Misinterpreted guidance may fuel a COVID-19 uptick, Northwestern expert says

While COVID-19 appears to have hit a plateau in the U.S., a misinterpretation of eased CDC guidance may contribute to an uptick this fall and winter, according to an epidemiologist at Chicago-based Northwestern Medicine. 

Cases have fallen for four consecutive weeks, according to the CDC's COVID data tracker weekly review last updated Aug. 19. Forecasts from Rochester, Minn.-based Mayo Clinic show the decline will continue, at least through Labor Day weekend, when all but three states are projected to see case rates fall. Hospitalizations are also trending downward, and the World Health Organization said new weekly global deaths were down 15 percent for the week ending Aug. 21 compared to the week before.  

But of course, all of this is subject to change come fall and winter when cooler weather moves in and people gather indoors and travel for the holidays. 

"I think we're going to see fairly rapid spread," said Mercedes Carnethon, PhD, vice chair of the department of medicine at Northwestern University. That may likely be in part because of misinterpreted guidance. 

Earlier this month, the CDC released updated COVID-19 guidance that did away with quarantine after exposure, regardless of vaccination status. The updated guidance largely focuses on mitigating the risk of severe disease, rather than infection itself, and underscores the importance of vaccination, boosters and treatment.

"I think a lot of people are considering it a little less seriously given the updated guidance about whether or not you need to quarantine with exposure," Dr. Carnethon told Becker's. "I think the most fearful thing is that people won't take infections and exposures to positive people as seriously and that they'll continue circulating." 

There are details in the guidance that may be overlooked, particularly surrounding recommendations for isolation. The CDC says people with COVID-19 may end isolation after five days if fever-free for 24 hours without medication, though a mask should be worn through day 10. The agency also advises immunocompromised people isolate for 10 days, not five. 

Dr. Carnethon expressed concern that employers may be less lenient and expect people who were out with COVID-19 to come back to work sooner than they would have earlier in the pandemic.

"I'm a little concerned that people won't pay attention to those nuances in the guidance and [infected people] come back prematurely and thus place higher-risk people at risk," she said. 

And just because there are more tools available now to prevent severe illness, the nation's healthcare system isn't out of the woods from facing a significant COVID-19 burden. 

Based on past experience in the winter months, Dr. Carnethon said hospitals could again feel significant strain from the disease, both from a rise in the number of infected patients who may need care and staff who are out sick. 

"We're going to see shortages in high-needs areas: nursing homes, rehabilitation facilities where people may go," she said. "Providers who spend a lot of time face to face and one-on-one with patients have throughout the pandemic shown a higher risk of being infected. That includes nursing staff in hospitals, registered nurses and other care providers in long-term care facilities." 


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