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Alana Casanova-Burgess: This is The Takeaway. I'm Alana Casanova-Burgess from WNYC Studios filling in for Melissa Harris-Perry. Good to be with you today. On Tuesday of this week, the CDC reported more than 441,000 new COVID cases in the US alone. That's actually the highest number of new cases we've seen in a day since the start of the pandemic, but on Monday, despite the number of infections, the CDC chose to cut COVID-19 quarantine and isolation times in half. From 10 days to five days.

Just to underline one part of this new guideline that seems to be getting lost, after those initial five days, the CDC is still advising anyone who has tested positive to wear a mask around others for the following five days. These altered rules may be confusing to the American public, only a few months ago people in the US were told to undergo a fourteen-day quarantine, and that was for anyone who tested positive or came into contact with someone who later tested positive. Here's Dr. Anthony Fauci explaining why that decision was made on CNN earlier this week.

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Dr. Anthony Fauci: If you are asymptomatic and you are infected, we want to get people back to the jobs, particularly those with essential, jobs to keep our society running smoothly. I think that was a very prudent and good choice on the part of the CDC, which we spent a considerable amount of time discussing, namely getting people back in half the time than they would have been out so that they can be back to the workplace doing things that are important to keep society running smoothly.

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Alana Casanova-Burgess: These new guidelines were issued about a week after Airlines for America, a large airline industry group, wrote a letter to the CDC asking them to lower their quarantine recommendations to avoid a labor shortage and other disruptions. Is the policy change about jobs in the economy? Or is it about public health?

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Alana Casanova-Burgess: Here to answer some of our questions about the new guidelines is Namandje Bumpus, Director of the Department of Pharmacology and Molecular Sciences at Johns Hopkins University. Thank you so much for coming on.

Namandje Bumpus: Thank you for having me.

Alana Casanova-Burgess: What are the guidelines?

Namandje Bumpus: Yes, so it is a change as you noted. Currently, a large change is that everyone, regardless of vaccination status, if they've tested positive for COVID-19 are asked to isolate for five days, if they have no symptoms or if their symptoms are resolving after five days. That time has been cut down to five days, but the key there is really being asymptomatic or having symptoms that are resolving, and, as you mentioned, after those five days, continuing to mask around others for an additional five days.

If a person does have fever, other symptoms, they should stay home longer, but if they're asymptomatic, the time has been cut to five days, and I think the important point there being that it's recommended for everyone regardless of vaccination status.

Alana Casanova-Burgess: What's the science behind that having from 10 to five days?

Namandje Bumpus: Obviously things are still emerging as far as on Omicron, but as far as what is currently known there is strong evidence that transmission or the majority of transmission has really occurring early in the course of the illness. Generally, one to two days prior to the onset of symptoms, and then, say, two to three days after. The idea being that if we're trying to capture that window, then isolating for five days after testing positive if asymptomatic, then there should be minimized risks for infecting others.

I think as I said, we are still learning more about Omicron and how transmissible it is at different levels of virus, but so far, at least what's been suggested from what we know about previous SARS-CoV-2 and what's emerging about this bearing is that there is that window, the one, two days prior of symptom onset and then two to three days after that most infection seems to be being transmitted.

Alana Casanova-Burgess: There are a lot of caveats to the rules, right? It's different if you've been unvaccinated or if you have a booster, then you have to figure out if you have symptoms or if they're resolving. Generally, it's one to two days prior, but generally sticks out to me there, and it just seems like an SAT logic problem to figure out what you should do and what you should do with employees who are sick. Do you worry that there's a lot of room for mistakes in trying to parse this out?

Namandje Bumpus: Certainly, I think because it can be hard to identify what is a symptom even. Certainly, I think that there are some people that may not recognize certain things as a symptom. I've certainly talked to people who have said, "Oh, it's just a sore throat." I think that certainly is one place where the interpretation can be difficult because we're talking asymptomatic, or symptoms resolving, and people may view that differently.

There is a lot of talk about there should be a negative test required for instance before leaving isolation. I think that one difficulty is that those are still limited. Right now it really is this timing, relying on this time period and for people to really think hard about what might be a symptom of what might not be.

I think we are on the side of if you are feeling some symptoms, if you do have a fever, even slight, then staying home longer, certainly, and talking to your healthcare professional if you feel that you're just having a hard time discerning what might be a symptom and what might not be.

Alana Casanova-Burgess: I mentioned that Airlines for America had asked the CDC to cut quarantine time, and I've also seen that interpreted as something that suggests that these rules are not are earnestly given by the CDC. Do you worry about the erosion of trust here?

