How Long to Isolate With COVID in 2024? California Now Says That Depends on Symptoms – KQED

Jan 19

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Updated 5:20 p.m. Friday

California health officials have updated the states official guidance on how long people with COVID-19 should isolate from others with new recommendations that represent a relaxing of the isolation guidelines still in place from the Centers for Disease Control and Prevention (CDC).

Up until now, the CDC has recommended that people who test positive for COVID-19 stay home and away from other people for at least five days regardless of whether or not they have symptoms. But on Jan. 9, the California Department of Public Health (CDPH) issued an update that their official recommendations for Californians would now move away from the five-day rule in favor of instead focus[ing] on clinical symptoms to determine when to end isolation.

Now, the new guidance for COVID-positive Californians says that they should still stay home until their symptoms improve and wear a mask around others indoors for 10 days. But COVID-positive people without symptoms can leave their homes and be in public, CDPH says albeit as long as they stay masked for that period.

This big change in state guidance, coming amid a wave of respiratory virus infections around California and running counter to the CDCs current advice might be causing confusion in your household. Keep reading for the breakdown of the new official guidelines for what happens when you test positive, why the state says theyre making this change, and how to think about the risk your positive COVID-19 test poses to others.

CDPHs new isolation guidelines are focused on whether or not a COVID-positive person has symptoms. (Jump straight to the guidance for people without symptoms.)

The new guidance for COVID-positive Californians who have symptoms:

CDPHs message is clear: You still need to stay home initially. But now, instead of setting a clear time period like before five days at home, 10 days masking CDPH now says that you should judge when youre safe to leave the house: until you have not had a fever for 24 hours without using fever-reducing medication AND other COVID-19 symptoms are mild and improving.

Not everyone gets a fever as one of their COVID-19 symptoms, so what should you do if thats you? CDPH confirmed via email to KQED that you should still stay home if sick until symptoms are mild or improving.

Once your symptoms have improved, CDPH recommends that you Mask when you are around other people indoors for the 10 days after you become sick. You should only remove your mask before the 10 days are up if you have two sequential negative tests at least one day apart, says the new CDPH guidance. If you have symptoms, Day 0 is the day those started.

CDPH also says to Avoid contact with people at higher risk for severe COVID-19 for those 10 days. The agencys definition of higher-risk individuals includes the elderly, those who live in congregate care facilities, those who have immunocompromising conditions, and that put them at higher risk for serious illness.

CDPHs new guidance includes a reminder that youre potentially infectious with COVID-19 two days before your symptoms start.

The biggest change in CDPHs guidance: If you test positive for COVID-19 but dont have symptoms, you should now:

The CDC still says that COVID-positive people should stay home a full five days whether they have symptoms or not. But now, CDPH says that symptom-free people with COVID-19 can leave their homes as long as they follow the guidance above.

Like people with symptoms, you should only remove your mask before the 10 days are up if you have two sequential negative tests at least one day apart, the new CDPH guidance says. If you have no symptoms, your Day 0 is the day you tested positive.

CDPHs new guidance advises that even if you have no symptoms, youre still potentially infectious with COVID-19 two days before you get a positive test.

The states updated isolation protocol applies to schools, and the Oakland Unified School District was one of the first to announce it will be adopting the new recommendations that allow students who test positive for COVID-19 but have no symptoms, to attend school, as long as they wear a mask for 10 days after testing positive. Cal/OSHA has also adopted the new rules for most workplaces around the state (PDF).

Remember, theres growing evidence that some people take longer to get a positive test on an at-home antigen test. If you have symptoms but have tested negative, dont assume it means youre COVID-free. The CDC recommends that you take another antigen test 48 hours later and then test again after another 48 hours. You can also seek out a PCR test, which is more sensitive.

CDPH is firm that for California, the time has come to make this change.

