Americans who test positive for the coronavirus no longer need to routinely stay home from work and school for five days under new guidance planned by the Centers for Disease Control and Prevention.
The agency is loosening its covid isolation recommendations for the first time since 2021 to align it with guidance on how to avoid transmitting flu and RSV, according to four agency officials and an expert familiar with the discussions.
CDC officials acknowledged in internal discussions and in a briefing last week with state health officials how much the covid-19 landscape has changed since the virus emerged four years ago, killing nearly 1.2 million people in the United States and shuttering businesses and schools. The new reality with most people having developed a level of immunity to the virus because of prior infection or vaccination warrants a shift to a more practical approach, experts and health officials say.
Public health has to be realistic, said Michael T. Osterholm, an infectious-disease expert at the University of Minnesota. In making recommendations to the public today, we have to try to get the most out of what people are willing to do. You can be absolutely right in the science and yet accomplish nothing because no one will listen to you.
The new guidance, which is expected in the spring, would bring covid-19 in line with recommendations for other respiratory viruses. Reporter Lena Sun explains. (Video: Drea Cornejo/The Washington Post)
The CDC plans to recommend that people who test positive for the coronavirus use clinical symptoms to determine when to end isolation. Under the new approach, people would no longer need to stay home if they have been fever-free for at least 24 hours without the aid of medication and their symptoms are mild and improving, according to three agency officials who spoke on the condition of anonymity to share internal discussions.
The federal recommendations follow similar moves by Oregon and California. The White House has yet to sign off on the guidance that the agency is expected to release in April for public feedback, officials said. One agency official said the timing could move around a bit until the guidance is finalized.
Work on revising isolation guidance has been underway since last August but was paused in the fall as covid cases rose. CDC director Mandy Cohen sent staff a memo in January that listed Pan-resp guidance-April as a bullet point for the agencys 2024 priorities.
Officials said they recognized the need to give the public more practical guidelines for covid-19, acknowledging that few people are following isolation guidance that hasnt been updated since December 2021. Back then, health officials cut the recommended isolation period for people with asymptomatic coronavirus from 10 days to five because they worried essential services would be hobbled as the highly transmissible omicron variant sent infections surging. The decision was hailed by business groups and slammed by some union leaders and health experts.
The plan to further loosen isolation guidance when the science around infectiousness has not changed is likely to prompt strong negative reaction from vulnerable groups, including people older than 65, those with weak immune systems and long-covid patients, CDC officials and experts said.
Doing so sweeps this serious illness under the rug, said Lara Jirmanus, a clinical instructor at Harvard Medical School and a member of the Peoples CDC, a coalition of health-care workers, scientists and advocates focused on reducing the harmful effects of covid-19.
Public health officials should treat covid differently from other respiratory viruses, she said, because its deadlier than the flu and increases the risk of developing long-term complications. As many as 7 percent of Americans report having suffered from a slew of lingering covid symptoms, including fatigue, difficulty breathing, brain fog, joint pain and ongoing loss of taste and smell, according to the CDC.
The new isolation recommendations would not apply to hospitals and other health-care settings with more vulnerable populations, CDC officials said.
While the coronavirus continues to cause serious illness, especially among the most vulnerable people, vaccines and effective treatments such as Paxlovid are available. The latest versions of coronavirus vaccines were 54 percent effective at preventing symptomatic infection in adults, according to data released Feb. 1, the first U.S. study to assess how well the shots work against the most recent coronavirus variant. But CDC data shows only 22 percent of adults and 12 percent of children had received the updated vaccine as of Feb. 9, despite data showing the vaccines provide robust protection against serious illness.
Coronavirus levels in wastewater indicate that symptomatic and asymptomatic infections remain high. About 20,000 people are still hospitalized and about 2,300 are dying every week, CDC data show. But the numbers are falling and are much lower than when deaths peaked in January 2021 when almost 26,000 people died of covid each week and about 115,000 were hospitalized.
The lower rates of hospitalizations were among the reasons California shortened its five-day isolation recommendation last month, urging people to stay home until they are fever-free for 24 hours and their symptoms are mild and improving. Oregon made a similar move last May.
Californias state epidemiologist Erica Pan said the societal disruptions that resulted from strict isolation guidelines also helped spur the change. Workers without sick leave and those who cant work from home if they or their children test positive and are required to isolate bore a disproportionate burden. Strict isolation requirements can act as a disincentive to test when testing should be encouraged so people at risk for serious illness can get treatment, she said.
