NEW CDC COVID GUIDELINES - MAKING SENSE OF THE CHANGES | Medicine & Health Podcast

Welcome to Medicine and Health with Dr. Paul Anderson. This is a show about opening the often mysterious world of how doctors think and how science works. This program exists to educate and empower you, the listener. Now here's your host, Dr. Paul. Good day and welcome to Medicine and Health. Today our topic, if you looked ahead, is, uh, Going through the new CDC COVID-19 guidelines. The date, in case you're wondering how current this is, is August 18th, 2022, that we're doing this. Guidelines changed on the 11th or thereabouts, and so this is fairly recent. Now, if you're listening to this a year from now, who knows what anybody's going to be talking about. We all stopped predicting the future a long time ago. So, uh, on Medicine and Health with Dr. Paul, that's me. I'm Dr. Paul Anderson, and we do this podcast once a week. Those of you that, uh, maybe have seen or consumed other, uh, social media content of mine know I'm on lots of platforms and I do shorter videos. This is one of the longer forms that I do. Uh, we do a lot of print stuff. I, uh, you look behind me, I write books, et cetera, et cetera. So there's a couple of things, just so you know where things are at. When I say I'll post a link, if you're like live streaming this on Facebook or you're on CTR Radio or you're on one of our mini pod burners for the audio, I don't have places there to post the link. So I post them on my YouTube channel, which CTR Radio takes this when we're done and they produce it and then they put it over on YouTube onto my channel, which is just DRA. Online, Dr. A Online. If you can't find me for some reason, just go to my hub website, which is dranow.com. There's links to all the many and various things that I do there, so you can find stuff. If you are looking for links in the YouTube version, you go down to the description box. On your phone or a smaller device, on the lower right corner, there's a down arrow, looks like a V, press on that. Now, if you press on that and you go to an ad, sometimes what they do is they put 2 down arrows, one on top of the other, and the ad sometimes is easier to click than my down arrow. If you're on your computer or a bigger device, go to the left side, you'll see a word, either it'll say show more or more, click on the word more and it will open up whatever links and other stuff we put in there. And today we'll have a few links and then I'll be referencing older You know, not terribly old, but past videos that we've done, and you can go back to those easily then through the YouTube channel. So there we go. COVID-19 guidance from the CDC. And one of the reasons I wanted to talk about this today was I— Obviously, all of us probably in the world, you know, we've been experiencing this world of COVID-19. Since whenever we, you know, became aware of it. And then, you know, along in the 2020 time period, we started to have, you know, effects on not only health but things happening in our world and access and, you know, lockdowns and masks and all that stuff. So I think we've all been, you know, watching the guidance or experiencing the guidance, however you want to think about it, for as long as it's been going on. And as I say, one of the reasons I wanted to do this today was that I think every time the CDC has changed their guidance, it's always controversial whenever a government agency does anything. And I'm not gonna comment on, you know, how good the scorecard for the CDC or the FDA or anybody else has been because you all have your own opinions about that and you can make up your own mind. But the fact is that CDC guidance, next to really only legal changes, the CDC guidance drives what we do in the US more than anything else, with the exception of a legal challenge. And that was exampled by the legal challenge to wearing masks on airplanes. And so they changed that after a federal judge struck that down. So sometimes the legal forces outweigh the public health forces, and sometimes the legal forces agree with the public health. So this particular guidance change is a little interesting in that it actually starts to stratify, like, how sick have you been? What are your symptoms? All that stuff. It also tries to stratify, when can I go back to work? When can I stop? Isolating, and also what are the exceptions around those things. And if you follow, you know, a variety of people, especially on social media in modern times, that's kind of how we see what's going on immediately, even more so probably than the news. I try to follow people from multiple, as many sides of an issue as I can, because I feel that that gives me a little bit better or a little deeper insight into the way people are thinking. Because you can, you know, if you follow whoever you want, I'm not telling you how to live your life or who to follow on social media. But if you only have input, you know, from one end of the spectrum of ideas or commenters or whatever, it's fine. But you can kind of get shoehorned into, into just seeing that as the entirety of the way people are thinking. Now, there's always a difference between our ideas and our variety of ideas and, you know, what the truth may or may not be, obviously. But as I look across this spectrum of people, and I really have tried to keep a spectrum of people that I, I appreciate their, uh, information, I, I trust, you know, their thought processes, etc., and know, I may or may not at the end of the day totally agree with what they're saying or thinking, or I might. Um, and then the next person might be completely saying the opposite thing. What I try and do with that is listen and say, well, why, you know, why would 2 people who seem to be very well informed be giving 2 very different versions of, you know, something? Well, this thing with the CDC putting out this new guidance has triggered a lot of that, as just a lot