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From the start of the Covid-19 pandemic, it has been doctor’s orders in this country: If you test positive, stay away from other people, even if you aren’t coughing or feverish. In recent months, however, that rule has been relaxed in two of the unlikeliest places.
Oregon and California, among the most cautious of states early in the pandemic, have surprised health officials elsewhere by breaking with Centers for Disease Control and Prevention guidelines and telling infected workers and schoolchildren that as long as they have no symptoms, they are generally free to go about their lives.
The new approach has been greeted with trepidation by some health experts in the United States, especially as wastewater data shows a surge in cases driven by a new variant. But many scientists say that Covid has transitioned from a public health crisis into more of a featured virus among an array of respiratory risks.
“The emergency has ended. Covid-19 is endemic,” said Dr. Melissa Sutton, medical director for respiratory viral pathogens at the Oregon Health Authority. “We’re in a different phase.”
As vaccinations, antiviral treatments and natural immunity have reduced the mortality rate of Covid, state officials have given more consideration to the societal cost of pandemic constraints.
Even in states where health rules were the toughest, officials say that for asymptomatic people, the benefits of strict isolation no longer exceed the cost of missed school, missed work and lost income.
“The question is, is the juice worth the squeeze?” said Dr. Shira Doron, chief infection control officer for the Tufts Medicine health system in Massachusetts. “We’re not achieving containment of the virus. So what are we getting from this policy?”
Studies have demonstrated that people with Covid-19 are most likely to spread the virus in the few days before and after developing symptoms.
The C.D.C. initially recommended that patients isolate for at least 10 days. Since 2021, the C.D.C. has recommended that Covid patients isolate for five days and wear a mask through Day 10, even if they have no symptoms. Most states still officially refer their residents to the federal guidance, even in politically conservative places such as Arizona, where pandemic enforcement was more laissez-faire than in neighboring California.
In May, Oregon became the first state to break with the C.D.C. by relaxing isolation rules for individuals who tested positive for Covid but showed no symptoms. California officials closely watched Oregon’s experience last year and decided last week that it was safe to let people with Covid continue to attend school and work — as long as they aren’t coughing or showing other signs of illness.
Like the C.D.C., Oregon and California still advise infected people to mask indoors in public and stay away for at least 10 days from individuals who are at high risk of illness. But otherwise, both states say individuals with symptoms can venture into the public once they have been free of fever for at least 24 hours and are on the mend.
Dr. Doron said she agreed with the policy shift but was surprised by who moved first. “California and Oregon are just not the states I would have expected to see this from,” she said.
In many states with liberal leaders, rigorous Covid precautions were treated as key to the social compact and helped to save lives during the worst of the pandemic. But California schools also were among the last in the nation to return to in-person instruction, and businesses struggled to rebound from extended closures and tight state policies requiring isolation, testing and masking.
Covid rules have continued to shape behavior in those states even as rates of serious illness and death have receded. Workers and their employers have felt the strain.
“We had asymptomatic individuals in the work force who had no sick leave benefits, who were being asked to stay out for five days because of infections,” said Dr. Sutton, who helped lead Oregon’s shift last year.
California’s chief epidemiologist, Dr. Erica Pan, noted that the previous policy discouraged some workers from even finding out if they had Covid because a positive result would have sidelined them for days.
National studies have found that attendance has failed to fully recover in schools disrupted by the pandemic, and a recent post-pandemic report card by Oregon’s Education Department determined that more than 38 percent of the state’s public school students last year were chronically absent.
A variety of factors are to blame for attendance woes, including a disruption in the relationship between students and their schools during the pandemic and learning losses that made classroom instruction more discouraging for children. But school districts in California and Oregon had the additional barrier of requiring students to isolate once they tested positive for Covid.
Dr. Sutton noted that some schoolchildren were missing “a solid week of school” despite feeling and appearing well. Meanwhile, she said, Covid was not going away.
“We knew that the virus was probably the most transmissible known to mankind and about half of all individuals don’t develop symptoms,” she said. “And isolation alone, in the absence of other protective measures, was doing almost nothing to halt transmission.”
The policy’s effectiveness is difficult to tease out from the natural surging and ebbing of infections, but Oregon’s rates of death and hospitalization have remained consistent with national rates — a sign, Dr. Sutton said, that the new system at least has not made matters worse. And, she said, asymptomatic people feel less compelled to miss work and skip classes, and more willing to abide by other Covid rules.
Encouraged by Oregon’s success, California, the nation’s most populous state with 39 million residents, adopted similar guidance, citing “reduced impacts from COVID-19 compared to prior years.”
The new guidelines have already been introduced by some of the state’s largest school districts, including those in Oakland, Sacramento and San Diego, and by the state agency that regulates workplaces.
Some public health experts questioned the shift. Jason Salemi, an epidemiologist at the University of South Florida, noted that vulnerable Americans are still dying from Covid, about 1,500 a week. And some evidence suggests that people infected by new variants may be most contagious a few days after symptoms appear.
“I don’t want people coming to work and interacting with me if they’ve got the flu and are still infectious, if they’ve got strep throat and they’re still infectious, and of course if they’ve got Covid-19 and they’re still infectious,” he said.
Dr. Peter Hotez, a vaccine expert and the author of a forthcoming book, “The Deadly Rise of Anti-Science.” worried that the relaxation of rules in Oregon and California might further encourage partisan bashing of Covid safeguards.
“The guidelines may make sense,” he said. But, he added: “what is their rationale for going off on their own, when doing so could cause confusion? There’s an inherent danger in doing that, because the Florida surgeon general might argue what California is doing is no different from Florida even though we know there’s a very different political agenda in play.”
A spokesman for the C.D.C. said the agency would “continue to evaluate the latest data as it considers its recommendations,” but declined to say whether the shift by the two West Coast states would affect federal guidelines.
Dr. Sutton said she expects other states to follow Oregon’s and California’s lead, regardless of what federal officials do. Already, she said, she has been invited make a presentation on her state’s experience later this month to Washington state health officials.
“We need policies that make sense to our population and are guided by the evidence,” she said. “And an arbitrary five-day isolation is not the most evidence-based policy.”
Apoorva Mandavilli contributed reporting.
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