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.
Well said. She's upset about the name calling and I agree nothing is gained by that, but our society is ableist and this CDC guidance really reads to the general public like COVID is over, it's fine to go to work or school and spread it around. I'm in California too and I was heartbroken when they made that change and it's being used to roll everything back. I also don't feel the California can translate to the rest of the country. Many of us have lunch outside and lots of indoor air mitigations. We can have windows and doors open for much of the year. I guess maybe I need to read the report the CDC came out with but at the end of the day it means folks with long COVID and autoimmune issues are being hung out to dry. I'm so sorry.
suppression of the virus that causes covid is not possible. It never was. And the virus is here for good.
The mainstream covid narrative that said if we all do the "right" things for some indefinite period of time, the virus will be "defeated" in some way, was a fairy tale.
I disagree. We could have made real changes, like having sick time and wearing masks when you have symptoms. Masking when sick is the norm in places like Japan. The biggest disappointment to me is that we haven't changed anything and haven't really learned from this whole experience. I'm vilified for masking to avoid covid at this point.
The virus is here to stay. The question is whether we coexist with it intelligently or stupidly, and unfortunately, you and most others in our society have evidently selected stupidly even when intelligently was still available for selection. So, millions needlessly dead and millions more disabled or on the way to a degree of completely avoidable disability.
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.
I’ve circled back to the comments after a few days to look for just this reaction. Exactly so, and I hope YLE takes the time to sit with it. There is no escaping the truth of the bias beneath the history beneath the science.
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.
“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.”
All the guidance and this discussion is built on this false house of cards ~ no data, as it it has been purposefully removed and undermined…
There are other ways to measure infection levels besides testing/reporting. Oregon and California's hospitalization / death stats should still be reliable. Same with waste water levels and number of Paxlovids prescriptions.
Many hosptials are NOT testing for COVID upon hospitalization/death. So, I'd argue the stats are less meaningful now that everyone has (wrongly) declared COVID a thing of the past/something no worse than other common respiratory illnesses. Waste water is cool, but not a widely implemented nor well-understood metric as I've seen many trying to argue that even though waste water levels show COVID cases increasing, COVID must be "less severe" because we aren't seeing increases in hospitalization/death... recall my first point about the fact that most hospitals aren't testing anymore. It's a self-licking ice cream cone of cognitive dissonance. Paxlovid is vastly under-prescribed, and you'll note not mentioned at all in the post nor the CDC's rationale/recommendations.
It's disappointing and worrisome to learn that hospitals aren't testing and reporting for Covid upon hospitalization/death. I have been following the (very lagged) numbers of deaths on the CDC linked website. They are still enormously higher than historical flue numbers, but down from reporting prior to the end of the Emergency was declared. Now I can't apparently take any comfort even from the lower numbers because they may be to a greater or lesser degree due to incorrect reporting from changes in the data sourcing and its collection rather than real improvement in the situation.
Yes, it is immensely disappointing. The true "excess death" numbers will eventually come out (5 or 10 years from now?), but you can see the impacts in other stats like workforce demographics and death insurance actuaries. I actually see a lot more useful COVID reporting from economic publications than from what the CDC reports. We are seeing more delayed/prolonged serious illness/death with COVID due to long-term complications (e.g., Long COVID illness/death, strokes, heart attacks, etc.) as opposed to the large numbers of serious illness/death from an acute COVID infection we saw earlier in the pandemic. This is all ignored when the policy decisions are made, like this one.
I never said perfect, but what we have is insufficient to make the changes that were made. The data doesn't support the decisions which were made for political and flawed economical reasons (the economic data doesn't support it either).
Thing is, they were already pretty much abusing and manipulating rules to get more or less the same result - people coming in sick.
BEFORE:
Strict isolation guidelines, so people don't test, because they don't want to have to isolate. So people don't isolate, and they end up not getting needed treatments
AFTER:
People are more willing to test, because they don't have to isolate as long if they test positive. And at least they get treatment.
