Hold Your Horses, Health Workers With COVID Still Must Isolate

On March 1, the CDC announced it was slashing the isolation time for COVID-19 for the general public, from 5 days to 24 hours if people are fever-free without taking fever-reducing medication and symptoms are improving. Just a week before, National Nurses United (NNU) had sent a letter to CDC Director Mandy Cohen, MD, MPH, to express the union’s concerns about “weakening isolation guidance” for COVID-19. Once the official news of the weakened guidance broke, NNU condemned this decision for putting public health at greater risk of acute sickness as well as long COVID.

However, these new guidelines don’t apply everywhere: the CDC’s COVID-specific guidance is still in place for healthcare settings. Healthcare workers with mild to moderate illness who are not moderately to severely immunocompromised should isolate until at least 10 days have passed and at least 24 hours since last fever and symptoms are improving — however, healthcare workers who test negative by day 7 can return if fever has resolved and their symptoms are improving. The isolation period is potentially longer for those with severe to critical illness.

But it may be only a matter of time before these guidelines change too. In November 2023, the CDC’s Healthcare Infection Control Practices Advisory Committee (HICPAC) voted unanimously to propose updates to CDC’s infection control guidance for healthcare settings that would lump COVID-19 in with other respiratory viruses like influenza. In doing so, HICPAC was setting the stage to weaken protections for healthcare workers caring for patients with COVID-19 from an N95 respirator to a surgical mask. But a surgical mask does not sufficiently protect the wearer from inhaling infectious virus, and we all know that COVID-19 spreads through the air.

NNU has been pushing back and speaking out on these proposals that would weaken protections for nurses and patients alike. Thankfully, in January, the CDC sent HICPAC’s draft back for further revision, which will hopefully address some of NNU’s core concerns. But there is still work to be done; the CDC has not yet added frontline nurses and their union to HICPAC’s workgroup. Without our input, the CDC won’t be able to develop guidance that takes our science-based perspective and insights into account.

Fortunately, the CDC continues to recommend a multiple-measures approach to respiratory virus prevention, including improving ventilation, avoiding crowded spaces, wearing masks, getting tested, and getting vaccinated.

Yet, it is deeply disheartening that the CDC weakened the COVID isolation timeframe for the general public. While keeping the isolation period recommendations in place for healthcare facilities is one piece of keeping patients safe, nurses and other healthcare workers do not spend all their time in healthcare facilities. We go to the grocery store and restaurants. We have a life outside of work. With this new guidance, we now face a higher risk of infection when we’re out in public. More people with COVID-19 who remain infectious may now be out and roaming, and while the guidelines recommend mask-wearing, not all people will adhere. Asymptomatic people with COVID can infect others and oftentimes don’t even know they are infectious. In addition, employers in various industries may pressure workers to go to work, regardless of how infectious they could be.

We must protect public health and nurses’ safety so that we can continue to care for our patients, especially due to the staffing crisis that many hospitals face. A recent NNU survey of more than 2,600 nurses found a majority of RNs (58.4%) who had COVID at least once required time off work to recover from post-COVID symptoms. For more than half of RNs surveyed who had COVID, their symptoms lasted longer than 3 months. More than half of nurses report that their long COVID symptoms have affected their ability to work. And we know that every infection increases the risk for long COVID. As a caregiver, I need to stay healthy. When I travel, I wear a mask in the airport and on the plane. If I’m in a crowd indoors, I wear my mask — the kind that will protect me. For some people, getting sick may not seem like a big deal, but for caregivers, it can be traumatic.

Nurses want to be there for our patients. We want to be there for our colleagues so our teams are not short-staffed. We need our institutions to protect our health and safety so that we can protect our patients.

To the CDC: Follow the science to protect public health; engage nurses, other healthcare workers, and the public in developing guidance updates.

Jean Ross, RN, is a president of National Nurses United, the largest union and professional association of registered nurses in the nation.