Public/Global Health

Local health departments say CDC testing change undermines their work

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Groups representing local health departments asked the Centers for Disease Control and Prevention (CDC) on Friday to reverse a change to coronavirus testing guidance that they argue would hurt their ability to slow the spread of the disease.

The CDC’s testing guidance was quietly updated Monday to say people without symptoms “do not necessarily” need to get tested, even if they’ve been in close contact with a COVID-19 case.

“As public health professionals, we are troubled about the lack of evidence cited to inform this change,” National Association of County and City Health Officials and the Big Cities Health Coalition wrote in a letter to CDC Director Robert Redfield and Adm. Brett Giroir, an assistant secretary at the Department of Health and Human Services.

“CDC’s own data suggest that perhaps as many as 40 percent of COVID-19 cases are attributable to asymptomatic transmission. Changing testing guidelines to suggest that close contacts to confirmed positives without symptoms do not need to be tested is inconsistent with the science and the data,” the groups added.

President Trump has repeatedly downplayed the importance of testing, saying that more testing means more cases.

Forgoing testing of close contacts to COVID-19 cases would miss infections in people who don’t show symptoms of the disease but can spread it to high-risk individuals who may in turn become seriously ill or die.

“Not testing all possible close contacts impacts the ability of local health departments to engage in effective case investigation and contact tracing, the primary tools we have right now to slow the spread of this disease,” the letter reads.

Redfield clarified the change in guidance in a statement Thursday, saying close contacts without symptoms “may be considered” for testing by local health departments and physicians.

A spokesperson for the Department of Health and Human Services (HHS) — the CDC’s parent agency — later said Redfield’s statement “amplifies the policy. It in no way changes the policy.”

The guidance on CDC’s website was not revised after Redfield’s clarification.

The local health groups indicated Friday that the statements from Redfield and HHS were “insufficient.”

“Regardless of this verbal clarification, we must do more to ensure that public health professionals, clinicians, and the public are clear about the importance of testing and the dangers of asymptomatic spread of the virus,” the letter reads.

“We recognize that the guidance does give deference to local and/or state health officials to make exceptions to the revised testing guidance. While it has been touted that this is to empower these leaders, in many ways, CDC’s guidance change will make their ability to respond to the pandemic even harder,” the groups added.

“Our members have stressed the vital importance of testing all close contacts and to do so with clear and consistent messaging,” they went on to say. “Without clear data backing up the rationale behind the revision, this change has put them in a position to say they will not be following the CDC guidelines.”

The letter notes that public health has become politicized in the U.S., and the change will make it even more difficult to communicate with the public.

“By removing the national recommendation and putting the decision-making squarely on individual leaders, it allows for skeptical elected officials and members of the public to again blame the individual public health leader who is simply trying to protect their health and safety,” the letter states.

The groups also raised concerns that the CDC did not give any warning about the change nor were they notified about it when it happened on Monday.

“Rather than empowering public health professionals and moving our nation forward in a cohesive way to address the pandemic, this abrupt change has caused confusion, consternation and undermined the credibility of the agency with public health professionals and the public alike,” the letter states.

Tags CDC Coronavirus COVID-19 Donald Trump guidelines HHS Pandemic testing
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