The Centers for Disease Control and Prevention on Friday reversed heavily criticized guidelines on who should be tested for the novel coronavirus after experts inside and outside the agency raised alarms about public confusion over testing and concerns about the country’s ability to control the epidemic.
Friday’s reversal, which was posted on the CDC’s website, took place after the agency was directed in August by the White House coronavirus task force to shift its testing guidance. The task force-directed recommendation said those without symptoms of covid-19 “do not necessarily need a test.”
Last month’s change caused an uproar among public health and medical professionals, who said the move would spark public confusion and impede the contact tracing needed to identify infected individuals and control transmission. They called for the guidance to be reversed.
Within the agency, scientists raised concerns that “what had happened was wrong, and it was not good public health practice,” according to one federal health official who spoke on the condition of anonymity to share internal discussions.
Trump administration officials said the push to limit testing was driven by the task force and other federal health officials overseeing testing.
Testing of people without symptoms is especially critical because the CDC estimates that up to 40 percent of people infected with the novel coronavirus show no symptoms of covid-19 but still may be highly infectious and spread the virus.
The guidance posted Friday essentially reverts to the CDC’s original recommendation calling for testing of all people who have had close contact with a person having a documented coronavirus infection.
Public health experts praised Friday’s decision but warned that the political interference that led to last month’s changes and the conflicting messaging surrounding testing undermine the government’s ability to fight the pandemic, which has killed more than 197,000 people in the United States, according to a Washington Post analysis. They also called for a return of daily CDC briefings to provide updates on the coronavirus response.
“This is an encouraging step in the right direction and confirms the importance of testing close contacts of people with COVID,” Tom Frieden, CDC director during the Obama administration, said in an email. “Now, the administration needs to show that political interference with CDC science will never happen again.”
“The constant politicization of this crisis has eroded trust in our nation’s leading public health institutions,” said Richard Besser, the president and chief executive of the Robert Wood Johnson Foundation and a former acting director of the CDC. “When guidance changes without explanation, trust is lost. CDC guidance should only change to reflect new science, not shifting political winds.”
Caitlin Rivers, an infectious-diseases expert at the Johns Hopkins Center for Health Security, said the U.S. response to the pandemic has been characterized by inconsistent and unclear messaging.
“It would be helpful if CDC could hold press conferences when important new guidance is released, to explain the updates. I worry that it’s confusing for clinicians and the public to interpret the guidance without context. That has been the practice during previous outbreaks,” Rivers said. “If the White House task force develops the guidance, then they should issue the document and hold a press conference.”
Brett Giroir, an assistant secretary at the Department of Health and Human Services, which includes the CDC, said last month that the idea for altering the testing guidance originated with him and CDC Director Robert Redfield and that the change was based on concerns that people can have misleading negative results if the test is given too soon after someone becomes infected. A senior administration official, speaking on the condition of anonymity to share behind-the-scenes discussions, said last month that Redfield was initially skeptical but then went along with the idea.
Giroir also said the guidance went through repeated drafts and was discussed with physicians on the task force, including Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases, and Scott Atlas, a Stanford Hoover Institution neuroradiologist who joined the coronavirus task force this summer.
Fauci, who was having surgery and under anesthesia when the task force approved the guidance, has said in a statement that he quickly reviewed a version of the guidelines before his surgery and was “not struck by the potential implication of this particular change” until he saw the final guidance.
A senior administration official who spoke on the condition of anonymity to share internal discussions said Friday that Atlas had pushed strongly for the guidance to limit testing of asymptomatic people. Atlas, who has no background in infectious diseases or epidemiology and has become President Trump’s favored in-house adviser on the virus, has said fewer people need tests.
Trump has said repeatedly that he does not like that more testing had revealed more cases.
In a statement Friday, HHS said: “As always, guidelines receive appropriate attention, consultation and input from the medical and scientific experts on the Task Force. This was the case then, and will continue to be the case in the future.”
Rivers, of Johns Hopkins, said that testing people who have had contact with someone who has a confirmed coronavirus infection is imperative.
“Testing enables contact tracing, which identifies chains of transmission to get ahead of the virus,” she said. “If we don’t test people who have had a known exposure, we may be missing opportunities to find more links in the chain.”
The Infectious Diseases Society of America, one of many professional medical groups that demanded the reversal of last month’s guidance, praised Friday’s return by the CDC to a science-based approach to testing guidance. “We urge officials to support the work of controlling this pandemic by following medical guidance of experts in the field,” the organization said.
In an interview, Thomas File, the president of the infectious-diseases group, said CDC scientists had shared their concerns with him about the way “that the guidance had come about.”
Giroir said during an interview on ABC’s “Good Morning America” that the guidelines were generated by the CDC and insisted that they did not recommend against testing people who are asymptomatic.
“It absolutely came from the CDC,” Giroir said. “I know for a fact that the version that went to the task force was reviewed and approved by Doctor Redfield.”
He said the testing of asymptomatic people remains critical.
“I want people to know that if you are asymptomatic, you can still spread the virus,” Giroir said. “That’s why masks are so important, and we want to encourage asymptomatic people to be tested.”
A federal health official said the guidance originated at the CDC after the agency heard from health-care providers who were worried about shortages of laboratory chemicals needed to conduct the tests. The providers were seeking federal guidelines to prioritize who should be tested.
The initial draft was developed by the CDC and sent to officials at HHS and the White House task force for additional input and approval. “After that, it went off the rails,” said the official, speaking on the condition of anonymity to share internal policy deliberations. When the final guidance was approved, “the document was dropped” on the CDC for posting to its website, said another federal official who spoke on the condition of anonymity to share behind-the-scenes discussions.
Reporters seeking comment about the changes made in August were referred to HHS.
Following the public outcry, CDC staffers were given talking points developed with input from the task force and the CDC to emphasize that the testing changes were aimed at identifying people with symptoms, according to a version of the talking points shared with The Washington Post.
The updated recommendation posted Friday says: “Due to the significance of asymptomatic and pre-symptomatic transmission, this guidance further reinforces the need to test asymptomatic persons, including close contacts of a person with documented SARS-CoV-2 infection.”