American policy surrounding COVID-19 has been nearly universally confusing, and yesterday things became even more mangled. A controversial change in the CDC’s coronavirus testing policy makes it so that fewer people require COVID-19 tests, even as rates and deaths climb across the country with no end in sight.
Prior to this week, the CDC recommended that anyone who had been in close contact with an infected person should get tested, regardless of whether they showed symptoms or not. Now, the government agency says only folks displaying symptoms should seek a coronavirus test.
The updated guidelines, made in conjunction with the White House Coronavirus Task Force, are supposedly in place to put more emphasis on testing patients with symptomatic illness, individuals with significant exposure, and vulnerable populations, CDC Director Robert Redfield told CNN. Today, he clarified that everyone who “needs” a COVID-19 test can get access to one, but not everyone who “wants” one.
Following the announcement, a number of public health experts cast doubts about the effectiveness of this new policy. So called asymptomatic spreaders (people who show no signs of infection but still test positive) account for as much as 40 percent of coronavirus cases. And many argue that this new recommendation could falsely decrease the number of reported cases in the United States. The fewer people that get tested, the fewer cases the public will know about.
Further, Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases and a key member of the White House’s coronavirus task force, was under anesthesia undergoing planned vocal cord surgery when the final decisions were announced. Here’s everything else you need to know and what it means for you.
What exactly are the changes?
Until yesterday, the CDC recommended testing for COVID-19 for all close contacts of someone who had the infection, whether or not they had symptoms. A big reason for this is because asymptomatic carriers are big players in spreading the virus unknowingly, leading to case surges after weddings, parties, and gatherings. People who didn’t know they were positive attended the events and spread it to other guests. Testing all folks exposed to the virus helps identify these potential silent spreaders.
The new changes to guidelines recommend you only get tested if you have symptoms, if you’ve been cozied up within six feet of a confirmed positive case for at least 15 minutes, or if your local healthcare provider recommends it. The updated CDC site reads “not everyone needs to be tested.”
Scientists say people with potential COVID-19 exposure should be tested more, not less
Unsurprisingly, experts across the country are already speaking out objecting the more relaxed new guidelines. Major organizations like the American Medical Association and the Infectious Disease Society of America put out official statements against the change yesterday.
“Testing asymptomatic individuals who have been exposed to a person with COVID-19 remains a critical evidence-based strategy for containing the pandemic and reducing transmission,” the ISDA wrote in a statement. AMA president Susan Bailey went a step further by asking the CDC to release any scientific evidence that supports the change.
One reason behind the new guidelines has been stated to focus on “vulnerable” populations, which would only be justifiable if there was a shortage of testing resources, says Leana Wen, an emergency physician and public health professor at George Washington University who previously served as Baltimore’s Health Commissioner. There’s been no such mention of such a shortage.
“If they came out and said [testing resources were in low stock], I think people would have a better understanding,” Wen says. “If that’s the actual justification, that’s understandable. But they should not be implying that asymptomatic people don’t need testing, which is what the implication is here.”
Another defense of the change is that a negative test might not mean that you are negative—especially if you get tested right after contact. But if that’s the case, Wen says, people who have been in contact with a positive person should be tested more, not less.
Other public health experts affirm that testing and quarantining if you come into contact with a COVID-19 positive person—even if you don’t have symptoms—is crucial.
Is the decision political?
Politics have played a big role in many countries’ successes and failures across the globe. And for countries that have successfully lowered their COVID-19 cases against the virus, testing has often played a big role. After all, trying to solve this dilemma without mass testing is kind of like “fighting a fire blindfolded,” World Health Organization director Tedros Adhanom Ghebreyesus said back in March.
But, the more testing is done, the more cases we will discover, a statement President Donald Trump has made several times., He has publicly stated that he’d like to slow down cases to keep official case counts low. When questioned further if his statements were a joke back in June, he told CBS’ Weijia Jiang “I don’t kid.” Additionally, a CDC official told CNN that the new guidelines came from “the top down.”
“The idea that we should be testing people less and not more is not only pure craziness, but seems to be in line with Trump’s claim that he’s asked his people to slow down testing,” says Craig Spencer, the director of global health in emergency medicine at Columbia University.
George Washington’s Wen adds there wasn’t a press release or official statement that accompanied the website change. Instead the new guidelines were thrown suspiciously onto the website “in the dark of the night.”
NIH leader Fauci was not present at the meeting where the new testing guidelines were being discussed, and instead was undergoing a planned surgery. However, he had seen an “earlier iteration” of the guidelines and posed no opposition.
“I am concerned about the interpretation of these recommendations and worried it will give people the incorrect assumption that asymptomatic spread is not of great concern. In fact it is,” Fauci told CNN.
Several governors, including Andrew Cuomo of the once hotspot New York, have decided to ignore the CDC’s guidelines, sticking with previous testing advice.
“The only plausible rationale is that they want fewer people taking tests, because as the president has said, if we don’t take tests, you won’t know the number of people who are Covid-positive,” Cuomo told The New York Times. Kentucky governor Andy Beshear and California governor Gavin Newsom echoed similar sentiments.
But even with these statements, local healthcare providers and state officials look to the CDC for guidance. Now, they are swimming in confusing murky waters when it comes to making decisions. Wen says, the credibility of the CDC, once the “premier health agency in the world”, will likely be tainted by this decision.
“If it’s not based on science, what is the motive behind this?” Wen says. “And what does that do for the credibility of this institution, and of public health in this time when we need that credibility the most?”
Long-term impacts of less testing
Without testing, asymptomatic cases fall through the cracks. And every time this happens, there’s a huge risk of spread. With less testing, Wen says, there will be more spread that could’ve been prevented, and we’ve already seen that happen in many regions of the country.
“We’ve already seen what happens when we don’t have the testing that we need,” says Wen, “which is community spread happens all around us, and before we know it, a single case turns into a cluster, a cluster turns into an outbreak, and an outbreak turns into an epidemic.”
We know that at least 30 or 40 percent of COVID-19 cases consist of asymptomatic carriers, says Spencer. So, a blanket statement of just quarantine might not be enough to keep potential carriers in lockdown. But an actual positive test can give people the motivation to stay in quarantine and not spread it further. The fewer tests we do, the fewer people have that bonus push to really stay in lockdown.
An additional repercussion of not doing enough testing is putting long-term cases, or people who continue to suffer even after they’ve recovered from COVID-19, in the horrible position of possibly never having a test to confirm that they even had the disease that in some cases may leave them with chronic suffering, says Spencer.
Spencer saw this firsthand in the treatment of patients during the early stages of outbreaks in New York City, where the patient obviously was ill but the resources to test them were unavailable. Now, in accessing care, these people have little evidence to hold up having COVID-19, and with fewer tests, more people are at risk of facing the same difficulties.
While it may feel hopeless to see all of this unfold, just remember that you can still take responsibility in securing the health of yourself and the people you love. Keep wearing masks, get takeout instead of sitting down at a restaurant, and take quarantine seriously even if you can’t, or don’t, get a positive test back.