Rochelle Walensky, MD, MPH, Director of the Centers for Disease Control and Prevention (CDC), has … [+]
Well, so much for returning to work after day five. On Monday, day nine after the U.S. Centers for Disease Control and Prevention (CDC) Director Rochelle Walensky, MD, had tested positive for Covid-19, the CDC announced that Walensky has tested positive again. Apparently, after her October 21 positive test, she had completed a course of Paxlovid, subsequently tested negative, but then “On Sunday, Dr. Walensky began to develop mild symptoms and has again tested positive. Consistent with CDC guidelines, she is isolating at home and will participate in her planned meetings virtually.”Hmm, the current CDC isolation guidelines also indicate, “If you had symptoms and your symptoms are improving, you may end isolation after day 5 if you are fever-free for 24 hours (without the use of fever-reducing medication).” So, with Walensky being yet another person experiencing such a Covid-19 rebound, you’ve gotta wonder whether this standing five-day isolation recommendation is too short.
Walensky is certainly not the only person to have experienced a so-called Paxlovid rebound. As I reported previously for Forbes, both U.S. President Joe Biden and Anthony Fauci MD, the Chief Medical Advisor to the President, have gone through the Covid-19 positive then Covid-19 negative then Covid-19 positive again thing as well. One could assume that all three, being high-level government officials, have had the luxury of ready access to regular testing and medical care. When any of them had questions about their symptoms, they most likely weren’t told by their doctors’ offices, “the next available appointment time is in May 2023, assuming that your doctor doesn’t quit in the meantime because our health system is forcing him or her to see patients every 15 minutes or so with no break to even go pee. In the meantime, if you need to be seen sooner, please go to the emergency room so that you can spent the whole day waiting among people who may have Covid-19.” So Biden, Fauci, and Walensky were all presumably caught on the rebound, so to speak, before they could spread the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to others.
But what if they had been “Joe Schmo”, “Anthony Manatee”, or “Rochelle Oh Well” instead, meaning everyday people who didn’t have others as closely monitoring their symptoms and Covid-19 status? Might they have simply returned to work without any further testing and then unknowingly infected others in the process? Would they have then gone on to cause additional Covid-19 outbreaks?
Moreover, Biden, Fauci, and Walensky have had the comparative luxury of being able to work from home. They haven’t needed CDC guidelines to justify to their employers why they hadn’t returned to the office, the restaurant, the grocery store, the factory, the hospital, the bus, the police station, the museum, the airport, the theater, the train, the circus tent, or wherever their employer would have wanted them to be yet. They don’t have to worry about their employers saying, “the CDC says you can be back here after day 5 so where the bleep are you?”
It’s still not clear how the CDC came up with this five-day isolation duration in the first place. In 2020 this duration was twice as long: 10 days. That 10-day number was not based on how long it took Kate Hudson to lose a guy but emerged from actual scientific studies on how long it may take a person to lose the possibility of shedding the virus. At the time, studies did find enough people still contagious at days six through nine to justify a recommended 10-day isolation period.
So what’s changed since then? Did the viruses subsequently say, “sorry, how rude of us to keep multiplying and appearing in your respiratory droplets for that long. We’ll knock it off and make sure that you are are no longer contagious after day five.” Not exactly. There are still plenty of examples of people shedding the virus for longer than five days and in some cases much longer.
The growing number of Paxlovid rebound cases has added further complexities to the duration of isolation needed. A Paxlovid rebound is when you test positive for Covid-19 again after testing negative following the completion a five-day course of the antiviral medication. So by definition, a Paxlovid rebound should occur at least six days beyond the first positive Covid-19 test. In many cases, rebounds have continued well past the ten-day mark.
Whenever a guideline changes without clear scientific justification, you’ve gotta wondering what else may be driving things. Could there have been political pressure to make it seem like things were “returning-to-normal?” Were employers pushing to shorten the isolation duration so that their employees would return to work sooner? The rationale for going to five days has been fuzzy…and not in a warm-and-fuzzy type of way.
Now if you are wondering whether the Covid-19 vaccination program might have helped reduce the isolation period, you’d be barking up the wrong tree. Getting vaccinated shouldn’t affect how long you should stay isolated. Walensky received the bivalent booster back on September 22, about a month before she tested positive for Covid-19, based on the following tweet from CVS Health:
This, of course, doesn’t mean that the bivalent Covid-19 mRNA boosters don’t work. They may still protect you against more severe Covid-19 outcomes. And the CDC’s announcements have indicated that Walensky’s symptoms have been thankfully mild.
It should, however, remind you of Swiss cheese. No, not real Swiss cheese, even though real Swiss cheese is good on nearly everything with the possible exception of a ceiling fan or your boss. Rather this is referring to the Swiss cheese model that Ian M. Mackay, PhD, a scientist and an adjunct Associate Professor at the University of Queensland, advanced back in 2020:
The Swiss cheese model shows that it is all about covering up your holes. The hole issue is that each Covid-19 precaution has its limitations or bunch of holes. For example, while Covid-19 vaccines can offer good protection, being up-to-date on your vaccination would not be like wearing a concrete full body condom. It won’t offer 100% protection against the virus. The best way to cover the limitations of each Covid-19 precaution is to layer on multiple precautions at a time. That would mean in addition to getting vaccinated, wearing face masks while indoors, staying at least six feet, which is about one Harry Styles, apart from others, and making sure that the surrounding air is well-ventilated with plenty of fresh air exchange. And it will be important to ensure that those who test positive for Covid-19 stay away from others long enough so that they are no longer contagious.
This multi-layered approach will be especially important in the coming months as the U.S. seems headed towards yet another Covid-19 surge with the weather getting colder and drier. The long and the short of it is that the CDC may want lengthen it’s recommended quarantine and isolation duration so that fewer contagious folks get thrown back into crowds. After all, Walensky’s Paxlovid rebound doesn’t seem to be an isolated case at all.