Giving people symptom-based guidance, similar to what is already recommended for flu, is a better way to prioritize those most at risk and balance the potential for disruptive impacts on schools and workplaces, Pan said. After Oregon made its change, the state has not experienced any disproportionate increases in community transmission or severity, according to data shared last month with the national association representing state health officials.
California still recommends people with covid wear masks indoors when they are around others for 10 days after testing positive even if they have no symptoms or becoming sick. You may remove your mask sooner than 10 days if you have two sequential negative tests at least one day apart, the California guidance states.
Its not clear whether the updated CDC guidance will continue to recommend masking for 10 days.
Health officials from other states told the CDC last week that they are already moving toward isolation guidelines that would treat the coronavirus the same as flu and RSV, with additional precautions for people at high risk, said Anne Zink, an emergency room physician and Alaskas chief medical officer.
Many other countries, including the United Kingdom, Denmark, Finland, Norway and Australia, made changes to isolation recommendations in 2022. Of 16 countries whose policies California officials reviewed, only Germany and Ireland still recommend isolation for five days, according to a presentation the California public health department gave health officials from other states in January. The Singapore ministry of health, in updated guidance late last year, said residents could return to normal activities once coronavirus symptoms resolve.
Even before the Biden administration ended the public health emergency last May, much of the public had moved on from covid-19, with many people having long given up testing and masking, much less isolating when they come down with covid symptoms.
Doctors say the best way for sick people to protect their communities is to mask or avoid unnecessary trips outside the home.
You see a lot of people with symptoms you dont know if they have covid or influenza or RSV but in all three of those cases, they probably shouldnt be at Target, coughing, and looking sick, said Eli Perencevich, an internal medicine professor at the University of Iowa.
The latest HILDA survey shows Australias gender gap in employment continuing to close, with progress beginning on the earnings gap.
Remarkably, the progress has continued notwithstanding the disruptions caused by COVID; there are indications they may even have helped.
Funded by the Australian government and managed by the Melbourne Institute, the Household, Income and Labour Dynamics in Australia (HILDA) survey is one of Australias most valuable social research tools.
HILDA examined the lives of 14,000 Australians in 2001 and has kept coming back each year to discover what has changed. By surveying their children as well, and in future surveying their grandchildren, it is building up a long-term picture of how the lives of Australians are changing.
The full span of the surveys through to the results for 2021 released this morning shows shows the proportion of women aged 18 to 64 in paid employment climbed from 64.3% in 2001 to 74.1% in 2019 before dipping during COVID and then bouncing back.
Separate labour force figures collected by the Bureau of Statistics suggest it might be as high as 76% by now, indicating that COVID may have merely dented rather than turned back progress.
For men of that age, the proportion in paid employment has changed little during those two decades, fluctuating between 80% and 84%, allowing the gap in employment between men and women to narrow eight percentage points.
Older women aged 65 to 69 are also much more likely to be employed. Most of the gain has taken place since 2009 when one in ten women of that age were in paid employment, a figure that has since climbed to one in four, not too far off the one in three men of that age employed.
Read more: Older women are doing remarkable things it's time for putdowns to end
Much of the increase would be due to the phased increase in the female pension age between 1995 and 2004 and the further increase in both the male and female pension age between 2017 and 2023. Broader social and economic changes such as the increase in two-earner couples will have also played a role.
While men remain well ahead in full-time employment, that gap is narrowing too. The proportion of women aged 18 to 64 employed full-time has climbed from around 35% to around 40% while the proportion for men has stayed close to 70%.
Previous HILDA reports have shown the arrival of children remains an important driver of divergence in the labour market experiences of men and women.
The arrival of a couples first child sees hours of paid work of the mother plummet and in many cases not recover for more than a decade. It has almost no effect on the paid working time of fathers.
Time spent on housework and child care, by contrast, rises dramatically for mothers and actually falls slightly for fathers.
If the gender gap in employment is to be eliminated, it is clear couples with children will need to share the load more equally.
Male and female earnings have been converging slower than male and female employment, but the pace has picked up.
In 2001, women employed full-time earned on average 79% of what men earned. As recently as 2016, they still earned only 78% of what men earned.
But, since then, their earnings relative to male earnings have shot up, hitting 86% in 2021.
The gap in earnings of all employees full-time and part-time is greater because women are more likely to be employed part-time, but growth in the number of women employed full-time means this gap is closing faster. Average female earnings have climbed from 66% of male earnings in 2001 to 75% in 2021.
