The Centers for Disease Control and Prevention is charged with safeguarding American lives. But in the 10th month of the coronavirus pandemic, as infections surge to new highs, the agency’s advice about what citizens should do remains confusing — right at a time when we need clarity most.
While local governments set their own quarantine rules, officials take their cues from the CDC For months, the agency has advised that people who have been exposed to someone with the virus should quarantine for 14 days.
This instruction arose from data that showed that people might not become symptomatic and infectious for as long as two weeks after being exposed to the coronavirus. People could not “test out” of quarantine, shortening their confinement period by producing a negative test result. This was a clear and effective message, since we don’t want people who might be infectious leaving home and potentially exposing others while they’re getting tested repeatedly in an attempt to secure an early release from quarantine.
While a 14-day quarantine remains the CDC’s preferred strategy, the agency recently revised its guidelines to add two other options: People without symptoms can quarantine for only 10 days, or take a test at least five days after exposure, and if that test is negative, end their self-isolation seven days after exposure.
Yes, the CDC does cite recent research to justify the revision of its original guidance, but in the end it does not offer a clear conclusion about the length of quarantine that is useful to ordinary people. Instead, federal health officials punt the ultimate decision to local public health officials, who are advised to choose a path based on trends in their area. But in much of the country, transmission is already a huge problem. Given that cases have risen 50 percent in the past month and hospitals are filling up, it’s puzzling that anyone would think that now is the time to be more relaxed.
Leaving these decisions up to individuals and local officials increases confusion. At my university and health care system, many people who’ve read about the changes in guidance have asked me what we are doing in response. Most people I hear from don’t understand which pathway is ideal, which one their local officials might prefer, or why.
Experts attribute the change in policy to a strategy of “harm reduction,” which I almost always support. This concept acknowledges that many people would not or could not quarantine for 14 days if they were exposed; it also addresses the very real possibility that a 14-day quarantine requirement might drive people to mislead contact tracers about potential exposure.
Knowing this, some experts back a shorter, more palatable quarantine period, noting that a seven- or 10-day quarantine is still better than no quarantine at all. All of this is correct. As I have argued, more is better than perfect when it comes to this pandemic.
But the role of the CDC is not to tell us what we might tolerate. It’s to tell us what we should do, regardless of whether we want to do it. It’s the agency’s job to evaluate the science and provide its best read on how we should respond. If the science supports a 14-day quarantine, the CDC should make that unequivocally clear, without clouding the picture by adding second and third options.
The public’s trust in scientific evaluation, and this kind of accuracy in scientific communication, will be critical in the coming months as more vaccines are approved. The CDC should continue to speak in clear language about vaccines’ efficacy, their safety, and who should get one and when. If officials defer to a “choose your own adventure” approach for fear that people won’t follow guidelines, chaos will follow. If governments waffle, or do not keep their pronouncements tied to data and evidence, the public will lose faith in the vaccination process.
To help states and counties come up with recommendations for quarantine that will be more tolerable, the CDC should be more clear about the risks and benefits of all pathways. The agency recommends its test-out-of-quarantine option be used only when local testing resources can meet demand for those who are symptomatic, but the CDC doesn’t explain how individuals can determine this. It shouldn’t take advanced degrees and a willingness to review the medical literature to understand CDC guidelines on a major public health issue.
For too long, the CDC has failed in its mandate to protect and guide us during this pandemic. Much of that was thanks to political interference, but this isn’t about blame. A new administration is imminent, and there’s little reason to fear further retribution for being forthright. The guidance of the CDC, and other groups, must be sure, specific and scientific. Our public health depends on it.
Aaron E. Carroll
Aaron E. Carroll is a contributing opinion writer for The New York Times. He is a professor of pediatrics at Indiana University School of Medicine and the Regenstrief Institute who blogs on health research and policy at The Incidental Economist.