Institutionalized Misconceptions

The CDC quietly changed its COVID guidance last week.  In an August 11 update to Isolation and Precautions for People with COVID-19, the CDC removed the vaccination advantage for ending COVID-19 isolation.  Now the CDC expects everyone to follow the same isolation guidance, regardless of vaccination status.  Yet even its newest guidance perpetuates myths that extend the COVID emergency unnecessarily.

Here is the new guidance.  If you suspect you have COVID-19, you should test.  Isolate until you receive your test result.  If your test is negative, end isolation.  Asymptomatic individuals with a positive test should isolate for five days and wear a mask for ten.  If your test is positive and you have symptoms, isolate for five days from the first day of your symptoms or for 24 hours after you are fever-free, whichever is longer.  Mask for ten days.  Better yet, mask until you have had two negative antigen tests 48 hours apart.

Previously, CDC recommended different isolation protocols depending on vaccination and booster status.  Now there is no difference, another tacit admission that the vaccinated and unvaccinated spread infection similarly.  This is a softening of its once bellicose “Pandemic of the Unvaccinated” position, and not the first time either.  In the last paragraph of a June MMWR report, the CDC admitted, “Despite the introduction of highly effective vaccines and medications to treat COVID-19, by the end of the study period, COVID-19 continued to cause substantial morbidity and mortality.”  Hopefully, this new direction will reduce fuel for those actively practicing health discrimination against the unvaccinated, or against the vaccinated but not up-to-date.

I am not holding my breath.  There continues to be a lot of momentum in that direction.

Despite this small positive, the new guidance continues to perpetuate misconceptions that have been institutionalized within the CDC.  Here are three examples.

There is a test for COVID-19.  The CDC confuses a SARS-CoV-2 test with COVID-19, something this blog has warned against since the early days of the pandemic, but which has become an institutionalized misconception at the CDC.  There is not a test for COVID-19.  Symptoms are necessary for diagnosis.  

Asymptomatic individuals should be tested.  Different guidance for those with and without symptoms implies a recommendation for testing asymptomatic individuals.  “Asymptomatic spread” is an unsubstantiated idea at best and deliberate fearmongering at worst.  Guidelines that promote asymptomatic testing perpetuate the myth that “asymptomatic spread” is a real concern, effectively prolonging the emergency.  Testing should be limited and focused.

Tests can determine when to end isolation. The updated guidance uses test results instead of symptoms to end of the isolation period.  This misconception relies on the assumption that an individual who has tested negative is unlikely to spread infection.  The fallacy of this assumption is embedded in the guidance, which requires two consecutive negative antigen tests to end masking.  Why two tests?  Antigen tests have low sensitivity, meaning lots of false negative results.  If the first test is not reliable, should the second test be any better?  “Past performance is no guarantee of future results.”—that works for investing and for testing.  The guidance might as well say, “Flip a coin every 48 hours; leave your mask on until you get two heads in a row.”  SARS-CoV-2 tests do not test for cure of COVID-19.  

Many people just ignore the CDC, but there are those who live in trauma and fear unnecessarily.  Misconceptions institutionalized by the CDC trap those individuals in a cycle of stress and panic.  It is time for sensible, uncomplicated, time-tested guidance.

If you feel sick, stay home.  When you feel better, get on with your life.

Stop scaring people already.