this ain't it. You even acknowledge that YOU WON'T FOLLOW THIS GUIDANCE. You are going to test-to-exit, which is the right thing to do but is NOT WHAT THE CDC RECOMMENDED. Your cognitive dissonance is showing.
Nothing really changes because lots of people wouldn’t or couldn’t follow the guidelines. Our local school district said anything but fever and vomiting- come to school! Completely ignoring other respiratory symptoms. I guess the CDC is on that page too, which, to me, continues to make them an entity that I am losing trust in. Their vaccine recommendations are not based in science; last week’s TWIV episode had both Vincent and Daniel frustrated that recommendations are being made without data. So, good luck to us all, I guess.
I feel abandoned by a once trusted ally. I am severely immunocompromised and my disease carries a high mortality, risk should I contract Covid. Vaccines are ineffective in providing me protection, and I have poorly functioning B and T Cells. My biggest problem with the CDC guidelines change and with support for that change is that it does not allow for people like me to get medical care. I cannot risk being in an environment of unmasked, potentially Covid infected people in an ER or hospital. How hard would it be to maintain respect for the life of people like me, or “grandma in the nursing home “, by adding the minimal requirement of masking and precautions in medical facilities? I can accept sacrificing restaurants, movies, visiting with others and other participation in society. But I am ill and dependent on medical care. This is a matter of my life and death. I am deeply disappointed to be sacrificed for society’s convenience. And I feel deeply disappointed with YLE.
I appreciate very much the clarity with which you parse the guidance. The extent of asymptomatic transmission is certainly significant, and the ability of rapid tests to pick it up appears nil. For those of us at higher risk because of age or other variables, it would be helpful, if you’re inclined in a future post, to reiterate what we should do, including offering your views on the best use of the tools available such as masks, ventilation, covid wastewater trends, and rapid tests.
I went into Covid with what now appears to be naive faith in WHO & CDC. This latest policy change is the last nail in the coffin that contains my now death faith.
I now have zero trust in epidemiologists. Et tu Brutes. This stab in the back from you hurts, I admit it.
You have all Failed to mount a successful public relations campaign to advocate for masking, the way the government in Japan has.
You have all Failed to advocate for higher indoor air quality, which is the #1 passive measure that could impact viral transmission.
You have all Failed to advocate for Paid Sick Leave, instead you adjust your recommendations to our Capitalist Oligarchs’ greed & subsequent mistreatment of workers. Shame on All of You.
I don't understand how the type of virus doesn't matter to you. COVID has a much much higher risk of long-term health problems (not just long COVID, but organ damage, vascular damage, brain damage) than the flu, RSV and the common cold. Perhaps since any symptoms could be an indication of possible COVID (and testing has not been made available/reliable), we should treat any sickness as we would COVID and isolate (or at least mask if isolation not possible) until the contagion period is over.
People do what they're legally allowed to do. If government permits people to go back to work earlier than even 10 days, let alone with no specific number of days, people will do it. Put something in place that mandates days off, and put teeth into it with employers being required to provide paid COVID sick leave (possibly paid for by tax dollars, as in other countries) and people will take the time off. It's that simple. All we need is politicians with courage.
There may be no difference in public behaviors according to the virus in our willfully ignorant, head stuck in the sand, we accept no realities that are even modestly uncomfortable or inconvenient world, but there are huge differences in impacts between viruses both in individuals and societally for the long term. The CDC and public health professionals know that, but have surrendered and given up the fight, and regulating according to what the majority will bear in their ignorance is absolutely an abdication of duty. Reinforcing COVID-19 to be "just like the flu" when scientifically and consequentially it is anything but "like the flu" is irresponsible, and we have consigned our children and our children's children to a much bleaker future because those in public health largely lack the fortitude and courage to still speak TRUTH and are transparently subservient to their political and economic masters. Sorry, not sorry - but the CDC has consistently disregarded the science to move the paradigm back to a pre-pandemic state that we will not see again despite the public's determination that it will be so, and this is just more of the same. Those in public health can rationalize and explain endlessly with protestations of good will and good faith, but when the impact continues unabated on the most vulnerable in our society both economically and physically, you'll pardon me for saying I'm not really interested in crediting those protestations of good will and good faith.
We have a local public health task force (in Maine) and we supply and encourage testing. I am sorry that testing was not incorporated or discussed. It seems like the antigen test is a valuable tool and if the option is there, which it should be, then use the information it provides. For those that want to use it that would be best.
We work with the community to talk about when risk of transmission is high and have a covid-o-meter. We use wastewater results in our local, and surrounding, areas as well as other information.
