The Arlington, Va.-based Infectious Diseases Society of America (IDSA) and its affiliated association, the HIV Medicine Association (HIVMA), on Wednesday evening, August 26, issued a statement calling on the Centers for Disease Control and Prevention (CDC) to immediately reverse new guidelines that that federal agency had released around testing, for individuals exposed to people who are COVID-19-positive.
On Aug. 24, the CDC issued revised guidelines to Americans around whether or not to get tested if exposed to someone who is COVID-19-positive. According to the revised guidelines, published on the CDC’s website on Monday, “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.
> A negative test does not mean you will not develop an infection from the close contact or contract an infection at a later time.
> You should monitor yourself for symptoms. If you develop symptoms, you should evaluate yourself under the considerations set forth above.
> You should strictly adhere to CDC mitigation protocols, especially if you are interacting with a vulnerable individual. You should adhere to CDC guidelines to protect vulnerable individuals with whom you live.”
The leaders at IDSA and HIVMA said this in a statement posted to the IDSA’s website:
“IDSA and HIVMA call for the immediate reversal of the abrupt revision of the CDC COVID-19 testing guidelines which diminish the importance of testing asymptomatic individuals who were exposed to COVID-19. The revision is concerning, particularly as the United States continues to lead the world in confirmed cases and deaths, with more than 5.8 million cases and nearly 180,000 lives lost to the virus. Evidence has clearly indicated that asymptomatic persons play a significant role in transmissions. Identifying individuals infected with COVID-19—even if they are asymptomatic—is critical to support appropriate isolation and identification of contacts, to limit spread, and to provide the data-driven, comprehensive view of community spread needed to inform effective public health responses. In addition to individuals with known contact with someone who has tested positive, other groups of asymptomatic individuals are also important to test, such as those who work in nursing homes or in other industries with high risks of transmission. Testing of asymptomatic children may also be critical to support safe reopening of schools.
Testing capacity has remained a major concern throughout the pandemic, with marked differences in total numbers of tests run and turnaround time from community to community. Given the shortages in testing supplies and personnel, IDSA does prioritize testing for symptomatic individuals. However, as a nation our goal should be to expand testing capacity to allow for testing of all recommended individuals, including asymptomatic people who have been exposed.
It is essential that public health guidelines be rooted in the best available scientific evidence. 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. IDSA stands behind our guideline on the diagnosis of COVID-19.”
IDSA and HIVMA leaders were not the only ones raising questions about the new testing guidance. Within 24 hours after the issuance of the new guidance, reports had emerged on possible political pressure coming from the White House that might have influenced the CDC’s actions.
A group-written report in The New York Times on Wednesday evening provided insights on potential political influence on the CDC. The Times reporters reported that “Trump administration officials on Wednesday defended a new recommendation that people without Covid-19 symptoms abstain from testing, even as scientists warned that the policy could hobble an already weak federal response as schools reopen and a potential fall wave looms. The day after the Centers for Disease Control and Prevention issued the revised guidance, there were conflicting reports on who was responsible.”
Indeed, the Times stated, “Two federal health officials said the shift came as a directive to the C.D.C. from higher-ups at the White House and the Department of Health and Human Services. Adm. Brett P. Giroir, the administration’s coronavirus testing czar, called it a ‘C.D.C. action,’ but he acknowledged that the revision came after a vigorous debate among members of the White House coronavirus task force — including its newest member, Dr. Scott W. Atlas, a frequent Fox News guest and a special adviser to President Trump.”
“We all signed off on it, the docs, before it ever got to a place where the political leadership would have, you know, even seen it, and this document was approved by the task force by consensus,” Dr. Giroir told the Times. He said “there was no weight on the scales” from the president. The Times added that, “Regardless of who was responsible, the shift is highly significant, running counter to scientific evidence that people without symptoms may be the most prolific spreaders of the virus.”
Meanwhile, CNN’s Jeremy Diamond, Kristen Holmes, and Sanjay Gupta, M.D., reported on Wednesday evening that “White House Coronavirus Task Force member Dr. Anthony Fauci said he was undergoing surgery and not in the August 20 task force meeting for the discussion on updated US Centers for Disease Control and Prevention guidelines that suggest asymptomatic people may not need to be tested for Covid-19, even if they've been in close contact with an infected person.
"I was under general anesthesia in the operating room and was not part of any discussion or deliberation regarding the new testing recommendations" at that meeting, Fauci told CNN Chief Medical Correspondent Dr. Sanjay Gupta. "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," said Fauci, director of the National Institute of Allergy and Infectious Diseases.
As the CNN reporters noted, “Fauci's comments undercut claims by Adm. Brett Giroir, the administration's coronavirus testing point person, who told reporters on Wednesday that the new guidelines had the White House Coronavirus Task Force's stamp of approval. Asked whether Fauci signed off on the guidelines, Giroir said, ‘Yes, all the docs signed off on this before it even got to the task force level.’”
The CNN report also quoted Admiral Giroir as stating that "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. I worked on them, Dr. Fauci worked on them, Dr. (Deborah) Birx worked on them. Dr. (Stephen) Hahn worked on them,” he said, denying any element of political pressure.
The CNN report added that “ The new CDC guidelines appeared to be the result of an idea raised to the task force by CDC Director Robert Redfield, M.D., a month earlier, when a surge of coronavirus cases strained US testing resources and some members were looking for new messaging on how to stem excess testing. Rather than continue to encourage anyone in close contact with a coronavirus-positive individual to get tested, Redfield suggested the CDC could relax the guidance, deeming a test unnecessary for otherwise healthy individuals not experiencing any symptoms, two sources familiar with the matter said. Experts worry that this will discourage the widespread testing of asymptomatic individuals that could help bring the pandemic under control.”
The CNN report went on to say that “The idea was met with immediate resistance from several task force members. In a coronavirus task force meeting Thursday, members debated the guidelines in-depth and in person, when Fauci was absent. The new guidelines were quietly published on the CDC website on Monday, catching media attention Tuesday evening and drawing a deluge of criticism from the public health community. The new guidelines stunned some federal health officials who are generally briefed on coronavirus matters, and many state health officials had also not been briefed on the change. Many federal health officials were scrambling on Wednesday to understand the impact of the new guidelines and who pushed through the change.”
