A couple of months ago, President Donald Trump said he told federal officials to “slow the testing down, please.”
Now the Trump administration is taking a step that would, in effect, slow down testing.
On Monday, the Centers for Disease Control and Prevention (CDC) updated its testing guidelines to no longer recommend people get tested even when they’ve come into close contact with someone who’s infected.
The previous guidelines stated, “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.”
The updated guidelines claim, “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.”
CDC Director Robert Redfield said in a statement that “testing may be considered for all close contacts of confirmed or probable Covid-19 patients.” But that still doesn’t explicitly recommend testing for close contacts of people with Covid, as many experts say is needed.
When I asked the CDC about the changes earlier this week, they referred the question to the Department of Health and Human Services — which struck me as unusual, since it suggested the CDC wasn’t overseeing the guidelines. An HHS official told me that the recommendations were “revised to reflect current evidence and the best public health interventions.”
HHS didn’t provide or explain that evidence when pressed further, or explain why someone who’s been exposed to a person with Covid-19 shouldn’t always try to get tested. Experts widely agree that more testing is crucial to stopping the coronavirus pandemic, with some already calling the guidelines change misguided and dangerous.
The change appears to have come from the White House’s coronavirus task force. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, told Sanjay Gupta at CNN he was under anesthesia for surgery when the task force met to finalize the changes.
He added, “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.”
Testing is crucial to stopping outbreaks. But Trump has called for less of it.
We don’t know how involved Trump was in the guideline change, if he was at all. But we do know Trump has repeatedly complained about the US testing too much. He’s argued that “testing is a double-edged sword,” adding that “when you do testing to that extent, you’re going to find more people — you’re going to find more cases.” The implication is that testing makes the US look bad, since it will have more confirmed coronavirus cases.
Experts counter that this is absurd: Whether testing confirms Covid-19 cases or not, those cases are there, leading to more infections, sickness, and deaths.
And it’s important to catch those cases. Paired with contact tracing, testing lets officials track the scale of an outbreak, isolate those who are sick, quarantine their contacts, and deploy community-wide efforts as necessary to contain the disease. It’s been successfully deployed in Germany, New Zealand, and South Korea, among other countries, to control Covid-19 outbreaks.
Successful testing includes asymptomatic and presymptomatic people. People who don’t show any or serious symptoms can still spread the disease, and there’s no way to verify whether they’re potentially infectious without a coronavirus test.
But the US has struggled to build its testing capacity to match the full scope of its outbreak. To gauge this, experts rely on the percentage of tests that come back positive. If a place tests enough, it should have a low positive rate because it should be testing lots and lots of people, including those who don’t have serious symptoms. High positive rates indicate that only people with obvious symptoms are getting tested, which suggests a need to ramp up testing to match the scope of an outbreak.
While the US has increased its testing capacity in the past few months, America’s positive rate for the past week was more than 6 percent — above the recommended 5 percent, and higher than the rates of Germany (less than 1 percent), New Zealand (less than 0.1 percent), and South Korea (about 2 percent). In some states, the positive rate is still above 15 percent or even 20 percent.
Given America’s ongoing testing problems, some experts have suggested that the US should be smarter about how it rations tests, which could include deprioritizing those who don’t have symptoms. But HHS said that’s not what’s going on here, telling the New York Times, “Testing capacity has massively expanded, and we are not utilizing the full capacity that we have developed. We revised the guidance to reflect current evidence and the best public health interventions.”
Brett Giroir, the administration’s testing czar, denied Trump’s involvement and said politics weren’t involved in the CDC’s new guidance. “We’re trying to get appropriate testing, not less testing,” he told reporters.
So we don’t really know exactly why the CDC changed its guidelines. But it conveniently accomplishes what Trump has asked for: potentially fewer people getting tested for Covid-19.
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