CDC’s Changed Testing Guidelines Could Lead To Less Testing, Experts Fear

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Testing contacts of those with confirmed cases of coronavirus is common public health practice. New CDC guidelines make it optional.

David L. Ryan/The Boston Globe via Getty Images

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David L. Ryan/The Boston Globe via Getty Images

Testing contacts of those with confirmed cases of coronavirus is common public health practice. New CDC guidelines make it optional.

David L. Ryan/The Boston Globe via Getty Images

The Trump administration has stirred confusion and concern by rewriting its guidelines for coronavirus testing. Public health experts fear the revised guidelines will lead to less testing – something the president has repeatedly asked for — but the administration denies that.

Part of the concern stems from the way the new guidelines were unveiled. There was no press release or announcement in advance, but instead on Monday the Centers for Disease Control and Prevention quietly updated the website that provides guidance for coronavirus testing. Journalists discovered the change.

The old guidelines said people who had been exposed to someone with coronavirus should get tested. The new guidelines leave the call about whether a test is necessary to people’s doctors and state and local public health officials. That led to widespread speculation that the guidance is intended to reduce testing.

«This makes no sense,» tweeted Dr. Leana Wen, former health commissioner of Baltimore and past president of Planned Parenthood. «People without symptoms account for up to 50% of transmission. We need MORE testing, not less.»

Former CDC director Tom Frieden called the change «highly problematic» in a tweet.

Wednesday Admiral Brett Giroir, who heads coronavirus testing for the Department of Health and Human Services and serves on the White House Coronavirus Task Force, said that reducing testing was not the intent.

«We don’t expect that the volume of tests will be reduced,» he told reporters, «In fact we do believe with some upcoming programs … that the number of tests will go up significantly over the next couple of months.»

Giroir acknowledged that the guidelines were reviewed and edited by members of the Coronavirus Task Force and were not simply a CDC product. But he said there was no political interference.

Giroir defended the changed guidelines, saying the intent is to shift testing so it’s driven more by public health officials around the country and less by individuals who want a test because they’re worried but not sick.

«In fact, the goal is to make this more strategic and intelligent by putting more power and more authority in the hands of the public health officials,» Giroir said. «That’s clearly the intent and I think it’s explicit within the guidance.»

But springing this as a surprise on public health officials, as happened here, is a fraught way to accomplish that.

«Nobody knows what they mean,» says Dr. Georges Benjamin, the executive director of the American Public Health Association. «They didn’t share this, as far as I know, with anybody beforehand.» He says Giroir’s explanation is «spinning it a little bit.»

Frieden noted that it’s true there are not enough tests and they must be prioritized. But «An asymptomatic close contact IS priority for testing,» he tweeted. «CDC does say defer to state and local guidance, but they should lead.»

Benjamin agrees that there’s a lot of room for improvement in who gets tested and under what circumstances. But he says this new directive doesn’t help.

«At the end of the day this undermines the credibility of the CDC because now you’ve got everybody pointing fingers at one another,» he says. «The truth of the matter is, if you want to make sure that the right people get tested with the right test at the right time, then you need a national testing strategy that’s been very thoughtful, that’s science based, that’s in print, and that everybody understands. And they’ve not done that yet.»

You can contact NPR Science Correspondent Richard Harris at rharris@npr.org.

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