In the CDC Executive summary that accompanied the Covid-19 isolation changes, they cite a survey in which less than half of participants would do an at-home test for Covid-19 if they had cold symptoms. Just ghoulish behavior.
That's not my point. Even when tests were free, isolation requirements increased the "total cost" of testing. I'm much more comfortable dropping $10 to $12 on a rapid test to see if it's safe to hang out with my 80 year old mom who has CLL now than I was before, knowing that I won't have to tell HR every time I test positive.
And, dropping the requirement of a negative test to *leave* isolation will likely lower the demand for tests which will in turn lower the cost.
Insofar as other people (besides my mom) ask me to test in order to hang out with them, it's just a matter of whether they're worth the $10 to $12. Less than the cost of a movie. Or, I'd ask them to pay for the tests.
That’s not how supply and demand works. Prices fall when demand exceeds supply. If fewer people are testing (because they aren’t required to and it is no longer convenient), demand decreases and costs rise.
It sounds like you won’t test unless you care about the individual you might infect. That isn’t public health. That’s still individualistic, and frankly, dishonest.
These guidelines have repeatedly reinforced bad behavior not incentivized good behavior. We saw the same with dropping mask recommendations. Fewer people masked, not more.
Test-to-exit combined with high quality masking indoors outside of the home, adequate indoor ventilation and filtration, (and vaccination) are the responsible public health policies and that “Swiss cheese model” was never required by the CDC nor adequately funded by the government. Vaxx and relax is a crock.
Even with tests costing $12, I incur a lower expense if I test positive with the new guidelines than I would have before, taking missed work into account.
Thanks for proving my point. The CDC is reinforcing bad behavior with these guidelines. Not testing doesn't mean you don't have COVID. If you have COVID, you shouldn't be at work spreading it to others who may be more affected by it than you. That's the whole point of PUBLIC HEALTH. It's supposed to be about the greater good, not just about the individual nor short-term corporate profits.
Test-to-exit would mean that the government/corporations would have to do the right things by providing free/affordable testing, sufficient leave, free/affordable masks/respirators, free/affordable anti-virals, and clean indoor air.
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 can relate, having a chronic medical condition that renders me vulnerable were I to become infected. I was very sick last fall, after spending less than 10 minutes in a vet’s office picking up prescriptions. A staffer behind the desk was sniffling and hacking. I knew I was doomed, and two days later I tested positive, with positive results for 24 days. I’m still not fully recovered. I wrote a letter to the editor of my local paper calling for mandatory masking in healthcare, including veterinary facilities, and subsequently received an anonymous letter in the mail addressed to “Dear Delusional.”
you have a skewed perception of your risk. Hospitals and ERs have always been a hub of viral infections. Lots of people contracted covid in hospitals over the past 4 years, even when everyone was masked. Viruses like covid will spread. There is nothing that anybody on this planet can do about it.
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.
Yes, please address this question. Seeing the statement that half of transmission is from asymptomatic cases, I don’t feel safe eating indoors with several friends unless I am in charge of ventilation/air filtration and don’t have to sit close to anyone else.
Yes, for us, it *does* matter what virus we have, because we need antivirals to reduce the chance of hospitalization/death if they are available, and all are time-sensitive.
Yes, I'd like to know where (and when) the figure of half of all transmissions being asymptomatic comes from. I had thought there was a great deal of asymptomatic transmission early in the pandemic, but I thought that it was much less common now - see, e.g.: https://www.medpagetoday.com/special-reports/exclusives/106901 The article suggests that COVID viral load/contagiousness tends to happen later in the course of the disease now (after a few days of symptoms). This implies that there isn't much asymptomatic spread (since if people don't test positive until day 3 or 4, why would they test positive before they even get symptoms?). I'd love some clarification.
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.
Masks have never stopped any viruses in Japan....covid, the flu, you name it. It is a cultural thing over there with no evidence of efficacy backing it up.
I understand your anger, though. You were lied to for years by "experts". Now that those same experts are finally admitting the obvious reality, you feel duped.
