Should Isolation Periods Be Shorter for People With COVID-19?

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People with COVID-19, the illness caused by the coronavirus, are most infectious about two days before symptoms begin and for five days afterward, according to a new analysis of previous research.A few patients who are extremely ill or have impaired immune systems may expel -- or 'shed' -- the virus for as long as 20 days, other studies have suggested. Even in mild cases, some patients may shed live virus for about a week, the new analysis found.Sign up for The Morning newsletter from the New York TimesThe accumulating data presents a quandary: Should public health officials shorten the recommended isolation time if it means more infected people will cooperate? Or should officials opt for longer periods in order to prevent transmission in virtually all cases, even if doing so takes a harsher toll on the economy?The Centers for Disease Control and Prevention recommends that infected people isolate for a minimum of 10 days from the beginning of their illness. The agency is considering shortening the recommended isolation period and may issue new guidelines as early as next week, according to two federal officials with knowledge of the discussions.In September, France dropped its required period of isolation to seven days from 14 days, and Germany is considering shortening it to five days. (Isolation refers to people who are ill; quarantine refers to people who have been exposed to the virus and may become ill.)Setting the isolation period at five days is likely to be much more palatable and may encourage more infected people to comply, said Dr. Muge Cevik, an infectious disease expert at the University of St Andrews in Scotland who led the new analysis, published in the journal The Lancet Microbe.A recent survey in the United Kingdom showed that only 1 in 5 people were able to isolate for 10 days after developing symptoms. 'Even if we do more testing, if we can't ensure people self-isolate, I don't think we'll be able to control the spread,' Cevik said.In the United S

A driver is tested for coronavirus infection at a site in Oakland, Calif., Nov. 19, 2020.

In September, France dropped its required period of isolation to seven days from 14 days, and Germany is considering shortening it to five days. Cevik and her colleagues set out to analyze the so-called kinetics of the coronavirus over the course of an infection, and to compare the pathogen to the closely related severe acute respiratory syndrome and Middle East respiratory syndrome viruses.

A few patients may carry infectious virus in their lungs — as opposed to the nose and throat — for as long as eight days after symptoms begin, noted Dr. Megan Ranney, an emergency physician at Brown University. For these patients, at least, isolation periods should probably be longer than five days, if only they could be identified.

The analysis underscores data that has accumulated since March. In July, based on similar evidence, the CDC truncated its recommendation for isolation to 10 days from 14 days. Some people who are older or very sick may be infectious for longer than a week. But if a shorter recommended period encourages more people to isolate, the benefit will more than offset any risk to the community from the small amount of virus that a few patients may still carry after five days, said Dr. Stefan Baral, a public health researcher at Johns Hopkins University.

But Bell said he was unsure how this would work in practice, because these early symptoms were similar to those from other viral infections, including the common cold.

 

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Should only be isolated if they don't know how to take precautions not to spread whatever they have. The rest of the world has been doing it for a century...we are just learning to crawl in that respect.

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