The United States Centers for Disease Control and Prevention (CDC) have recently updated their guidelines for the public regarding COVID-19 as of August 2022. Overall, these updates essentially relax the guidance on COVID-19 measures, leaving the focus on preventing and addressing the most severe cases of the virus.

These updates can be broken down into three categories: 1) changes, 2) additions, and 3) clarifications. The updates are below according to these categories:

Changes

1. Change in social distancing guidance: The CDC guidelines no longer recommend that people need to stay at least 6 feet away from others indoors.
2. Change in contact tracing guidance: The CDC now recommends that contact tracing should be limited to hospitals and high risk group living homes such as nursing and assisted care homes.
3. Change in testing guidance: The CDC now de-emphasizes regular testing for COVID-19 outside of high risk environments like prisons or homeless shelters.
4. Change in quarantine guidance in schools: Unvaccinated students are no longer required to quarantine after exposure unless they develop symptoms in school, but these students should test at day 5 and wear a mask for at least 10 days.
5. Change in quarantine guidance for the general public: The CDC no longer advises people to quarantine after they have been exposed to COVID-19 if they are not actively infected (testing positive). The agency emphasizes, however, that anyone exposed should still wear a high quality mask such as an N95 for at least 10 days after the exposure and test for at least five days after the exposure. This guidance is the same whether or not you are vaccinated.
6. Change in masking guidance for people infected: The CDC now recommends that people who test positive for the virus can end their full 10 days of masking early if they take two rapid antigen tests 48 hours apart.

Additions

1. Addition of guidance on rebound infections: The CDC now recommends that individuals with rebound infections after taking antiviral treatment Paxlovid should isolate for another five days.
2. Addition of isolation guidance specifically for people with more severe cases: The CDC now recommends that people with moderate symptoms (like shortness of breath) or people who were hospitalized due to the virus should stay home for at least 10 days.
3. Addition of isolation guidance specifically for people who have a weakened immune system: The CDC now recommends that people with weakened immune systems should talk to their doctor about when and how to end isolation after infections.
4. Addition of exposure guidance for those around people at high risk: The CDC now recommends that people who have been exposed should be extra cautious around people at high risk for severe COVID infections like the elderly, people with immunocompromised systems, etc.

Clarifications

1. Clarification of guidance for those infected with COVID-19: The CDC clarified that people who have been diagnosed with a COVID-19 infection need to isolate for at least five days regardless if they have symptoms or not. If someone has no symptoms and is free from fevers for at least 24 hours at the end of day five, they can end isolation as long as they wear a mask in public up to 10 days after testing positive. 

Many recommendations remain in place. One of these is the recommendation that people stay home for five days and isolate if they test positive. Another recommendation staying in place is that people who have symptoms should test for COVID-19. A third recommendation staying in place is that people should mask indoors in counties with high community transmission levels.

There are several reasons the CDC gave for this updated guidance. Two main ones are 1) high levels of population immunity from vaccines and prior infections, and 2) the prevention tools that we now have to fight the spread of the virus. 

Experts have had mixed responses to these new guidelines. Some public health experts believe that these updated guidelines are the right step forward given that COVID-19 is likely to be with us for some time and eventually become endemic. For context, COVID-19 would likely be considered endemic when the virus continues to spread and infect us, but rarely causes severe disease because most of us have some immunity against it. 

Other public health experts believe these guidance updates do not do enough to protect people against the virus and will lead to more transmission. Below are a few of the critiques from public health experts in this second camp:

• Some experts believe that the new guidelines do not do enough to protect those most vulnerable, such as seniors and highly vulnerable people. Another critique is that the CDC. 
• Some experts believe that the CDC should change their definition of fully vaccinated to include booster shots.
• Some experts believe that the five-day isolation policy in the guidelines is not strict enough because most people are still infectious after day 5.
• Some experts believe the CDC is using the wrong metric to monitor which populations are at high risk, and that more communities are at high risk than their guidance is based on.
• Some experts believe the new guidelines don’t do enough to encourage prevention methods we have available, such as Evusheld, and treatment methods we have available, such as Paxlovid.  

While the CDC has revised it guidelines, many scientists and researchers continue to urge people to be cautious, wear masks, frequently wash their hands, and be selective about which indoor settings they enter.

COVID-19 is still a highly transmissible virus and though most people infected will not be hospitalized or suffer very severe infections, the risk is still high for many and a challenging experience for many in general.