While the pandemic seemed to hurt womens employment prospects more than mens, longer term it seems to be improving the relative position of women.
HILDA shows the proportion of employees working from home in 2020 and 2021 has increased substantially.
The proportion working any hours at home climbed from 25.1% in 2019 to 37.3% in 2021. The proportion working only at home climbed from 3.5% to 17.7%.
There has also been a sizeable rise in the proportion of employees reporting an entitlement to work from home, from 35% in 2019 to 45%.
While the increases were greatest in the regions that experienced extensive lockdowns Victoria, NSW and the ACT working from home increased in almost all parts of Australia.
Read more: HILDA finds working from home boosts women's job satisfaction more than men's, and that has a downside
HILDA shows women have been more likely to work from home than men since COVID, even after accounting for differences in the occupations and industries in which they work.
This is probably because of an increase in the number and types of jobs that can be worked at home by mothers with caring responsibilities.
But this latest 2021 HILDA survey also reveals another gender gap in the labour market: women are more likely to work while unwell, including working at the workplace while unwell.
There are health risks from working from home while unwell and also career risks from working at home. Being physically present in the workplace is likely to assist with career advancement.
Out of sight can mean out of mind when it comes to promotions.
Also providing a glimmer of hope for closing the gender gaps in the labour market is that, among parents with children, weve seen an increase in the time men have been spending on household chores and looking after the children.
The improvement accelerated slightly in 2020 and 2021, via both an increase in the hours worked on domestic chores by men and a slight decrease for women.
But there is a long way to go. In 2021, mothers of dependent children were still spending 75% more time on unpaid housework and child care than their male partners.
The mothers spent 53 hours per week. Their male partners spent 30 hours.
Read more: HILDA survey at a glance: 7 charts reveal we're smoking less, taking more drugs and still binge drinking
As the medical world continues to grapple with the complexities of the ever-changing COVID-19 virus, theres a growing focus on the potential long-term effects of the illness.
Now there's a new comprehensive analysis recently published in the American Academy of Pediatrics' (AAP) publication Pediatrics. They looked at research from previous scientific studies around the world to highlight what is currently known about long COVID and the potential effects it has on children. It is sometimes also called long haul COVID or Postaacute Sequelae of COVID-19 (PASC).
The review found that in some cases, long COVID can lead to neurological, gastrointestinal, cardiovascular, and behavioral issues months after acute infection.
Suchitra Rao, MD, a pediatric infectious disease expert at Childrens Hospital Colorado, and co-author of the review explains that occasionally, a persons immune response to fighting off a virus can be harmful.
It can start attacking its own cells inadvertently, which can lead to autoimmune and other post-infectious conditions, she says. The studies included in the review found those post-COVID conditions included type 1 diabetes, Graves disease, lupus, and Immune thrombocytopenia (ITP) or low platelets.
Long COVID, she cautions, can present in many different ways, affecting virtually any organ system.The review includes a range of studies that look at a variety of factors, such as the patients age, severity of initial infection, and hospitalizations.
Rachel S. Gross, MD, MS, a general pediatrician, clinical research investigator, and an Assistant Professor of Pediatrics at the NYU School of Medicine and Bellevue Hospital Center, is one of the dozens of pediatric clinicians and researchers participating in the National Institutes of Health-funded RECOVER (Researching COVID to Enhance Recovery) Initiative. It aims to improve the diagnosis, treatment, and prevention of long Covid in children.
Dr. Gross says while the research currently indicates that long COVID is more prevalent in adults, its a common misconception that children are not at risk.
According to the Centers for Disease Control and Prevention (CDC), long COVIDin both children and adultsis when a person has symptoms that last weeks, months, or even years after their COVID infection. It can include symptoms they had during the infection that lingers or new symptoms that they didnt have beforeand these symptoms can even come and go.
Sometimes, long COVID can happen to people who had a mild COVID-19 infection or didn't even know they had the virus to begin with. Some may also start to feel better after an initial infection and then begin having symptoms again.
According to RECOVER,there are more than 40 symptoms of long COVID in children and young adults. Children who have long COVID can have any mix of them.
Some of the most common symptoms of long COVID in children include fatigue, brain fogor trouble concentrating on daily tasks, headaches, and sleep issues.It may also affect what a child can do during the day, like how they play or if they can go to school. They may also have trouble walking or standing, including walking up stairs, worsening of symptoms after being active, or needing to rest more.
Dr. Gross says the impact of long COVID on childrens mental health is also well-documented, and these symptoms can include mood changes, feeling sad, anxious, angry, or stressed.
