- COVID cases have declined, but flu cases remain high on campus.
- New COVID vaccine recommendations for those with a weakened immune system or 65 years and older.
- Isolation guidance for COVID is now aligned with recommendations for all respiratory viral illnesses.
As we head into March, I write to share a respiratory illness update and several notable announcements from the CDC concerning COVID.
Respiratory illness update
While COVID cases and hospitalizations have declined at the state and local levels, flu has remained stubbornly elevated, and at Yale Health has outpaced COVID in patients in our Acute Care department.
- Flu tends to have a characteristically sudden onset with fever, intense body aches, and headache.
- As with COVID, most people will recover quickly from flu without treatment. However, if you are immunocompromised, live with someone who is vulnerable, or have significant respiratory symptoms, you should contact your healthcare provider, as treatment with Tamiflu (oseltamivir) may be appropriate.
COVID vaccine for those 65 and older
Last week the nation’s premier expert body on immunizations, the Advisory Committee on Immunization Practices (ACIP), recommended that individuals aged 65 and older should receive a second dose of the current 2023-24 COVID vaccine if they received their last dose at least four months ago. A similar recommendation was made several weeks ago for those who have a compromised immune system. ACIP cited the following considerations:
- Vaccine efficacy decreases over time and this decline is more notable in those over age 65.
- Studies of vaccine effectiveness to date demonstrate that those who have received an updated vaccine dose this fall are about half as likely to develop COVID or be hospitalized for COVID compared to those who did not receive an updated vaccine dose.
- Evidence shows that the current vaccine provides comparable protection against the current dominant variant, JN-1, as it has for other circulating variants.
Yale Health members may self-schedule a vaccination appointment through MyChart OR may receive the vaccine at a pharmacy (present your Yale Health ID card). Individuals with other insurance should consult with their insurance provider.
New respiratory illness guidance from the CDC
The CDC has updated their recommendations for steps individuals should follow if they develop symptoms of any respiratory infection, including COVID. The new recommendations represent a notable change in policy, as they eliminate the five-day isolation period for COVID and align recommendations for all respiratory viral illness. Those recommendations are the following:
- STAY HOME until you have been fever-free for 24 hours without fever-lowering medications AND your symptoms are improving.
- This is the period where you are most contagious.
- Staying home is also important for respiratory viral infections without fever
- Return to routine activities but take ADDITIONAL PRECAUTIONS for five days to prevent the spread of infection to others: wear a well-fitting mask, take steps to improve air flow, distance from others, and wash hands frequently.
- If fever returns or symptoms worsen, return to the stay-at-home phase.
The CDC noted that similar recommendations implemented in California and Oregon and in European countries have not been accompanied by increased community transmission or hospitalization.
Importantly, the new guidance does NOT apply to healthcare settings, which continue to follow existing guidance. Yale healthcare workers with respiratory symptoms should test for COVID and should remain in isolation for seven days from symptom onset if they test positive. If symptomatic but COVID negative, healthcare workers should follow the general respiratory viral guidance above.
The new recommendations come with some important background:
- It is still possible to shed virus after the stay-at-home period, so masking and other precautions are critical to protecting those around you.
- Testing is identified as “a choice,” recognizing that many are not currently testing, and that other common viral infections (e.g. flu) do not have easily available tests. Still, COVID tests may provide valuable information that may influence your behavior. Yale will continue to offer free COVID rapid antigen tests around campus for the remainder of the semester.
- Testing remains important especially if you are at increased risk of more severe COVID (over age 50, immunocompromised, or with certain conditions) and are a candidate for anti-viral treatment with Paxlovid, if you have high risk individuals at home, or if you are a healthcare worker.
- In making these recommendations, the CDC is balancing considerations, including a higher level of immunity across populations due to infection or vaccination and reduced severity of COVID infections generally. They also note the difficulty that many have accessing tests or complying with isolation recommendations, and the desire to simplify guidance.
Not everyone will agree with these changes, but making public health policy is a balancing act that considers science, behavior, and health equity concerns. The university will continue to align with CDC recommendations. We urge all of you to follow the new CDC guidance carefully to protect our community and avoid spreading infections—COVID, flu, RSV, or other cold viruses—to colleagues, friends, and family.
In closing, stay home if you’re sick with respiratory symptoms, whether or not you test positive for COVID, and follow extra precautions afterward. It’s the right thing to do!
In health,
Madeline S. Wilson, MD, FACP
Chief Campus Health Officer