AMA raises questions about CDC's changes to COVID-19 testing guidance
The U.S. Centers for Disease Control and Prevention this week revised its official testing guidelines regarding asymptomatic people, triggering concerns from public health and industry groups.
The new guidelines state that those without symptoms may not need a test, even if they have been in close contact with someone with a COVID-19 infection. The guidelines were similar for those in a high-transmission area who have attended a gathering of more than 10 people without widespread mask wearing or physical distancing.
"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," reads the agency website.
The American Medical Association and the Infectious Diseases Society of America were among groups who raised questions about the new guidelines, and noted that the novel coronavirus can be spread by those without symptoms.
"Months into this pandemic, we know COVID-19 is spread by asymptomatic people," said AMA President Susan R. Bailey in a statement.
"Suggesting that people without symptoms, who have known exposure to COVID-positive individuals, do not need testing is a recipe for community spread and more spikes in coronavirus. When the [CDC] updates a guidance the agency should provide a rationale for the change," she added. "We urge CDC and the Department of Health and Human Services to release the scientific justification for this change in testing guidelines."
The ISDA and HIV Medicine Association's joint statement was more pointed, calling for the immediate reversal of the guidance.
"The revision is concerning, particularly as the United States continues to lead the world in confirmed cases and deaths, with more than 5.8 million cases and nearly 180,000 lives lost to the virus. Evidence has clearly indicated that asymptomatic persons play a significant role in transmissions," read the statement.
"Identifying individuals infected with COVID-19 – even if they are asymptomatic – is critical to support appropriate isolation and identification of contacts, to limit spread, and to provide the data-driven, comprehensive view of community spread needed to inform effective public health responses," it continued.
Former CDC Director Dr. Tom Frieden also expressed concerns on social media, saying the new guidance "isn't scientifcally valid."
The CDC #COVID19 testing guidance simply isn't scientifically valid. Asymptomatic contacts need to be tested in order to find and stop chains of transmission. I hope to see the guidance updated to reflect this.
— Dr. Tom Frieden (@DrTomFrieden) August 27, 2020
WHY IT MATTERS
The CDC's recommendations had previously emphasized the possibility of asymptomatic testing. Top infectious disease expert Dr. Anthony Fauci told ABC's "Good Morning America" in June that 25% to 45% of infected people do not have symptoms.
Fauci told CNN that he had been under general anesthesia for surgery when the discussion of the new guidelines took place.
"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," said Fauci.
At the same time, the CDC continued to stress the importance of testing in long-term care or nursing facilities, saying that it was necessary for both residents and staff members.
Last week, the U.S. Department of Health and Human Services announced that the administration had leveraged the Defense Production Act to expedite the shipment of testing supplies for those nursing homes certified by the Centers for Medicare and Medicaid Services.
Meanwhile, the U.S. Food and Drug Administration continued to greenlight testing technology, and issued an emergency use authorization for a rapid test produced by Abbott. That test also includes a corresponding, no-cost phone app.
THE LARGER TREND
Confusion has continued to swirl in recent months about the federal response to the COVID-19 pandemic. This past week, the Wall Street Journal reported that HHS had reversed its directive for hospitals to bypass the CDC when reporting COVID-19 data. The HHS denied this claim to Healthcare IT News.
The Trump administration this week increased the pressure for hospitals to share data, with CMS making reporting a requirement of participation in the Medicare and Medicaid programs.
ON THE RECORD
"Testing capacity has remained a major concern throughout the pandemic, with marked differences in total numbers of tests run and turnaround time from community to community," read the ISDA/HIVMA joint statement.
"Given the shortages in testing supplies and personnel, IDSA does prioritize testing for symptomatic individuals. However, as a nation our goal should be to expand testing capacity to allow for testing of all recommended individuals, including asymptomatic people who have been exposed. It is essential that public health guidelines be rooted in the best available scientific evidence. 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."
Kat Jercich is senior editor of Healthcare IT News.
Healthcare IT News is a HIMSS Media publication.