Californians infected with COVID-19 may go about their lives without isolating or testing negative as long as their symptoms are improving, according to new and significantly loosened guidelines from the California Department of Public Health.

California's top public health official, Dr. Tomás Aragón, last week quietly rescinded the state's previous order, which encouraged people infected with COVID-19 to isolate for five days.

The new health order allows Californians with COVID-19 to return to work or school as long as their symptoms are improving and they are fever-free for 24 hours without medication. Asymptomatic individuals who test positive are not considered infectious and do not need to isolate, according to the order.

"Instead of staying home for a minimum of five days, individuals may return to work or school when they start to feel better," state public health officials said in an unsigned statement.

The guidelines came down as California tipped over the edge of a major respiratory illness surge fueled by COVID-19, seasonal influenza and respiratory syncytial virus, also known as RSV. Flu and COVID-19 hospitalizations both peaked during the first week of January and have been trending downward since, according to state data.

Masking requirements have not changed, and people with COVID-19 should wear masks for 10 days whether or not they have symptoms. The new guidelines do not apply to employees at high-risk health care settings like hospitals and nursing homes, which may also have different policies for visitors.

It is unclear whether employers can require workers to return to work if they wish to isolate until they test negative. Cal/OSHA, the agency that enforces state workplace safety laws, did not respond to a request for clarification on the rule by deadline.

Some experts say the new guidelines represent a major shift in California's COVID-19 strategy, but they are not necessarily an unexpected change.

"I think it's reasonable, mainly for the amount of population immunity that we have including in kids, and for the fact that we have a menu of options to prevent and treat COVID," said Dr. Peter Chin-Hong, an infectious disease expert with UCSF Health. "It does come with responsibility...we still have to wear masks and be cautious around people who are older or immunocompromised."

A national study from the Centers for Disease Control and Prevention in June estimated about 96% of people 16 and older had acquired COVID-19 immunity either through vaccination, previous infection or both. State data shows that while relatively few Californians are fully vaccinated with updated boosters — only about 12% — at least 82.5% of the population has gotten at least one COVID-19 shot.

The state's move also signals a shift toward treating COVID-19 like all other endemic respiratory infections.

"Many people may be infected with COVID-19 or other respiratory infections and do not test or know what infection they may have. Updating our public health approach and recommendations incorporates our recommendations into a broader, multi-pronged approach to multiple respiratory viruses," department officials said in a statement.

Dr. Noha Aboelata, chief executive of Roots Community Health Center in Oakland, is one of many community doctors who have expressed disappointment in the state's new direction. COVID-19 does not necessarily behave like other respiratory viruses — hospitalizations and deaths have never dropped to zero the way flu does outside of the winter months — and it is still unpredictable, Aboelata said.

"We still believe that if there's enough to detect (on a test), there's enough to infect," Aboelata said. "So I would recommend people test negative before going around others."

California schools adjust to new COVID-19 rules

The state's new strategy also seeks to minimize disruptions in school where long periods of quarantine and virtual instruction adversely impacted student learning and led to widespread mental health challenges for young people.

Some California school districts adopted the new guidelines immediately, while others said they were waiting for direction from their local public health agencies.

Oakland Unified was among those that notified parents of its new policy not long after the state released the guidelines. In an email to families, the district said students and staff can come to school if they test positive for COVID-19, as long as they're asymptomatic, wear masks and avoid people who are at high risk of sickness, such as those who are immunocompromised.

In line with the state guidelines, those with COVID-19 symptoms should stay home but can return to school once the symptoms improve. The district said it will continue to stock masks and COVID-19 tests and keep air purifiers in classrooms.

Los Angeles Unified, the largest school district in the state, said it was waiting for direction from the county public health agency. In a note to families, Fresno Unified recommended that students and staff who test positive for COVID-19 stay home, regardless of their symptoms.

The mixed response mirrored schools' earlier reactions to COVID-19 in 2020. While most districts closed in March that year, some started bringing back special education students as soon as late spring while others — mainly larger districts — didn't reopen for in-person instruction until fall 2021.

Teachers and parents on board with COVID rules

For many districts, re-opening decisions hinged on negotiations with teacher unions. This week, California's largest teacher union was generally supportive of the state's update to COVID-19 guidelines, saying that schools have adopted enough safety measures to keep staff, students and families safe.

"We're always concerned about individuals who are high-risk, and we'll continue monitoring the situation and re-open (contracts) if necessary," said Rachel Warino, a spokesman for the California Teachers Association. "But we're confident that negotiations that happened at the height of the pandemic — over air filtration, testing, masks, reasonable accommodations — will be sufficient for now."

Some parents were relieved at the new guidelines because they encourage students to be in school. Thousands of students statewide are still struggling to catch up academically after remote learning, and many suffered mental health challenges during quarantine.

Scott Davison, who's part of a parent group in Carlsbad Unified near San Diego, said parents have been sending asymptomatic students to school for a year or more, regardless of state or local guidelines.

"This changes nothing for most parents," Davison said. "We could have had these guidelines two years ago and the result would be the same. ... we all know kids belong in school."

Concern for vulnerable Californians

Disability and equity advocates are particularly critical of the new guidelines. They contend the change could increase risk of infection for vulnerable Californians.

"This policy is not based in science, equity or public health. It devalues the lives of immunocompromised and disabled people, and completely ignores the risk of long COVID," said Lisa McCorkell, co-founder of the Patient-Led Research Collaborative, which studies the impacts of long COVID.

There is no treatment for long COVID, which can leave some patients debilitated for years, and increased transmission will disproportionately harm poor communities, McCorkell said.

California officials have made other significant changes to the state's COVID-19 response strategy in recent months, including returning the majority of the state's Paxlovid stockpile to the federal government in December, effectively ending California's free antiviral program.

The free COVID-19 hotline where residents could get Paxlovid prescriptions and vaccine appointments will also shut down at the end of February, state public health officials told CalMatters in a statement. The state has spent $2.3 million on the hotline since July 2022.

These changes, too, are worrisome for equity advocates.

"Not everybody has a primary care doctor. If you don't have a primary care provider or good access to a primary care provider that's knowledgeable about treating, then you're going to have a difficult time accessing it," Aboelata said.

State-regulated health insurance plans are required to permanently cover in-network COVID-19 testing, vaccination and treatment free of charge, although about 6 million Californians are enrolled in federally regulated plans that are only required to cover vaccines. You can ask your employer what kind of coverage you have.

Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.