CDC clarifies surprise guidelines that people without COVID-19 symptoms don't need testing
The Centers for Disease Control and Prevention attempted Thursday to clarify controversial coronavirus testing guidelines published Monday that said people with no symptoms "do not necessarily need a test" even if they were exposed to an infected person.
The medical community criticized the agency's looser guidelines, which some scientists said had been made for political rather than scientific reasons. President Donald Trump has claimed that the USA's large number of coronavirus cases is the result of widespread testing, though that hasn't been supported by the number of deaths and hospitalizations.
Public health officials said testing people who might have been exposed to COVID-19, whether or not they show symptoms, is crucial to knowing how many people in the USA are infected. It makes it possible to do effective contact tracing and quarantining to stop the spread of the virus.
Before Monday, the CDC website said testing was recommended “for all close contacts of persons with SARS-CoV-2 infection,” the virus that causes COVID-19.
Monday, that was changed to say that someone who was in close contact (within 6 feet) of a person with COVID-19 for at least 15 minutes but didn't have symptoms does not “necessarily need a test.”
Guidance released Thursday by CDC Director Robert Redfield says those who come in contact with a confirmed or probable COVID-19 patient can be tested, even if they don’t show symptoms.
Why test people without symptoms?
Testing people who have potentially been exposed to COVID-19 helps the public health effort to stop the spread of the virus, said Dr. Tom Frieden, president and CEO of Resolve to Save Lives, an initiative of Vital Strategies.
“How important is testing of contacts? Important – that way you can find, trace and stop chains of transmission,” he said.
"There are still things we’re learning about which contacts to test, when and how best to use that information, but it’s clear that if we don’t test asymptomatic contacts, we will miss chains of transmission and weaken our ability to stop the virus,” he said.
Without access to testing, contact tracing becomes very difficult because people are told to quarantine for 14 days without an opportunity to learn whether they're infected, said Dr. William Schaffner, a professor in the division of preventive medicine and infectious disease at Vanderbilt University in Nashville, Tennessee.
Monday's revision meant “people were scratching their heads and a little taken aback," Schaffner said. "We were looking to expand testing, particularly among asymptomatic people."
Health and Human Services Assistant Secretary Dr. Brett Giroir said during a news conference Wednesday that the change was meant to encourage more "appropriate testing, not less testing."
The guidance released Monday said exceptions could be made for vulnerable individuals or those who were recommended to take a test by a health care provider or public health official.
Americans 'losing confidence in the US public health response'
The CDC has faced tremendous pressure and second-guessing for its coronavirus response. In part, that's because the agency sent faulty tests to labs in the early days of the pandemic. Later, it revised its guidelines on reopening schools after Trump criticized them.
CNN reported Wednesday the change in testing criteria was due to pressure from the upper ranks of the Trump administration.
Giroir said Wednesday the looser guidelines had been reviewed by the Coronavirus Task Force, including Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. Fauci told CNN he was under general anesthesia for surgery when the matter was discussed last week.
The USA leads the world in the number of reported COVID-19 cases, according to Johns Hopkins University. As of Thursday, the country had about 24% of the world's reported cases and about 22% of COVID-19 deaths, but it has about 4% of the world population.
At a rally in Tulsa, Oklahoma, in June, Trump told the crowd the USA had conducted 25 million tests. “When you do testing to that extent, you’re going to find more people, you’re going to find more cases, so I said to my people, ‘Slow the testing down, please.’”
The next day, White House trade adviser Peter Navarro said Trump's comment was "tongue in cheek."
This week's back-and-forth further undermines public faith in government health institutions when it's most needed, said Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine.
Monday's “guidelines made no sense, as they were not supported by the science," he said. "While it’s good CDC is walking it back, this misstep comes at a price. The American people are losing confidence in the U.S. public health response to COVID-19.”
People who are just worried don't need tests
Redfield's statement Thursday said, "Everyone who needs a COVID-19 test, can get a test.”
But, he said, “everyone who wants a test does not necessarily need a test; the key is to engage the needed public health community in the decision with the appropriate follow-up action.”
Public health doctors agreed with that statement, given that COVID-19 tests in the USA are in short supply in some areas. Backlogs this summer meant some people had to wait a week to get results, though the largest commercial labs say they average two days.
It makes sense to discourage people who are simply among the “worried well” from getting tested, Schaffner said. “Just having Suzy or Frank walk in off the street, we can discourage that,” he said.
William Hanage, an epidemiologist at the Harvard T.H. Chan School of Public Health, said testing may not be necessary if someone has no symptoms, has not had contact with an infected person and if the community prevalence is low.
But for someone who may have been exposed, it's crucial to test, Hanage said, because so many people have no symptoms and pass the virus to others.
"We have been trying really hard to help people understand that anybody can be infected. You don’t have to have obvious symptoms," he said.
Hanage said he is concerned about the shifts in public messaging, which are "creating a massive amount of confusion that shouldn't be there."
Contributing: Karen Weintraub
Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.
