A positive Covid-19 test result (Getty)
Instead of relying on a test of your infectiousness from Covid-19 and symptoms to determine the need to isolate, California now is ignoring the test results.
California’s Department of Health recently made major changes to its isolation requirements, one based on symptoms alone.
On January 9, Tomás J. Aragón, M.D., Dr.P.H., director of the CDPH, issued the relaxed regulations, which allow adults to resume normal activities and interactions if they are afebrile for 24 hours and have improving symptoms. Such people are advised to wear a mask for 10 days.
Previously, the regulations required isolation for five days for Covid infections.
CDPH says they are initiating these changes “due to broad immunity from vaccination and/or natural infection, and readily available treatments for infected people” and that this is “to align with common practice of other respiratory viruses.” California is in a period of “reduced impacts from COVID-19,” the department stated.
There are problems with their statements. Covid-19 cases in California have surged. The test positivity rate was 12.3% on January 3 and remains high and above levels in December. Deaths due to Covid-19 were high then as well, at 3.6% of the total. Available ICU beds continue to decline.
Another issue is that Covid-19 causes long Covid in up to 20% of those infected and can cause chronic, seriously debilitating illnesses. Other seasonal respiratory infections don’t appear to do that.
A third is that treatments are not readily available to all. As noted previously, Paxlovid is underprescribed. The CDPH notes that Paxlovid has “been underused – especially among populations disproportionately impacted by Covid-19.”
Per CalMatters, the free COVID-19 hotline—the source for Paxlovid and vaccines for people without a personal physician—is set to shut down in February. The CDPH says, “The state's COVID-19 telehealth program will continue to provide free appointments through February, 2024. The cost of the medication may vary on the patient’s insurance status after commercialization of Paxlovid/Lagevrio begins in November.” [They have not yet answered what happens after February or for patients who cannot afford Paxlovid.]
Another problem CalMatters notes is that Covid-positive students and staff can come to school if they are asymptomatic. They are advised to wear masks and “avoid people who are at high risk of sickness, such as those who are immunocompromised.” One might ask how many children will wear a mask reliably. How will they know who is at risk and to stay away from?
Lisa McCorkell, who studies long COVID and is co-founder of the Patient-Led Research Collaborative, told CalMatters, “This policy is not based in science, equity or public health. It devalues the lives of immunocompromised and disabled people, and completely ignores the risk of long COVID.”
California’s new guidelines differ from the CDC’s, which states that test-positive patients should isolate for five days. The CDC has not yet responded to a request for comment.
It’s also important to remember that asymptomatic patients can transmit Covid-19. If you have a positive test, you should consider yourself infectious.
Noha Aboelata, M.D., CEO of Roots Community Health Center, also criticized the policy on X (formerly Twitter), saying it is “Promoting reckless disregard for everyone.“ She continued, “The message: Presenteeism is encouraged. You don't deserve to rest & fully recover. You shouldn't care about the well-being of those around you, or even your own.” She added, “This decision is not evidence-based, and it clearly does not consider the impacts of long covid, the need for people to rest and recover when sick, or the ramifications of increased transmission such as new variants. The consistent dialing back of precautions every time we think we're in ‘a better place’ is what keeps us from actually getting to a better place. Zero mention of the burden of repeat infection or risk of long Covid.”
In an interview, Aboelata further stressed social disparities: “These types of policies are going to disproportionately impact folks who use public transportation who live in crowded intergenerational housing, who don't have time from work.”
Stanford sociologist Pantea Javidan, J.D., Ph.D., concurred, adding (via email) the new guidelines “shock the conscience.” As a sociologist and social justice advocate, she noted the policy “also fosters a culture of disregard for self and others, undermining both individual and collective health.”
California has been more protective about Covid-19 than the CDC, so Aboelata was equally as taken off guard. The driver for these unexpected relaxation in protections is not entirely clear. Is it employers? Aboelata noted that there are “worker shortages in several industries, including bus drivers, teachers and health care providers.” She added, it “seems very short sighted and likely will ultimately exacerbate the problem.” She mused about “whether this was to put pressure on the CDC or nationally.” It will be interesting to see what follows.
