WASHINGTON – The director of the Centers for Disease Control and Prevention, who wanted to clarify recommendations on coronavirus tests that caused a stir, said that "Tests may be considered for any close contact with confirmed or likely Covid-19 patients ".
But its clarification may have further confused the subject.
The statement from the director, Dr. Robert R. Redfield, was announced late Wednesday and Thursday morning after a storm of criticism of the new C.D.C. Guidelines. Those guidelines claimed that people who have been in close contact with an infected person – usually within a meter of a person with the coronavirus for at least 15 minutes – "don't need a test" if they have no symptoms .
Administration officials said “not necessarily” the need for a test is compatible with “possibly considered” for a test. However, experts said the language change left patients, doctors, and state and local health authorities – relying on the C.D.C. to leadership – at a loss.
"& # 39; Maybe & # 39 ;?" asked Dr. Carlos del Rio, an infectious disease expert at Emory University. “I want a little more than that in a recommendation. "Can be" doesn't help. "
Democrats, including the governors of California and New York and spokeswoman Nancy Pelosi, have awarded the C.D.C. Bowing to political pressure from President Trump to minimize the number of infections. Administrative officials say the guidelines are the result of heated debate in the White House's coronavirus task force.
In his statement, Dr. Redfield explained, “Tests are designed to drive action and achieve specific public health goals. Anyone who needs a Covid-19 test can get a test. Everyone who wants a test doesn't necessarily need a test. The key is to involve the required public health community in the decision with the appropriate follow-up. "
The clarification does not change the new guidelines posted on the C.D.C. remain. But it's unusual. Public health experts say clear, consistent communication is essential to fighting an infectious disease outbreak, and in interviews several said statements from the C.D.C. and Dr. Redfield had missed that goal by a long way.
"What we from the C.D.C. is a clear, specific guideline, ”said Dr. Leana Wen, a former Baltimore health commissioner. "It shouldn't be a Rorschach blot we're looking at, and everyone gets a different answer looking at the same guide."
Dr. Wen said she was concerned about the impact of the rule on insurance coverage for tests. Insurers have resisted the mandate to pay for all tests without requiring co-payment from patients. Gregg Gonsalves, assistant professor of epidemiology at the Yale School of Medicine, said the new guidelines suggested that the administration "would not fund asymptomatic testing with new money or allow Medicaid to pay for it".
"I don't think the CDC's decision will prohibit states from covering tests beyond the CDC's approval, but they could provide coverage to states to save money through cuts," said Stan Dorn, senior fellow at Families USA , a non-partisan member of the health consumer advocacy group.
A person near the C.D.C. and the White House said the new guidelines were introduced partly to reconcile them with testing for other infectious diseases such as Zika, and partly because of a feeling among administrative scientists – as well as doctors and insurers – that "too many people were made out of fear and emotion put to the test. "
The stone came when the Trump administration announced the purchase and production of 150 million rapid tests to be distributed across the country. White House officials said the administration partnered with Abbott Laboratories to create affordable, easy-to-use BinaxNOW tests.
In the new test guidelines published on Monday, the C.D.C. The close contacts of Covid 19 patients “do not need a test” unless they are in need of protection or their doctor or a state or local health officer has recommended it.
In a conference call with reporters on Wednesday, Admiral Brett P. Giroir, the government's tsar for coronavirus testing, said the policy reflected the existing recommendation for health care and other frontline workers and that the task force had simply decided to put it on to expand the general population.
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frequently asked Questions
Updated August 27, 2020
What do I have to consider when choosing a mask?
- There are a few basic things to keep in mind. Does it have at least two layers? Well. If you hold it up to the light, can you see through it? Bad. Can you blow a candle through your mask Bad. Do you feel okay most of the time wearing it for hours? Well. The most important thing after finding a mask that fits well with no gaps is finding a mask that you will wear. Take some time to choose your mask and find something that suits your personal style. You should always wear it when out in public for the foreseeable future. Read more: What is the best material for a mask?
What are the symptoms of the coronavirus?