You are wrong. And I’m saving over $6,000 a year because you are wrong about masks.
Before I started masking around disease spreaders like you, I always got 4 to 6 respiratory infections a year. They would always drop into my chest & become bronchitis, giving me asthma attacks, &/or giving me sinusitis.
Since I’ve been masking I haven’t had a single respiratory infection in 4 years. The medications I was on to treat those infections cost me, out of pocket over $6K/yr. Not to mention being miserable.
I’m quite happy to discover that a relatively inexpensive n95 mask produces such a large savings!
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.
Covid is also much more contagious - so unless you're willing to live a bomb shelter for the rest of your life, sooner or later you are going to get covid.
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.
Mask mandates are illegal, even in hospitals, in Florida. Our state government never really had accurate Covid numbers and they instructed those running it to lie. And they haven't had any tracking in over 2 years. We have never had contact tracing, tests are expensive and not provided. Only 6.89% of the population got the most recent booster. They are actively trying to make the vaccines illegal. Our SG is anti-science and an anti-vaxxer. We can't get his license revoked because the GOP owns the licensing board here. It's a shit shield and DeathSantis is actively trying to unalive us. We still have one of the highest Covid death rates in the country.
Nobody's stopping anyone from testing, but there are legit questions about whether it's more equitable at this point to expect people to pay for their own tests at this point. Not everyone *wants* to test right now, and if someone doesn't want to test, why should their tax dollars pay for tests?
Insofar as some people may have specific medical conditions require frequent testing of themselves and/or caregivers, those costs can be factored in to public assistance.
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.
Hi Bev, Just curious... have you tried the CDC recommendations for air ventilation (https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/improving-ventilation-in-buildings.html ) ? I have used 5-6/7 of the recommendations and have not had illness run through the entire group. I also do it at home/car (at least an open window) and have not been sick for the last 9 years in a row. Our office is small though and we still mask but not consistently. I suspect we are the last COVID cautious pod in CA.... So I'm just curious to see what schools have implemented what and look at the efficacy of it.
We have used air purifiers, some classrooms more consistently than others. One main factor in this outbreak is that likely “patient zero” went to a class birthday party where the majority of the class attended over the weekend …all had been invited. Then they all returned to school! Patient Zero showed symptoms two days after attending the birthday party. The birthday boy the next day and so it went on! Patient Zero tested positive for influenza A four days after attending the party and two days in school…as with Covid we do what we can in school but what happens outside of school is up for grabs! Then siblings from the first outbreak in a different class were taken sick too. One family completely isolated their sick child, who also tested positive for influenza A and Strep! Her sibling has not been sick and the parents have worn masks whenever they have been with the sick child. I suspect taking these extra measures as you are doing certainly helps.
Also one child returned on Thursday last week after being 48 hours without a fever and by the end of the day his temperature was at 103f! It’s been quite the virus…
Yes, it's many of the out- of -school events that can contribute but if schools deploy some of the changes in their ventilation and filtration I think it can minimize wide spread outbreaks. Nationally and internationally it seems that schools are at aprox. 30%chronic absenteeism. I have started to teach my patients about air quality in hopes that they can enjoy themselves and gather but to be conscious of air quality/ventilation. Sometimes it just means opening up some widows. UCSD for the most part had created outdoor auditoriums for their bigger lectures and many classes are outdoors. If sewer studies look like they are on the up (usually with the start of school and after Halloween), classes can do the same depending on the weather. I find that purifiers are not enough unless they actually pump air through at 5 cycles /hr. That pretty much means that every single particle of air needs to go through MERV 13 filter every 12 minutes or less. Openable windows that are "school approved" can help get CO2 to be less than 800ppm as an additional mitigation if you can't get the purifiers to pump that fast. Mine also includes UV light and has been tested to actually kill COVID. I really love Corsi Rosethenthol boxes in a pinch--- they cover aprox 500sq ft of space. I use ARANET 4 as a proxy for ventilation. If you have the "big bucks," you can hire an ASHRAE certified company to come and look at your cafeterias/auditoriums and classrooms to make changes recommended by CDC for "Clean buildings." The link is above. Again, I know it seems impossible with kids but I think it really works. I have not been sick for the last 9 years using these air mitigation methods. I have had close contact with COVID many many times including my household. I've continued to check with antigen/pcr testing with exposure and with blood periodically throughout the year....and so far.... no exposure enough to tick off an immune response. And I still mask at work but pick and choose where I mask out in public depending on the sewer data and building ventilation.