of duality in the way it's being received. Now, on one side you have people saying, well, it's about time. And there's going to be some of the details that I bring up that, you know, people have— and I'll point out, you know, what I've seen and what I've heard. Um, there's some of these details where you're going to say, well, you know, we should have been doing this all along, or we should have known this all along, or they're finally admitting it. Uh, and then there's other details that are like, well, Okay, you know, maybe that kind of makes sense, or maybe that's a good shift. Um, I think that the critiques, if you will, of the CDC's current guidance that I have seen are coming, uh, from, again, people, you know, you usually— when I'm listening to these things, it's people somewhere in the medical healthcare world, you know, they're normally some sort of healthcare provider. Often they're physicians or researchers or, or a little of both. Um, but I think the critiques that I'm hearing of this new guidance are, well, it's being a little lax on everybody. We should be doing more masking. We should be doing, um, you know, more, uh, isolation if needed. We should be doing a lot more of a lot of other things. And where that comes from is, uh, the idea that we still have COVID, and it's still evolving. And as we've talked about on past programs here, we're not really going to reach a level of true herd immunity because we have an easy-to-evolve virus. Like, you could say, well, the common cold is similar. Like, we don't develop herd immunity to common cold because it mutates. And the same could be said with some of the influenzas, etc. So that, you know, that kind of makes sense since we're not going to get true herd immunity. We're building up some sort of immunity, but not true herd immunity. We, you know, we, we have the opportunity to be infected and infected again and potentially have post-COVID sequelae. So that's the concern, I think, that drives a lot of the critique of like these new guidelines. What I would say is the new guidelines from that point of view seem to be doing, I will say, the best they can at the CDC for protecting people who— both the person who is sick and then the people that they may infect out there in the world. The guidelines, if they're followed, would seem to do that. Should these guidelines have come out earlier? Probably. Um, should, should they have been completely the opposite and we go back to more masking and lockdowns and things? You know, that's up for you to make your own decision. So just a couple of things really quickly. Number one, um, I am not here to tell you what to do. I'm here just to inform you and give you information. Nothing I talk about is medical advice for any particular person. I'm a doctor, I have a license, but I am not your doctor, and you should never take medical advice from people on any audio or video source unless it happens to be your doctor and you're talking to them on Zoom or something. So this is not medical advice. The next thing is, um, I am really agnostic as to what you or your family decide to do with regard to any of this. Meaning, I care about you, I care about humanity, I would like us to protect each other, I would like us to do things that we'll talk about, you know, that may be better to protect one another. Uh, but if you decide to do a therapy, or if you decide to do more vaccinations or less vaccinations or whatever, that's your business. That's your business with your healthcare providers, your healthcare team, to decide. That is, again, not something that you should be deciding with people who are online talking to you about stuff. And I just want to say those things up front because people, you know, come and say, well, it seems like you're, you know, pro this or anti that. And that's— I'm not. It's just sharing what's out there in the world, the news. and in the science. So start off here, and I'll put the link in if you have not seen it. I think most people have at this point because— so this is the 18th of August, 2022. This was posted, I think, on the 11th of August, so not that long ago. And so I'll post a link. We got 2 big links, and there'll be some others. So CDC streamlines COVID-19 guidance to help the public better protect themselves and understand their risk. That is a good and noble idea. It's a good, good thing to be doing. That's what CDC ought to be doing. And so they had one of the authors, Dr. Massetti, quoted here saying, we're in a stronger place today as a nation with more tools to protect ourselves and our communities from severe illness. We also have a better understanding of how to protect people from being exposed to the virus, like wearing high-quality masks. improving ventilation and testing. And the guidance that we're going to read about right now, what she says is, acknowledges the pandemic isn't over, but it helps us move to a point where COVID-19 is no longer severely disrupting our daily lives. And of course, there's some parts of that that I didn't read. You can read it if you want to. It's all in the link. So there's a couple of big picture things, and I want to get into the specifics because I think if we look at the big picture first, it makes the specifics a little less confusing. Because when you get to the specifics, it's like, well, geez, if I have these 2 things here and then I got this one thing over here, I do this other thing over here. But if I got 4 things over here, I got to do this, you know, other— this other thing that I wasn't doing before. So what are we looking at here? So, so overall, um, the first kind of thing is that, um, they're recommending that instead of a quarantine, if you're exposed to COVID-19, you wear a high-quality mask for 10 days. But get tested on day 5. Now, this doesn't mean— so this is before you have COVID, or you don't know you have COVID, but you know you were exposed. Now, what would be