Is quarantine over? What the new CDC guidelines actually mean

The CDC’s updated Covid-19 guidelines remove some long-standing recommendations like quarantining directly after exposure and keeping 6 feet from others while indoors. They claim the relaxed rules will help Americans navigate a virus going nowhere fast. But the suggestions have been selectively reported across media platforms. And there’s been significant backlash among healthcare professionals, too. (Even CDC director Rachel Walensky recognized her department’s shortcomings.)

Let's review the updated recommendations so that you can both enjoy social spaces and keep those in your communities safe.

Where Americans are now

We’re currently racking up around 100,000 cases daily—a number assumed underreported given the prevalence of at-home testing. But we have more tools to reduce severe illness than we did earlier in the pandemic. “I'm still seeing a lot of COVID in the emergency room, but it's minor compared to earlier periods,” says Dr. Sudip Bose, an emergency medicine physician on Dr. B’s medical advisory team. In response, the CDC now aims to reduce severe disease rather than limit transmission.

The new guidelines also make COVID-19 less disruptive to everyday life, especially as children return to school. “People have their own risk tolerance,” Dr. Bose points out about our different approaches to smoking, dietary and travel risks. “You have to make protocols based not only on biology and science but also human behavior—how will humans embrace or follow it? It's about finding that balance.”

Significant shifts to the CDC guidelines for Covid:

Exposure and isolation: Those exposed to Covid-19 who are asymptomatic no longer have to quarantine. Screening tests are no longer recommended in “most community settings.” These remove “test to stay” protocols that have shuttered classrooms.

Social distancing: Past guidance recommended that we stay 6 feet from others when indoors. But scientists have long pointed out that Covid-19 can travel farther than a 6-foot radius. With Covid infections rampant, "it may not be practical" to stay clear. They now emphasize hand washing, improved ventilation, mask-wearing and isolation during infection as preventative measures.

Vaccination: The CDC guidelines for vaccinated adults no longer differ from those for unvaccinated adults. This recognizes that breakthrough infections occur amongst vaccinated people (though they’re milder). And that recent infection rates amongst unvaccinated people imply some level of protection.

But here’s the fine print…

Vaccination: Vaccinated and unvaccinated people now follow the same recommendations. But the new guidelines articulate that up-to-date vaccination (booster shots) best protects against severe illness. Hospitalization and death rates continue to be higher among unvaccinated people. And emerging evidence shows that vaccination slightly reduces post-Covid-19 conditions—a problem for about 20% of those infected.

Masking: Masks are no longer recommended indoors in low community settings. But they are for immunocompromised people in medium community settings and for everyone when their community level is high—around 40% of the country right now. You can find your local community level.

Pre-screening: Schools, workplaces and other lower-risk social spaces do not have to offer pre-screening protocols. But individuals should self-test when community levels are medium or high—about 75% of the country right now. Or when meeting someone at high risk for serious illness.

Exposure: While individuals don’t have to quarantine after exposure if asymptomatic, they do need to mask around others for 10 days (starting the first day after exposure). Anyone who suspects they are sick should quarantine immediately and await test results.

Active Infection: Anyone leaving quarantine still needs to mask through day 10—whether or not they've had symptoms—and should avoid high-risk individuals through day 11. Those with moderate illness (like difficulty breathing), severe illness or a weakened immune system should isolate for 10 full days. And those with high-risk conditions should get on antiviral medications like Paxlovid and Molnupiravir as soon as possible—they work best within the first 5 days of symptoms. Check out our Visitless Prescription program to learn how we can help you get these no-cost medications ASAP.

These guidelines replace “test to exit” recommendations. But negative at-home antigen tests remain the safest way to avoid spreading the virus. Take 1 test when you’ve been symptom and fever-free for over 24 hours (at least day 6). Test again 48 hours later. And wait until 2 consecutive tests are negative before unmasking.

Concerns and critiques of the new CDC guidelines

Many physicians worry the new guidelines threaten community protection. Ending quarantine after 5 days means little when peak viral load usually hits around day 4. Articulating that schools should “consider” not punishing individuals who mask does not actually protect high-risk people. And an average of 400-500 daily deaths set a low bar of achievement.

Covid deaths continue to be most common among unvaccinated, elderly and immunocompromised people for whom vaccines are less effective—and around 20% of the over 1 million American deaths have happened in 2022 despite progress. Epidemiologist Katelyn Jetelina points out that this decoupling of transmission rates and severe disease is “not perfect, especially for high-risk groups.” Calculating community levels by hospitalization factors and not infection rates contradicts the CDC’s focus on reducing severe illness: If you are more likely to become severely ill, you need to know your risk of falling ill to begin with. Many people have “invisible” immune system-compromising conditions, so unmasked people may put others at risk without realizing.

Physicians worry this places even heavier burdens on those who have the most to lose. And disability rights activists point out the guidelines again discard and exclude them from discussions about public safety and mental health.

How to use this information

“These recommendations are recommendations,” Dr. Bose points out. “They're well-intentioned. But they have to be tested in the real world with people going about everyday activities.”

We can’t assume those around us share the same risk or risk tolerance—healthy 20-year-olds consider Covid differently than pregnant people or those going through cancer treatments. “It's worth a conversation when making decisions,” says Dr. Bose about how schools, businesses and individuals can still set protocols that serve their communities best. “In this case, knowledge is power. Try to understand the disease—how it spreads, how that relates to you. And then be open and respectful to people on both sides of the argument. Think about others and try to make the best decision.”