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.
But we never require people to isolate for the maximum number of days someone could be contagious. 10 days waa no less arbitrary than 5 or 14 or 1 or 200. The point isn't to isolate until there's zero chance of infecting others, it's to isolate until you're no more likely to be infectious than a randomly chosen person.
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?
I agree with this, assuming you started with a positive test first.
But since RATs sometimes don't pop positive until Day 5 of your illness, you can totally have 2 negative tests 48 hours apart anytime within Days 1-4 and think "Phew! I'm in the clear!" when you'd likely pop positive a day or two later... but folks might not think to test again. I totally understand why.
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.
Well said. She's upset about the name calling and I agree nothing is gained by that, but our society is ableist and this CDC guidance really reads to the general public like COVID is over, it's fine to go to work or school and spread it around. I'm in California too and I was heartbroken when they made that change and it's being used to roll everything back. I also don't feel the California can translate to the rest of the country. Many of us have lunch outside and lots of indoor air mitigations. We can have windows and doors open for much of the year. I guess maybe I need to read the report the CDC came out with but at the end of the day it means folks with long COVID and autoimmune issues are being hung out to dry. I'm so sorry.
suppression of the virus that causes covid is not possible. It never was. And the virus is here for good.
The mainstream covid narrative that said if we all do the "right" things for some indefinite period of time, the virus will be "defeated" in some way, was a fairy tale.
I disagree. We could have made real changes, like having sick time and wearing masks when you have symptoms. Masking when sick is the norm in places like Japan. The biggest disappointment to me is that we haven't changed anything and haven't really learned from this whole experience. I'm vilified for masking to avoid covid at this point.
Nothing is the norm in our country of late
The virus is here to stay. The question is whether we coexist with it intelligently or stupidly, and unfortunately, you and most others in our society have evidently selected stupidly even when intelligently was still available for selection. So, millions needlessly dead and millions more disabled or on the way to a degree of completely avoidable disability.
This is how things are working in northeastern Ohio. No need to quarantine. Come to school with anything but fever or vomiting. We learned nothing.
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.
Thank you for taking the time to carefully articulate this issue. I appreciate the illustration and your thoughtful encouragement.
Thanks for reading. I’ll step down from my soapbox now <3
I’ve circled back to the comments after a few days to look for just this reaction. Exactly so, and I hope YLE takes the time to sit with it. There is no escaping the truth of the bias beneath the history beneath the science.
Brilliantly written and right on the money.
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.
Touché!
“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.”
All the guidance and this discussion is built on this false house of cards ~ no data, as it it has been purposefully removed and undermined…
There are other ways to measure infection levels besides testing/reporting. Oregon and California's hospitalization / death stats should still be reliable. Same with waste water levels and number of Paxlovids prescriptions.
Many hosptials are NOT testing for COVID upon hospitalization/death. So, I'd argue the stats are less meaningful now that everyone has (wrongly) declared COVID a thing of the past/something no worse than other common respiratory illnesses. Waste water is cool, but not a widely implemented nor well-understood metric as I've seen many trying to argue that even though waste water levels show COVID cases increasing, COVID must be "less severe" because we aren't seeing increases in hospitalization/death... recall my first point about the fact that most hospitals aren't testing anymore. It's a self-licking ice cream cone of cognitive dissonance. Paxlovid is vastly under-prescribed, and you'll note not mentioned at all in the post nor the CDC's rationale/recommendations.