the idea of wearing a high-quality mask? So it's sort of like, well, isn't the horse kind of out of the barn at that point? The idea there is that— and we'll get into this a little bit more later— regardless of your vaccination status, vaccinated Unvaccinated, prior infection, no prior infection. For all intents and purposes, everybody is exposed and everyone is transmissible. Everybody can give everybody else COVID, okay, if they're exposed. Now, it doesn't mean you're going to. So let's say, as has happened to me, I am somewhere and I Again, regardless of vaccine status or prior infection status, whatever. I get exposed, I don't know it. The person maybe calls you the next day or 2 days later and says, geez, you know, we were at that party, I just, you know, came down with COVID symptoms, I tested positive, I'm sorry, but, you know, here, I'm supposed to let you know. So that means I am exposed. So why then would I go and, you know, wear a high-quality mask somewhere? The goal there is not so much about protecting me anymore. It is keeping my secretions from going, you know, on to other people. Now, can we nitpick about masks and can we talk about, you know, proper fitting and all of that? Certainly, yes, we can. The biggest thing that masking does in this situation where you've been exposed and you don't know if you're going to get sick or not Okay, we're trying to lower the transmissibility from me, the exposed person who may now be a reservoir for COVID, to you if I talk to you. And if you've ever looked at those films of people talking and there's, you know, always this spray of stuff coming out, it is transmitted, you know, through the air and through respiratory secretions. If I'm wearing a mask, uh, it significantly lowers the amount of those secretions that can go out. Now, is the pore size, you know, small enough? That depends on your mask. That depends on the fit, all that business. Okay, so the mask thing is its own issue. Now, that's why they keep saying— they say high-quality masks. They don't identify what a high-quality mask is in this report. They do elsewhere. And really what they mean there is a properly fitted N95 or KN95 or one in that range. So meaning that it's been fitted to you, you understand how to use it and all that stuff. So there's a whole bunch to the masking thing. Um, and then if you have— so these are just the big bullet points. So if I'm exposed, uh, I wear a mask and I get tested on day 5. What they're hoping for there is if I get exposed yesterday— so let's say I got exposed yesterday, that's going to be, you know, day 1, 2, 3, 4, 5. On the 5th day, I'm going to do a test. If I'm negative, then I go on about my life. If I'm positive, then I'm going to go into this rubric of potential isolation and masking and stuff like that. The next thing as a big picture bullet point, so not getting into specifics here yet, the guidance reiterates that regardless of vaccination status, so vaccinated, unvaccinated, boosted, unboosted, prior infection, no prior infection, doesn't matter anymore. You should isolate from others if you have positive COVID-19. And this is because, unlike what we were told for the first portion of the vaccination program, vaccination does nothing to stop you from getting the disease, and it also does nothing to stop you from transmitting the disease. So, you know, the idea that I'm going to get a vaccination, which would be more, you know, typical vaccine strategy— I'm going to get vaccinated against, you know, disease X because I don't want to get it, but I really— I don't want to give it to, you know, Grandma or something. Or, you know, I'm a healthcare provider, I don't want to, you know, get it, I don't want to give it to my patients, right? Well, with the type of vaccines that we have for COVID, We don't have that protection, so the idea that, you know, being vaccinated is going to protect you from giving it to Grandma is— that doesn't work. It's not, not how it works. And, you know, early on, you take people at their word. They said, well, it probably would work that way because that's how other vaccines work. Well, we figured out now that doesn't. And in, in many places where there's high vaccination levels, you now have these really high transmission levels. And it's not the unvaccinated people doing it, it's, it's the vaccinated people and the unvaccinated people all together. So that's why they're saying here, regardless of your vaccine status, you should isolate when you have COVID-19. Well, this shouldn't really upset anybody, the idea of if I get COVID-19, I should probably stay away from other people, because we would tell you that if you had many other things. If you have influenza, we're not going to tell you to go out and, you know, be with lots of folks and spread it around, right? So this is sort of like, you know, what advice your grandma would probably give you. If you, if you're sick, stay away from other people. You should also isolate if you're sick and suspect you have COVID-19, but you don't have a test yet. Now, this does make some sense because there's so much transmission, especially right now here in August 2022. And the upside of the transmission is the, the current type of variant going around is pretty low. You know, as far as bad symptoms go, you feel rough, but, you know, people aren't getting terribly bad symptoms. If you feel like you have those symptoms and you're waiting on your testing, until you know what your test is like, you shouldn't be around people anyway. Because what if you have those symptoms and you had some other infection that's very transmissible, like influenza, or you had, you know, a cold virus that's not COVID, or you had You know, a fresh infection with mycoplasma pneumoniae or something like that. You don't want to be spreading that around either. You're going to be symptomatic, your COVID test will be negative, but if you're sick and