Concerns that the omicron surge could lead to a breakdown of essential services have spurred new quarantine and isolation rules

Health officials’ recommendation this week to shorten the isolation period for people with asymptomatic coronavirus infections to five days was largely driven by fears that essential services could be hampered amid one of the worst surges. of infection from the pandemic, senior officials familiar with the discussions said. .

Top administration health officials met over Christmas weekend to discuss the trajectory of the outbreak in the United States, with several expressing concern about how case levels could climb in the coming weeks, according to four senior officials briefed on the discussion. They feared the sheer volume of infections would mean that tens of thousands of police, firefighters, grocers and other essential workers would be out of work, making it difficult to keep society running, even if many many infections would be mild or produce no symptoms, officials said.

Although omicron is the most transmissible variant to date, it appears to have less severe effects than the delta variant and, so far, a lower percentage of infected people end up in hospital, according to international studies and the first data from American hospitals. Vaccinated people, and especially those who receive a booster, are likely to have mild or asymptomatic infections, according to early research – a finding that also contributed to the recent change in guidelines.

The decision to halve the recommended isolation time, which has been praised by business groups and criticized by some union leaders and health experts, reflects the increasingly difficult decisions being made by health officials as they seek to strike the right balance between vigilance and normalcy as a nation. enters the third year of the pandemic. Even with a burgeoning variant, President Joe Biden has said he does not consider lockdowns and stressed that those vaccinated and boosted do not need to fundamentally change their lives as they did in the beginning. of the pandemic.

The Centers for Disease Control and Prevention (CDC) advice “was based on the anticipation that large numbers of cases could impact societal function,” CDC Director Rochelle Walensky said in an interview. “There were starting to be limits in society, not just in our healthcare workforce, but in other parts of society. We were seeing infections in many places and realized this could be a harbinger of many more essential workers we needed. »

The decision comes as the omicron variant pushed the seven-day average of daily new cases in the United States to 266,889 on Tuesday, surpassing the previous record of 248,209 cases on January 12. These figures do not include the results of thousands of home at-tests because many people do not report these results to their doctor.

Biden was notified by his covid response team on Monday of the CDC’s decision to revise its guidelines, according to a senior White House official. The White House stressed that the agency had come to its own conclusion. “We follow him. We are being kept informed,” said Kevin Munoz, a White House spokesman. “We don’t make the decision.”

Advice suggesting that those with no symptoms or whose symptoms disappear can reduce their time in isolation from 10 days to five and then hide for a further five days has been criticized by some experts and union leaders, who say they are based more on economics than on health considerations.

The president of the country’s largest nurses’ union said on Tuesday the recommendation will lead to increased viral spread as many will return to work – or face pressure from their employers to return – while still contagious.

“It will only lead to more disease, more cases,” said Jean Ross, president of National Nurses United, during an appearance on CNN.

Sara Nelson, president of the Association of Flight Attendants, said she was concerned the guidelines were so closely aligned with demands from business leaders.

“No worker should be forced to come to work while still sick,” Nelson said on CNN. “We are very concerned about this.”

[Healthy, boosted people unlikely to develop severe omicron infections, but jury’s out on older, at-risk populations]

The agency also reduced the recommended quarantine time from 10 days to five days for people exposed to the virus who are not yet boosted and show no symptoms, adding that they should also wear a mask for an additional five days.

Along with concerns about keeping society running, the CDC’s decision was based on a growing body of scientific evidence, as well as the agency’s internal modeling, showing that people are most contagious within one to two days before they develop symptoms and the two to three days after, Walensky says. Most people will not be tested until they start to develop symptoms, she added, which means by day 5 of isolation they will be much less likely to transmit the virus.

After the agency updated its quarantine and isolation guidelines for healthcare workers last week to avoid staffing shortages, officials realized many industries would face the same challenges, Walensky said. . After a conversation over the Christmas weekend, they realized they should also provide advice to others, Walensky said.

“We had to be. . . able to update our recommendations in real time at the moment,” Walensky said. “These tips are only good if society is willing to follow them.”

Experts criticizing the guidelines have particularly criticized the agency’s failure to require people to test negative before completing their isolation or quarantine. The agency said best practice would be for people to take a test on day 5 of quarantine, but did not strongly recommend that they do so.

“There are people who are infectious and can transmit after five days,” said Walid Gellad, professor of medicine at the University of Pittsburgh. “It’s probably not the majority, but there are people, so by doing that you’re actually encouraging people to engage in activities that might increase transmission.”

Gellad recommended that individuals not use CDC advice to make their own personal decisions, “if they are able to do something different than what the CDC says.”

The advice “does not appear to be based on science and data and what is best for the public, unless it takes into account the complete collapse of society”, he added.

Walensky said the agency decided not to require a negative test result after people self-isolate for five days because results are often inaccurate at this stage of infection. PCR tests — those typically done in the lab that are around 98% effective — can show positive results long after a person is no longer contagious due to the presence of viral remnants, she said. It is still unclear to what extent rapid home tests determine a person’s ability to transmit the virus in the latter part of their infection, she added.

Instead, agency officials determined that wearing a mask after the isolation or quarantine period would help protect against continued transmissibility, she said.

Some health experts said they supported the updated quarantine and isolation guidelines for healthcare workers, but were unsure if they made sense for the rest of society. Healthcare workers are required to mask and wear personal protective equipment in the workplace, but millions of other Americans are not, said Lisa Maragakis, senior director of infection prevention for the Johns Hopkins Health System.

The indications “seem like it’s too early and not coming at the right time because we’re still in the very sharp uptick of this surge,” Maragakis said. “It seems to me that now is not the time to relax any guidance for the public.”

The guidelines could offer relief to airlines, which began preemptively canceling flights ahead of Christmas as coronavirus cases surged among their crews. The carriers had lobbied the CDC for changes last week, arguing that it would be impossible to keep planes in the air with so many infected employees.

Airline industry group Airlines for America welcomed the decision. “The aviation workforce is essential to maintaining operations in the air transport and cargo supply chains,” the group said in a statement.

Holly Wade, executive director of the National Federation of Independent Business, also applauded the decision, saying it could help ease the workforce disruption affecting many businesses.

– – –

Ian Duncan of The Washington Post also contributed to this story.

Michelle J. Kelley