Covid isn't over.

But the Biden administration and its Centers for Disease Control (CDC) would like to pretend it is. So they're floating a trial balloon to reduce their recommendation for isolation/stay-at-home after a positive Covid test to one (1!) day. California and Oregon have recently taken this step, both with minimal notice and little explanation.

First of all, the current guidance of staying home 5 days is already too short. People infected by breathing in the SARS-CoV-2 virus start shedding the virus (breathing it out in an aerosol that hangs in the air like smoke) several days before they develop symptoms, and for 7-9 days after (range: 6-11 days). The earliest CDC isolation guidance in 2020 was for 14 days, based on this clinical evidence of infectious days after exposure and applying the precautionary principle to minimize spread; it was shortened later that year to 10 days. The change to the much shorter, inadequate 5-day period was made in late 2021, right after public lobbying pressure by airline executives. Nothing then or since changed about the science of infectious days after Covid exposure, as Julia Doubleday shows in an incisive review of CDC's relationship with Covid infection science.

In the intervening years there has been some evidence that rest is of special importance to optimal recovery from the acute phase of Covid infection, which would argue for returning to the original 10-day isolation. Even stronger support comes from the mounting pile of studies showing that repeat infections increase the risk of Covid's many and various long-term harms. In the face of those harms, especially given the number of people who've already had more than one case of Covid, public health advice should recommend no action that actually increases the chances to catch it (say, from sick schoolmates or co-workers who were only given one day off).

Minimizing Covid as a "normal seasonal respiratory illness" by grouping it with flu and RSV has been going on for a while in the Biden administration's messaging, so it's no surprise to see it deployed here as a reason for shortening the stay-home to just a day to "harmonize" with them. My question is, why not harmonize by extending the RSV and flu isolation period to 5 days? Bouts with those diseases are rough on people. Encouragingly, a doctor quoted in NPR's report on the CDC decision reacts with the same recommendation. It should be emphasized, though (and wasn't even mentioned in the NPR story), that more people die from Covid than from flu. Also ignored, as usual, is the apparently unmentionable elephant in the room: neither flu nor RSV does the kind of lasting or varied organ and systemic damage that Covid can. Unlike flu or RSV, Covid is as much a vascular as a respiratory disease; the virus binds to ACE-2 receptors, which are found in every part of the body with capillaries.

Another purported reason for shortening Covid isolation to just a day is to reflect "the new reality — with most people having developed a level of immunity to the virus because of prior infection or vaccination." There. is. no. such. new. reality. "A level of immunity" = one so weak and easily evaded, even among the diminishing population slice of the fully-vaxxed-and-boosted, that it doesn't completely prevent infection when exposed to the virus. Breakthrough infections are routine, and even more common is re-infection among unvaccinated people.

Here's the actual, stark "new reality": we've allowed a majority of the population, including growing children, to get infected repeatedly with a virus that does long-term damage to a wide variety of organs and systems, including the immune system itself -- and the risk for such damage rises with each new infection. In some non-trivial percentage of people who are infected, the virus persists in the body and causes the chronic illnesses known as Long Covid. It's a mass disabling event already; the real question is what the eventual scale and severity are going to be. The obvious priority for public health is to minimize any more infections, particularly among those who have already had multiple cases.

The best chance to keep infection by SARS-2 to a minimum is by putting in place layers of protection beyond just vaccines: mitigations like ventilation, air filtering, effective masks, testing and isolation, paid sick leave, remote options for meetings and work, etc. A bonus is that these mitigations are equally protective against all variants of the SARS-2 virus, the many other existing airborne pathogens (including colds, flu, and RSV), and those that may arrive in the future. Not to mention those that threaten to return from the past, like measles.

Update: The CDC put out a non-denial denial of the story, which only makes prompt feedback more important. The planned timing seems to be April, when infections drop, but if the stay-at-home guidance goes away it will be nearly impossible to bring back when cases rise again. Let them hear from you at their Contact Form. Shoot down this dangerous trial balloon with flaming arrows!

Update 2: The timing turns out to be Friday, March 1. There is no comment period; it takes effect immediately. The guidance explicitly ties ending isolation not to testing negative, which means no longer being infectious, but to improvement in symptoms like fever. This is unsupported by any science, and completely focused on the individual rather than the community. Between this dangerous, compromised advice in a persistent pandemic and the horrific co-genocide with Israel, the idea of voting for Joe Biden right now has become unbearable.