The Centers for Disease Control and Prevention on Tuesday clarified its guidelines around what to do when you get COVID-19, a move that comes after criticism last week that their newest guidance to shorten the isolation down to five days without calling for a negative test was confusing and lax.
The latest update still does not include a recommendation for people to get a negative COVID test before leaving isolation, but gives guidance for people who "have access" and "want to test" — language that reflects the challenges many Americans have faced in recent weeks trying to get their hands on them — while still holding ground that a negative rapid test isn’t an all-clear.
People who test positive after five days should isolate for another five days, the CDC says, while people who test negative should still follow the guidance for those who don’t test: until day 10, wear a mask, avoid high-risk people, don’t travel and don’t eat or drink around others.
The CDC said the decision was based on data that negative rapid tests do not necessarily mean someone has stopped spreading the virus, and PCR tests — the most accurate type — can’t be relied on either, because they continue to show positive results for weeks afterward even when someone isn’t contagious.
“As such, regardless of the test result, wearing a well-fitting mask is still recommended,” the guidance said.
While more detailed, the updated guidance is not significantly different from last week’s guidelines, which changed the recommended isolation period for a person with COVID from 10 days down to five, followed by five days of masking around other people. It applies to everyone, vaccinated or not, who gets COVID, so long as people are largely clear of symptoms by Day 5.
But the decision rankled public health experts who thought a shorter isolation without a negative test would lead to more spread.
"CDC's new guidance to drop isolation of positives to 5 days without a negative test is reckless," Dr. Michael Mina, an epidemiologist and chief scientific officer at eMed tweeted last week following the initial announcement. "I absolutely don't want to sit next to someone who turned [positive] five days ago and hasn't tested [negative]."
Federal officials pushed back in the criticism, insisting that the new recommendations were based on science and not on social pressure.
"You can get people safely back out in a five-day period so long as they wear a mask if they are without symptoms. That is the science," Dr. Anthony Fauci, chief medical adviser to the White House, told ABC News last week. "The impact of that is to try and not be in a situation where we essentially have to shut down the entire country."
CDC Director Rochelle Walensky also defended the guidance, saying it was based on behavioral studies showing that only one-third of people were following the previous guidelines, and data showing up to 90% of COVID spread occurs in the first five days that someone has it.
"It really had a lot to do with what we thought people would be able to tolerate,” she said in an interview last week with CNN.
And on Tuesday, the guidance largely stuck to that stance, though it further clarified what people should do in all scenarios, including if they decide to test.
Here’s the latest:
If you get COVID, you should isolate for five days, the CDC says.
Day 0 is the first day of symptoms and day 1 is considered "first full day after your symptoms developed." For example, if you have symptoms on Monday, Tuesday is Day 1 and Saturday is Day 5.
If your case is asymptomatic, Day 0 is the day you tested positive. But the CDC’s guidance on Tuesday clarified that if people test positive without any symptoms, and then develop symptoms in the days afterward, they should reset their isolation clock back to zero on the day they have symptoms and isolate for another five days.
After five full days, you can leave isolation if you are mostly all better. What does that mean? Fever-free and on the mend.
"You can end isolation after 5 full days if you are fever-free for 24 hours without the use of fever-reducing medication and your other symptoms have improved," according to CDC guidance.
Loss of taste and smell, two common COVID symptoms, can last "for weeks or months after recovery" and do not qualify as symptoms that should keep you in isolation.
Then, after five days, you should wear a "well-fitting mask around others at home and in public for 5 additional days (day 6 through day 10) after the end of your 5-day isolation period,” the guidance says.
If you’re unable to mask, or if you can mask but will be around high-risk people, opt instead for the isolation, the CDC says.
"If you are unable to wear a mask when around others, you should continue to isolate for a full 10 days. Avoid people who are immunocompromised or at high risk for severe disease, and nursing homes and other high-risk settings, until after at least 10 days," according to the CDC.
If you still want to test, and can find one
As for the testing component, the CDC recommends that people who can and want to test should do so around day five, if they have been fever-free for 24 hours.
"If your test result is positive, you should continue to isolate until day 10," the guidance says.
And, importantly, a negative test is not an all-clear, according to the CDC.
"If your test result is negative, you can end isolation, but continue to wear a well-fitting mask around others at home and in public until day 10," the guidance says.
The CDC recommends against traveling, going anywhere where you are unable to wear a mask like restaurants and gyms, and avoid eating around people — both at home and in public — "until a full 10 days after your first day of symptoms," even with a negative test.
Walensky, asked about the guidance in an interview with "The Late Show" host Stephen Colbert on Monday night, said she would interpret even a negative test as possibly having "some transmissibility ahead of you."
"If you have access to a test, and if you want to do a test at day five, and if your symptoms are gone and you're feeling well, then go ahead and do that test," Walensky said.
"But here's how I would interpret that test. If it's positive, stay home for another five days. If it's negative, I would say you still really need to wear a mask. You still may have some transmissibility ahead of you," she said.
"You still should probably not visit grandma. You shouldn't get on an airplane. And you should still be pretty careful when you're with other people by wearing your mask all the time."
While the rollout of the guidance has been met with much criticism, experts have noted that its ultimately a fast-paced environment with no easy one-size-fits-all solution.
"The CDC is sending a mixed message -- but I don't think there's any way around that," Dr. David Dowdy, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health, told ABC News.
"And I don't think we should be too quick to judge mixed messages in the context of a rapidly evolving situation. We want our guidelines to reflect the most recent knowledge we have, meaning that those guidelines are going to change, sometimes quickly," he said.