Category: US

More than 2½ years into the pandemic, and with a highly contagious version of the virus circulating, the CDC guidelines for what to do when falling ill — and when to return to public life — continue to stoke as much confusion as clarity. That’s a reflection of the changing nature of the virus, the inherent unpredictability of an infection, and the demands and expectations of work and home life.

With new research showing that people are often infectious for more than five days, the CDC guidance has drawn criticism from some infectious-disease experts. The Biden protocol strikes many of them as the right way to go — because it’s empirical evidence that a person isn’t shedding virus.

The CDC does not explicitly recommend a negative test to patients who want to resume activities. It describes such a test, which offers a direct if imperfect measure of contagiousness, as optional. The guidance states that a patient should isolate for at least five days. (Day 1 is the day after your symptoms manifest or your test was collected.) Patients who end isolation should continue to wear a well-fitting mask around others at home or in public through Day 10.

“Given that a substantial portion of people do have a rapid positive test after 5 days, I think an updated recommendation should include people having a negative rapid test before coming out of isolation for COVID,” said Tom Inglesby, director of the Johns Hopkins Center for Health Security, who was the Biden administration’s senior adviser on testing from December until April.

Rapid tests are widely available, and “there is new science and practical experience with this virus since December when isolation guidance was issued,” Inglesby said in an email.

People who are being required to go back to their workplaces after five days of being sick with covid even if they still have a positive test result “shouldn’t do that,” Inglesby said. “It’s exposing others in the work environment to the risk of COVID spread. CDC guidance on that would be valuable.”

Biden has used his brief about the coronavirus as a sign that the administration is on top of the pandemic and has made the right moves by relying on vaccinations, testing and new antiviral drugs to lower the death rate. But across the country, hundreds of thousands of people a day are getting infected with the omicron subvariant BA.5 — the exact number is impossible to know — and they have a common, urgent need to know when they are no longer contagious.

The CDC’s guidance has been under internal review in recent months. A revamped set of recommendations is expected to be rolled out in coming weeks, according to three administration officials and advisers who spoke on the condition of anonymity to describe sensitive internal discussions. A draft of the updated guidance at the moment does not include a requirement to test negative before exiting isolation, they said.

The existing CDC guidance says patients can end isolation five days after their first day of symptoms, so long as their symptoms have improved and they have been fever-free for at least 24 hours without fever-reducing medication. The CDC encourages people who become very sick or have weakened immune systems to isolate for 10 days.

That leaves a negative test result as optional.

Robert Wachter, chair of medicine at the University of California at San Francisco, said people can easily misconstrue the CDC five-day guidance as a personal assurance of no longer being contagious.

“Unfortunately, people hear the ‘five days’ and think, ‘Oh, it must be that I’m not infectious,’ ” Wachter said. “That’s just wrong.”

A recent study in the New England Journal of Medicine looked at how long people could shed viruses that could be cultured in a laboratory — the best test of infectiousness. The result: People shed such virus for eight days, on average, before testing negative.

The CDC guidance “doesn’t make sense,” said Andrew Noymer, an epidemiologist at the University of California at Irvine. “They’re telling people to go back to work while they’re still contagious, essentially.”

Wachter suggests that people test negative before heading out in public.

“The antigen test turns out to be an awfully good ‘are you infectious’ test,” Wachter said. “If they’re still testing positive on Day 6, 7 or 8, I don’t want them hugging me in a room without a mask on.”

Officials familiar with the crafting of covid policy say the administration has to take into account human behavior — what people can, and will, do in their daily lives to limit virus transmission.

The administration’s decision not to push strongly for a negative test before ending isolation reflects an awareness that not everyone has access to tests or can extend time away from work, school, caregiving or other duties.

When CDC Director Rochelle Walensky was asked recently why the agency doesn’t recommend that all Americans use successive negative tests to exit isolation, as Biden did, she said the president was in a special category.

The president received multiple rapid tests because he was being monitored for a Paxlovid “rebound” infection, which can occur days after initially testing negative. Biden tested negative Thursday and Friday mornings before a positive result Saturday morning indicated the rebound, sending him back into isolation, White House physician Kevin C. O’Connor said in a letter. “Unsurprisingly,” Biden tested positive again Sunday, O’Connor said.

