On March 15, 2024, Pennsylvania Department of Health (DOH) released a health advisory about the CDC New Respiratory Virus Guidance (which is a general guidance for community settings).

Pennsylvania Department of Health (DOH) provides this guidance based upon available information and is subject to change.

The Centers for Disease Control and Prevention (CDC) has released new guidance for preventing respiratory virus diseases.  CDC has included COVID-19 in the new guidance because effective vaccines, treatments, and widespread immunity to SARS-CoV-2 have contributed to lower rates of severe disease and death.

COVID-19 also shares risk factors and prevention strategies with other respiratory virus diseases.

What are the new changes?

The new CDC Respiratory Virus Guidance recommends that people with respiratory virus symptoms (not better explained by another cause) stay home and away from others until at least 24 hours after both resolution of fever (without using fever-reducing medications) AND overall improvement in symptoms. For COVID-19, this differs from the previous recommendation of a minimum of 5 days of isolation following symptom onset or a positive test, but it does align with previous guidance for other respiratory virus illnesses.

This recommendation addresses the period of greatest infectiousness and highest viral load for most people, which is typically in the first few days of illness and when symptoms, including fever, are worst. A residual risk of disease transmission may remain after fever is gone and symptoms improve, depending on the virus, person, and circumstances. Therefore, for five days after leaving isolation, CDC also recommends taking additional precautions to help protect others. These precautions may include masking, diligent hand hygiene and cough etiquette, distancing, testing, and/or actions to improve air quality.

Who does the new guidance apply to?

The new CDC guidance applies to the public as well as non-healthcare congregate settings, such as non-healthcare portions of correctional facilities and shelters. Correctional and detention facilities should make sure their populations can protect themselves using the core prevention strategies outlined in the guidance. Because individuals’ personal prevention decisions are often limited during confinement, many must rely on correctional and detention facilities to provide what they need to protect themselves.

This guidance will align with the new Respiratory Virus Guidance and other disease-specific guidance and include considerations for students with special health care needs. Guidance for educational settings will be released prior to the 2024-2025 school year. Schools and childcare facilities should continue to follow core prevention strategies outlined in the CDC guidance, with the exception of the previous 5 days of isolation guidance and masking recommendations which are no longer applicable.

Other information such as optimizing ventilation, encouraging hand hygiene and respiratory etiquette, and frequent cleaning remain applicable to reducing transmission of viral respiratory pathogens.

Does the new guidance apply to health care settings?

NO, this new guidance does NOT apply to healthcare facilities. The new guidance applies to the public as well as congregate settings.

Healthcare facilities should refer to the specific guidance CDC offers for COVID-19, influenza, and other diseases. Links to the guidance for healthcare facilities can be found under resources (link below).

What is the rationale for the shift in COVID-19 guidance?

COVID-19 is being included in unified guidance for respiratory viruses because:

• Effective vaccines are widely available
• Effective treatments are widely available
• Over 98% of the United States population has some protective immunity against COVID-19 from vaccination, prior infection, or both.

These factors have contributed to lower rates of severe disease and death from COVID-19.

Weekly hospital admissions for COVID19 are down more than 75% from the peak of the initial Omicron wave in January 2022, and deaths are down by more than 90%. Complications like multisystem inflammatory syndrome in children (MIS-C) are now also less common, and prevalence of Long COVID is decreasing.

What about people with higher risk for sever illness?

• Immunocompromised persons: Persons ages 6 months and older who are moderately or severely immunocompromised should receive at least 1 dose of a 2023-2024 updated COVID-19 vaccine. Immunocompromised persons should also receive an age-appropriate flu vaccine. When ill with COVID-19 or influenza, antiviral treatments are recommended. Because this group may shed respiratory viruses longer than others, an extension of precautions taken after illness may be considered. Precautionary measures for this group should also consider their heightened risk of coinfections
• Older adults: All adults ages 65 years and older are recommended to receive an additional dose of the updated 2023-2024 COVID-19 vaccine. In addition, older adults are recommended to receive a high dose or adjuvanted influenza vaccine and discuss with their provider whether an RSV vaccine is appropriate for them. Treatment with COVID-19 antivirals is recommended for all adults over age 50 with COVID. Flu antivirals are recommended for adults ages 65 years and older.
• Young children: Children ages 6 months or above should receive a current COVID-19 vaccine and an annual flu vaccine. To prevent severe RSV disease in infants, CDC recommends either RSV vaccination while pregnant or infant immunization with RSV monoclonal antibody. Paxlovid is not authorized to treat children with COVID-19 who are under 12 years of age. Oseltamivir is approved for treatment of flu in children 14 days old and older.
• People with disabilities: Offer vaccines, antiviral treatments, and address unique support needs.
• Pregnant or recently pregnant people: Vaccination during pregnancy is strongly recommended for both maternal and infant protection. Treatment for COVID-19 should not be withheld in pregnant or lactating individuals. Flu antivirals are recommended for pregnant people.

Is COVID-19 still reportable to PA DOH?

Laboratory-confirmed influenza and RSV are reportable to PA DOH via PA-NEDSS. COVID-19 is still reportable in some PA counties and can still be reported to PA DOH. All outbreaks are still reportable to PA DOH. All facilities are reminded to be aware of and adhere to all local, state, and federal reporting requirements applicable to them.

Additional Resources & References

https://www.cdc.gov/respiratory-viruses/guidance/respiratory-virus-guidance.html

https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html

https://www.cdc.gov/flu/professionals/infectioncontrol/healthcaresettings.htm

https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html

https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html

PENNSYLVANIA DEPARTMENT OF HEALTH 2024 – PAHAN – 741-03-15-ADV. New Respiratory Virus Guidance (which is a general guidance for community settings).