The Centers for Disease Control and Prevention's decision to revise their COVID-19 testing guidelines has sparked shocking reactions from many experts. In previous guidelines it was clearly stated: "Tests are recommended for all close contacts." That said, anyone believed to have come into contact with a confirmed case of COVID-19 should be tested. The revised guidelines indicate that asymptomatic individuals "don't necessarily need a test" so testing only needs to be done on individuals who have developed symptoms after exposure to a case of COVID-19.
There is an exception for so-called vulnerable people, as the CDC explained elsewhere on its website, and that the elderly and those with underlying conditions such as cancer, obesity and chronic obstructive pulmonary disease (COPD) are particularly at risk. Additionally, the new guidelines recommend following directions from local and state health authorities.
Critics speak out
One critic of the changes was Dr. Tom Frieden, former director of the CDC, who tweeted regarding the new test guidelines: "… unexplained, inexplicable, probably not justifiable".
Leana Wen, MD, told CNN the guidelines didn't make any sense. "I am concerned that these recommendations indicate that someone who has been significantly exposed to someone with COVID-19 no longer needs to be tested," she said. "This is key to contact tracking, especially given that up to 50% of all transmissions are due to people who have no symptoms. One wonders why these guidelines have changed – is this a right to persistent testing deficit?" Dr. Wen, professor of public health at George Washington University, was a former health commissioner for the city of Baltimore.
Wiggle room in the rules
Guidelines are just that – guidelines. A spokesman for the Department of Health and Human Services told the New York Times that testing for asymptomatic individuals would still be possible "if directed by public health executives or health care providers." The spokesman added that when a person is infected with the virus from an unknown source, whether or not someone will be tested should take into account their individual circumstances and the status of its spread in the community. Better testing and contact tracing means fewer people in the community are passing the virus on.
These tests are an important step in containing COVID-19. After someone becomes infected with the infection, there is a presymptomatic phase during which the virus can unwittingly be passed on. The average time between infection and symptoms is 4 to 5 days, but it can range from 3 to 14 days. Some people with COVID-19 develop no symptoms at all. Although they don't seem sick, they can still pass the virus on to others who may get sick. Research published in the journal Nature found that 20% of infected people were asymptomatic, but other studies report that up to 40% of patients were asymptomatic. Having no symptoms doesn't tell you anything about a patient's chances of getting COVID-19.
In addition to being a public health crisis, COVID-19 is a deeply political problem. In a tweet, New York Governor Mario Cuomo said: “… (T) this is not science. It's politics. Policies that are dangerous to public health.