What I find really sad is that for a disease that can cause serious long term sequelae and can be contagious for 10 days, 5 day isolation was ever instituted. Five day isolation is inadequate for serious transmission reduction. So when 5 days wasn't really working any better than 1 day, the response was to go to 1 day after symptom reduction rather than going back to 10 days. Sure there is lots of data to show 1 day is no worse than 5 days, but it is not being compared to 10 days. It seems there is no desire to actually reduce transmission below a level to just keep our hospitals functioning. We have reached herd apathy.
Thank you for your reflections on these changes. I am a school principal at a private school and have continued to follow all CDC guidance as well as our local health department. For us the big issue right now is flu and RSV. We have had 15 out of 20 children come down with influenza A over a 7 day period, which has also spread to their families including three pregnant mothers. It is troubling when families send their children back to school when they are clearly unwell but are fever free. For this particular virus we ended up closing the classroom for a long weekend and have instituted a 48 hour fever free without medication and much improved symptoms to try and stop the spread of flu. In our infant classroom we have had 4 out of 6 infants with RSV and 3 were hospitalized. It has been scary how virilent these viruses have been. Covid remains in our community but messaging is difficult when the CDC seem to be saying "24 hours fever free" and you are good to go! We will see what the rest of the spring brings our way - respiratory illnesses have been quite brutal on our small community so far this winter.
Thanks for this summary and your commentary — very clarifying!
I feel like antigen testing has largely disappeared from any guidance language and I understand why — tests are expensive and no longer a tool that can be recommended broadly for that reason. But if one has the resources to spend on tests, what’s the best way to use them as a tool in this toolbox?
Specifically, I’m curious whether using antigen testing to mark the *end* of the transmission period is a reliable approach?
I have had Covid twice and both times have only had symptoms for a day (I tested because of known exposures). I have family that is high risk, so use testing to determine when it’s safe to assume I’m no longer contagious — is that right? If an antigen test is negative on the back end of an infection, is that a reliable measure of the end of infectiousness? Or is the infectious period likely shorter and this is excessively cautious?
Thank you for sharing your perspective. I can’t say I agree with all of it, but I respect you. I know from the research that many, if not most, folks don’t get a fever with COVID. The change in guidance here in CA is only a few months old so I can’t imagine there’s enough data to prove it hasn’t been problematic.
My daughter’s school in CA allows and encourages students with COVID-19 to return to school and does not require them to mask. Both myself and my husband are immunocompromised and my daughter has had classmates with COVID sitting next to her causing her a great deal of anxiety. I have LC and have been disabled by it. I can’t take another infection.
This guidance leaves families like ours feeling abandoned.
People don't mask anymore so they won't be masking even if they have symptoms. I have ZERO confidence or trust that the average person will do what they should in this situation because they have refused to do so for 4 years. People will not follow 'guidence' if it's at all inconvenient for them to do so. They have stopped caring if they ever did at all. Vulnerable communities can no longer safely participate in public life. I no longer see a future where I will ever be comfortable in public spaces again. I'm tired of being told that we have to trust people to do the right thing because they don't. They have proven that time and again. I'm tired of being a hostage in my own home. And I'm tired of the bad messaging and complete lack of accountability from agencies like the CDC for contributing to this problem instead of fixing it.
I think public health professionals should be allowed to say that some policies or experts are anti-public health, ableist, participating in eugenics, and calling for death because they’ve reached different conclusions. I would like to see more of a strong moral conviction towards preserving life in public health experts and professionals - not a the “immuno-compromised will fall by the wayside,” type attitude which is baked into many of these policies. I’d like public health professionals to learn more about eugenics history, how that history is intertwined with public health.
For example, the entire basis of statistics and concepts of the “average” person from the invention of the “mean, median, and mode” are ideas that didn’t exist always in scientific thinking. This idea of “normal” has created a mindset of normal = people who can work and a striving to be “above average.” These concepts are related to eugenics thinking from this mindset. I bring this up only to say, it might feel extreme or hurtful when people begin to bring these concepts to light, but they do have a basis in reality and history and are born from equally important and meaningful research in the disability studies community. Many of these experts (bc I know who she’s talking about here) are also disability history experts or allies to immuno-compromised or disabled people.
