Q&A: What PCPs should know about COVID-19 testing in asymptomatic patients

On Friday, the CDC changed its recommendations for testing asymptomatic patients who were exposed to COVID-19.

Last month, the CDC published guidance that stated patients who had been in close contact with someone with COVID-19 but were not showing symptoms did not need to be tested unless they were vulnerable to infection or if testing was recommended by their health care provider or public health officials. However, with this most recent update, the CDC now recommends testing these patients, regardless of symptom status.

The updated CDC recommendations also state that one negative test result does not necessarily mean that a person does not have the virus, and that those who were exposed to COVID-19 but test negative should still self-isolate for 14 days.

Healio Primary Care spoke with Ravina Kullar, PharmD, MPH, FIDSA, an infectious disease specialist and epidemiologist in Los Angeles and a spokesperson for the Infectious Diseases Society of America, to learn more about these changes and what PCPs should consider when making COVID-19 testing recommendations to their patients.

Q: Why is it important for the CDC to reverse its previous decision to loosen these guidelines?

A: It is important that the guidance was changed due to a high proportion of asymptomatic and pre-symptomatic transmission from “silent spreaders” that occurs with this virus. These updated recommendations further strengthen the need to test asymptomatic individuals, including close contacts of a person with documented SARS-CoV-2 infection. We know that at least 40% of people are asymptomatic and most of the transmission that occurs happens prior to an individual developing symptoms. If we do not test these asymptomatic individuals, there will be outbreaks and [it] will hurt contact-tracing efforts.

Q: The new guidance recommends that patients who were in close contact with a person with COVID-19 self-isolate for 14 days, even if they test negative. Should these patients be tested again before ending isolation precautions? Why or why not?

A: Yes — a small percentage of individuals can still harbor the virus after 14 days, so it is important to get a test prior to ending self-isolation. It is imperative, when in self-isolation and not in self-isolation, that strict infection prevention procedures are followed as we know they work in slowing and preventing the spread of SARS-CoV-2 — wearing masks, hand hygiene, physically distancing.

Q: Have there been any other changes or additions to CDC recommendations related to COVID-19 that PCPs should be aware of?

A: For months, the CDC advised travelers to quarantine for 14 days following international travel and travel to areas with high levels of coronavirus transmission. However, this recommendation no longer exists. If an individual has returned from an area with high levels of COVID-19 cases, it is important to quarantine and monitor symptoms prior to being exposed to others. We know that asymptomatic and pre-symptomatic cases are quite prevalent, meaning that it could take 5 to 6 days to develop symptoms. Regardless, it is important to follow strict infection prevention measures, including wearing a mask, physically distancing and proper hand hygiene.

Q: The CDC guidance has changed multiple times throughout the pandemic. How does this affect its reputation as a public health agency among physicians?

A: I think we have to keep in mind that these are unprecedented times and individuals, including the CDC, are grappling with this new territory — there is no dress rehearsal for this pandemic. Our understanding of SARS-CoV-2 is evolving day by day and the CDC is trying their best to be transparent with the public.