Walensky said during a Washington Post Live interview that “I think we can all agree that the president’s protocols likely go above and beyond and have the resources to go above and beyond what every American is able and has the capacity to do.”

“As we put forward our CDC guidance, we have to do so, so that they are relevant, feasible, followable by Americans,” she said, noting that some communities have fewer resources and greater work constraints.

She also noted that the guidance gives people the option to get a rapid test before ending isolation.

The five-day isolation period reflects an approximation of when people are most likely to be infectious. But these are averages, covering broad populations.

A positive result from a rapid antigen test, often called an at-home test, is the best indicator of how much virus is present and how likely you are to infect someone, said Michael Mina, a former Harvard University infectious-disease epidemiologist and immunologist who is an expert on rapid tests. Rapid antigen tests look for specific viral proteins to detect infection. Mina is chief science officer at a telehealth company that uses rapid testing, including for covid, to link patients to care.

“If you still have enough virus to see it on a rapid test, you know that you’re still infectious,” Mina said.

The California Department of Public Health, for example, requires a negative test on the fifth day after first testing positive, or later, to leave isolation.

Policymakers could help patients by releasing “clearer guidelines on using antigen tests” to leave isolation, like in Biden’s case, said Amy Barczak, an infectious-disease expert at Massachusetts General Hospital. Her research on her suggests that one-quarter of people infected with an omicron variant could still be infectious after eight days.

The CDC guidance dates to the wave of illness caused by the omicron variant that began in December and sickened tens of millions of people in a matter of weeks, causing daily cancellation of thousands of commercial airline flights and leading to staff shortages in all sectors of the economy. Under immense pressure to keep essential services from being hobbled, and amid signs that omicron was less likely to cause severe disease in a largely vaccinated population, the CDC shortened its recommended isolation period from 10 days to five.

Rapid tests were in short supply at that point, but then the federal government expanded its acquisition of tests, with millions now available. Since this spring, Americans have been able to go to a government website, covid.gov, order free rapid antigen tests and have them shipped to their homes. At drugstores and at online retailers, a package of two tests generally costs about $25, depending on the location. Private insurance is supposed to cover purchases of at-home tests.

Some elements of the CDC guidance may prove confusing.

The CDC says that people who choose to take a coronavirus test after Day 5 and get a positive result should extend their isolation to 10 days. But the agency does not directly recommend taking a test after Day 5. The guidance as written says, in effect, you can take a test after five days but be prepared to handle the result. People for whom isolation is a hardship may see no incentive to learn whether they are still shedding viruses.

Experts say the CDC should recommend what’s best for public health.

“That’s kind of the feeling they’re giving off right now: … ‘It’s an okay idea, but we don’t want to actually recommend it,’ ” Mina said. “It should be the other way around.”

The expected release by the CDC of revamped covid guidance in coming weeks is prompted by a desire to provide clarity, according to administration officials and others familiar with the discussions, who spoke on the condition of anonymity because the guidance is not final.

“We just know that people are hungry for guidance at this time,” one CDC adviser said.

The new guidelines are intended to help consumers determine covid risk by evaluating several factors, including whether they will be around people with frail immune systems or other underlying conditions, whether they will be outdoors or indoors, and the quality of the ventilation.

CDC has more than 600 websites related to its covid response, each with different messages on testing, ventilation and masking in different settings, the adviser said. The agency wants to share “important messages that everyone needs to hear in all settings across the country … and then make sure that all of the other guidance underneath it reflects those key messages.”

In the meantime, people testing positive at home past Day 5 are trying to figure out whether it’s safe to go back to work or resume other activities.

How quickly a rapid test turns positive can help guide behavior, Mina said.

“If you have a really dark line that shows up in five seconds before the control line even shows up… you probably really want to stay in isolation,” Mina said. “If you start to see the line in 10 seconds, and it gets really, really dark, you are teeming with viruses.”

If there is a weaker or fainter line, “it’s likely that you have less virus there, but you still do have virus. And there’s no way to define the cutoff at which you’re likely to transmit to other people,” Barczak said.

