THE MASSACHUSETTS DEPARTMENT of Public Health has officially retired its five-day isolation requirement for people who test positive for COVID-19, one of the last remaining vestiges of community pandemic mitigation measures.

The time is right for Massachusetts to make this change. While this new guidance, which aligns with Centers for Disease Control and Prevention recommendations from March, represents a major policy shift, health authorities in California and Oregon had already taken this step some months ago, as had many European countries.

Every policy has both upsides and downsides, and isolation policy is no exception. At this stage, the scales are tilted far more to the harms of the policy than the benefits.

Under the new guidance, people who test positive for COVID-19 are free to return to school or work (unless they work in healthcare) if their symptoms are mild and improving and if they have not had a fever for 24 hours – aligning SARS-CoV-2 policy with that of other seasonal respiratory viruses, as we advocated nearly a year ago.

Some experts have correctly noted that people can continue to be contagious once fever resolves. Indeed, people with respiratory viruses like COVID-19 can be contagious if they never have fever, or any symptoms at all (although asymptomatic people appear to be much, much less likely to spread). The recommendation to isolate until resolution of fever is primarily about self-care, not about preventing the spread of infection.

The rationale behind the old five-day isolation policy was its potential to limit spread. Some have argued longer isolation might help keep kids in school, the theory being that if potentially infectious kids are kept out of classrooms longer, they will be less likely to infect other kids.

But that view neglects the reality of the current environment. COVID-19 spreads efficiently, even with a five-day isolation guideline in place, just as it did prior to January 2022, when the isolation period was 10 days.

Leaving the house always carries a risk of encountering someone who knowingly or unknowingly has COVID-19, either because they didn’t test, because the tests can now take up to four days to turn positive (due to widespread immunity reducing viral load in the nose), or because they tested and decided they were not willing or able to isolate.

Continuing to recommend longer isolation has other downstream consequences that must be weighed in crafting any evidence-informed public health policy. The previous isolation guidelines provided a disincentive to test by people who can’t afford to or don’t want to stay home for five days – and this includes parents who do not want to keep their healthy kids home from school.

Chronic absenteeism in US schools– and Massachusetts specifically– is a true public health crisis – and one which we don’t have adequate tools to address, leading to increasingly drastic measures and a statewide campaign. We already know the kids are far behind in their education. Eliminating isolation guidelines is not a magic solution to these entrenched problems, but it does send a necessary message that school is important and attendance needs to be a priority for kids who are feeling well enough to participate.

Public health shouldn’t always “meet people where they are” (campaigns to increase seatbelt use, for example, faced an uphill battle) but if they don’t, the juice should be worth the squeeze. Oregon hasn’t seen higher rates of COVID-19 than the rest of the country since making the change last spring. Neither have the UK, Denmark, Norway, or Singapore. Continuing to maintain restrictive policies when they are not supported by top scientists and thought leaders or high-quality data will further erode trust in our public health institutions, which is already stubbornly low.

Although immunity has changed the landscape of COVID-19 for most Americans, some remain at high risk of severe disease, even if vaccinated. While maintaining isolation requirements may seem tempting to protect these individuals, a “one-size-fits-all” approach may actually be harmful.

A new study published in the CDC’s MMWR journal demonstrates that uptake of potentially life-saving antiviral therapies among high-risk patients remains low, limiting the potential benefits of these important clinical tools. Although it did not make it into the article, when immunocompromised patients in this study were informed of their SARS-CoV-2 diagnosis, those who did not receive antivirals were often nevertheless counseled about isolation rather than treatment.

Fear of isolation causes some people to avoid testing even though they have risk factors that would make it advisable to receive antiviral treatment to prevent severe disease. The time is right to shift away from a hyperfocus on isolation and put our efforts into what really matters: getting effective treatment into the hands of those who need it.

As we have navigated our new world living with COVID-19, each major policy change (such as the end of travel restrictions, the full reopening of schools, and the removal of mask mandates) has been met with trepidation and political headwinds. But every time we have taken a step toward normalcy, we have adjusted to the change and realized that we are OK.

It’s time to take this next step—and focus our efforts on treatment rather than ineffective mitigation strategies. The DPH is right to move forward with a policy change that will help just about everyone.

Dr. Shira Doron is the chief infection control officer for Tufts Medicine and the hospital epidemiologist at Tufts Medical Center. She is a professor of medicine at Tufts University School of Medicine. Dr. Westyn Branch-Elliman is an associate professor of medicine at Harvard Medical School and an infectious diseases specialist. Both have served as unpaid advisers to the Massachusetts commissioner of education. Doron has served as an unpaid adviser to the governor.