Another similarity, sometimes white people get feedback from BIPOC that makes them feel defensive or outraged at the specific wording of the remarks. When white people do not have a basis of understanding about internalized white supremacy or how white supremacy is baked into history and concepts then, when they receive negative feedback from BIPOC people, the white people will then participate in defensiveness and white fragility. BIPOC ppl who shared their opinion are often tone-policed. I think this same pattern of fragility, defensiveness, and tone policing can happen to other groups, such as disability activists, when they share their very real and intimate understanding and knowledge of eugenics thinking in society and their opinions on how our current government structures and experts perpetuate eugenics thinking through policies such as the CDC’s new isolation guidance. Please imagine if this were feedback that someone had named some action that someone had taken as potentially racist, and their reaction among the professionals was “you’re name calling me! We are good people and we got into public health because we have a good heart! How dare you call me racist.” If you know anything about white supremacy and structures, you would know that it is very possible to inadvertently act in racist ways due to ignorance. Take this metaphor and apply it to the disability community and realize how mistaken it is to then say the same lines of defensiveness towards the disability studies and community.
Instead of feeling outraged and defensive, how helpful would it be for public health professionals to be able to pause and reflect on:
-How does the policy affect the safety of the most marginalized among us?
-How does this policy impact immuno-compromised and disabled individuals?
-How can I take care of the big feelings that are coming up inside of me right now in a way that helps me take care of me while supporting my ability to lean into the feedback and learn from it?
-Where can I look for further resources on disability studies and what what steps can I take to advance my own learning on this topic?
All of the above action steps would be more helpful than commenting on hurt feelings because of statements that while the language is strong (just as strong as the concept of racism, deploying the metaphor), but could be true. Anything that serious of an accusation, merits investigation and reflection, not deflection and defensiveness.
Naming eugenics thinking is not the same as name-calling.
My 10-yo tested positive for 16 days last month and only had a fever of 99F for about 1 day! The school said they could come back after 5 days (old CDC guidance) regardless of subsequent positive tests with NO OTHER MITIGATIONS, so I know that the next time they will say it is fine to come back after 1 day. We are privileged enough to be able to keep them home and isolate while practicing effective airborne mitigations (swiss cheese model) and prevented any household spread to the other 5 members of our family, including high risk. Most are not privileged nor properly informed. Schools and employers will absolutely ABUSE this guidance (and continue to ignore all of the "cautionary" advice), which is frankly, NOT INFORMED BY SCIENCE. When the majority of folks aren't testing/reporting, then the stats from California, Oregon and the UK are utter nonsense. Your colleagues are right to call out the abandonment of EFFECTIVE PUBLIC HEALTH GUIDANCE, because this ain't it. You even acknowledge that YOU WON'T FOLLOW THIS GUIDANCE. You are going to test-to-exit, which is the right thing to do but is NOT WHAT THE CDC RECOMMENDED. Your cognitive dissonance is showing.
Nothing really changes because lots of people wouldn’t or couldn’t follow the guidelines. Our local school district said anything but fever and vomiting- come to school! Completely ignoring other respiratory symptoms. I guess the CDC is on that page too, which, to me, continues to make them an entity that I am losing trust in. Their vaccine recommendations are not based in science; last week’s TWIV episode had both Vincent and Daniel frustrated that recommendations are being made without data. So, good luck to us all, I guess.
I feel abandoned by a once trusted ally. I am severely immunocompromised and my disease carries a high mortality, risk should I contract Covid. Vaccines are ineffective in providing me protection, and I have poorly functioning B and T Cells. My biggest problem with the CDC guidelines change and with support for that change is that it does not allow for people like me to get medical care. I cannot risk being in an environment of unmasked, potentially Covid infected people in an ER or hospital. How hard would it be to maintain respect for the life of people like me, or “grandma in the nursing home “, by adding the minimal requirement of masking and precautions in medical facilities? I can accept sacrificing restaurants, movies, visiting with others and other participation in society. But I am ill and dependent on medical care. This is a matter of my life and death. I am deeply disappointed to be sacrificed for society’s convenience. And I feel deeply disappointed with YLE.
I appreciate very much the clarity with which you parse the guidance. The extent of asymptomatic transmission is certainly significant, and the ability of rapid tests to pick it up appears nil. For those of us at higher risk because of age or other variables, it would be helpful, if you’re inclined in a future post, to reiterate what we should do, including offering your views on the best use of the tools available such as masks, ventilation, covid wastewater trends, and rapid tests.
I went into Covid with what now appears to be naive faith in WHO & CDC. This latest policy change is the last nail in the coffin that contains my now death faith.
I now have zero trust in epidemiologists. Et tu Brutes. This stab in the back from you hurts, I admit it.
You have all Failed to mount a successful public relations campaign to advocate for masking, the way the government in Japan has.
You have all Failed to advocate for higher indoor air quality, which is the #1 passive measure that could impact viral transmission.