It's disappointing and worrisome to learn that hospitals aren't testing and reporting for Covid upon hospitalization/death. I have been following the (very lagged) numbers of deaths on the CDC linked website. They are still enormously higher than historical flue numbers, but down from reporting prior to the end of the Emergency was declared. Now I can't apparently take any comfort even from the lower numbers because they may be to a greater or lesser degree due to incorrect reporting from changes in the data sourcing and its collection rather than real improvement in the situation.
Yes, it is immensely disappointing. The true "excess death" numbers will eventually come out (5 or 10 years from now?), but you can see the impacts in other stats like workforce demographics and death insurance actuaries. I actually see a lot more useful COVID reporting from economic publications than from what the CDC reports. We are seeing more delayed/prolonged serious illness/death with COVID due to long-term complications (e.g., Long COVID illness/death, strokes, heart attacks, etc.) as opposed to the large numbers of serious illness/death from an acute COVID infection we saw earlier in the pandemic. This is all ignored when the policy decisions are made, like this one.
"It's a self-licking ice cream cone of cognitive dissonance" - nice metaphor.
We don't need perfect testing everywhere to understand whether the relaxed guidelines are causing more transmission.
I never said perfect, but what we have is insufficient to make the changes that were made. The data doesn't support the decisions which were made for political and flawed economical reasons (the economic data doesn't support it either).
Thing is, they were already pretty much abusing and manipulating rules to get more or less the same result - people coming in sick.
BEFORE:
Strict isolation guidelines, so people don't test, because they don't want to have to isolate. So people don't isolate, and they end up not getting needed treatments
AFTER:
People are more willing to test, because they don't have to isolate as long if they test positive. And at least they get treatment.
But they ended the free test distribution program today, so people are now less likely to test since it costs money.
In the CDC Executive summary that accompanied the Covid-19 isolation changes, they cite a survey in which less than half of participants would do an at-home test for Covid-19 if they had cold symptoms. Just ghoulish behavior.
(Significant lost income, that is)
That's not my point. Even when tests were free, isolation requirements increased the "total cost" of testing. I'm much more comfortable dropping $10 to $12 on a rapid test to see if it's safe to hang out with my 80 year old mom who has CLL now than I was before, knowing that I won't have to tell HR every time I test positive.
And, dropping the requirement of a negative test to *leave* isolation will likely lower the demand for tests which will in turn lower the cost.
Insofar as other people (besides my mom) ask me to test in order to hang out with them, it's just a matter of whether they're worth the $10 to $12. Less than the cost of a movie. Or, I'd ask them to pay for the tests.
That’s not how supply and demand works. Prices fall when demand exceeds supply. If fewer people are testing (because they aren’t required to and it is no longer convenient), demand decreases and costs rise.
It sounds like you won’t test unless you care about the individual you might infect. That isn’t public health. That’s still individualistic, and frankly, dishonest.
These guidelines have repeatedly reinforced bad behavior not incentivized good behavior. We saw the same with dropping mask recommendations. Fewer people masked, not more.
Test-to-exit combined with high quality masking indoors outside of the home, adequate indoor ventilation and filtration, (and vaccination) are the responsible public health policies and that “Swiss cheese model” was never required by the CDC nor adequately funded by the government. Vaxx and relax is a crock.
Even with tests costing $12, I incur a lower expense if I test positive with the new guidelines than I would have before, taking missed work into account.
I don't test if it results in lost income.
Thanks for proving my point. The CDC is reinforcing bad behavior with these guidelines. Not testing doesn't mean you don't have COVID. If you have COVID, you shouldn't be at work spreading it to others who may be more affected by it than you. That's the whole point of PUBLIC HEALTH. It's supposed to be about the greater good, not just about the individual nor short-term corporate profits.
Test-to-exit would mean that the government/corporations would have to do the right things by providing free/affordable testing, sufficient leave, free/affordable masks/respirators, free/affordable anti-virals, and clean indoor air.
