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California’s 24-hour isolation recommendation will lead to more long COVID | Opinion

Sacramento Bee - 2/3/2024

Following the lead of Oregon, California has shortened the recommended isolation period for individuals who test positive for COVID. Formerly five days, a person without symptoms is now only required to isolate for 24 hours.

This policy is not based on science, and we urge for it to be reversed. Public health officials in Oregon and California should revise their harmful one-day isolation policies, and should, instead, work to decrease the spread of COVID while carefully balancing the costs and benefits of each policy’s impact on the community.

COVID remains the third-leading cause of death in the U.S. Last week, there were 1,700 COVID deaths; a toll that would have been staggering early in the pandemic. This new policy will result in additional deaths and substantial reductions in quality of life — with the heaviest burden on marginalized populations, as the risk of death is disproportionately higher for older, immunocompromised Black and Hispanic individuals.

The policy appears to put COVID practices on even footing with other illnesses (such as flu) by noting that individuals can return to work or school after 24 hours without a fever. The key difference is that, unlike COVID, other illnesses are not contagious at that time.

For those without symptoms, peak COVID infectiousness can vary from three to seven days after an infection begins. A far better indication of whether someone is contagious is their results on a rapid test; while some individuals test positive for a handful of days, others test positive for over two weeks. The new policy disregards asymptomatic spread.

The policy also recommends that those who are sick avoid individuals who are at higher risk for severe outcomes from COVID. This sounds responsible, yet it is absolutely impossible to implement.

How should high-risk individuals access public transportation? Should they wear a sign disclosing their high-risk condition? Should they avoid going to work because someone there could be COVID positive? And what about secondary effects, such as a schoolchild who contracts COVID from their known-positive classmate and then brings the illness home to their high-risk family member? This scenario is even more likely in communities of color, where multi-generational living is more common.

The lack of masking has already made public spaces inaccessible to many high-risk individuals. Why would we increase the already undue burden on high-risk individuals to protect themselves rather than asking individuals who are temporarily contagious to avoid spreading the virus?

In addition to the risks of acute COVID, everyone who contracts the disease is at risk for long COVID; 4% of U.S. adults have long COVID that limits their daily activities, and this rate is substantially higher for disabled and transgender individuals. There is growing evidence that not getting enough rest during the acute infection increases one’s risk for long COVID, and the shortened isolation period will encourage individuals to return to their normal activities sooner.

If the goal of the new policy is to avoid individuals missing work and/or school, it will likely be counterproductive due to increased symptomatic infections and the effects of long COVID. Four million U.S. adults are out of work due to long COVID, and long COVID affects children and their ability to attend school.

There are no FDA-approved treatments for long COVID, which people can contract after reinfection. The health-care system is already straining even to help with its basic symptom management. Clinics that specialize in long COVID care often have long waits and turn away patients without PCR-positive tests. These issues will only worsen with increasing waves of infection.

We should be encouraging the use of high-quality masks in all public places to protect high-risk individuals from infection, which would make these spaces more accessible; and continue to upgrade air filtration systems, particularly in places where masking is less likely to be effective, such as in schools with young children for whom it is difficult to find well-fitting masks.

We should also make rapid tests freely available — for instance, by sending a pack of five to anyone who tests positive, which would enable them to test negative two days in a row as their indication of when to leave isolation. And we should make paid sick leave available to those who are sick, allowing them time to recover at home so they can avoid spreading the illness.

Public health policies should be rooted in science and data with the goal of protecting our whole community, including the most vulnerable among us. Instead, this new policy will only enable contagious individuals to spread viruses that will lead to more illness, disability and death.

California public health offices must do better. Our entire community depends on it.

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