A sudden change to federal guidelines for Coronavirus testing this week prompted widespread concern that asymptomatic carriers of the disease would not be tested, which could lead them to unknowingly transmit the virus. Now there are more questions about the implementation of the rule which Dr. Anthony Fauci said was pushed through while he was undergoing surgery and another official says was the result of pressure from the Trump Administration.
The CDC website has advised since Monday morning, “If you have been in close contact (within 6 feet) of a person with a 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.”
Previously, the recommendation said, “Testing is recommended for all close contacts of persons with SARS-CoV-2 infection.” The CDC specifically cited “the potential for asymptomatic and pre-symptomatic transmission” and noted, “it is important that contacts of individuals with SARS-CoV-2 infection be quickly identified and tested.”
Health experts say that the new guideline makes no sense. Referring to people exposed to COVID-19 but not exhibiting symptoms, Dr. Leana Wen, an emergency physician and public health professor at George Washington University and who was previously Baltimore’s health commissioner, told CNN, “These are exactly the people who should be tested.”
Wen gave the example of a person who has been exposed and does not have symptoms but is concerned about spreading the virus to family and friends. The CDC previously estimated that as many as 40 percent of Coronavirus cases may be asymptomatic. These carriers do not have symptoms of the illness but can still spread the disease to more vulnerable and high-risk people. It is vital for asymptomatic carriers to know if they are COVID-positive so that they can isolate and avoid spreading the virus.
Dr. Fauci, a prominent member of the White House Coronavirus Task Force, said that he was not involved in changing the recommendation and expressed concern. The Task Force meeting where the change was discussed occurred on August 20 while Fauci was undergoing vocal cord surgery.
“I was under general anesthesia in the operating room and was not part of any discussion or deliberation regarding the new testing recommendations,” Fauci told CNN.
“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 added.
Adm. Brett Giroir, who heads up the Coronavirus testing effort, had previously said that Fauci had agreed to the changes, telling reporters on Wednesday, “Yes, all the docs signed off on this before it even got to the task force level.”
“We worked on this all together to make sure that there was absolute consensus that reflected the best possible evidence, and the best public health for the American people,” Giroir said. “I worked on them, Dr. Fauci worked on them, Dr. (Deborah) Birx worked on them. Dr. (Stephen) Hahn worked on them.”
Dr. Birx has not spoken about the new change publicly, but two weeks ago she recommended increased testing as schools and colleges reopen. On a private call with state and local leaders reported by the Center for Public Integrity, Birx recommended a testing “surge” that would include “entrance testing” for students. Birx’s comments from earlier in August seem to be at odds with the new CDC guidelines.
In a statement, Giroir said, “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.” He did not specify what new evidence led to the change.
CDC Director Robert Redfield argued that the changes are simply a change in focus, saying in a statement, “We are placing an emphasis on testing individuals with symptomatic illness, individuals with a significant exposure, vulnerable populations including nursing homes or long term care facilities, critical infrastructure workers, healthcare workers and first responders, or those individuals who may be asymptomatic when prioritized by medical and public health officials.”
“These updated guidelines, coordinated in conjunction with the White House Coronavirus Task Force, received appropriate attention, consultation and input from task force experts,” Redfield said.
Another unnamed official also told CNN that the changes were the result of pressure from the Trump Administration, rather than sound medical advice.
“It’s coming from the top down,” the official said.
President Trump has long argued that the US is testing too much. As far back as June, the president said, “Without testing, or weak testing, we would be showing almost no cases.”
While it is true that Coronavirus statistics would show fewer cases with less testing, it is also true that those cases would still exist. The difference would be that many people would unknowingly spread the disease. As a result, total cases and deaths from the pandemic would ultimately be higher as the virus became more widespread. The new recommendations seem to be less of an attempt to fight the virus than to conceal it.
Last night at the Republican National Convention, Vice President Mike Pence told the attending crowd, “I promise you we’ll continue to put the health of America first.”
Considering the controversy and misstatements regarding the new guidelines, as well as the fact that the audience for Pence’s speech was neither social distancing nor wearing masks, I’m a bit skeptical.
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