you've, you know, got fever, cough, chills, aches, any of those things, stay away from people, right? I mean, that really shouldn't have changed ever, right? Just take care of the other people by not giving your illness, you know, to them. Knowingly. Um, if you're— so again, just high, high-level bullet points here. If you are positive, follow CDC's isolation recommendations. We're going to get to what those are. If you are negative, you can end your isolation. Now, there's a little caveat to that, because if you turn negative but you're still very ill, you should, uh, still stay away from people if you are having infectious type symptoms, especially if you're febrile, you're coughing, uh, you have body aches, any of those sort of things, because you could have other things. Remember on prior programs we've talked a lot about how many co-infections— so other non-COVID infections go along with all having COVID— so you could wind up testing negative but have other stuff that you don't want to be spreading to people. So going by your symptoms is another bigger marker than we used to have in the Guidance. Now there's going to be some specific stuff we'll get to, but let's just go through— this is the first, uh, the first link, which is the high bullet points from CDC. Then we're going to get into the nitty-gritty of the bullet points from the CDC as well. Um, so regardless of when you end your isolation— so let's say you ended your isolation, you know, on day 6. avoid being around people who are more likely to get very sick from COVID-19 until at least day 11. And that tends to be either immune-compromised folks, people over the age of 60 to 65, certainly over the age of 70 to 75, etc. Immune-compromised folks, newborn babies, other, you know, other categories like that. And the reason for that is a couple of things. One is You could start to feel better, your tests could be negative, and it might be truly negative, or it might be a false negative, meaning you still are carrying some reservoir. So that can happen for a while. The other thing that we're seeing is that you could have a recurrence. So like a rebound, and we see that a lot with some like Paxlovid. You see that in other stuff, but I've seen it with just people not doing Paxlovid but just doing other treatments, and they get better, and then 2 days later, bam, they get hit again, and they thought they're out of the woods. So I think that their idea of avoid immune-compromised folks until day 11, regardless of how you're doing it, it's just a safety factor. Okay, now we do want to keep in mind, we've talked about this a lot before, that a lot of the immune-compromised people in the world are not easy to identify, and that's because there's a number of ways to be immune-compromised. One can be your age, so very close to birth, or the more elderly we are, we, we have weaker immunity. Okay, there's a lot in the most, uh, fastest-growing group of drugs in the world are biological drugs, targeted drugs, and many of them have side effects of immune suppression. You could also be around somebody maybe who's undergoing chemotherapy and they have immune suppression. You could be around somebody who has an autoimmune process and they are on steroids and they're immune suppressed. A lot of reasons why people are immune suppressed and they may look normal to you. So sometimes taking a bit precaution if you feel that you're sick is just doing the right thing for others who are around you who you may not realize, you know, could maybe get very sick if they got something. And like I say, that's, you know, whether it's COVID-19 or the flu or, or myco or any other thing. We see if you're sick, we want you to avoid things. Um, so then they're talking about high-quality masks again, and then they get into this sort of stratification, and I do want to get into that in the second handout. We'll put that link up too. It'll be a little more linear. And they start to go into, just as an entree there, if you have, you know, mild illness versus moderate versus severe illness and/or immune compromise, then we may have different levels of what we want you to do. Okay? If you get COVID. And they do, you know, rightly so, and, and good for legal reasons also. You know, they always say, look, if you, if you have severe symptoms, if you're having trouble breathing, if you had very high fevers, you have anything else that's very disturbing to you as a symptom, and you should contact your doctor. And then if you have those symptoms, and you have a reason for immune deficit, such as I'm on steroids, or I'm on a certain biologic drug, or whatever, I'm on chemo, you really need to talk to your doctor about the best way to protect yourself. Okay. And, and that is going to be something that, you know, when you get to that level of severity, or you're on a mixture of drugs, and you have no idea what they do to your immune system, if you get sick, you really should let your doctor know, whoever's prescribing those drugs, because they may tell you, well, you know, with your condition and the type of drugs you're on, your chance of immune suppression is pretty low, or they might tell you, yeah, with your condition and the drugs that we're giving you now, your immune system is going to be suppressed and we need to— you just need to be more careful than the average person. Okay. Um, another thing is to clarify— again, these are their high-level bullet points— uh, to clarify that if you've ended isolation and then your COVID-19 symptoms come back or they worsen, you have to restart your isolation and then talk to your healthcare provider. And this again is because we do get people that get a window of a break from their symptoms. And I've seen this with Paxlovid. I've seen it with just regular non-Paxlovid treatment of folks where they're literally going along and they get X number of days in and they're just better, and then, you know, 2 days