With its August 11 summary of COVID–19 guidance, the CDC essentially acknowledges that it has given up on reducing the spread of the virus and is leaving us all on our own. The piece begins by explaining that “high levels of vaccine- and infection-induced immunity and the availability of effective treatments and prevention tools have substantially reduced the risk for medically significant COVID-19 illness (severe acute illness and post–COVID-19 conditions) and associated hospitalization and death.” So, given that most people who get COVID will survive, it’s now going to focus on measures that “minimize strain on the health care system, while reducing barriers to social, educational, and economic activity,” even though for many of us the continued spread of COVID is what’s keeping us from such activity.
This disappointing guidance does recommend universal masking indoors when COVID community levels are high, but these “community levels” are not the same as “transmission levels.” Transmission levels can be high but community levels low, because community levels aren’t high until hospitals start getting overwhelmed, even though a true public health approach would institute preventive measures long before that point is reached. I’d much rather see the CDC call on state and local officials to require masks in all indoor settings as soon as *transmission* levels are high, which they are in most of the country at the moment.
Another problematic element is the recommendation that people who test positive only need to isolate for five days (and mask when around others for five days beyond that). This is despite the fact that studies of people infected with the Omicron variant have found many to be shedding virus beyond five days, which is why a better approach to ending isolation is to wait for successive negative rapid tests. In the paragraph making this recommendation, the CDC authors cite two systematic reviews and one study, all of which were conducted before Omicron’s arrival at the end of 2021. In fact, the word “Omicron” doesn’t appear in the document at all, and CDC’s last COVID-19 Science Update is from December 2021. If the CDC is going to recommend an earlier end to isolation than they have in the past, they ought to back that up with recent, relevant studies. They have not done so.
An Inequitable Approach
The words “equity” and “equitable” appear 10 times in the document, but this is not a response that advances equity. The CDC authors repeatedly stress the importance of individuals knowing their own risks and taking precautions accordingly, but the best way to reduce risks is to lower the amount of virus that’s circulating. The CDC’s position is that as long as hospitals aren’t overwhelmed, it’s okay if a lot of people get sick. But the people at most risk of getting sick are those with compromised immune systems or jobs that put them amidst a lot of other people. Black, Native, and Latinx workers are more likely than white workers to hold jobs that must be done in person, so they’re most at risk of COVID exposure. And some proportion of those who get COVID will go on to develop long COVID.
People at high risk of developing serious illness or dying from COVID-19 include older people and those whose immune systems are compromised in some way. If consideration for these groups drove the COVID response, we’d all be wearing high-quality masks in public indoor settings and all buildings would have ventilation sufficient to substantially reduce the risk of catching the virus. CDC’s individual-focused approach tells people who fear severe consequences from COVID that they should take steps to reduce their own risk. Reducing one’s own risk when COVID is running rampant means limiting one’s activities and interactions as much as possible. Should people be forced to stay inside their homes and only venture out for terrified essential errands just because they’re older or have one of the health conditions that puts them at high risk? Should pregnant people and parents of children too young to be vaccinated fear trips to grocery stores full of unmasked shoppers? Should those at high risk whose situations require them to be out in public fear removing their masks for a few moments to drink water? None of this sounds like a country I want to live in, but it’s where we are right now.
Sharing the Blame
The CDC isn’t the only entity that’s to blame for a U.S. response that fails to take an equity- and prevention-focused approach. Congress has failed to produce the additional appropriations that could better support universal use of high-quality masks and use of rapid antigen tests regularly and to end isolation, not to mention paid sick leave that could make it feasible for people to isolate for as long as they continue shedding virus. Political actors and certain media entities have turned what should be a straightforward public health issue into a political one. Now public health officials fear for their safety, and that makes it much harder for states and localities to adopt policies like mask requirements. But seeing what should be the nation’s primary public health agency, which is full of skilled and dedicated professionals, ignore the most recent science and promote an inequitable and individual-focused COVID-19 response is particularly painful.
Liz Borkowski is a contributor to the public health blog The Pump Handle. She is managing editor of Women’s Health Issues, the peer-reviewed journal of the Jacobs Institute of Women’s Health, and a researcher in the Department of Health Policy and Management at the Milken Institute School of Public Health at George Washington University.