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 can relate, having a chronic medical condition that renders me vulnerable were I to become infected. I was very sick last fall, after spending less than 10 minutes in a vet’s office picking up prescriptions. A staffer behind the desk was sniffling and hacking. I knew I was doomed, and two days later I tested positive, with positive results for 24 days. I’m still not fully recovered. I wrote a letter to the editor of my local paper calling for mandatory masking in healthcare, including veterinary facilities, and subsequently received an anonymous letter in the mail addressed to “Dear Delusional.”
I’m sorry that happened to you. It is cruel and despicable, not to mention childish, to taunt people for advocating for their health needs.
FWIW, the sender is being prosecuted for doing this to a number of people, including me.
you have a skewed perception of your risk. Hospitals and ERs have always been a hub of viral infections. Lots of people contracted covid in hospitals over the past 4 years, even when everyone was masked. Viruses like covid will spread. There is nothing that anybody on this planet can do about it.
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.
Yes, please address this question. Seeing the statement that half of transmission is from asymptomatic cases, I don’t feel safe eating indoors with several friends unless I am in charge of ventilation/air filtration and don’t have to sit close to anyone else.
Yes, for us, it *does* matter what virus we have, because we need antivirals to reduce the chance of hospitalization/death if they are available, and all are time-sensitive.
For treatment it matters. Isolation guidance is directed at the person who poses a risk to others.
Yes, I'd like to know where (and when) the figure of half of all transmissions being asymptomatic comes from. I had thought there was a great deal of asymptomatic transmission early in the pandemic, but I thought that it was much less common now - see, e.g.: https://www.medpagetoday.com/special-reports/exclusives/106901 The article suggests that COVID viral load/contagiousness tends to happen later in the course of the disease now (after a few days of symptoms). This implies that there isn't much asymptomatic spread (since if people don't test positive until day 3 or 4, why would they test positive before they even get symptoms?). I'd love some clarification.
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.
Masks have never stopped any viruses in Japan....covid, the flu, you name it. It is a cultural thing over there with no evidence of efficacy backing it up.
I understand your anger, though. You were lied to for years by "experts". Now that those same experts are finally admitting the obvious reality, you feel duped.
You are wrong. And I’m saving over $6,000 a year because you are wrong about masks.
Before I started masking around disease spreaders like you, I always got 4 to 6 respiratory infections a year. They would always drop into my chest & become bronchitis, giving me asthma attacks, &/or giving me sinusitis.
Since I’ve been masking I haven’t had a single respiratory infection in 4 years. The medications I was on to treat those infections cost me, out of pocket over $6K/yr. Not to mention being miserable.
I’m quite happy to discover that a relatively inexpensive n95 mask produces such a large savings!
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.
Covid is also much more contagious - so unless you're willing to live a bomb shelter for the rest of your life, sooner or later you are going to get covid.
I'm not living in a bomb shelter, and I've gotten COVID, but given the potential long-term effects, I'd like to minimize the number of times I get it.
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.
And apparently we also need public health experts with courage.
They, too, are cowed. Their jobs are often on the line if they don't get with the denial/minimizing program.
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.
Mask mandates are illegal, even in hospitals, in Florida. Our state government never really had accurate Covid numbers and they instructed those running it to lie. And they haven't had any tracking in over 2 years. We have never had contact tracing, tests are expensive and not provided. Only 6.89% of the population got the most recent booster. They are actively trying to make the vaccines illegal. Our SG is anti-science and an anti-vaxxer. We can't get his license revoked because the GOP owns the licensing board here. It's a shit shield and DeathSantis is actively trying to unalive us. We still have one of the highest Covid death rates in the country.
Wow, I looked at the website for the task force, and it is brilliant. Kudos to all involved for doing this important work.
I looked at your website and the viral loads are from December, right? It is impressive that it still exists. But I don't think it's updated.
Nobody's stopping anyone from testing, but there are legit questions about whether it's more equitable at this point to expect people to pay for their own tests at this point. Not everyone *wants* to test right now, and if someone doesn't want to test, why should their tax dollars pay for tests?
