Politics, Policy & Law
CDC reversal on asymptomatic COVID-19 testing, guided by White House task force, prompts backlash
CDC’s flip on asymptomatic COVID-19 testing in exposed individuals has drawn rebuke from at least two state governors, and further jeopardizes public confidence in the agency’s independence.
According to HHS officials, the policies — developed at CDC with guidance from experts in the White House Coronavirus Task Force — did not stem from political pressure or constraints on testing capacity, but rather from concerns that negative results could give asymptomatic people a dangerous false sense of security.
Public health officials have expressed worries that the policies could stymie contact tracing by discouraging exposed individuals from seeking testing. They also run counter to the growing momentum to maximize asymptomatic screening capacity and accept less sensitive tests that can be administered more frequently (see “Asymptomatic Testing Pushes Forward”).
In an update to its guidelines published Monday, CDC said asymptomatic people who had been within six feet of someone with COVID-19 for at least 15 minutes “do not necessarily need a test,” unless they are a “vulnerable individual,” or are recommended to take a test by state or local public health officials.
Previously, CDC said individuals in this same scenario should be tested because of “the potential for asymptomatic and presymptomatic transmission of SARS-CoV-2;” that recommendation is still part of CDC’s guidelines on testing in non-healthcare workplaces, last updated July 22.
The new policy also says testing is not necessarily required for individuals in a high COVID-19 transmission area who have attended gatherings of more than 10 people without widespread mask wearing and distancing, unless that individual is vulnerable or has been recommended to take a test by local officials.
Asymptomatic individuals who have attended such gatherings or had close contact with a COVID-19 patient are advised to “strictly adhere to CDC mitigation protocols” including social distancing, mask wearing and hand washing. The guidelines say people who don’t have symptoms and have not been in contact with a known COVID-19 patient do not need a test.
In a press briefing Wednesday, HHS Assistant Secretary for Health Brett Giroir said the goal is “appropriate testing, not less testing,” with priority going to prospective surveillance studies instead of individuals seeking testing on a whim. He said the guidelines let local public health officials determine when asymptomatic testing is necessary, based on factors such as case prevalence in the community.
Giroir said variability in the lag time between when an individual is exposed and when they have detectable viral loads limits the value of post-exposure testing, making a negative result three days after exposure “not totally meaningless, but close.” He said the concern is that individuals with such false negative results will engage in risky behaviors like visiting older relatives or not wearing a mask.
Giroir said the guidelines were not meant to decrease the number of COVID-19 tests conducted, and are not expected to reduce the volume of tests. He said the U.S. is now “flush with testing” and that the turnaround time issue is “essentially solved,” with 91.3% of test results returned within three days.
He said the policy was “evidence-driven” and not directed by President Donald Trump, Vice President Mike Pence or HHS Secretary Alex Azar.
According to Giroir, it was reviewed by White House Coronavirus Task Force members including the task force’s Response Coordinator Deborah Birx, NIAID Director Anthony Fauci, FDA Commissioner Stephen Hahn and Scott Atlas, a senior fellow at Stanford University’s Hoover Institution. Atlas, who was added to the task force this month, has publicly advocated against broad COVID-19 testing.
California Gov. Gavin Newsom and New York Gov. Andrew Cuomo have both put out statements saying their states will not follow the new CDC guidelines.
In a joint statement Wednesday, the Infectious Diseases Society of America (IDSA) and the HIV Medicine Association (HIVMA) called for “the immediate reversal of the abrupt revision of the CDC COVID-19 testing guidelines which diminish the importance of testing asymptomatic individuals who were exposed to COVID-19.”