More severe cases can include prolonged cardiac complications like myocarditis (MIS-C) and arrhythmias.Long COVID in those with pre-existing conditions may experience aggravated or worsening of those conditions, particularly those with respiratory issues like asthma, according to the CDC.
Long COVID does not look the same in everyone, with different people experiencing different symptoms. In children, who are still growing, this is especially true, says Dr. Gross. Thats why RECOVER is conducting research to learn why this happens, how to treat it, and ways to prevent it.
Data from the National Health Interview Survey published by the CDC shows the prevalence of long COVID in children in 2022 was about 1.3% while the estimate in adults was closer to 7%.
According to the RECOVER Initiative though, estimates appear higher. The review, which gathered data from the start of the pandemic in 2019, says 10-20% of children who had an initial COVID infection developed long COVID, and that it affected up to 5.8 million children.
Dr. Rao says there is still much to be learned about why some patients experience long COVID symptoms but not others and more clinical trials are needed to evaluate the effectiveness of treatments for the illness in children. She says the current COVID vaccine, along with booster shots, have helped reduce and prevent the risk of long COVID-19.
There are trials underway exploring whether longer courses of antiviral treatments during the acute phase of infection may decrease the risk of long COVID, but it is not recommended at this time, she explains.
For children who do experience long COVID, getting lots of rest can help in the recovery process and may help symptoms from getting worse.
Doctors also say recovery should include:
Experts say if you notice your child having lingering or new symptoms following a COVID-19 infection, it is important to consult with a health care professional. Parents and caregivers can make an appointment with their childs doctor to talk about their concerns or talk about these issues during their childs regular visits.
It is also recommended to keep a log of the start of symptoms, the severity, and anything that may make their child feel better or worse.
For more information on symptoms of Long COVID, and how parents and caregivers can speak with a pediatrician, please see the RECOVER Pediatric Long COVID Tip Sheet.
The COVID-19 pandemic may be largely in the rear view mirror for most of us, but its still causing thousands of hospitalizations and hundreds of deaths each month in the United States. Recent data from the Centers for Disease Control and Prevention suggests the latest vaccine is still pretty effective, but the percentage of those who are up to date of their COVID-19 boosters here and across the country remains really low.
And now, county public health officials are warning residents that an international visitor to Arizona was diagnosed with measles and could have exposed people in public late last month. And Arizonas high rate of unvaccinated children puts us at increased risk of an outbreak.
Dr. Nick Staab is assistant medical director for the Maricopa County Department of Public Health, and he joined The Show to tell us more.
Nick Staab
Nick Staab
LAUREN GILGER:Good morning, Dr. Staab.
DR. NICK STAAB:Good morning, Lauren.
GILGER:Let's begin with the vaccination rates here in our county.When we say there's a low child vaccination rate here.What does that mean?How low is it?
STAAB:So when we're looking at vaccination rates, what we're really trying to aim for is that rate that gives us community immunity or a herd immunity and, and really protects those who for a variety of reasons can't be vaccinated or their immune systems have not responded to vaccination.So we're looking to reach that level. Each disease that we can vaccinate against kind of has a different level that you need to reach.And so when we're looking at something like measles, it's a very infectious disease.So we need a, a high degree of community immunity and we've fallen well below that, especially amongst our school age children that we really need to protect against severe disease with measles.
GILGER:So what does that mean when it comes to this measles case that was in, I believe, parts of Chandler and a few public places late last month.What should people know?
STAAB:What we want people to know is that measles is spreading both nationally, globally and, and with this case here in our community.And so we really need to increase that vaccination rate so that we can stop that transmission when we have these single cases that pop up here and there.And so this is really an opportunity to remind folks the best way we can prevent transmission, prevent disease with measles is that vaccination and people should be up to date on their vaccination.
GILGER:What about COVID vaccination rates?Do we know how many people here are vaccinated against COVID?And how many are even up to date on those, those boosters?
STAAB:Yeah.Our, our data our data on COVID vaccine is not what it was during the pandemic.We don't have as strong data but we, what we do know is that the rates are very low.So even compared to flu vaccine, we know that the updated COVID vaccine, that one that came out for this respiratory season 2023-24,we're looking at 10% or lower of eligible individuals who have gotten that updated vaccine.So we have lots of room to improve there.
GILGER:That's interesting.So I wonder like it's so low, does it start to raise concerns about sort of the public trust in public health and institutions and authorities like you and, and like the CDC in general?