Previous isolation recommendations were implemented to reduce the spread of a virus to which the population had little immunity and had led to large numbers of hospitalizations and deaths that overwhelmed our healthcare systems during the pandemic, the agency says in the introduction to its new guidelines. We are now at a different point in time with reduced impacts from COVID-19 compared to prior years due to broad immunity from vaccination and/or natural infection and readily available treatments for infected people.

The agency says its now recommending these new guidelines to align with common practice of other respiratory viruses, and in an email to KQED, elaborated that a significant proportion of COVID-19 infections are asymptomatic or include minimal symptoms, and many people may be infected with COVID-19 or other respiratory infections and do not test or know what infection they may have.

Acknowledging that COVID-19 now spreads alongside flu, RSV and other respiratory viruses, CDPH says in its email that this update incorporates our recommendations into a broader, multi-pronged approach to multiple respiratory viruses.

But if you look now at the weekly hospitalizations and deaths theyre much higher for COVID than they are for flu, like for the flu season, says Dr. Abraar Karan, an infectious disease physician and researcher at Stanford University. Late December, we had [around] 6500 [nationwide] recorded deaths for COVID. It was [around] 1500 to 2000 per week.

I wouldnt say that COVID has come down to the level where its less pathogenic than the flu per se, just by the numbers, Karan says.

The states COVID-19 dashboards show that hospitalizations and deaths of people with COVID-19 have risen since early November 2023. And when it comes to COVID-19 levels in Bay Area sewage, Stanford Universitys WastewaterSCAN team says that those levels of COVID-19 are high and increasing right now.

Dr. Peter Chin-Hong, an infectious disease expert at UCSF, says this new chapter in the states health policy took us all a bit by surprise.

But when you step back and think about it, were in a different place in January of 2024 compared to March of 2020, Chin-Hong says. There are some things that are changing. It seems dramatic, but there are many things that are not changing in terms of continuing to protect each other.

CDPH says that in 2024, the agencys policies and priorities for intervention are now focused on protecting those most at risk for serious illness while reducing social disruption that is disproportionate to recommendations for the prevention of other endemic respiratory viral infections. Chin-Hong says that he sees this latest CDPH guidance as really speaking to workplace and schools, and especially notes the impact of the pandemic on kids education, particularly in California and in the Bay Area because we probably were shut down more than most places in the country for a long, continuous time.

So I think in some ways it might be a response to that and sort of a nervousness around making sure that our kids are really as well prepared for the future as they can be, Chin-Hong says, given the fact that were going to be seeing these kinds of viruses emerge at least twice a year, we know, for COVID and at least once a year for many of the other respiratory viruses.

While Stanfords Dr. Karan says he has concerns about how much the general public will be able to adhere to mask guidelines and avoid higher-risk people after testing positive, he also says that even before this new guidance, a lot of people werent testing at all or even if they were testing positive, they probably werent following [existing isolation] guidance to 100%.

So I think what the health officials were trying to do was to be more practical and more pragmatic and say, Okay, well, people are probably going out anyways if they feel okay so lets at least just try to emphasize wearing a mask [and] staying away from others who are higher risk, Karan says. Thats my assumption of what drove this.

After almost four years of public health policy at the federal and state levels thats emphasized If youre COVID-positive, stay the heck away from other people, this new update might seem jarring to you.

Theres also the fact that since 2020, weve been told that not only can asymptomatic people be contagious with COVID-19, they might be responsible for fueling a lot of the spread of COVID-19 because those folks are so often unaware they even have the virus.

We know that you can be contagious without symptoms, Karan says. We also know that symptomatology can increase the risk of transmission. So if youre coughing and sneezing, youre probably emitting more viral particles.

This new California guidance focuses on symptomatic people as posing the most risk to others, noted Karan hence the continuing recommendation that those people stay home until those symptoms get milder. As for those asymptomatic people, Karan says, CDPHs take appears to be that if those people wear a mask for 10 days after their positive test, their risk is going to be pretty low that theyre going to be transmitting over time.