- In the beginning, the coronavirus appeared to be primarily a respiratory illness – many patients had a fever and chills, were weak and tired, and coughed a lot, although some people don't show many symptoms at all. Those who seemed the sickest had pneumonia or acute respiratory distress syndrome and were given supplemental oxygen. By now, doctors have identified many more symptoms and syndromes. In April the C.D.C. added to list of early signs of sore throat, fever, chills, and muscle pain. Gastrointestinal disorders such as diarrhea and nausea have also been observed. Another tell-tale sign of infection can be a sudden, profound decrease in your sense of smell and taste. In some cases, teenagers and young adults have developed painful red and purple lesions on their fingers and toes – nicknamed "covid toe" – but few other serious symptoms.
Why does it help to stand three feet away from others?
- The coronavirus spreads mainly through droplets from your mouth and nose, especially when you cough or sneeze. The C.D.C., one of the organizations using this measure, bases its six-foot recommendation on the idea that most of the large droplets that people make when they cough or sneeze fall within six feet of the ground. But six feet has never been a magical number that guarantees complete protection. For example, sneezing, according to a recent study, can trigger droplets that are far farther than two meters away. It's a rule of thumb: it is best to stand six feet apart, especially when it's windy. But always wear a mask even if you think they are far enough apart.
I have antibodies. Am i immune now?
- As of now, this seems likely for at least a few months. There have been appalling reports of people apparently suffering from a second attack of Covid-19. However, experts say these patients may have a protracted course of infection, with the virus taking a slow toll weeks to months after initial exposure. People infected with the coronavirus typically produce immune molecules called antibodies, which are protective proteins made in response to an infection. These antibodies may only last in the body for two to three months, which may seem worrying, but that's perfectly normal after an acute infection subsides, said Dr. Michael Mina, an immunologist at Harvard University. It may be possible to get the coronavirus again, but it is highly unlikely to be possible in a short window of time after the initial infection or make people sick the second time.
I am a small business owner. Can I get relief?
- The stimulus packages passed in March provide help to millions of American small businesses. Eligible companies and non-profit organizations with fewer than 500 employees, including sole proprietorships, independent contractors and freelancers. Some larger companies in some industries are also eligible. The assistance offered, administered by the Small Business Administration, includes the Paycheck Protection Program and the Economic Injury Disaster Loan Program. But a lot of people haven't seen any payouts yet. Even those who have received help are confused: the rules are draconian and some are stuck with money they cannot use. Many small business owners get less than expected or hear nothing at all.
What are my rights if I am worried about going back to work?
However, the guidelines met protests from public health experts who said the nation needs more testing, not less, and that there is no point in advising anyone exposed not to get a test, especially because of the virus is transmitted by asymptomatic people.
"I am very confused about this," said Dr. del Rio, adding, "I really don't understand what C.D.C. is thinking and makes no sense from an infectious disease point of view."
The Scientific Director of the Association of American Medical Colleges, Dr. Ross McKinney Jr., described the move as "irresponsible" and said the guidelines released Monday "are against the welfare of the American people and are a step backwards in the struggle." the pandemic. "
Mr Trump has suggested that the nation should be doing fewer tests, arguing that doing more testing increases the number of cases and makes the United States look bad. However, experts say the real measure of the pandemic isn't in the number of cases, but rather the test positivity rates – the percentage of tests that come back positive.
In an interview on Wednesday, Dr. Anthony S. Fauci, task force member and lead government expert on infectious diseases, said he was concerned that the guidelines could be misinterpreted. Dr. Fauci had signed an early version of the rule but had surgery to remove a polyp on his vocal cord when it was completed last Thursday.
In the statement, Dr. Redfield stated that the agency "places a focus on screening people with symptomatic medical conditions, people with significant exposure, vulnerable populations such as nursing homes or long-term care facilities, critical infrastructure workers, healthcare workers and first responders, or people who may be asymptomatic when they are from." medical and public health authorities are prioritized. "
Dr. Redfield also said that anyone – even people who tested negative – should be exposed to someone who is or may be infected should strictly adhere to public health guidelines such as: B. social distancing, wearing a mask, avoiding crowded interiors, and frequent hand washing.