Experts Question CDC’s New COVID Testing Guidance

The push for fewer tests runs counter to all available science.

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Even in a week stuffed with eye-popping headlines, one piece of news out of the Centers for Disease Control was enough to turn heads: The federal body overseeing the pandemic had quietly changed its guidelines on who ought to receive a coronavirus test. Formerly, the CDC had recommended that anyone who had come into contact with a confirmed carrier be tested as quickly as possible. The simple reason was that people infected with COVID tend to become contagious some time before they begin to show symptoms.

The new guidance, however, flips that on its head: If you aren’t showing symptoms, the CDC now says, and aren’t personally in a high-risk group yourself, there’s no need to get a test.

What accounts for this change? Several outlets—citing anonymous sources—reported Wednesday that the change had been decreed to the CDC by the White House, a claim buttressed by the fact that President Trump has repeatedly griped that he thinks the U.S. is testing too many people for coronavirus.

Making things weirder, Dr. Anthony Fauci, the nation’s top epidemiologist, has criticized the change and said that the CDC made the decision while he was undergoing surgery and anesthetized. 

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    Dr. Anger

    It harms nobody to test. It is an absolute good. Nothing more really needs to be said on this.

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    Jason Gibson

    The problem with this theory is that testing fewer people works AGAINST the administration's message. The more positive tests there are the more the death rate will plunge.

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  • Jon Heiderscheit

    Andrew,

    I am a practicing primary care physician at a well-known healthcare system. We have not been testing asymptomatic close contacts throughout the pandemic. Instead, the advice which we have been providing is that asymptomatic close contacts should place themselves in quarantine for 14 days, unless they develop symptoms (at which point we do testing).

    To understand why this is the case, one must always ask the question: how will the results of this test change the management of the patient? In the case of an asymptomatic close contact, there is no treatment or preventive therapy known to be effective other than social distancing. A positive test result will impact numbers on a spreadsheet, but will not change how we manage that specific patient. Furthermore, a negative test result does not rule out that the patient will develop COVID within the next 14 days. The tests do not have 100% sensitivity (which is the ability to indicate a true positive result when it is present), and the sensitivity varies depending on when during the course of illness a person receives the test.

    So, the bottom line is that whether the test result on an asymptomatic close contact is positive or negative, the advice to that patient will be the same: 14 day quarantine.

    The only rationale for testing these patients is a public health reason: to increase the accuracy of the public health data. The sensitivity and specificity of the available tests is quite variable, however, so it is not really clear to me that doing more testing will really increase the accuracy of our data. If a hypothetical test with 90% sensitivity and 90% specificity (which are both good numbers) is done on an asymptomatic patient where the incidence of the disease is 1/1000 (which is true in my community), then the positive predictive value (likelihood that a positive result indicated true disease) is less than 1%.

    I cannot speak to the political discussions which led to this change, but this particular change is supported by best medical practice:

    https://askmayoexpert.mayoclinic.org/topic/clinical-answers/cnt-20488222/cpm-20487608

    I hope this helps. Let's all take a step back and keep in mind that this stuff is complicated, and there will be differences of opinion out there. Keep up the good work.

    Jon

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  • @Fakejohn

    I hope one of the priorities of the (fingers crossed) Biden Administration is to raze and rebuild the CDC. Yes, Trump probably pressured leaders in the CDC to change testing recommendations. That doesn’t mean you need to succumb to the pressure! These recommendations affect people’s lives and jobs, it’s pathetic.

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    Adam

    The CDC guidelines are non-binding, right? Any idea how much real-world impact this will have if most medical professionals are dead-set against it?

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      cheerio

      I know that NYS is continuing as normal and not paying any attention to the latest political suckup policy.

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    Adam

    Excellent work Andrew!

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    Mike B

    In the absence of a credible explanation from real scientists I think we have to assume that this is exactly what it looks like: the CDC bowing to political pressure from the administration.

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  • Kaweeka

    So why did the Surgeon General show up in Hawaii with 70,000 tests? Latest plan is to shut down a major freeway to conduct testing. Doesn’t sound like a push for fewer tests to me!

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    1. Tim Johnson

      That's actually part of the major frustration for me: What IS the government's plan?
      Why do some from the government encourage wearing a mask, while the president doesn't?
      While I appreciate differing opinions within government, the mixed signals are ridiculous.

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