National Nurses United (NNU) condemned new COVID-19 recommendations by the Centers for Disease Control and Prevention (CDC) that shortens the isolation period for the public to as little as 24 hours if symptoms abate and the person is non-febrile.
“Slashing the COVID isolation guidance from five days to potentially just 24 hours based on the presence of fever ignores the available scientific evidence that people with COVID infections often remain infectious well beyond five days,” the NNU said in a statement.1
“We are deeply disheartened to once again see the CDC weakening protections for public health, which will mean more transmission, illness, hospitalizations, and cases of long COVID,” stated Jean Ross, RN, president of the NNU. “We must protect nurses’ health and safety so that they can continue to care for their patients, especially due to the staffing crisis that many hospitals face.”
In guidance on respiratory infections released March 1, 2024, the CDC recommendations suggest returning to normal activities if — for at least 24 hours — symptoms are improving overall and no fever is present without the use of fever-reducing medication.2
The move “reflects the progress we have made in protecting against severe illness from COVID-19,” Mandy Cohen, MD, director of the CDC, said in a statement.3 “However, we still must use the commonsense solutions we know work to protect ourselves and others from serious illness from respiratory viruses — this includes vaccination, treatment, and staying home when we get sick.”
The largest nursing union in the nation, the NNU tried to head off the CDC in a Feb. 23, 2024, letter to Cohen.4 The letter cited research that concluded that a “recommendation to end isolation based solely on the presence of improving symptoms risks releasing culture-positive, potentially infectious individuals prematurely.”5
In a frequently asked questions section, the CDC said the previous recommendation for a minimum isolation period of five days plus a period of post-isolation precautions was created during the public health emergency with lower population immunity and fewer tools to prevent serious outcomes.
“It is important to note that the guidance doesn’t end with staying home and away from others when sick,” the CDC states.6 “The guidance encourages added precaution over the next five days after time at home, away from others, is over. Since some people remain contagious beyond the ‘stay-at-home’ period, a period of added precaution using prevention strategies, such as taking more steps for cleaner air, enhancing hygiene practices, wearing a well-fitting mask, keeping a distance from others, and/or getting tested for respiratory viruses can lower the chance of spreading respiratory viruses to others.”
The NNU letter also accused the CDC of not prioritizing the prevention of long COVID, a post-infection condition with multiple symptoms that can be debilitating.
“Long COVID can develop even after initial mild or asymptomatic infections; in fact, a large multi-country study reported that 90% of people living with long COVID had initial mild infection,” the NNU stated in the letter.7 “While the CDC recognizes that long COVID is a condition, it has not adequately prioritized prevention of long COVID in crafting public health and infection prevention guidance. Research indicates that, at best, vaccines and anti-viral medications offer only partial reduction in long COVID risk and that reinfections with SARS-CoV-2 significantly increase the risk of developing long COVID.8,9 This means that the only way to prevent long COVID is to prevent infections.”
The CDC’s revised respiratory guidelines are aimed at the community, and there were no changes in recommendations for healthcare settings. In adopting a “unified approach” to respiratory pathogens — including SARS-CoV-2 — the CDC stressed the following in an executive summary of the document:10
As a result, in part, to the high degree of population immunity, there now are fewer hospitalizations and deaths caused by COVID-19. Weekly hospital admissions for COVID-19 have decreased by more than 75% and deaths by more than 90% compared to January 2022, the peak of the initial Omicron wave.
Protective tools, such as vaccines and treatments, that decrease risk of COVID-19 disease, particularly severe disease, now are widely available. “Complications like multisystem inflammatory syndrome in children are now also less common, and prevalence of long COVID also appears to be decreasing,” the CDC stated.
The CDC emphasized “active” recommendations on core prevention strategies that include:
• Staying up to date with vaccinations for COVID-19, influenza, and respiratory syncytial virus (RSV) and RSV if eligible.
• Practicing good hygiene by covering coughs and sneezes, washing or sanitizing hands often, and cleaning frequently touched surfaces.
• Taking steps for cleaner air, such as bringing in more fresh outside air, purifying indoor air, or gathering outdoors.
REFERENCES
- National Nurses United. NNU condemns CDC’s decision to shorten the five-day isolation guidance for Covid-19. Published March 06, 2024. https://www.nationalnursesunited.org/press/nnu-condemns-cdc-decision-to-shorten-isolation-guidance#
- Centers for Disease Control and Prevention. Respiratory virus guidance. Last reviewed March 1, 2024. https://www.cdc.gov/respiratory-viruses/guidance/respiratory-virus-guidance.html
- Centers for Disease Control and Prevention. CDC updates and simplifies respiratory virus recommendations. Last reviewed March 1, 2024. https://www.cdc.gov/media/releases/2024/p0301-respiratory-virus.html
- National Nurses United. Letter to Dr. Mandy Cohen, MD, MPH. Feb. 23, 2024. https://www.nationalnursesunited.org/sites/default/files/nnu/documents/February_23_2024_NNU_letter_to_CDC_plan_to_weaken_Covid_isolation_timeframe.pdf
- Cosimi, LA, Kelly C, Esposito S, et al. Duration of symptoms and association with positive home rapid antigen test results after infection with SARS-CoV-2. JAMA Network Open 2022;5: e2225331.
- Centers for Disease Control and Prevention. Respiratory virus guidance update FAQs. March 1, 2024. https://www.cdc.gov/respiratory-viruses/guidance/faq.html
- Global Burden of Disease Long COVID Collaborators; Wulf Hanson S, Abbafati C, Aerts JG, et al. Estimated global proportions of individuals with persistent fatigue, cognitive, and respiratory symptom clusters following symptomatic COVID-19 in 2020 and 2021. JAMA 2022;328:1604-1615.
- Al-Aly Z, Bowe B, Xie Y. Long COVID after breakthrough SARS-CoV-2 infection. Nat Med 2022;28:1461-1467.
- Bowe B, Xie Y, Al-Aly Z. Acute and postacute sequelae associated with SARS-CoV-2 reinfection. Nat Med 2022;28:2398-2405.
- Centers for Disease Control and Prevention. Background for CDC’s updated respiratory virus guidance. Executive summary. Last reviewed March 1, 2024. https://www.cdc.gov/respiratory-viruses/background/index.html#executive
National Nurses United condemned new COVID-19 recommendations by the Centers for Disease Control and Prevention that shortens the isolation period for the public to as little as 24 hours if symptoms abate and the person is non-febrile.
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