later, all of a sudden the symptoms come back. And that's not uncommon, especially in the days of Omicron and some of the stuff that we got going around right now. Um, also, screening recommendations have changed in that testing of asymptomatic people— so just general people off street with no symptoms, uh, with, with no known exposure— will not be recommended in most community settings. So They do reserve that if you, you know, if you've been in certain areas, you've been exposed to maybe a large group, you might be exempt from this and tested anyway. But basically just wholesale testing of asymptomatic people, no, no one's recommending that anyone do that anymore. And then emphasizing some of the protective things, so distancing is a component. Looking and assessing your risk in a particular situation. Number one, are you, are you going to be around people who have symptoms or not? Are you going to be close to those people or spread out? How's the ventilation? All of those things. And then they gave this guidance, and they want to let everyone know this is guidance for the general public. The guidance that we follow in a hospital or healthcare setting is largely unchanged at this moment, and they are trying to update those other guidelines for facilities, etc. And if you've watched, there are some facilities, some healthcare facilities that have already adjusted their own internal guidelines, which they can do. So a hospital system There are some of the university hospital systems, for example, that have said if you're negative COVID, you're not required to wear a mask anymore, etc., stuff like that. Again, you can decide that's a great idea or dumb idea. I'm just telling you the way it is out there. Then the next one is another breakdown of when should I isolate. This is another CDC link that I will put in there. And this gets in then to the more specifics of when, uh, you know, when I have XYZ problem, how long do I stay away from people, or what do I do, uh, what's, what's the guidance there if I'm sick? And remember, if, if we, you know, if we— and, and believe me, if you've heard my, uh, you know, my history with the federal government and regulatory bodies and activities I'm involved in a lot of that. I used to be involved in drug development, and, um, you know, now I'm involved in, uh, other areas of medical regulatory activity. Uh, those of us in that world, you know, sometimes get along great with the government, sometimes it's a little bit dicey. Uh, so, you know, I've had plenty of problems, uh, with federal government agencies. But what I will say is, if we take off, you know, that sort of, you know, angry skeptic kind of hat, which is easy to wear, uh, if you're, you know, on my side of the healthcare equation and public health, really, when I read through these guidelines, they're just, they're just trying to give fairly common sense guidelines and tell us, you know, this other stuff that we were saying before It didn't turn out to be true. We're going to get into that. So let's focus on what we know right now. Let's focus on the information we have in front of us, and let's keep each other safe, because that's really what it's about— it's about keeping all of us safe. So the first point here in, uh, this more specific missive from the CDC is if you have COVID-19, you can spread the virus to others, and that is regardless of your vaccination or your prior infection status. So many people in North America— not as much in some other countries when I talk to colleagues around the world— but many people in North America, we've been told repeatedly that one of the reasons to be vaccinated is to protect those around us. And, uh, it turns out, especially in modern times, that when we are vaccinated and then we get COVID, we are just as likely to not only get COVID but to transmit it to other people. So our vaccination doesn't protect anybody else. Okay, so we need to get that out of our minds. Uh, the other thing is that there is there's some long-term protection in some groups with vaccination and also from prior infection that are about equal. And I did a prior show on that, and if I remember, I'll put the link in, but you can just go back to my YouTube and look at the one about vaccine versus prior infection that basically shows, well, neither one— prior infection or vaccination— neither protects us from new infections, breakthrough infections. And it doesn't protect us from not spreading it to someone else if we get it. But what it does protect us from, either prior infection or vaccination at an equal rate, is if I do get COVID, I'm much less likely to be severely ill. Okay, and certainly that works a little differently in those 2 groups, but it works. But that's the only protection you really get out of your vaccination. So When to isolate. So now they're getting to the nitty-gritty here. Regardless of your vaccine status, and this is a new thing that they put in because before it was stratified, etc., you should isolate from others when you have COVID-19. You should isolate if you are sick and suspect you have COVID-19 but you don't have test results yet. We already hit that. Now, they get into this, do I test, do I not test, blah blah blah. So if you test negative, You can end your isolation. So let's say I have symptoms or I'm exposed, I test tomorrow because, you know, I couldn't get my test till tomorrow, test comes up negative and I have no symptoms, I don't need to isolate. If I have symptoms, it's going to be some caveats there. If I test positive, however, then I will follow the isolation protocol that we're going to go through. Okay, so you count your isolation in days, and if you have no symptoms but you test positive, then day 0 is the day that you tested positive. The reason for this from public health point of view is if I have no symptoms and I test positive today, it is highly likely, uh, if, if that's a true positive