The CDC has built this guidance around a timeline — a prescribed minimum number of days of isolation — rather than the immediate, individualized indications of virus shedding that rapid antigen tests provide. But the usefulness of those tests was highlighted again Saturday when Biden, who had taken the antiviral during his illness, tested positive again and returned to isolation at the White House residence. Subscribe to The Post Most newsletter for the most important and interesting stories from the Washington Post. More than 2.5 years after the pandemic and with a highly contagious version of the virus circulating, the CDC’s guidelines for what to do when you get sick — and when to return to public life — continue to be as confusing as they are clear. This reflects the changing nature of the virus, the inherent unpredictability of infection, and the demands and expectations of work and home life. With new research showing that people are often infectious for more than five days, the CDC’s guidance has drawn criticism from some infectious disease experts. The Biden protocol sees many of them as the right way — because it’s empirical evidence that a person isn’t spreading the virus. CDC does not specifically recommend a negative test for patients who want to resume activities. He describes such a test, which offers a direct if imperfect measure of contagiousness, as optional. The guidance states that a patient should be isolated for at least five days. (Day 1 is the day after you develop symptoms or collect your test.) Patients who end isolation should continue to wear an appropriate mask around others at home or in public until Day 10. The story continues “Given that a significant portion of people have a positive rapid test after 5 days, I think an updated recommendation should include people who have a negative rapid test before they come out of isolation for COVID,” said Tom Inglesby, director of the Center Johns Hopkins. for Health Security, who was the Biden administration’s senior adviser on testing from December to April. Rapid tests are widely available and “there has been new scientific and practical experience with this virus since December when the isolation guidance was issued,” Inglesby said in an email. People who are told to return to their workplaces after five days of being sick with Covid, even if they still test positive, “shouldn’t do it,” Inglesby said. “It exposes others in the work environment to the risk of spreading COVID. CDC guidance on this would be valuable.” Biden used his brief battle with the coronavirus as a sign that the administration is on top of the pandemic and has made the right moves by relying on vaccinations, testing and new antiviral drugs to lower the death rate. But across the country, hundreds of thousands of people a day are infected with the BA.5 subvariant — the exact number is impossible to know — and they have a shared, urgent need to know when they’re no longer contagious. The CDC’s guidance has been under internal review in recent months. A renewed set of recommendations is expected to be issued in the coming weeks, according to three administration officials and advisers who spoke on condition of anonymity to describe sensitive internal discussions. A draft of the updated guidance currently does not include a requirement to test negative before leaving isolation, they said. Existing CDC guidance says patients can end isolation five days after the first day of symptoms, as long as their symptoms have improved and they have been fever-free for at least 24 hours without fever-reducing medications. The CDC encourages people who become very sick or have a weakened immune system to self-isolate for 10 days. This leaves a negative test result as optional. Robert Wachter, chair of medicine at the University of California, San Francisco, said people can easily misinterpret the CDC’s five-day guidance as a personal reassurance that they are no longer contagious. “Unfortunately, people hear ‘five days’ and think, ‘Oh, it must be that I’m not contagious,’” Wachter said. “This is wrong”. A recent study in the New England Journal of Medicine looked at how long people could shed virus that could be grown in a lab — the best test of infectivity. The result: People shed such a virus for eight days, on average, before testing negative. The CDC’s guidance “makes no sense,” said Andrew Noymer, an epidemiologist at the University of California, Irvine. “They’re telling people to go back to work while they’re still contagious, essentially.” Wachter suggests people test negative before going out in public. “The antigen test turns out to be an awfully good ‘are you infectious’ test,” Wachter said. “If they’re still positive on day 6, 7 or 8, I don’t want to be hugged in a room without a mask.” Officials familiar with the formulation of Covid policy say the administration needs to consider human behavior — what people can and will do in their daily lives to limit the transmission of the virus. The administration’s decision not to push hard for a negative test before the lockdown ends reflects the realization that not everyone has access to tests or can spend extended time away from work, school, caregiving or other duties. When CDC Director Rochelle Walensky was asked recently why the agency doesn’t recommend that all Americans use back-to-back negative tests to come out of isolation, as Biden did, she said the president is in a special category. The president underwent multiple rapid tests as he was being monitored for a “rebound” Paxlovid infection, which can occur days after initially testing negative. Biden tested negative on Thursday and Friday mornings before a positive result on Saturday morning showed recovery, sending him back into isolation, White House physician Kevin C. O’Connor said in a letter. Biden tested positive again on Sunday and “as could be expected,” remained positive on Monday, O’Connor said. Walensky said during an interview with Washington Post Live that “I think we can all agree that the president’s protocols probably go beyond and have the resources to go above and beyond what any American can and has the ability to do.” . “As we present our guidelines to the CDC, we have to do it so that it’s relevant, that it’s doable, that Americans can follow,” he said, noting that some communities have fewer resources and greater work restrictions. He also noted that the guidance gives people the option to take a quick test before ending isolation. The five-day isolation period reflects an approximation of when people are most likely to be infectious. But these are averages, covering large populations. A positive result from a rapid antigen test, often called a home test, is the best indicator of how much virus is present and how likely you are to infect someone, said Michael Mina, a former infectious disease epidemiologist and immunologist at Harvard University. who is an expert in rapid testing. Rapid antigen tests look for specific viral proteins to detect infection. Mina is chief science officer at a telehealth company that uses rapid tests, including for Covid, to connect patients to care. “If you still have enough virus to see it on a rapid test, you know you’re still infectious,” Mina said. The California Department of Public Health, for example, requires a negative test on the fifth day after the first positive test, or later, to leave isolation. Policymakers could help patients by issuing “clearer guidelines for the use of antigen tests” to escape isolation, as in Biden’s case, said Amy Barczak, an infectious disease specialist at Massachusetts General Hospital. Her research suggests that a quarter of people infected with a microbe variant could be infectious after eight days. The CDC’s guidance dates back to the wave of illness caused by the microbe strain that began in December and sickened tens of millions of people within weeks, causing the daily cancellation of thousands of commercial airline flights and leading to staff shortages across all sectors of the economy. Under enormous pressure to prevent the disruption of essential services and amid evidence that omicron was less likely to cause severe disease in a largely vaccinated population, the CDC reduced its recommended isolation period from 10 days to five. Rapid tests were in short supply at that point, but then the federal government expanded acquisition of tests, with millions now available. Since this spring, Americans have been able to go to a government website, covid.gov, order free rapid antigen tests and have them sent to their homes. At drugstores and online retailers, a two-test pack generally costs about $25, depending on location. Private insurance is supposed to cover home test purchases. Some elements of the CDC guidance can be confusing. The CDC says people who choose to test for coronavirus after Day 5 and test positive should extend their isolation to 10 days. However, the agency doesn’t directly recommend testing after Day 5. The guidance as written says, in fact, you can test after five days, but be prepared to handle the result. People for whom isolation is a difficulty may not be motivated to find out if they are still shedding the virus. Experts say the CDC should recommend what’s best for public health. “That’s kind of the feeling they’re giving right now: … ‘It’s an okay idea, but we don’t really want to recommend it,’” Mina said. “It should be the other way around.” The CDC’s expected release of updated Covid guidance in the coming weeks is…
