Second update 8/26/2020 3:00 PM: In a news conference Wednesday afternoon, Admiral Brett Giroir — deputy secretary of health in the Department of Health and Human Services and leader of the diagnostic tests for COVID-19 — strongly defended the changes to the CDC’s testing recommendation, saying it came from the public health experts from the CDC and was evidence-based. There was “no direction” from the president, vice president or other top Trump administration officials, he said.
As for the changes themselves, Admiral Giroir said the decision not to recommend testing for those exposed to COVID-19 without symptoms was intended to avoid testing too early after an exposure. This can give a negative result before an infection has had enough time to develop and register as positive on a test, giving an exposed person a false assurance that they are not infected.
It’s still unclear why the CDC has not instead provided a recommended time frame for asymptomatic testing after an exposure, especially given that some infected people may never develop symptoms. A positive test result is necessary to ensure that COVID-19 patients receive appropriate care, isolation instructions and appropriate follow-up. Identifying patients through testing is also critical for contact tracing. After a person tests positive, contact tracers can inform people who may have been exposed to the COVID-19 positive person before testing positive and/or quarantining.
First update 8/26/2020 1:15 PM: An unnamed Centers for Disease Control and Prevention official told CNN that the change in the agency’s testing recommendations came under pressure from the higher ranks of the Trump administration. “It comes from the top down,” the official said.
Original story: In a mind-boggling and dangerous move, the Centers for Disease Control and Prevention this week quietly reversed their recommendation on COVID-19 testing for those exposed to the virus. Now the CDC says exposed but asymptomatic people do not need to be tested.
The change alarmed and outraged public health and infectious disease experts. It is well known that SARS-CoV-2 — the pandemic coronavirus that causes the disease COVID-19 — can cause completely asymptomatic infections in some and spread through other infected people before developing symptoms (so-called “presymptomatic transmission”). Some pilot studies have even suggested that presymptomatic transmission may account for nearly half or even more of the spread of SARS-CoV-2.
That information previously urged the CDC to: to advise testing for anyone known to have been in close contact—or even suspected—to have come into contact with an infected person (that is, to be within six feet within 15 minutes or more).
“Testing is recommended for all close contacts of individuals with SARS-CoV-2 infection,” the agency said on its website on Aug. 22. “Due to the potential for asymptomatic and presymptomatic transmission, it is important that contacts of individuals with SARS-CoV-2 infection be identified and tested promptly.”
But that evidence-based recommendation has disappeared. Instead, the agency now says exposed or potentially exposed people “don’t necessarily need a test unless you are a vulnerable person or your health care provider or state or local public health officials recommend that you get one.”
When Ars contacted the CDC to ask why the recommendation had been changed and what evidence supported the new recommendation, the agency told Ars to ask questions to the Department of Health and Human Services. It noted that HHS plans to hold a press conference about testing today at 2 p.m. ET. We will update this post with all relevant information from that conference.
As the nation’s leading public health agency and one that planned to independently issue critical health recommendations for Americans, the CDC’s postponement to HHS raises even more questions about the change in testing recommendations. Amid the pandemic, the Trump administration has repeatedly undermined and sidelined the CDC, eroding trust in the agency and reducing guidelines for staying safe amid this historic global health crisis.
In other news related to CDC’s guidelines, the agency also issued new recommendations this week for customer-facing employees of retail and service companies, such as restaurants and gas stations. The CDC warns these employees of the risk of violence from people who refuse to follow recommended or required health measures.
“Employees can be threatened and attacked if companies try to implement COVID-19 prevention policies and practices (for example, mandatory mask use, social distancing and limits on the number of customers allowed in a company),” the CDC says. The agency advises employees not to argue with people who make threats or appear violent. Instead, employees should report impending incidents to a manager or supervisor and seek a safe environment if necessary.