Namandje Bumpus: I think with confusion and was people feeling that they're being told different things, but I think at the same time, we're always trying to balance livelihood and people being able to do the things that they need to do in their lives, go to work, care for others with what we know. The quarantine guidelines have changed as well as you noted where if you've been boosted or if you've been fully vaccinated recently, so completed the Pfizer Moderna and within six months or the J&J within the last two months, then wear a mask for 10 days, test on day five, if possible.

If you develop symptoms, stay home, but otherwise, for people who are boosted or recently fully vaccinated, no quarantine period suggested. Masking for 10 days, and of course, there is the quarantine suggests that if you're not boosted, if you're un-vaccinated and that is the stay home for five days and to wear a mask and additional time. I do think that it is a big change and something to really try to pay attention to these delineations, but I think it also shows the importance and the confidence we have in the booster helping.

With getting a booster, you actually are able to cut that quarantine time, at least based on the suggestions now, and wear a mask for 10 days and then get tested on day five, and if you become positive then of course make decisions based now on having that positive test.

Alana Casanova-Burgess: What do you make of how these changes were communicated to the public? We're in such a high surge right now. It seems like a little bit of whiplash.

Namandje Bumpus: There is some confusion about this change happening now when people do have concerns about this variant and the surge and what the next few weeks are going to bring. I think that we do need more communication on where it's coming from, what the science currently is, but the idea of being, as I mentioned, this balancing act between people doing the things they need to do in day-to-day life with what we know about the virus so far.

I think that certainly we know that the vaccine and the booster is giving protection, so people should feel confident in the changes made around that. Hopefully, even though these are the guidelines could be a bit confusing, I do think on first read, hopefully, it will help to encourage more people to get vaccinated and boosted.

Alana Casanova-Burgess: Can you talk about how the CDC guidelines compare to the guidelines from other countries? I've heard that just Canada up north it's a way different situation.

Namandje Bumpus: Yes, I think it's a different place to place and people really public health officials, I think have to make the decisions based on their local situation. What are the vaccines available? What is the vaccination status of their population? What they're seeing currently, as far as hospitalization, positive rates, things like that. I think that it is a very individual situation from location to location, and there are differences definitely. These are decisions made based looking at the data in the US, and they certainly may change over time as we learn more, but it's different on the ground in every place. In large part, due to differences in levels of vaccinations.

Alana Casanova-Burgess: On being vaccinated. What's the impact of how long ago a person was fully vaccinated when it comes to these isolation times?

Namandje Bumpus: If you were vaccinated with the mRNAs vaccines, the Pfizer or Moderna, over six months ago. You become eligible for the booster once you've been vaccinated over six months ago. If you have not been boosted, even though you received those vaccines over six months ago, or J&J over two months ago and are not boosted, then you in these guidelines are following the same suggestions of people who are unvaccinated. It's stay at home for if exposed. Then to quarantine or stay at home for five days and after that mask around others for five additional days and test on day five if possible, and ideally test on day five.

Alana Casanova-Burgess: Since this is so confusing, can you repeat the guidelines in case anyone listening missed them the first time?

Namandje Bumpus: Yes. I think a take-home message is that isolate if you test positive for COVID-19, that everyone, regardless of vaccination status being suggested to isolate, stay home for five days if you are asymptomatic or your symptoms are truly resolving. You don't any fever, haven't had a fever for instance for at least 24 hours. No symptoms, symptoms [unintelligible 00:10:46] resolving. Then, you can leave your house after five days, but it's important to continue wearing a mask for an additional five days.

The differences come based on vaccination status when we're talking about quarantine, which is when you've been exposed to someone with COVID-19. If you have been boosted, or if you've completed the Pfizer or Moderna vaccine recently, so within six months, or the J&J vaccine, you've received it recently within two months, then you actually can wear a mask around others for 10 days so without quarantine. It's important to wear that mask around others and to test on day five ideally, but you actually do not have to quarantine if you've been boosted or recently vaccinated.

If you have not been boosted, but you're eligible for a booster, so you've completed the Pfizer, Moderna in over six months ago and have not been boosted, or the J&J over two months ago and have not been boosted, or you are not vaccinated, then you do need to quarantine following exposure to someone with COVID-19, which means staying home for five days, and after that, wearing a mask for an additional five days and testing again ideally on day five if possible.

Alana Casanova-Burgess: Well done. Namandje Bumpus is the director of the Department of Pharmacology and Molecular Sciences at Johns Hopkins University. Namandje, thank you for coming on and doing that heavy lift.

Namandje Bumpus: Thank you for having me.

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