AMA pans CDC's 'confusing' COVID-19 isolation guidance, calls for negative test requirement

The American Medical Association (AMA) is the latest big name criticizing recent updates to COVID-19 isolation guidance developed by the Centers for Disease Control and Prevention (CDC) that do not include a recommendation to retest before returning to work.

“A negative test should be required for ending isolation after one tests positive for COVID-19,” AMA President Gerald E. Harmon, M.D., said in a Wednesday statement. “Reemerging without knowing one’s status unnecessarily risks further transmission of the virus.”

On Dec. 27, the public health agency published guidance stating individuals who tested positive for COVID-19 may end isolation after five full days should they be fever-free for 24 hours and have no other symptoms. The CDC also recommended that these individuals wear a mask for at least another five days after isolation.

Of concern to the policy’s critics is the absence of a hard recommendation for an additional COVID-19 test following the five-day isolation of a confirmed case in the Dec. 29 guidance as well as in a Jan. 4 update, which included instructions—but not a recommendation—for an isolating individual without symptoms who “has access to a test and wants to test.”  

In a post accompanying the update, the CDC said it reached its guidance following a review of 113 studies from 17 countries but noted that much of those data reflected variants that preceded the highly infectious omicron.

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But the guidance and its justification weren’t enough for the AMA, which said the updates on quarantine and isolation were “not only confusing, but [were] risking further spread of the virus," according to a statement released Wednesday.

Specifically, the association pointed to U.K. modeling data—which were highlighted by the CDC in its explainer post—estimating that 31% of individuals remain infectious five days after a positive test.

“With hundreds of thousands of new cases daily and more than a million positive reported cases on January 3, tens of thousands—potentially hundreds of thousands of people—could return to work and school infectious if they follow the CDC’s new guidance on ending isolation after five days without a negative test,” Harmon said. “Physicians are concerned that these recommendations put our patients at risk and could further overwhelm our health care system.”

The AMA head acknowledged the widespread shortage of COVID-19 tests among both the general public and hospitals and urged the Biden administration “to pull all available levers” to increase the country’s supply.

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However, “a dearth of tests at the moment does not justify omitting a testing requirement to exit a now shortened isolation,” Harmon wrote.

COVID-19 case counts have skyrocketed to January 2021 highs during the last month due to the rise of the highly infectious omicron variant. Monday, more than 1 million new daily cases were reported, further contributing to the strain on numerous hospitals across the country.

Against this backdrop, the CDC has weathered a wave of criticism from prominent academic and public health experts since publishing the initial isolation guidelines.

In a Dec. 28 blog post, Eric Topol, M.D., director of the Scripps Research Translational Institute, argued that the CDC’s “vacuous” isolation guidance was unjustified because it was not based on evidence related to the omicron variant, did not take into account the varying viral clearance timelines of vaccinated and unvaccinated individuals and discounted the value of testing.

Further, the language of the Jan. 4 update surrounding individuals who have access to tests and want to test “adds to the confusional state,” he tweeted.

Ashish Jha, M.D., dean of the Brown University School of Public Health, said that the Dec. 27 isolation guidance was “reasonable” in turning the public’s attention to the first five days when individuals are most contagious and limiting “unnecessary constraints on people,” but noted that he would have welcomed additional guidance around masking, vaccination status and a negative test requirement.

Following the CDC’s update, Jha reasserted that an “ideal” COVID-19 isolation guidance would include daily testing after five days and isolation until two negative test results. With rapid testing in short supply, however, he said that the recommendation of five days isolation and diligent mask use for vaccinated and symptom-free individuals “is reasonable.”

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Prior to the Tuesday update, National Institute of Allergy and Infectious Diseases Director Anthony Fauci, M.D., told press that the CDC was weighing whether to add a negative test requirement to the five-day isolation recommendations.

Appearing on "The Late Show" the night before the guidance update, CDC Director Rochelle Walensky, M.D., said that “about 80% to 90%” of transmissibility occurs during the two days prior to symptom onset and the three days after.

“We really want people to be sure if they’re going to be home, they’re going to be home for the right period of time, when they’re maximally transmissible,” she said.

Walensky also stressed the importance of wearing a mask during the period following isolation.

Tuesday, White House Press Secretary Jen Psaki told press that the updated recommendations are “based on the science” and that the agency would continue to assess available data and its guidance “every day, every week.”