Karan says it might also be helpful to see this recent change in the context of how isolation recommendations have evolved throughout the pandemic but also how they havent. At the outset, the CDC stipulated a 10-day period of isolation for COVID-positive patients, a period shortened to five days in December 2021. But this update was still accompanied by guidance to wear a well-fitted mask for another five days.

That aspect wearing a mask for 10 days is something thats remained the same in this latest California update, and the mask part of it is key, Karan says. Its just sort of extending this a little bit to say people who no longer have any symptoms: To people that are either asymptomatic or theyve been fever-free without medications for 24 hours, he says. So theyre adding a contingency.

I think it will confuse the public, Karan says.

One big element hes looking at: As the isolation advice shifts from a clearly set time period five days, regardless of symptoms toward monitoring your own symptoms and you deciding when youre safe to leave the house, will people still remember that crucial next step of wearing a mask for 10 days? And will they have all the necessary information to also follow the other part of CDPHs new guidance that urges them to stay away from people at higher risk from COVID-19?

Karan says that he worries that people are going to forget the second and third part of that, Karan says and hes especially concerned that the importance of that well-fitted, high-filtration mask is going to get lost.

Karan says hed also liked to have seen CDPH give the public more information about the rationale behind why they were doing it, so that the public could understand that this new guidance wasnt a green light to go out into the world with COVID-19.

If theyd said, People that are not symptomatic can be contagious, but its less likely, and people without symptoms are likely going to be shedding less virus, so if you wear a high filtration mask, your risk of infecting others is quite low, and thats why were doing it? I think that would have made a lot of sense, Karan says.

Chin-Hong also acknowledges the emphasis these new guidelines place on avoiding exposing people who are at higher risk of severe illness and death from COVID-19. I worry about that population every night I go to sleep, he says, and thats because were still seeing 1600 Americans die every week.

When I look at the patients who Im taking care of in the hospital right now, the people who are doing poorly are people who didnt get the recent vaccines, Chin-Hong says. Theyre generally older than 75, and they didnt get access to or take advantage of Paxlovid.

Calmatters has reported that disability and equity advocates have particularly criticized CDPHs new guidelines, which they say could increase the risk of infection for Californians most vulnerable to severe illness or death from the virus.

This policy is not based in science, equity or public health, Lisa McCorkell, co-founder of the Patient-Led Research Collaborative that studies the impacts of long COVID, told CalMatters. It devalues the lives of immunocompromised and disabled people and completely ignores the risk of long COVID.

Michelle Gutierrez Vo, a registered nurse with Kaiser Permanente and a president of the California Nurses Association, echoed these concerns, calling the new guidelines a step backwards from protecting public health and very dangerous.

High risk people do not walk around with a flag saying I am high risk, so then the people that are COVID-positive can identify them and stay away from them, said Gutierrez Vo. It doesnt work that way.

So therefore, if you cannot be selective of who you need to be getting away from, then there just has to be a general understanding or a mandate which is what we had to make sure to protect the general public. It is is the Department of Public Healths responsibility to uphold public health, and they are not doing that with this new guidance, said Gutierrez Vo.

On the risks of long COVID, Gutierrez Vo said that Californias relaxing of isolation protocol puts everyone in danger. COVID, she said, is not like any other respiratory illness. When you have flu and you get over it, it doesnt have long term effects. When you have RSV, or any other respiratory illness like a viral syndrome, it doesnt damage your kidney or it doesnt damage your heart.

Chin-Hong urged the public to remember the ongoing basics of COVID-19 prevention seeking out the latest vaccine, wearing a well-fitted mask when necessary, remembering the importance of ventilation indoors and testing for COVID-19 amid the latest guidance. Reminding ourselves of those things should be really front and center, he says.

This story contains reporting by KQEDs Lesley McClurg.

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How Long to Isolate With COVID in 2024? California Now Says That Depends on Symptoms - KQED