The Ministerial Advisory Committee (MAC) on Covid-19 has advised that the isolation period for people who test positive for Covid-19 and are symptomatic be reduced from 10 to seven days. However, it notes that these individuals should continue wearing masks at all times from Days 8 to 10.
The committee also advised that asymptomatic people should no longer be expected to isolate.
Currently, people who test positive are required to isolate for 10 days from the onset of symptoms or from the date of testing positive.
In an advisory note sent to Health Minister Dr Joe Phaahla and officials in his department last week, the MAC discussed the isolation reduction suggestion.
The memo to the minister is dated 16 December – the same date the MAC delivered another advisory to the government to suggest that contact tracing be stopped as well as the quarantine requirement for people who have come into contact with someone who has tested positive.
In the advisory on isolation, the MAC said: “From a public health perspective, the utility of isolation is dependent on rapidly identifying individuals with Covid-19. Unfortunately, there is good evidence that the rate of case ascertainment in South Africa is low. Testing is heavily biased towards symptomatic cases, but only a small percentage of cases (perhaps 16%) are symptomatic. Furthermore, only a limited proportion of symptomatic cases access testing, and even when testing is performed, false negative results occur. Thus, only a small proportion of positive cases are identified.”
The committee also wrote that “the period of isolation for symptomatic patients should be reduced from 10 days to 7 days, but that all symptomatic cases be required to wear a mask, as mandated, at all times even at home from Day 8 to Day 10”.
It also suggested that “no period of isolation be required for asymptomatic patients”.
Other recommendations include the following:
- Where a symptomatic patient returns to work in a healthcare setting, an N95 mask should preferably be worn from Day 8 to Day 10, and contact with extremely high-risk individuals (such as severely immunocompromised patients) should be avoided;
- No Covid-19 test (either PCT or antigen-based) should be performed prior to a symptomatic patient returning to work after the 7-day isolation period; and
- The isolation rules should be applied equally to vaccinated and unvaccinated individuals, and to high- and low-risk individuals.
The recommendations further note: “For any symptomatic patient, return to work from Day 8 onwards must, as always, take into consideration the patient’s clinical status. Only those patients who are well enough to work should do so.”
In explaining the rationale for its advice, the MAC argues that isolation “should be seen as a trade-off between its (limited) benefits and its costs, rather than an effort to reduce the chances of onward transmission to zero for the small proportion of cases that are identified”.
It makes the case that isolating people who test positive for over a week “serves little overall public health purpose”.
“Asymptomatic cases should not isolate at all, as a positive test does not indicate when they were infected, and shedding of non-infectious virus fragments can be protracted. Individuals are most infectious close to the time of their symptom onset. Testing prior to return to work is not feasible, as tests may remain positive for much longer than the period in which the patient is infectious.”
The economic and social burden
In reaching its recommendations, the committee also noted the social and economic impact of the 10-day isolation period on individuals, businesses, the economy and learning.
It said isolation “significantly” depletes staffing levels at healthcare facilities and “other frontline or critical workers in and outside the healthcare sector”, threatening the integrity of these institutions.
In addition having people self-isolate reduces “economic and governmental activities due to high levels of staff absenteeism”, while individuals face the prospect of loss of income, unemployment, and loss of learning time.
Vaccinated vs unvaccinated
While it noted that the proposed isolation recommendations apply both to people who are vaccinated and those who are not, the committee said vaccinated individuals “typically have a shortened period of viral shedding following breakthrough infections compared to unvaccinated individuals; the difference appears to be 2-3 days shorter”.
“The infectivity, as measured by the proxy of a positive viral culture, may be lower in vaccinated vs unvaccinated individuals even at the same viral load,”
The committee said a technical working group was constituted to re-evaluate the effectiveness of self-isolation.
The group consisted of “experts from the MAC on Covid-19, the National Institute for Communicable Diseases, the National Institute of Occupational Health, and the fields of public health and infectious diseases”.