test, That by tomorrow or the next day I will develop symptoms, and yet I am transmissible that whole time. So their point is, we're not going to gamble on a false positive. Even if you have no symptoms, if you test positive, you're going to need to stay away from people until you test negative, even without symptoms. Um, so day 1 is the first full day following the day you were tested Positive if you develop symptoms within 10 days of when you were tested. So here's the thing too, let's say I test positive yesterday and in the next 9 days, on day 9, I suddenly get COVID symptoms, then the clock for my isolation restarts because now I have symptoms and it pushes it out further. Okay. So if you have no symptoms You're still going to isolate if you have a positive test, either for the number of days, the 10 days, or till you test negative. If you develop new symptoms or new positive test within that 10-day period, you may— and you were asymptomatic, you have to restart the clock. Now, if you do have symptoms when you test, so day 0 of isolation is whenever your symptoms started, day 1 is the first Full day after your symptoms start. Now, this is when you tested positive. So let's say 2 days ago I got a cough and fever and body aches, and then yesterday I did a test and I got my positive test results yesterday or today. Then the clock starts from 2 days ago. So what do they say about isolation if I have symptoms? Okay. If you test positive for COVID, stay home for at least 5 days and isolate from others in your home. You're, you're likely the most infectious during the first 5 days, so you want to isolate, you want to try and avoid people in your house. Now that's easier for some people than others based on their living situation, so this is one of the reasons why, globally speaking, and almost always statistically, the higher level of socioeconomic activity a person has, the actually the less, you know, overall they're affected by certain, you know, infectious processes. Not all of them, but certain ones. And the reason for that is if you have a very large house or you have a guest house and you can just go live separate, great, you can live separate. What if you have a house such as my family had for quite a while where there's one bathroom and everyone uses it. Well, it's a little hard unless you move away. It's a little hard to really isolate from the rest of the people in your world. Now, one thing that you can do, and this is something that I mentioned earlier, this is not protecting you because you already got COVID. But if you've got to be around people and you can put a high-quality mask on, you're going to decrease the amount of secretions that go out into the world and onto your family and whatever. And that's a nice way to avoid giving them what you already have, or if you have to, you know, go out in public for some reason— you shouldn't be if you're isolating. Now, some tips that they give you here. Do not, if you are COVID positive— okay, so you're a sick person— don't go any place where you can't wear a mask to protect others. Do not travel. That's a really good thing. So, you know, I've talked about this before, long before COVID and certainly before COVID because part of my work is teaching. I teach other physicians and stuff. I was flying all the time. And I would be on planes just before COVID with people with active respiratory symptoms. I mean, they're coughing and hacking, and, you know, there's people with obvious febrile signs. And, you know, I've been across the aisle from people with bad coughs and got, you know, the spray all over my face. And, you know, and I've, I've come off of a fair number of flights where I had a cold or a flu or something that I had to deal with. Um, so, you know, you, you like, unless it's a life or death matter, if you're sick with anything, you really shouldn't travel, or you should You know, if it's life and death, you should make arrangements to work around that. Stay home and separate as much as you can. Improve ventilation if at all possible. And ventilation is another thing. So, and this is something when, you know, way 100 years ago, when I was a young intern, I worked in a number of clinics that were free clinics. and we had a lot of tuberculosis patients. And one of the things that we would always talk about, protection for tuberculosis, which of course can be airborne, was ventilation. And good ventilation was protective. Okay, well, good ventilation is protective for anything that is potentially airborne. Now, this you should know already, but they say it out loud: don't share things with other people Like cups, towels, utensils, toothbrushes, etc., etc. Monitor your symptoms, and if you have trouble breathing or any other emergency symptoms, call EMS or call your doctor. Don't just sit at home with that. Then we get to this next part, which is the part everyone's looking for, which is ending isolation. So how do we do that? Well, Their, their top-line advice is ending isolation based on how serious your COVID-19 symptoms were. So if you had no symptoms, so you test positive, you have no symptoms, at 5 days you can end your isolation. So I tested positive 5 days ago, I've had absolutely no symptoms, I'm done at day 5. Okay. If you had symptoms, you can end your isolation at day 5 if you're fever-free for 24 hours without the use of a fever-reducing medicine. So it doesn't count if you took Tylenol or aspirin or Advil or steroids or anything else that reduces fever. Has to be just natural on your own. You've had no fever for 24 hours. You, they say, can end your isolation at day 5. You can end your isolation at day 5 if your symptoms are improving. So if you still have a fever or other symptoms that have not improved, continue to isolate. But if your symptoms are improving and you get 24 hours of fever-free, Then they say you can stop. Now they get into moderate versus severe illness. So