CDC relaxes COVID-19 testing guidelines for asymptomatic people
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(Editor’s note: The CDC has reversed this revision and now recommends again that asymptomatic people who have been in close contact with an infected person get tested. You can read more here.)
The CDC updated its COVID-19 testing guidance to say that people who have come in close contact with an infected patient but remain asymptomatic “do not necessarily need a test.”
Previously, the CDC recommended testing for “all close contacts of persons with SARS-CoV-2 infection.”
The updated guidance lists three recommendations for those who come within 6 feet of a person with COVID-19 for at least 15 minutes:
- 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.
- 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 vulnerable individuals. You should adhere to CDC guidelines to protect vulnerable individuals with whom you live.
In a press conference addressing the change, Adm. Brett P. Giroir, MD, the U.S. Assistant Secretary for Health, said the goal is not to test fewer people but to “get appropriate testing.”
“There will be more asymptomatic testing in areas where it’s needed, and hopefully less where it’s not needed,” he said. “When this goes away completely, we obviously don’t need many tests anymore.”
Giroir said many people had input on the guidance, including himself and White House advisors Anthony S. Fauci, MD, and Deborah Birx, MD, “but it was a CDC product with lots of editing, lots of input, probably over about a month.”
In a statement issued days after the guidance was changed, CDC Director Robert R. Redfield, MD, used different language, saying that “testing may be considered” for any individual who comes into close contact with someone with confirmed COVID-19.
“Everyone who needs a COVID-19 test, can get a test,” Redfield said. “Everyone who wants a test does not necessarily need a test; the key is to engage the needed public health community in the decision with the appropriate follow-up action.”
Giroir refuted multiple media reports that the CDC guidance was changed as a result of pressure from the White House.
“There was no weight on the scales by the president or the vice president, or [HHS] Secretary [Alex] Azar,” Giroir said. “This was a product produced by the scientific and medical people that was discussed extensively at the task force, and everyone approved that.”
Perspective
Back to TopAmesh A. Adalja, MD
Testing is a cornerstone to management of the COVID-19 pandemic and is a task at which the United States has failed miserably since January. We still face scarcities with reagents and unacceptable turnaround times. Because of this, it has become necessary to prioritize certain groups for outpatient testing, and that priority has to be symptomatic individuals. Additionally, regardless of a test result, an individual who has had a significant exposure should self-quarantine for 14 days from exposure. It is also difficult to know at what time frame to test a contact because a test just captures one moment in time in a 14-day incubation period.
Accordingly, I have never been one to advocate reflexively testing all asymptomatic significant case exposures but have deferred to local and state public health authorities conducting case investigations to make testing decisions as they deem necessary. Such decisions likely reflect when a case investigator reaches a contact and the potential for stopping possible third-generation spread.
I initially interpreted the new CDC guidance in light of the above-mentioned scarcity and prioritization issues, but now, learning that the decision reportedly was not one made by the CDC makes it more difficult to understand the rationale, given the continual undermining of the CDC that has occurred since the start of this pandemic.
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CDC. Overview of Testing for SARS-CoV-2. https://www.cdc.gov/coronavirus/2019-ncov/hcp/testing-overview.html. Accessed August 26, 2020.
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