Americans who test positive for the coronavirus no longer need to routinely stay home from work and school for five days under new guidance released Friday by the Centers for Disease Control and Prevention.

The agency is loosening its COVID isolation recommendations for the first time since 2021 to reflect the changing landscape of COVID-19 four years after the virus emerged. The CDC laid out its justification for the guidance change in a 25-page document that describes the evolving risk environment. Although coronavirus infections are continuing at levels similar to years past, new infections are now causing less severe illness and far fewer hospitalizations or deaths, CDC data show.

The change, as reported by the Washington Post last month, is effective immediately, CDC officials said. The agency said it is streamlining its guidance for respiratory viral illnesses, and the new recommendations bring COVID-19 in line with how other common viruses, such as influenza and RSV, are managed.

“Our goal here is to protect those at risk for severe illness while also reassuring folks that these recommendations are simple, clear, easy-to-understand and can be followed,” CDC Director Mandy Cohen said during a media briefing Friday. The change, she added, “reflects the progress we’ve made in protecting against severe illness from COVID.”

The basic advice is now the same: Stay home when you’re sick and away from others. Under the new approach, people who test positive for the coronavirus would no longer need to isolate at home if they have been fever-free for at least 24 hours without the aid of medication and their overall symptoms are improving.

Once people resume normal activities, the updated guidance encourages them to take additional preventive steps for the next five days to curb disease spread. This includes improving ventilation by opening windows to bring in fresh outside air or purifying indoor air, washing hands often and cleaning frequently touched surfaces, wearing a well-fitting mask and keeping a distance from others, CDC officials said.

Not all respiratory infections result in fever, so paying attention to other symptoms, such as cough and muscle aches, is important as someone determines when they are well enough to leave home, according to the CDC.

Giving people symptom-based guidance is a better way to prioritize those most at risk and balance the potential for disruptive impacts on schools and workplaces, health officials and experts have said. The federal recommendations follow similar moves by Oregon and California. California shortened its five-day isolation recommendation in January; Oregon made a similar move last May.

Other countries have implemented similar guidance, including Britain, Australia, France and Canada, and found no significant change in spread or severe disease, according to a CDC blog post on the respiratory guidance.

A simplified message

Many experts have said the changes are long overdue and public health guidance needs to shift to a more practical approach. The COVID-19 reality is far different now than early in the pandemic, when the population had no protection against a novel pathogen. By the end of last year, 98% of people in the United States had disease-fighting antibodies from vaccination, prior infection or both, which confers the strongest immunity.

There are still about 20,000 people a week hospitalized for COVID-19 and about 2,000 deaths a week caused by the disease, according to CDC.

The updated recommendations are for the general population and community settings; there are no changes to respiratory virus guidance for health-care settings, such as hospitals, with more vulnerable populations. The respiratory virus guidance covers most common respiratory viral illnesses, but does not replace specific guidance for pathogens, such as measles, an extremely contagious disease that requires much stricter isolation and quarantine measures.

Advocates for people with disabilities and others who face higher risk of severe COVID condemned the CDC’s shift, which they say endangers them by abandoning attempts to control transmission.

“Changing COVID isolation times does not change how the virus behaves,” Maria Town, president of the American Association of People with Disabilities, said in a statement last week condemning the CDC’s plans. “Mild COVID is still COVID. A person who has COVID without a fever still has COVID. And that means they are still posing a risk to the high-risk, immunocompromised, and disabled members of their community.”

CDC officials said protecting vulnerable people was a top priority while revising the guidance, and they believe the new approach helps if it means more people stay home while sick with any virus instead of depending on coronavirus tests.

Work on revising isolation guidance has been underway since last August but was paused in the fall as COVID cases rose. Agency officials have said they recognized the need to give the public more practical guidelines for COVID-19, acknowledging that few people are following isolation guidance that hasn’t been updated since December 2021. Different guidance for different viruses also makes it difficult to know what to do when someone doesn’t know what is causing their symptoms, officials said.

While every respiratory virus does not act the same, having a common approach to limiting disease spread makes recommendations easier to follow – and more likely to be adopted – and does not rely on people to test for illness, CDC officials said. Estimates suggest only about 50 percent of individuals were testing for COVID-19, said Demetre Daskalakis, who heads CDC’s National Center for Immunization and Respiratory Diseases.

David Margolius, Cleveland’s top public health official, applauded the updated guidance, adding that hospitalizations from RSV and influenza have exceeded those from COVID-19 in his community.

“Simplifying the public health messaging to treat all of these dangerous contagious respiratory viruses the same makes a lot of sense,” Margolius said. “We really want the takeaway to be when you’re sick, stay home until you feel better.”

He said he’d continue to urge employers to not force sick employees to come into work. Revised guidance emphasizing being fever-free could help, he said, because some employers made sick employees come to work if they test negative for COVID. As a result, people with other contagious viruses or who received false negatives would still be exposing others in the workplace, Margolius said.

Many businesses already stopped offering workers with COVID infections five paid days to isolate and celebrated state officials who moved away from the CDC guidance, arguing it was overly burdensome to keep workers with mild or no symptoms off the job for so long.

Cohen acknowledged that organizations need to consider policies that would allow employees to stay home when sick, such as working from home or paid sick leave. Cohen said federal health officials anticipate there will be updated vaccines for flu and COVID-19 this fall. As part of a common approach to respiratory viruses, “we’d like to see employers hold flu and COVID clinics,” she said.

Nearly 1.2 million people have died of COVID-19 as of Feb. 10, 2024. The virus was the third leading cause of death in 2021, accounting for 12 percent of all deaths. In 2022, it was the fourth leading cause of death, after heart disease, cancer and unintentional injury. Preliminary data from 2023 shows COVID-19 as the 10th leading cause of death, according to CDC.

CDC officials also said more people need to get vaccinated with the latest version of the vaccine made available last fall. Uptake of the updated vaccine among adults has been low – only about 22 percent of those 18 and older have received a dose. And only about 42 percent of those 65 and older have received a dose. Among those hospitalized with COVID-19 this past season, Cohen said, more than 95 percent had not received an updated coronavirus vaccine.

Most COVID-19 deaths and hospitalizations last year were among people 65 years and older. The CDC this week recommended an additional vaccine dose because it can provide added protection to immunity that may have waned over time.