if you have moderate illness or severe illness, meaning you were hospitalized— so moderate illness is you had some shortness of breath or difficulty breathing. Severe illness is anything that put you in the hospital due to COVID-19, not due to other stuff. Or you have a weakened immune system due to drugs, due to other medications, due to other diseases, etc., then you need to isolate all the way through day 10. And this is because if I have a weakened immune system or I've been very sick, I am more likely to have residual COVID and other infectious material that I'm dealing with for a longer period of time. And then they add in again, which is smart for the CDC not to have someone sue them, if you have a severe illness or weakened immune system, please contact your doctor before ending your isolation. So what they're really saying is if you're really sick and you've been isolating and you're still sick, you probably should talk to your doctor. Now, that doesn't mean they're going to make you go do anything, but it's, it's good to get that clarity, and they may, they may have some other ideas for you, your doctor, if you're really that sick. Now, The next thing that they have, and this is on the second thing, it's in bold in the bottom, so I'm going to read it directly from our friends at the CDC here. Regardless of when you end isolation, avoid being around people who are more likely to get very sick from COVID-19 until day 11. So let's say you ended at day 5. You've got 6 more days to day 11, and it would be a nice human thing to do to avoid being around people who are immune compromised due to drugs or disease or whatever, uh, and very elderly and very new babies and stuff like that, at least till day 11. And, um, you know, the reason for that is just in case there's any transmissibility left, let's not do it. Um, if you are around people and you have to be around people indoors Or other public places, but mostly they're talking about indoors here. They should wear a high-quality mask, and again, that's not to protect you, okay? That is to protect your spit and your respiratory secretions from going on to other people. Then the next part, you know, If you do have to use public transportation or travel or basically be around anybody, um, and you're in the window, then, you know, wear a mask and don't spit on people. Now they do say something interesting, which, uh, we're now seeing, and we see reported in the— both the reporting and the data and everything. Loss of taste and smell might persist for weeks or months after recovery and shouldn't delay your isolation. So what they're saying here is, okay, you're, you're all better, but you still don't have smell or taste. Those sequelae are neurological damage usually, and we've done a prior program on that. It's quite interesting. And they are not associated at a certain point with you being transmissible or infectious to anybody else. So that's important. So if you have just all that you've got left is loss of taste or smell, do whatever you want because you're, you're not transmissible, they're saying. Now, I will say that a lot of people that I'm seeing now who have active COVID are not getting to the loss of taste or smell till a little bit later in their illness, like the viremia is starting to recover and the taste and smell are going away a little bit later. So that might be important. So there Advice on removing your mask. This is the next big part. After you've ended isolation, when you are feeling better and you have no fever— and that's a real no fever, not no fever with aspirin or Advil or Tylenol or whatever— when you're feeling better, still mask around others till day 10. Or if you have access to an antigen test, You should consider using an antigen test. And if you get 2 negative tests 48 hours apart, you can stop masking. And they even say that can be at any time. So let's say you maybe, you know, thought you were sick for— in the beginning you had the right symptoms, and so you started to isolate. And then you get a pair of antigen tests, and a lot of the ones that you get at the pharmacy come with 2 in there, okay? And you do your first antigen test on day 2 and it's negative, okay, great. And you're starting to feel better. You do your next antigen test 48 hours later, 2 days later, it's negative. You can stop masking, stop isolating, et cetera, if you have those 2 in a row. And then it says continue taking antigen tests at least 48 hours apart until you have 2 in a row that are negative. So let's say, because these tests are not 100% sensitive or specific, meaning they're not always giving you a true positive or a true negative, um, your first one is negative. We all, you know, party happy. Uh, you wait your 48 hours, you do a second one, it's positive. Okay, well, that means now you got to start over, and 48 hours later you take another one. That one's negative. Take 48 hours later after that, you take another one. That one's negative. Then you're, you're free and clear. You've got 2 in a row. After you have ended isolation, and this is a repeat of their advice before, if your COVID symptoms recur or worsen, restart your isolation at day 0. Now, it's kind of a bummer. But I believe that they put this in because it's fairly clear now that there is a lot of rebound and, you know, kind of recirculating and cycling back of COVID in some people. Now it's, you know, it's kind of famous with Paxlovid where we saw that a lot. My experience was if we use Paxlovid and we didn't give other things to cover other problems that were going on, we had more likelihood of rebound infection, although it certainly didn't happen to everybody. So there you go. Now, there's a couple of things— we're kind of coming into the home stretch of the end of our time here— but just a couple of things through this guidance. Number one, if you're watching us live or listening live on CTR Radio or Facebook Live, The