Reffitt was convicted March 8 of five felony offenses, including obstruction of Congress as it met to certify the 2020 election result, interfering with police and carrying a firearm to a riot, and threatening his teenage son, who turned him in to the FBI.

The defense for Reffitt, a 49-year-old former oil industry rig manager, asked for a below-guidelines sentence of two years in prison. Attorney F. Clinton Broden said in a filing that his client committed no violence and has no criminal history, yet prosecutors are seeking far more time for him than for defendants who have pleaded guilty to assault police.

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“It makes a mockery of the criminal justice system, the Sixth Amendment right to trial, and the victims assaulted by [others] to argue that Mr. Reffitt should be given a sentence greater than (let alone three times greater than) a defendant who assaulted police officers on at least two separate occasions, spent three hours on the Capitol grounds and who has a past history of violence, Broden wrote.

But Assistant US Attorneys Jeffrey Nestler and Risa Berkower said Reffitt’s case is exceptional.

Reffitt “played a central role” at the head of a vigilante mob that challenged and overran police at a key choke point, a stairway leading up from the Lower West Terrace, before the initial breach of windows near the Capitol’s Senate Wing Doors at 2: 1 p.m., prosecutors said. After the riot, Reffitt warned his son and 16-year-old daughter that “if you turn me in, you’re a traitor, and traitors get shot,” his son testified at the trial.

Conventional sentencing rules are of “inadequate scope” to account for the range of Reffitt’s obstruction, witness tampering and weapon offenses, prosecutors wrote in a 58-page sentencing memo.

“Reffitt sought not just to stop Congress, but also to physically attack, remove, and replace the legislators who were serving in Congress,” prosecutors wrote.

They called his conduct “a quintessential example of an attempt to both influence and retaliate against government conduct through intimidation or coercion” and said it reflected the statutory definition of terrorist violence that is subject to harsher punishment.

A jury found that Reffitt traveled to DC from his home in Wylie, Tex., with an AR-style rifle and semiautomatic .40-caliber handgun and repeatedly stated his intention to come armed with a handgun and plastic handcuffs to drag lawmakers out of the building. After returning home from Washington, he threatened his children to ensure they did not turn him in to authorities.

The request by the US attorney’s office in DC, which is overseeing prosecutions of roughly 840 Capitol siege defendants federally charged so far, is not binding on US District Judge Dabney L. Friedrich, who has gone below prosecutors’ recommendation in 22 of 24 Jan. 6 sentencings to date.

The longest sentence in a Jan. 6 case so far is 63 months, given to a Florida man who pleaded guilty to attacking police with a fire extinguisher and wooden plank and a DC man who assaulted three officers and shattered a riot shield with a pole.

By comparison, Friedrich has sentenced only three defendants who have pleaded guilty to felonies so far, the longest to 27 months in prison, also for attacking police.

Nevertheless, prosecutors may be hoping to send a clear signal to the roughly 330 defendants still awaiting trial on felony charges and who may still be considering whether to accept a plea deal or gamble before a jury. About 70 people have pleaded guilty, and nine, including Reffitt, have been convicted at trial.

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Reffitt left home at 15, moved in with his older sister and began working as a KFC dishwasher after enduring years of physical abuse from his father, Broden wrote. After becoming a father himself, Broden said, Reffitt was devoted to his children by him and to creating safe spaces for others. Reffitt, his attorney deél said, was a self-made man who took his family abroad while he worked in places including Malaysia in charge of operations worth tens of millions of dollars, but was financially and emotionally devastated after a downturn in the oil and gas industry. He lost his job in November 2019, only a few months before the pandemic swept the United States.

Reffitt’s daughters noticed that “his mental health was declining” over that period, Broden wrote. Reffitt fell “down the rabbit hole of political news and online banter,” he wrote one of his daughters, and he fell under the sway of Donald Trump “constantly feeding polarizing racial thought.”

“I could really see how my father[’]s ego and personality fell to his knees when President Trump spoke, you could tell he listened to Trump’s words as if he was really truly speaking to him,” one of Reffitt’s daughters said.

Letters from nine friends and relatives provided to the court by Reffitt’s defense “describe a depressed man who believed he was unable to adequately provide for his family (his life’s mission), and a man who felt cast aside and marginalized,” Broden wrote.

