- The CDC makes confusing guideline changes
- Explanations for the changes
- Health experts confused by the change in guidelines
- Authorities on change in guidelines
The CDC makes confusing guideline changes
In late August, the federal Centers for Disease Control and Prevention(CDC) changed its health guidelines regarding testing for the coronavirus to say that some people without symptoms may not need to be tested, even if they had been in close contact with someone who has contracted the disease. The previous guidelines had recommended all those who had come into recent or suspected exposure to the virus even if they were asymptomatic to get tested.
Specifically it said, “Testing is recommended for all close contacts of persons with SARS-CoV-2 infection. 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.” It now says, “If you have been in close contact(within 6 feet) of a person with COVID-19 infection for at least 15 minutes but do not have symptoms, you do not necessarily need a test unless you are a vulnerable individual or your health care provider or State or local public health officials recommend you take one.”
On the CDC website, it says, “Not everyone needs to be tested” and that “If you do get tested, you should self-quarantine/isolate at home pending test results and follow the advice of your health care provider or a public health professional.” The guidelines also advise that if mild symptoms are exhibited, health care providers “may advise a COVID-19 test.” However if symptoms are severe, the patient should contact their health care provider and seek emergency care.
The CDC referred to asymptomatic individuals as “healthy people” which is a justification used by media posts against the use of masks on their website. The full recommendation says, “In areas where there are a limited number of new cases, State or local public health officials may request to test a small number of asymptomatic ‘healthy people’, particularly from vulnerable populations.” Despite this, the CDC reports an estimate of 40% of coronavirus infections as asymptomatic and about 50% of coronavirus transmission occur before symptoms are exhibited.
Explanations for the changes
A senior federal health official told CNN that the change was due to increasing pressure from the Trump administration. He said, “It’s coming from the top down,” referring to the White House and the Department of Health and Human Services.
The CDC referred questions to the US Department of Health and Human Services’(HHS) Assistant Secretary Doctor Brett Girior who explained the change in policy, “This Guidance has been updated to reflect current evidence and best public health practices, and to further emphasize using CDC-approved prevention strategies to protect yourself, your family, and the most vulnerable of all ages.” However, Girior did not explain what the changes to the “current evidence” was.
Although Girior explained that the White House coronavirus task force, including Dr. Anthony Fauci and CDC Director Dr. Robert Redfield, discussed and agreed to the new guidelines, Fauci told CNN that he “was under general anesthesia in the operating room and was not part of any discussion or deliberation regarding the new testing recommendations.”
Health experts confused by the change in guidelines
Dr. Leana Wen, an emergency physician and public health professor at George Washington University and former health commissioner of Baltimore said, “I’m concerned that these recommendations suggest someone who has had substantial exposure to a person with Covid-19 now doesn’t need to get tested.” She added that, “This is key to contact tracing, especially given that up to 50% of all transmissions is due to people who do not have symptoms. One wonders why these guidelines were changed — is it to justify continued deficit of testing?”
Infectious disease specialist and the associate dean of Emory University School of Medicine, Dr. Carlos del Rio, told CNN that testing may not be necessary for specific instances like brief contact. However he noted, “But if you have been in contact for 15 minutes and that people doesn’t have a mask, I think you need to be tested regardless if you have symptoms or not.” He gave the example of young students saying, “We know especially young people going into the house and then transmit inside the household. So, the guidelines baffle me and I don’t really understand them.”
Del Rio expressed concern over the Trump administration’s influence on the decision. President Trump has commented on testing before saying that more coronavirus testing leads to more cases in the US.
However, a Department of Health and Human Services spokesperson said that the new guidelines would not hinder contact tracing efforts. “The guidance fully supports surveillance testing, done in a proactive way through federal, state, and local public health officials,” said the spokesperson.
Authorities on change in guidelines
Former CDC director under Barack Obama, Dr. Tom Frieden tweeted that the change is “probably indefensible” and was “likely imposed on the CDC’s website.” The executive director of the Arizona Public Health Association and former director of Arizona’s Department of Health Services said that the change was “bizarre” adding, “Testing contacts is a core part of contact tracing!”
Andrew Cuomo, the governor of New York criticized the CDC change in public guidelines and called it “political propaganda” to support Trump’s reelection efforts.