BARCELONA, Spain — Just hours after the Centers for Disease Control and Prevention announced on Dec. 27 that it was slashing the isolation time for people who test positive for COVID-19, European governments scrambled to follow the U.S. health agency’s lead.
Mirroring the new edict, Greece cut the requisite days of self-confinement from 10 to five days, a move followed by the Czech Republic. Portugal and Ireland likewise fell in line, like Spain lessening isolation periods for those with COVID-19 to a week.
The stakes surrounding the CDC’s decision are high in Europe, which last week reported over 5 million cases of the disease caused by exposure to the coronavirus. With the Omicron variant continuing its breathtaking spread, this week Europe accounted for 57 percent of the world’s confirmed new COVID cases, shattering all previous case records, resulting in labor shortages, disruptions to public transport and overburdened hospitals. That helps to explain why many European government officials quickly jumped on the CDC bandwagon, not only shortening isolation periods but many also controversially scrapping the need for a negative test before someone can return to public life.
But the new guidelines, modeled after the CDC’s, are triggering alarm among European public health agencies and epidemiologists, who question whether they are justified or wise.
Dr. Daniel Lopez-Acuña, former director of crisis management at the World Health Organization, told Yahoo News that it is perilous to ignore the highly contagious nature of Omicron. “We are gambling, we are playing with fire and making quick fixes,” said Lopez-Acuña. “We need to stick to isolations and quarantine that will impede circulation of this contagion.” He recommends that countries maintain their previous 10-day isolation policies.
Cellular biologist Salvador Macip, who advises Spain’s regional government in Catalonia, also views the scramble to change isolation times with concern. "Seven days, five days — that's risky," he told Yahoo News. “We don't have enough data about Omicron yet. With the Delta variant there is sound science that the first five days are when you see most of the infections. But we have no idea if Omicron behaves the same way,” he added, noting that Omicron acts quite differently once in a host. “Omicron may be less intense as a disease but may be contagious for longer than Delta.”
Martin McKee, professor of European public health at the London School of Hygiene & Tropical Medicine, was likewise surprised by the CDC's change in isolation guidelines as well as by those European countries that quickly adopted the U.S. protocol. “It is far from clear what the evidence is for this decision,” he told Yahoo News, adding that there is “considerable evidence that many people remain infectious at five days.”
Acknowledging that countries must make their own policies, the WHO isn’t changing its recommendations about the coronavirus. “While some governments are shortening isolation periods [due to] the massive surge of COVID-19 cases and the disruption that is causing, WHO guidance remains the same,” Dr. Catherine Smallwood, COVID-19 incident manager at WHO Europe, told Yahoo News. That guidance, she added, is 10 days of isolation after a positive test for asymptomatic cases. For those exhibiting symptoms, she said, the WHO recommends 13 days of isolation at minimum.
The European Center for Disease Prevention and Control is also wary of the ongoing reductions in isolation times, all the more since studies on Omicron are lacking. The agency, currently reviewing its guidelines, is particularly concerned about those who haven’t gotten COVID shots. “For unvaccinated individuals with COVID-19, no evidence exists to allow decreasing the isolation period,” an agency spokesperson noted in an email to Yahoo News. While recognizing that the latest surge has crippled workforces, including essential workers, the ECDC is urging European countries to “take into account the local epidemiological situation, testing capacity and the socio-economic effects of the pandemic in the specific setting. As a rule, the shorter the isolation period, the higher the residual risk. Therefore, shortening the isolation period requires a balance of probabilities and a decision on how much residual risk of transmission one is willing to accept.”
Some countries in Europe, such as the U.K. (which reported 194,747 new cases on Wednesday) and France (which reported a whopping 332,252 cases), are lowering isolation times to a week, but still require negative tests before isolation can be ended. However, the tossing out of test requirements by other countries — including Spain, which reported 137,180 new cases on Wednesday — while shortening self-isolation periods is raising eyebrows among COVID experts.
For one thing, Europe isn’t currently experiencing the widespread shortages of at-home antigen tests seen in the U.S. “If countries are going to shorten the isolation times, [they should] require tests,” Macip said. “They’re still taking a risk, but it’s less of a risk.”
The CDC, whose advice includes wearing “well-fitting masks” for five days once one reenters public life from isolation, opted this week not to formally add a testing requirement to its isolation guidelines, as had been widely anticipated. It did, however, add mention of it on a list of recommendations posted on its website. “If an individual has access to a test and wants to test, the best approach is to use an antigen test” around the fifth day, read the updated CDC guidelines. Those testing positive should isolate for another five days, according to the agency.
But experts say the agency’s no-test-necessary policy only increases the chance that European countries won’t add testing requirements to their altered isolation policies either. “CDC has a lot of clout internationally,” said Lopez-Acuña, noting that Spain, for one, is listening to the CDC over European health agencies and its own government’s medical board of advisers, which did not endorse the changes to isolation protocol before they went into effect. Lopez-Acuña — critical of the new American guidelines, which he said ignore “epidemiological logic” — regards the public health agency’s recent changes as “a rushed action, a mistake by CDC that was then followed by a number of countries” that will have effects around the world.
Macip thinks some European governments are adopting CDC guidelines in a belief that they will escape blame if the moves backfire. “They were waiting for somebody to cast the first stone,” he said. “Now they can say, ‘Look, the CDC is doing it!’ That can be their excuse.” He is also chagrined that the results of home tests often aren’t reported to health authorities, thus skewing the true extent of the Omicron wave.
In Europe, which collectively reported 1.29 million new cases on Wednesday, according to Our World in Data, “the official numbers are crazy high,” Macip said. “But it looks like there are many more cases than that.”
A public relations specialist in Brussels, who requested anonymity, underscores that point. When she and her family tested positive at Christmas while visiting a small town in France, she didn’t report their status to French health authorities, nor did she report it to the Belgian health agency when they returned home, a situation mirrored by other people she knows. “There’s a hidden community of people who have COVID and don’t declare it,” she said. And since they haven’t blipped on government radar, they are free to ignore the official guidelines for isolation, which in Belgium is 10 days. After a week and two negative COVID home tests, she returned to socializing.
Lopez-Acuña laments that the CDC guidance is having such an effect on Europe, especially during the holidays, which in some European countries don’t officially end until Jan. 7, and he wishes European health agencies would step up and issue cautionary advisories. “We are reducing isolation times at the worst possible moment,” he said, “when steady increases are producing a tsunami of Omicron cases, during a season of unprotected social interactions.” He predicts that January in Europe “is going to be a very difficult month,” all the more with decreased isolation times and discarded testing requirements increasing the odds that Omicron — which so far appears to cause less severe illness than Delta, though it is already overwhelming hospitals and shaking economies — will spread even faster.