STAAB:There's, there's a lot of conversation in public health about that in our communications throughout the pandemic and then following.So we will continue to do what we do, which is try and get the best information out to people in a way that they can understand.And certainly in the area of immunizations and vaccines. That is that is our goal.So we work with a lot of community partners to make sure that they have the best information they can, they can to reach their memberswith the message that, that the best way to protect ourselves and protect our community is to be vaccinated.
GILGER:The CDC is now loosening some of its guidelines on COVID.Its new guidance it sounds like we take away the five day isolation period for people who test positive for COVID.Can you tell us what the guidance will look like instead?Like if you don't need to stay home for five days alone, what do you do instead if you test positive for COVID?
STAAB:So the report out this week is, is kind of a leak of a plan to change that guidance. So we have not received that guidance from CDC or from our State Health Department.It is an eventuality, we expected that we would lower that isolation period to, to look more like what we recommend for flu or RSV or other respiratory viruses,but we don't have that guidance just yet.So, from a public health perspective, we are still recommending COVID isolation as it's recommended by CDC.But eventually we expect that it will look more like that 24 hour fever free, improving symptoms and that kind of thing, but again, not quite there yet.
GILGER:It's interesting is it just because there's so much immunity built up in the community, we don't need to be concerned in that way or is this something, you know, more people who are at risk should be concerned about?
STAAB:So the risk is still there.And certainly if you are at increased risk for severe disease from COVID, there are extra steps that you should takebeyond what is kind of that basic recommendation.It's not really that anything has changed.It's kind of like what do, what we know people are doing.And so if, if the if the guidance is not really being followed, if it's not effective, then I think we, we try to in public health meet people where they are to, to have the greatest benefit.We know that there's a lot of difficulty in isolating for five days if you are a working parent or a single income household.So many things go into that to make it really difficult to follow that five day isolation.
GILGER:Yeah.So practicality is a factor there.Last question for you, Dr. Staab about home tests.There are lots of questions out there about whether or not they still work or if they're maybe just taking longer to come up with a positive result.What's the status there?
STAAB:So, based on what we know about current circulating variants and what we're told by the manufacturers and the FDA about how these tests are working, we believe that the home tests are still effective and accurate.I think the bigger question is, you know, how are we distributing them?How are they accessible to everyone in the community and, and how are people using them if they have symptoms?And I think that those practices have all changed a lot in the last couple of months.So that we just have fewer people testing. And again, the reason why from a messaging standpoint kind of having isolation recommendations that are more, they're applied more evenly across these respiratory infections.The easier it will be for people to follow.
GILGER:Makes sense.All right, we'll leave it there for now.Dr. Nick Staab, assistant medical director for the Maricopa County Department of Public Health.Dr. Staab, thank you for coming back on.I appreciate it.
STAAB:Thank you.
ICYMI - Governor Murphy Announces Allocation of $95 Million from New Jerseys Opioid Recovery and Remediation Fund
Governor Phil Murphy today announced the allocation of over $95 million from New Jerseys Opioid Recovery and Remediation Fund to support critical programs tackling the opioid crisis, connecting New Jerseyans with tools to reduce overdoses and other harms of substance use, and supporting the treatment and recovery of residents struggling with substance use disorders. At the recommendation of the States Opioid Recovery and Remediation Advisory Council and with extensive input from the public, six programs addressing four priority areas harm reduction, prevention and recovery support, treatment, and housing have been identified to receive funding over the next two to three years.
Learn More >
People who test positive for Covid should still isolate for five days, according to the Centers for Disease Control and Prevention, even though many Americans are already ignoring the policy. That guidance is likely to change at some point, however.
Following reports that the CDC was considering easing Covid isolation restrictions including guidelines that people can leave their homes after being fever-free for 24 hours the agency refused to confirm that such plans were in the works. The potential change was first reported by The Washington Post.
But an official at the Department of Health and Human Services who asked not to be identified said federal health officials are considering relaxing Covid isolation guidelines, although the discussions are at an early stage and no definitive decisions have been made.
Its way too preliminary, the source said. Theres lots more consultation to be had.
The CDC is looking at changes to its overall Covid guidance, which could include recommendations about masking as well as isolation, said a public health official who was involved with a recent call with the CDC. The CDC currently recommends masking for 10 days following a Covid diagnosis.
Theres no evidence that the virus that causes Covid has evolved to become less dangerous or contagious. What has changed is Americans attitudes about Covid restrictions. People are no longer willing or able to spend a week out of work or school because of Covid, experts say.
