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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

A Tragedy of Errors: CDC Scales Back Testing During a Pandemic

By Gary Evans, Medical Writer

In a move widely seen as further evidence that the pandemic response has been politically undermined, the Centers for Disease Control and Prevention (CDC) recently revised SARS-CoV-2 testing guidelines, de-emphasizing the need to test asymptomatic people who have been in contact with a case of COVID-19.

The response from the infectious disease community was swift and severe, with many arguing that decreasing testing during a pandemic makes no sense and will lead to more infections.

“In a dramatic shift from previous federal guidelines, the CDC disclosed that some people without COVID-19 symptoms may not need to be tested, even though they may have been in close contact with an infected person,” Georges C. Benjamin, MD, executive director of the American Public Health Association, said in a statement. “This is inconsistent with the evidence that shows up to 40% of individuals who are infected spread the virus asymptomatically. It is also unclear what problem this change solves.”

The revision created an immediate problem for Robert Redfield, MD, director of the CDC, who tried to walk back the change by issuing a statement that conceded testing may be “considered” for all close contacts of confirmed or probable COVID-19 patient.

“We are placing an emphasis on testing individuals with symptomatic illness, individuals with a significant exposure, vulnerable populations including nursing homes or long-term care facilities, critical infrastructure workers, healthcare workers and first responders, or those individuals who may be asymptomatic when prioritized by medical and public health officials,” Redfield stated. “Testing is meant to drive actions and achieve specific public health objectives. Everyone who needs a COVID-19 test, can get a test. 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.” [Italics his]

Public health officials and clinicians are certainly engaged now, as the Infectious Disease Society of America stated, “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. 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.”

Testing or lack thereof, has hobbled the U.S. response since the outbreak began. The CDC previously cited potential transmission from asymptomatic cases in emphasizing the importance of testing contacts of those with COVID-19. The revised language reads: “If you are in a high COVID-19 transmission area and have attended a public or private 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.”

In a tweet, Tom Frieden, MD, former director of the CDC, called the revision indefensible. “If an asymptomatic contact tests positive, their contacts can be identified, warned, and quarantined,” Frieden said. “Not testing asymptomatic contacts allows Covid to spread. The CDC guidance is indefensible. No matter who wrote it and got it posted on the CDC site, it needs to be changed.”

In a bizarre note that seems only fitting during the tragedy of errors that has been this nation’s pandemic response, Anthony Fauci, MD — arguably the most respected infectious disease physician worldwide — told CNN he was literally unconscious during a surgical procedure when the testing revisions were made.

"I was under general anesthesia in the operating room and was not part of any discussion or deliberation regarding the new testing recommendations," said Fauci, director of the National Institute of Allergy and Infectious Diseases. “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."