You have all Failed to advocate for Paid Sick Leave, instead you adjust your recommendations to our Capitalist Oligarchs’ greed & subsequent mistreatment of workers. Shame on All of You.
I don't understand how the type of virus doesn't matter to you. COVID has a much much higher risk of long-term health problems (not just long COVID, but organ damage, vascular damage, brain damage) than the flu, RSV and the common cold. Perhaps since any symptoms could be an indication of possible COVID (and testing has not been made available/reliable), we should treat any sickness as we would COVID and isolate (or at least mask if isolation not possible) until the contagion period is over.
People do what they're legally allowed to do. If government permits people to go back to work earlier than even 10 days, let alone with no specific number of days, people will do it. Put something in place that mandates days off, and put teeth into it with employers being required to provide paid COVID sick leave (possibly paid for by tax dollars, as in other countries) and people will take the time off. It's that simple. All we need is politicians with courage.
There may be no difference in public behaviors according to the virus in our willfully ignorant, head stuck in the sand, we accept no realities that are even modestly uncomfortable or inconvenient world, but there are huge differences in impacts between viruses both in individuals and societally for the long term. The CDC and public health professionals know that, but have surrendered and given up the fight, and regulating according to what the majority will bear in their ignorance is absolutely an abdication of duty. Reinforcing COVID-19 to be "just like the flu" when scientifically and consequentially it is anything but "like the flu" is irresponsible, and we have consigned our children and our children's children to a much bleaker future because those in public health largely lack the fortitude and courage to still speak TRUTH and are transparently subservient to their political and economic masters. Sorry, not sorry - but the CDC has consistently disregarded the science to move the paradigm back to a pre-pandemic state that we will not see again despite the public's determination that it will be so, and this is just more of the same. Those in public health can rationalize and explain endlessly with protestations of good will and good faith, but when the impact continues unabated on the most vulnerable in our society both economically and physically, you'll pardon me for saying I'm not really interested in crediting those protestations of good will and good faith.
We have a local public health task force (in Maine) and we supply and encourage testing. I am sorry that testing was not incorporated or discussed. It seems like the antigen test is a valuable tool and if the option is there, which it should be, then use the information it provides. For those that want to use it that would be best.
We work with the community to talk about when risk of transmission is high and have a covid-o-meter. We use wastewater results in our local, and surrounding, areas as well as other information.
(https://www.bewellyarmouth.org/)
We also try to help people with different risk tolerance decide what they will do in different scenarios.
Thanks for your newsletters as they help us with these goals.
What I find really sad is that for a disease that can cause serious long term sequelae and can be contagious for 10 days, 5 day isolation was ever instituted. Five day isolation is inadequate for serious transmission reduction. So when 5 days wasn't really working any better than 1 day, the response was to go to 1 day after symptom reduction rather than going back to 10 days. Sure there is lots of data to show 1 day is no worse than 5 days, but it is not being compared to 10 days. It seems there is no desire to actually reduce transmission below a level to just keep our hospitals functioning. We have reached herd apathy.
Thank you for your reflections on these changes. I am a school principal at a private school and have continued to follow all CDC guidance as well as our local health department. For us the big issue right now is flu and RSV. We have had 15 out of 20 children come down with influenza A over a 7 day period, which has also spread to their families including three pregnant mothers. It is troubling when families send their children back to school when they are clearly unwell but are fever free. For this particular virus we ended up closing the classroom for a long weekend and have instituted a 48 hour fever free without medication and much improved symptoms to try and stop the spread of flu. In our infant classroom we have had 4 out of 6 infants with RSV and 3 were hospitalized. It has been scary how virilent these viruses have been. Covid remains in our community but messaging is difficult when the CDC seem to be saying "24 hours fever free" and you are good to go! We will see what the rest of the spring brings our way - respiratory illnesses have been quite brutal on our small community so far this winter.
Sounds to me like we’ve fully embraced the 2020 Great Barrington Declaration
Thanks for this summary and your commentary — very clarifying!
I feel like antigen testing has largely disappeared from any guidance language and I understand why — tests are expensive and no longer a tool that can be recommended broadly for that reason. But if one has the resources to spend on tests, what’s the best way to use them as a tool in this toolbox?
Specifically, I’m curious whether using antigen testing to mark the *end* of the transmission period is a reliable approach?
I have had Covid twice and both times have only had symptoms for a day (I tested because of known exposures). I have family that is high risk, so use testing to determine when it’s safe to assume I’m no longer contagious — is that right? If an antigen test is negative on the back end of an infection, is that a reliable measure of the end of infectiousness? Or is the infectious period likely shorter and this is excessively cautious?