Dr. William Schaffner, an infectious diseases expert at Vanderbilt University Medical Center in Nashville, Tennessee, said he and his colleagues have privately encouraged the CDC to drop the five-day isolation period, in part because theres little evidence its stopping the spread of Covid.
The rigorous recommendations that are currently in place do not reflect common practice, Schaffner said. Its difficult to demonstrate that strict isolation has had a notable impact on transmission.
California and Oregon have already broken with the CDC, suggesting that people don't need to stay home if they've been fever-free for 24 hours without medication.
With each day, the risk of communicability diminishes, Schaffner said. Public health recommendations have to be practical. That is, people may stay home for a few days if they have a fever and feel achy and fatigued. After that, its back to business as usual.
Dr. David Margolius, the public health director for the city of Cleveland, said he was also in favor of easing isolation restrictions.
For a couple years, people really associated public health with the elimination of Covid, Margolius said. But public health is about increasing life expectancy for our residents. Its about improving quality of life. And that is more than just controlling one virus.
Covid is still contagious, said Dr. Abraar Karan, an infectious disease physician at Stanford Medicine. What the CDC and health departments are trying to say is that we need to have policies that people are going to actually follow, Karan said.
As of this month, emergency room visits, hospitalizations and deaths from Covid are down, according to the latest CDC data.
In a statement, the CDC said it had no updates to Covid guidelines to announce at this time, adding that it would continue to make decisions based on the best evidence and science to keep communities healthy and safe.
Erika Edwards is a health and medical news writer and reporter for NBC News and "TODAY."
Berkeley Lovelace Jr. is a health and medical reporter for NBC News. He covers the Food and Drug Administration, with a special focus on Covid vaccines, prescription drug pricing and health care. He previously covered the biotech and pharmaceutical industry with CNBC.
Fewer nursing facility residents and staff are getting COVID-19 vaccines, according to a new KFF analysis of federal data. Only 38% of residents and 15% of staff have received the latest vaccine. In comparison, 50% of residents and 22% of staff received updated vaccines in 2022 and 87% of residents and 88% of staff completed the initial vaccination series.
The percentage of residents who received the latest COVID-19 vaccine varies by state and type of facility. Vaccination rates range from 20% in Arizona to 63% in Vermont and North Dakota and were higher in nonprofit facilities (46%) than in for-profit (35%) or government (43%) facilities. Nursing staff had less variation and lower vaccination rates across states and in all facilities.
Residents and staff vaccination rates have declined with the release of each new COVID-19 shot for a variety of reasons, including fewer federal initiatives aimed at increasing vaccinations, the end of vaccine mandates for health care workers, and declining concerns about COVID-19 risks. Recent KFF polling shows that more than half of previously vaccinated adults are not worried about getting COVID-19.
Variation in nursing facility vaccine rates across states may be affected by several factors, including ownership patterns and partisanship, with higher rates in states that have more non-profit facilities and states that voted for President Biden in 2020, as well as whether facilities have established successful vaccination programs.
By Michael E. Newman
In a study involving nearly 1,000 patients seen at a Baltimore field hospital during a five-month period in 2022, researchers at Johns Hopkins Medicine, the University of Maryland School of Medicine, and five other collaborators report that a rapid antigen test for detecting SARS-CoV-2, the virus that causes COVID-19, can be used at home with accuracy comparable to the same test being administered by a health care professional.
The study was first posted online on Feb. 13 in the American Society for Microbiology journal Microbiology Spectrum.
Zishan Siddiqui
Assistant professor of medicine, Johns Hopkins
The researchers say their findings, based on patients seen at the Baltimore Convention Center field hospital, show that self-administered rapid tests rivaled the clinician-administered tests in both:
They added that both the self-administered and clinician-administered rapid tests evaluated in the study were comparable to the sensitivity and specificity of the established standard test for COVID-19the polymerase chain reaction, or PCR, assay.
"We found the results between the self- and clinician-administered rapid tests were statistically similar in sensitivity83.9% to 88.2%, respectivelyand specificity99.8% to 99.6%, respectively," says study senior author Zishan Siddiqui, assistant professor of medicine at the Johns Hopkins University School of Medicine. "We believe this is an important finding because it suggests physicians can feel confident prescribing treatment based on patient-reported, self-administered tests with positive results."
