Which way to go? Coping with whiplash from CDC guidelines

Part of the COVID-19 “new normal” is looking to public health officials for guidance on how to safely navigate the ever-changing pandemic landscape. With the rapid spread of the omicron variant, the Centers for Disease Control and Prevention (CDC) has adapted and re-adapted guidelines, leaving the public and health care professionals alike confused and questioning their intent.

In my role as a nurse practitioner and graduate-level nursing faculty member, patients and students look to me for clarification on these recommended practices. In my personal life, family and friends ask for my advice, because of my health care background. Most people with whom I interact want to follow the rules and the science, but may feel like they’re experiencing whiplash. I’m right there with them.

To be sure, COVID-19 is evolving quickly and most everyone is trying to keep up, including leading health care professionals who look to the CDC for guidance. Yet the CDC has faced repeated backlash for unclear guidelines.

Certainly, it’s unreasonable to ask for guidance through a future-predicting crystal ball, and it is difficult to push vetted information quickly through bureaucracies. However, guiding principles of public health require simple, understandable guidelines that are developed with a sense of trust so people are willing to follow them.

Currently, the guidelines are a series of “if … then” instructions for various scenarios. The public is left to choose their own adventure and hope that they and others are doing what’s appropriate.

Options for the public vary, based on vaccination and booster status, type of vaccination, and length of time since vaccination. People also need to consider symptom monitoring and to check whether their symptoms are improving or whether they have a fever.

In the public guidelines, one of the terms of early release from isolation is that people should continue to wear a mask for 10 days post-infection. However, throughout the pandemic, mask compliance has been a continued issue. This is even more a concern with the increased transmissibility of omicron; some experts recommend using medical-grade masks, versus cloth masks.

There is also a separate set of rules for health care workers that includes conventional, contingency and crisis-level options. The crisis option removes a work restriction minimum for COVID-positive health care personnel.

Not only is there confusion on how to follow the guidelines, but the CDC is experiencing backlash from some who are questioning the potential influence of the business world. CDC Director Rochelle Walensky recently stated, “We can’t take science into a vacuum. We have to put science in the context of how it can be implemented in a functional society.”

After spending more than a year with messaging aimed to convince people not to come to work if they are sick, suddenly the CDC cut in half the minimum recommended time to stay home.

This means employers call upon a short-staffed essential workforce again to step up and hurry back to work so society can function at its most basic level. The CDC’s rationale is that the time when omicron is most contagious falls within that shortened time frame, but it does not bode well for trust that these shortened recommendations came after an airline asked them to reconsider the previous 10-day isolation period.

Some distrust among the public has emerged as memes that poke fun at the CDC with fictitious recommendations that are in opposition to actual guidance or reason, including one that the CDC no longer recommends washing your hands with soap. Other references to pop culture include endorsing Jurassic Park-like dinosaur theme parks as a good and safe idea.

While these are meant as a humorous outlet for frustration, they show a larger problem that the public clearly has reduced trust for an institution that plays a critical role in providing health guidance that is evidence-based and clear to follow.

In a survey by Monmouth University, only 48 percent of participants said they felt federal health agencies were doing a good job dealing with the coronavirus outbreak in December 2021 — down from 65 percent who felt that way in March 2020.

Perhaps even more concerning is the frustration expressed by some in the health care community. A Medscape poll that surveyed nurses and doctors found that 77 percent had decreased trust in the CDC compared to when the pandemic started. Some participants attributed this lessened level of trust to the agency’s ability to recommend best practices without the influence of politics.

Still, many Americans try their best to follow CDC guidelines. Many U.S. employers use these guidelines when considering return-to-work policies. Schools use the guidelines to map out return-to-classroom policies — even if these policies are still hot topics of debate.

The CDC suggests monitoring transmissions and screening, but these nonspecific guidelines leave much to interpretation for actual implementation. With a virus that’s still spreading rapidly, everyone’s participation is required to quell its spread. Public health messaging and trust are just as important as public health guidelines.

Amanda LaMonica-Weier is a family nurse practitioner and instructor at Rush University and a Public Voices Fellow of The OpEd Project. The opinions expressed here are her own.