Reffitt started a security business and joined the Three Percenters in Texas. The right-wing anti-government group is named after the myth that only 3 percent of colonists fought in the American Revolution against the British.

In a letter to the judge, Reffitt outlined a string of family traumas since 2020 including medical and mental health emergencies and pleaded for leniency for the sake of his family.

“My regrets for what has happened is insurmountable. There’s not a day go by that I don’t regret how much this has affected [my wife and children],” Reffitt wrote. “Yes, what is happening to my family is all my fault, I would like to fix it, please. … I simply ask for a chance to prove myself again.”

Ramos’s defection was among the highlights of the People Power movement that overthrew the Marcos regime, which was known for widespread human rights violations and plundering up to $10 billion from government coffers.

He went on to serve as army chief and defense secretary of the post-revolution administration under democracy icon Corazon Aquino. He later succeeded her as the 12th president of the republic, from 1992 to 1998.

Ramos leaves behind a mixed legacy. To his supporters of him, he is a hero of the revolution who went on to urge the Marcos family to publicly apologize for their misdeeds. As president, he was credited with helping modernize the economy and forging a peace agreement with rebel forces in the southern Philippines.

To his detractors, he has yet to be held liable for police and military abuses under his watch — and his actions were not enough to prevent an eventual Marcos comeback.

Born on March 18, 1928, Ramos was a career military official before he got into politics. I have graduated from the US Military Academy at West Point and served in both the Korean and Vietnam wars.

When Marcos declared martial law in 1972, Ramos led the Philippine Constabulary. In a 2017 interview with Maria Ressa, co-founder of the news site Rappler and a 2021 Nobel Peace Prize laureate, Ramos explained why he turned against Marcos — despite a long history that involved the future dictator hiding in his family’s sanctuary during World War II .

“You must understand that even with that close relationship and association during the war… why did I go against this guy?” he said. “It’s because of what is in the constitution. … You obey the orders of your superior, your commanding officer, if they are legal orders. But when he started to stray during the martial law years… that went against my values.”

During his term, Ramos brokered a peace agreement with the Moro National Liberation Front, then a separatist group operating in the Muslim majority south.

In 2016, Ramos threw his support behind populist candidate Rodrigo Duterte, the tough-talking strongman who would later be known for a brutal anti-drug campaign that left thousands dead.

But within the same year, the former president said Duterte’s government was “a huge disappointment and let-down,” criticizing Duterte’s constant cursing and hostility toward the United States in foreign policy in a column for the broadsheet Manila Bulletin. I have resigned as Duterte’s appointed special envoy to China that same year.

Duterte also allowed the controversial state burial of Marcos in the Cemetery of Heroes. Ramos opposed the decision, which sparked thousands to take to the streets in protest. When Ramos was president, he allowed the family to bury the late dictator in their home region of Ilocos when they returned from exile in the United States. Some Marcos critics believe Ramos should not have allowed them to return.

In this year’s national elections, the party that Ramos founded endorsed the dictator’s son, Ferdinand Marcos Jr., who won in a landslide. However, officials from Ramos’s cabinet publicly endorsed opposition candidate Maria Leonor Robredo. Ramos himself, who had been out of the public eye because of the pandemic, did not make a public endorsement.

Despite the criticism, Ramos has generally aged as a respected figure in Philippine politics. His contemporary of him Juan Ponce Enrile, a former Marcos defense minister who defected alongside him, faced corruption scandals and has since walked back criticism of the dictator. He has since returned to the fold of power, and serves as legal counsel to Marcos Jr. at 98. Ramos’s successor to the presidency, Joseph Estrada, was later ousted in a second People Power revolution amid corruption issues.

In a forum covering Ramos’s legacy last year, political columnist and veteran journalist John Nery said the former president “passed the test of time.”

“It should be clear now that, in the end, and to the end, I have retained an abiding loyalty to the primacy of the constitution. … whatever the constitution was,” Nery said. I have added that Ramos’s loyalty to him to the law explained his defection to him.

“There is no gainsaying his constitutional sense, and his fidelity to it. When I think of the possibilities open to him, during the era of the coup attempts, to choose the other side — which would have completely changed the country’s history — I appreciate all the more that he knew his limits of him. ”