The first step for both the PCR and rapid antigen tests is obtaining a sample from a patient, either by nasal swab or collected saliva. The difference lies in how the sample is processed and analyzed. A PCR test takes a tiny bit of SARS-CoV-2 genetic material from a sample and reproduces it thousands of times so it can be more easily detected.
A rapid antigen test uses laboratory-produced antibodies to seek out and latch onto proteins on the surface of SARS-CoV-2 particles in the sample. The PCR test requires a skilled laboratory technician, special equipment, and up to an hour or more to process. Testing on a massive scale can only be conducted at a large, centralized testing facility, such as a hospital laboratory.
On the other hand, rapid antigen testing uses a premade kit with a reagent that contains antibodies specific for SARS-CoV-2. The test can be conducted by anyone, administered anywhere, and provides results in approximately 15 minutes.
For their study, the researchers enrolled 953 adult patients being seen at the Baltimore Convention Center between Feb. 12 and July 15, 2022. The study group was 60.6% female, 58.6% white, and 98.2% English-speaking. The median age was 34.
Participants reporting at least one COVID-19 symptom were categorized as symptomatic, while those reporting no symptoms were marked asymptomatic. Attending staff conducted both rapid antigen and PCR tests on the participants, and then had them independently perform a rapid test as well. The patients were asked to report their own results, which the researchers re-read and assessed.
In an earlier study at the Convention Center, the researchers showed that rapid tests could be broadly, quickly, and effectively applied to a large community such as Baltimore.
"What we determined from our previous work was that while the PCR test may be a better test from a clinical perspectiveas it's basically 100% accurate at detecting SARS-CoV-2the rapid antigen test provided significant advantages from a public health standpoint because of its ease of use, and the fact that it proved to have sufficient accuracy, specificity, and reliability for detecting the coronavirus in a high-volume setting," says study lead author Mary Jane Vaeth, a clinical assistant at the field hospital, which is now closed.
Added Siddiqui: "The first study suggested that a health care system can provide an equitable response to COVID-19, with [rapid antigen tests] making it possible to test all socioeconomic levels of a large population quickly and repeatedl. The new study bolsters that belief by showing comparable accuracy between self- and physician-performed [rapid antigen tests] and, therefore, helping build clinician confidence in patient-reported results from at-home tests."
The rapid antigen test used in this study is the BinaxNOW COVID-19 test manufactured by Abbott and supplied at no cost by the Maryland Department of Health.
"Despite the robust findings of our latest study, there were some limitations," Vaeth says. "The main one, of course, was the fact that we evaluated the self- and clinician-administered accuracy of only one brand of RAT, and therefore, future studies should look at an array of brands across a broader demographic spectrum so that our results can hopefully be confirmed and amplified."
Along with Siddiqui and Vaeth, the members of the study team from Johns Hopkins Medicine are Ishaan Gupta, Melinda Kantsiper, Charles Locke, Yukari Manabe, Henry Mitchtalik, Sophia Purekal, Resham Rahat,and Matthew Robinson.
Study co-authors from other institutions are Charles Callahan (BCCFH co-director), James Campbell, Minahil Cheema, E. Adrianne Hammershaimb and J. Kristie Johnson from the University of Maryland School of Medicine; Maisha Foyez, Asia Mitchell and Sarah Omer from the BCCFH; Maryam Elhabashy and Lucy Wilson from the University of Maryland Baltimore County; Aamna Cheema from the University of Maryland College Park; Kristie Sun from the Case Western Reserve University School of Medicine; Binish Javed from the Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital; and the CONQUER COVID Consortium.
No funding support was received for this study.
Manabe receives salary support from National Institutes of Health grants U54EB007958, A1272201400007C and 3U54HL143541. The other study authors do not have financial or conflict of interest disclosures.
The Centers for Disease Control and Prevention is considering loosening its recommendations regarding how long people should isolate after testing positive for the coronavirus, another reflection of changing attitudes and norms as the pandemic recedes.
Under the proposed guidelines, Americans would no longer be advised to isolate for five days before returning to work or school. Instead, they might return to their routines if they have been fever free for at least 24 hours without medication, the same standard applied to the influenza and respiratory syncytial viruses.
The proposal would align the C.D.C.s advice with revised isolation recommendations in Oregon and California. The shift was reported earlier by The Washington Post, but it is still under consideration, according to two people with knowledge of the discussions.
The C.D.C. last changed its policy on isolation in late 2021, when it scaled down the recommended period to five days from 10. If adopted, the new approach would signal that Covid has taken a place alongside other routine respiratory infections.
