Column by Dr. Richard Sternberg
Vaccines and infection induced immunity and the availability of effective treatment and prevention methods have decreased the risk of symptomatic COVID infection, hospitalizations, and deaths. Therefore, On August 11 the Center for Disease Control issued a new set of guidelines for minimizing the impact of COVID on people, communities, and health care providers. This takes into account the psychological and economic effects of the various actions. It allows considerably more freedom than the previous guidelines.
Below is a summarization of the recommendations but I strongly recommend reviewing the original article in MMWR, Morbidity and Mortality Weekly Review, which is published weekly by the CDC, online. The August 11, 2020 edition has the article. You can go to www.cdc.gov/mmwr to find it. The article besides containing the information in more detail contains a table that lists actions to minimize impact based on effects on different persons, communities, and health care system and a figure which lists recommendation for isolation, masking, testing, and other precautions for people who are ill with COVID symptoms and/or have tested positive. I think the figure and article may be easier to understand then in narrative form.
Efforts to expand access to vaccination and therapeutics should be increased to reduce risk of severe illness and post infection symptoms. In order to protect people with high risk it is important for everyone to understand prevention and treatment strategies not just for themselves but for others especially those at high risk. All people must understand their risk, protect themselves and others, receive testing and wear masks if exposed, and test according to protocol and wear masks for five or more days if they are infected. The figure in the article is very specific for how long to mask and when to test if exposed or affected.
It is important to know the community level of COVID cases to determine what precautions to follow. At all community levels (low, moderate, and high) it is recommended to stay up to date with vaccination and boosters, improving ventilation, testing symptomatic and exposed individuals, and isolating infected persons. Others who are asymptomatic and do not have high risk people to protect do not have to routinely wear masks. At medium levels protection for persons who are at high risk should be added. At high levels all people should wear masks indoors. On August 15, the Otsego County level was low. Knowing the local levels provides a framework on when to add or reduce prevention strategies.
Testing for current infections can be used so that individuals can take action to reduce their risk of infecting others, especially high risk individuals, and to determine when they should be treated . Everybody should be tested when they have symptoms or have been exposed to others with active disease. Screening testing strategies have to include everyone, regardless of vaccination status since vaccination seems not to prevent disease but to ameliorate it though it is still contagious.
Isolation is another area where the new guidelines are more specific. They help to return people to the community sooner but at a usually safe time. If symptomatic or infected one should immediately isolate for 5 or more days, wear a well-fitting mask properly, preferably N-95 or equivalent. They may end isolation after 5 days when they are fever free (without fever lowering medications) for 24 hours and other symptoms have improved. People who wish to use testing to determine when to come out of isolation should start no sooner than day 6 (with day zero being the first with symptoms). Two negative tests, 48 hours or more apart improves reliability. Routine quarantine of non-symptomatic exposed persons is no longer recommended though monitoring is reasonable.
As I said in the beginning the figure and chart referenced are much clearer and more specific.
The CDC as decreased restrictions on many of us and we can further return to more active social interactions and contacts with reasonable safety.
Dr. Richard Sternberg is providing his professional perspective during the COVID-19 threat.
Also a village trustee, he lives in Cooperstown.