NEW YORK (AP) — U.S. health officials sparked criticism and confusion after posting guidelines on coronavirus testing from the White House task force that run counter to what scientists’ advice, prompting one expert to call the situation “a public health version of Vietnam.”
The area of conflict is becoming a war zone indeed.
The new guidance says it’s not necessary for people who have been in close contact with infected people, but don’t feel sick, to get tested. It was posted earlier this week on the website of the Centers for Disease Control and Prevention.
The CDC previously had advised local health departments to test people who have been within 6 feet of an infected person for more than 15 minutes.
Across the country, public health experts called the change bizarre. They noted that testing contacts of infected people is a core element of public health efforts to keep outbreaks in check, and that a large percentage of infected people — the CDC has said as many as 40 percent — exhibit no symptoms.
“The recommendation not to test asymptomatic people who likely have been exposed is not in accord with the science,” said John Auerbach, president of Trust for America’s Health, a nonprofit that works to improve U.S. preparedness against disease.
“We are seeking clarification from CDC about its recent guidance around testing,” said a spokesman for Michigan’s health department.
Federal officials said the new recommendation was issued by consensus of the White House virus task force.However, Dr. Anthony Fauci, the country’s top infectious disease expert and perhaps the best known task force member, said Wednesday that he hadn’t been part of the discussion that green-lighted the change.
Fauci told CNN he was undergoing surgery when the new guidance was discussed last week, adding he was “worried it will give people the incorrect assumption that asymptomatic spread is not of great concern. In fact it is.”
The American Medical Association, in a statement, called the change “a recipe for community spread.” The Association of American Medical Colleges called it “a step backward in fighting the pandemic.”
Some officials — including some state governors — said it was another sign of a dysfunctional federal response to the pandemic.
“This is like a public health version of Vietnam,” said Brian Castrucci, president and CEO of the de Beaumont Foundation, which works to strengthen the public health system.
CDC officials referred all media questions to the agency’s parent organization, the U.S. Department of Health and Human Services in Washington. That suggests that HHS ordered the change, not CDC, said Jennifer Nuzzo, a Johns Hopkins University public health researcher.
After Twitter lit up with head-scratching and alarm about the change, HHS officials sent an email Wednesday saying the guidance was revised “to reflect current evidence and the best public health interventions,” but did not detail what the new evidence was.
The decision came out of meetings of the White House coronavirus task force, HHS officials said.
In a call with reporters, Dr. Brett Giroir, the HHS assistant secretary for health, said guidance language originated at the CDC. But he also said many federal leaders outside the agency were involved in “lots of editing, lots of input.” He said federal officials achieved consensus but it was difficult to attribute the final language to any one source.
Ultimately, restricting testing could be self-defeating, because it could skew the numbers and create a perception that rates of infection are higher. Testing people who appear to be healthy would tend to lower the overall rate of positive results, while narrowing testing to people who are sick would raise the overall positive rate, Auerbach said.
Why HHS would order such a change quickly became a matter of speculation. Dr. Carlos del Rio, an infectious diseases specialist at Emory University, suggested in a tweet that there are two possible explanations.
One is that it may be driven by testing supply issues that in many parts of the country have caused widely reported delays in results of a week or more, he suggested.
HHS officials suggested that wasn’t the reason, arguing that testing capacity is plentiful.
But Dr. Mysheika Roberts, health commissioner for Columbus, Ohio, said the city had to curtail testing last month because of a shortage of reagents used in lab procedures.
“When we were testing asymptomatic people here in Columbus, we were picking up a large number of individuals” with the virus, she said
Another possible explanation for the change is that President Donald Trump simply wants to see case counts drop, and discouraging more people from getting tested is one way to do it, del Rio said in his tweet.
Giroir said the change was made without input from Trump or Vice President Mike Pence. “There was no weight on the scales by the president or the vice president” or HHS Secretary Alex Azar, Giroir said.Dr. Tom Frieden, who was head of the CDC during the Obama administration, said the move follows another recent change: to no longer recommend quarantine for travelers coming from areas where infections are more common.
“Both changes are highly problematic” and need to be better explained, said Frieden, who now is president of Resolve to Save Lives, a nonprofit program that works to prevent epidemics.
Frieden said he, too, believes HHS forced CDC to post the changes. He called it “a sad day” because “CDC is being told what to write on their website.”
The governors of California, New York, Washington and Kentucky — all Democrats — criticized the new recommendations.
Washington Gov Jay Inslee said on Twitter that the changes likely will cause thousands of infections in his state to go unrecognized, and allow the virus to spread even more. Kentucky Gov. Andy Beshear called the new guidance “reckless.”
California Gov. Gavin Newsom and New York Gov. Andrew Cuomo said their states will not follow the new guidance.
“We will not be influenced by that change,” Newsom said. “We’re influenced by the folks that are experts in the field who feel very differently.”
“Why would you reverse yourself on the quarantine order?” Cuomo told reporters on a conference call. “Because they don’t want publicity that there is a COVID problem. Because the president’s politics are, ‘COVID isn’t a problem We’re past COVID.’”