Insofar as some people may have specific medical conditions require frequent testing of themselves and/or caregivers, those costs can be factored in to public assistance.
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.
Hi Bev, Just curious... have you tried the CDC recommendations for air ventilation (https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/improving-ventilation-in-buildings.html ) ? I have used 5-6/7 of the recommendations and have not had illness run through the entire group. I also do it at home/car (at least an open window) and have not been sick for the last 9 years in a row. Our office is small though and we still mask but not consistently. I suspect we are the last COVID cautious pod in CA.... So I'm just curious to see what schools have implemented what and look at the efficacy of it.
We have used air purifiers, some classrooms more consistently than others. One main factor in this outbreak is that likely “patient zero” went to a class birthday party where the majority of the class attended over the weekend …all had been invited. Then they all returned to school! Patient Zero showed symptoms two days after attending the birthday party. The birthday boy the next day and so it went on! Patient Zero tested positive for influenza A four days after attending the party and two days in school…as with Covid we do what we can in school but what happens outside of school is up for grabs! Then siblings from the first outbreak in a different class were taken sick too. One family completely isolated their sick child, who also tested positive for influenza A and Strep! Her sibling has not been sick and the parents have worn masks whenever they have been with the sick child. I suspect taking these extra measures as you are doing certainly helps.
Also one child returned on Thursday last week after being 48 hours without a fever and by the end of the day his temperature was at 103f! It’s been quite the virus…
Yes, it's many of the out- of -school events that can contribute but if schools deploy some of the changes in their ventilation and filtration I think it can minimize wide spread outbreaks. Nationally and internationally it seems that schools are at aprox. 30%chronic absenteeism. I have started to teach my patients about air quality in hopes that they can enjoy themselves and gather but to be conscious of air quality/ventilation. Sometimes it just means opening up some widows. UCSD for the most part had created outdoor auditoriums for their bigger lectures and many classes are outdoors. If sewer studies look like they are on the up (usually with the start of school and after Halloween), classes can do the same depending on the weather. I find that purifiers are not enough unless they actually pump air through at 5 cycles /hr. That pretty much means that every single particle of air needs to go through MERV 13 filter every 12 minutes or less. Openable windows that are "school approved" can help get CO2 to be less than 800ppm as an additional mitigation if you can't get the purifiers to pump that fast. Mine also includes UV light and has been tested to actually kill COVID. I really love Corsi Rosethenthol boxes in a pinch--- they cover aprox 500sq ft of space. I use ARANET 4 as a proxy for ventilation. If you have the "big bucks," you can hire an ASHRAE certified company to come and look at your cafeterias/auditoriums and classrooms to make changes recommended by CDC for "Clean buildings." The link is above. Again, I know it seems impossible with kids but I think it really works. I have not been sick for the last 9 years using these air mitigation methods. I have had close contact with COVID many many times including my household. I've continued to check with antigen/pcr testing with exposure and with blood periodically throughout the year....and so far.... no exposure enough to tick off an immune response. And I still mask at work but pick and choose where I mask out in public depending on the sewer data and building ventilation.
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.
But we never require people to isolate for the maximum number of days someone could be contagious. 10 days waa no less arbitrary than 5 or 14 or 1 or 200. The point isn't to isolate until there's zero chance of infecting others, it's to isolate until you're no more likely to be infectious than a randomly chosen person.
Sounds to me like we’ve fully embraced the 2020 Great Barrington Declaration
Sounds the same to me. Utterly shameful. Hope the consulting fees are worth it.
hopefully. The truth and reality can't be denied forever.
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?
It is widely accepted that two negative tests on RAT’s 48-hours apart are an indicator for no longer being contagious.
I agree with this, assuming you started with a positive test first.
But since RATs sometimes don't pop positive until Day 5 of your illness, you can totally have 2 negative tests 48 hours apart anytime within Days 1-4 and think "Phew! I'm in the clear!" when you'd likely pop positive a day or two later... but folks might not think to test again. I totally understand why.
Anyway, Covid is a sneaky jerk and I hate it.