Testing is still as
important as ever, politics aside.
By Sara Kiley Watson August
27, 2020
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?x
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
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.
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