Shifting CDC testing guidance sparks backlash

Public health experts warn that the Trump administration’s change to testing guidance is a step backward in the COVID-19 response that could lead to more cases, outbreaks and deaths.

The Centers for Disease Control and Prevention (CDC) altered its guidance this week to say people who have been exposed to COVID-19 “don’t necessarily need a test” if they don’t have symptoms, threatening contact tracing efforts which seek to stop lines of transmission. 

The change alarmed public health officials and experts, who note that about 40 percent of people with COVID-19 are asymptomatic, meaning they will never show symptoms of the virus and won’t know they have it without testing, but can spread it to others who may become seriously ill or die. 

Anthony Fauci, the nation’s top infectious disease expert and member of the White House coronavirus task force, said Wednesday he was undergoing surgery during the task force meeting when updated CDC COVID-19 testing guidelines were discussed, prompting backlash as well.

“I was under general anesthesia in the operating room and was not part of any discussion or deliberation regarding the new testing recommendations,” Fauci, director of the National Institute of Allergy and Infectious Diseases, told CNN Chief Medical Correspondent Sanjay Gupta. 

Fauci said he is “concerned about the interpretation of these recommendations” and is “worried it will give people the incorrect assumption that asymptomatic spread is not of great concern.”

“In fact it is,” he added. 

While CDC Director Robert Redfield attempted to clarify the changes Thursday by saying people who had been in close contact with confirmed COVID-19 cases “may be considered” for testing, the changed guidance remains on the agency’s website. A spokesperson for the Department of Health and Human Services (HHS) — the CDC’s parent agency — doubled down on the changes and Redfield’s Thursday statement, saying “It amplifies the policy. It in no way changes the policy,” he said. 

The new guidance was widely criticized by public health experts and doctors as dangerous and not supported by science. 

“Months into this pandemic, we know COVID-19 is spread by asymptomatic people,” American Medical Association President Susan Bailey said in a statement Thursday. “Suggesting that people without symptoms, who have known exposure to COVID-positive individuals, do not need testing is a recipe for community spread and more spikes in coronavirus.” 

A key part of the pandemic response and contact tracing is testing the close contacts of people who have COVID-19. That becomes much more difficult if people who don’t show symptoms aren’t being prioritized for tests, experts say. 

“It’s certainly the case that when test capacity is severely limited, you need to prioritize but one of the things that we prioritize is testing of contacts,” said Tom Frieden, CDC director under former President Obama. 

“You can make a pretty good argument that it’s more important to test an asymptomatic contact than it is a symptomatic contact,” adding that someone with signs of illness can be presumed to have COVID-19, while it is less clear for people who appear healthy.

Redfield’s comments Thursday that people without symptoms who have had close contact with a confirmed COVID-19 case “may be considered” for testing is notably weaker than the agency’s previous guidance: “Because of the potential for asymptomatic and pre-symptomatic transmission, it is important that contacts of individuals with SARS-CoV-2 infection be quickly identified and tested.” That language was removed from the agency’s website. 

People who aren’t showing symptoms of COVID-19 can spread it to others. The World Health Organization (WHO) warned last week that young people are becoming the primary spreaders of COVID-19, particularly because they are most likely to experience mild symptoms or none at all. But the CDC did not address this fact in its most recent guidance or provide scientific evidence or data backing up its decision, frustrating experts.

Redfield’s comments Thursday “didn’t deal at all with the fact that we know spread in the community is happening through people who are asymptomatic,” said Cynthia Sears, former president of the Infectious Diseases Society of America, which wants the change reversed. “The impact is that some of those individuals will likely be infected and they will spread the infection and that will lead to at least localized outbreaks, and that again puts a strain on all our health care systems and causes unnecessary deaths.” 

“We are placing an emphasis on testing individuals with symptomatic illness, individuals with significant exposure, vulnerable populations including nursing homes or long term care facilities, critical infrastructure workers, healthcare workers and first responders, or those individuals who may be asymptomatic when prioritized by medical and public health officials,” Redfield wrote Thursday. 

Experts are also frustrated that neither Redfield nor other Trump officials have clearly explained why they made the change, except to suggest that some people are getting tests unnecessarily. 

“Everyone who needs a COVID-19 test can get a test. Everyone who wants a test does not necessarily need a test,” Redfield said Thursday. 

Frieden said the changes are not “scientifically justifiable.” The president of the American Medical Association said the CDC should “release the scientific justification” for the change in testing guidelines. 

“When the Centers for Disease Control and Prevention (CDC) updates a guidance the agency should provide a rationale for the change,” Bailey said.

The changes have once again prompted fears from experts and some members of Congress that the CDC is being undermined by the president and his political appointees. 

President Trump has repeatedly downplayed the importance of testing in controlling the pandemic, remarking that more testing means more cases. 

“I don’t think there’s ever been a time before when people from the White House or HHS are dictating what goes on technical documents on the CDC website,” Frieden said. “This is dangerous. This is a big problem.”