But by focusing on the isolation policy for Covid, the agency is squandering an opportunity to foster better public health policies, several experts said.
From a long-term public health perspective, I think this sets really an unfortunate precedent, said Dr. Syra Madad, senior director of the special pathogens program at NYC Health and Hospitals.
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A loss of smell (anosmia) is a common COVID-19 symptom, and researchers are just starting to understand why COVID-19 causes a loss of smell and when and how this sensation returns. The data support theories that loss of smell results from an immune response, inflammation, and a disruption of nerve signals. As many as 86% of people with mild or moderate COVID-19 experience this symptom.
This article reviews some of the factors behind a loss of smell and what steps you can take to restore your sense of smell after recovering from COVID-19.
fotostorm / Getty Images
There are still a lot of unanswered questions about COVID-19. As new variants of the coronavirus emerge and researchers collect more data about the infection, the virus's short- and long-term effects become more apparent. While the topic is still under review, the following recommendations have emerged as ways to help people regain their sense of smell following a COVID-19 infection.
Time is a great healer for many ailments, and COVID-19 is no exception. In many cases of COVID-19, where smell or taste is affected, senses return to normal within weeks to months. A 2022 report found that 88% of people who lost their sense of smell during a COVID-19 infection regained it within two years.
Olfactory training is one way to treat anosmia. With this therapy, you use daily exposure to common odors to help retrain your sense of smell.
The key with this treatment is to breathe in certain scents twice daily for 10 to 20 seconds at a time, focusing only on the scent in front of you. You can use multiple scents, but pause for a few clear breaths between each.
According to experts at the American Academy of OtolaryngologyHead and Neck Surgery, you may have to try this treatment for as long as three months before noticing improvement.
Some of the best scents to use to retrain your sense of smell include:
You can use the natural object for your scent testing, but many people prefer to use essential oils.
You can also use various strong-smelling items or scents tied to pleasant memories. One expert suggests that because smell is so closely linked to memory, scents like peanut butter or peppermint candies, which often are prominent in childhood, are especially useful in helping to regain some strength of smell.
When inflammation and other conditions damage the neurons that power your sense of smell, it takes time for them to recover and return to their pre-illness state. Neurons regenerate very slowly, but researchers are studying additional therapiesperhaps even stem cell therapiesthat could help expedite the process.
Some medications that reduce inflammation in your nasal passages may help restore some of your sense of smell. One study showed that glucocorticoids (steroid medications) like Nasacort Allergy 24HR (triamcinolone) and Flonase (fluticasone) nasal spray help significantly improve the sense of smell for people recovering from COVID-19. Some study participants reported a restored sense of smell within a week.
Nasal hygiene is another method that may help you restore your sense of smell. Often recommended as part of the treatment strategy for allergies and other forms of nasal irritation, daily nasal lavageor rinsingwith saline or an added steroid may offer relief.
More research is needed to determine the best way to treat anosmia related to COVID-19. However, if you notice a loss of smell after COVID-19, schedule an appointment with a healthcare provider to ensure no underlying problems contribute to your loss of smell.
Conditions such as nasal polyps or allergic rhinitis can diminish the sense of smell and require additional or separate treatment from your COVID-related issues.
The onset and duration of the loss of smell can vary from one person to another, but research suggests it's an early and short-term symptom for most people. In one report from 2021, loss of smell and taste happened about four to five days after the onset of other symptoms at the start of a COVID-19 infection. The same study revealed that smell and taste usually returned within seven to 14 days.
However, a newer report, from 2023, found that a loss of taste or smell could last nine months or more after a COVID-19 infection.
Your ability to smell may not seem like the most important function of your bodyat least until it's gonebut a sense of smell contributes to quality of life and helps you appreciate the tastes and scents of the world around you.
In some professions, like cooking, a sense of smell is crucial. In otherssuch as firefighters or emergency respondersa sense of smell is needed to detect dangerous situations or conditions.
See a healthcare provider if olfactory training and other simple at-home methods aren't working after several months. They may refer you to an ear, nose, and throat (ENT) specialist (otolaryngologist) for additional treatment.
There is still a lot of ongoing research on COVID-19-related anosmia, but a specialist can guide you toward prescription medications, additional testing, or other therapies that may help.
Loss of smell has been highlighted as one of the most noticeable symptoms of COVID-19and one that takes quite a bit of time for some people to recover from. No single therapy or treatment alone is proven to restore your sense of smell after a COVID-19 infection. Still, you can try various at-home therapies and seek advice from a qualified healthcare provider.
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