links I'll put up over on the YouTube channel, DRA Online, Dr. A Online. If you can't find that, go to my hub channel, dranow.com, dranow.com. There'll be a link to my YouTube. So I'll put it in the description box. If you're on your phone, the description box is the lower right-hand corner below the video, and there's a little down arrow or a little V. If there's 2, one on top of the other, one is an ad and one is the actual description box. So if you open my description box and there's something being sold to you, that's not me, that's whoever YouTube is advertising for. If you're on your computer, it's usually on the left side and they'll say more or show more. Click on those words, more or show more, and it will open up. That's where all the description, all the links, all that stuff will be in there. Okay, so that's the, that's the first little thing. The next thing is we've mentioned a few times on the program here, um, the community is building, the subscribers are building both on the, um, podcast side. So we're on every pod burner that I know of. Look for Medicine and Health with Dr. Paul Anderson. That's our real name, although I usually just Dr. A or Dr. Paul. Medicine Health with Dr. Paul Anderson, any pod burner, you should be able to find me there. If you want to follow, like, share, subscribe, all that, thank you so much. That's been growing over the years we've been doing this. Now that we're on video and on YouTube, um, we're growing that community. And what you'll notice on the YouTube is we have all of these radio show podcasts, and then we have a lot of shorter material as well. And we're producing more and more of both types of content. So that's over on the YouTube side. And as I say, that community is growing. We'd love to have you there as a subscriber. So like, share, subscribe, do the notifications, all that stuff. It really does help, helps the community. And it, it helps us, you know, get the word out, because my whole goal with the program is truly to be educational. And so, you know, Sometimes, like for instance today, I was relating what the CDC is saying that, you know, it really doesn't matter anymore whether you're vaccinated or not as far as spreading the disease to other people or, you know, getting the disease even. Um, we've known that for a while now, but this is sort of coming out. And for some people that's like, oh well, I told you all along. And for other people it's like, well, you know, even whatever. Um, I'm just sharing that, that that's actually a fact. And sort of like on the prior programs when I shared the research that showed, you know, the one thing that the vaccine might do would be long-term protection against, you know, advanced disease from COVID And then we got, you know, some more recent research that showed also having COVID before protects you in the same way the vaccine does. And so there again, those are not pro or anti-vax statements. They're just— this is a different kind of vaccination itself, a different kind of vaccination strategy than you would think of for most other diseases that you're going to deal with. So, you know, sometimes by bringing those things up, even though they're facts and it's just the way it is, that's not the story you were sold, or all of the story you were sold earlier. And, you know, that upsets people sometimes, and it's— I'm not here to upset anybody. I'm just here to share. Um, but the other thing about that, just to— I'm nearing the end of my time period that I'm on here. Um, just to end with a minor editorial comment. Um, if you look at other parts of public health, even, you know, whether it's my— the state I practice in, we get public health updates because if you have a medical license, you— they keep trying to keep you in the loop, uh, or if it's on the national scale, when some of these things change, the, the language from before gets carried forward. So we, we have all this, well, it doesn't matter if you, you're vaccinated or not, we got to do these things, uh, and then, you know, they turn around and say, well, it's still the best strategy is to get lots of vaccines. Uh, even though they're not going to stop you from getting sick or transmitting the illness to other people. And whether or not you get a vaccine is between you and your healthcare provider, and if it's appropriate for you, etc. Uh, but the rhetoric around it is still a little bit outdated when you read these things. So, you know, that's, um, that's just sort of the way it is. Government and their postings change quite slowly unless there's a big emergency, and that's what we're seeing happen. So if you want to get into these Like I say, the first link on here will be more of the high-level bullet points. Second link will be the actual— if, if you have X and Y, then you isolate for Z. If you have A and B, you isolate for D, or, you know, whatever it is that you got going on there. We'll put those in. And like I say, as long as I remember to do it, I've got it in my notes. I will also put in some of the links to the prior programs where we talked about protection against severe disease by vaccine versus protection against severe disease by prior infection, which at this point, most of the world has one or the other of those. Not everybody, but most of the world does at this point. So that changes the conversation around a little bit too. But we are now out of time. We have burned up all of our time for the podcast today. I'm Dr. Paul Anderson with Medicine and Health. And like I said, you can find us on any of the pod burners. If you go to CTR Radio Network, that's my home where all of this is produced, and they, they are the host source. And then like I said, later they will move over the video over to YouTube on DRA, Dr. A Online, and we would love for you to join us on all of those platforms. So thank you very much, and I'll see you guys on the radio or the podcast next week.