The Center for Disease Control updated its Covid-19 testing guidelines to exclude those exposed to the virus who are asymptomatic. This is a sudden change of direction as the previous rendition encouraged everyone who came in contact with an infected person to seek testing. The revised guidelines are put in place as students return to school and businesses continue to reopen. Reduced testing puts these populations at risk as asymptomatic carriers are thought to be the most contagious spreaders of Covid-19.
It is unclear who made the final decision on the revisions as Brett P. Giroir, assistant Health and Human Services secretary and member of the White House Coronavirus Task Force, noted that the decision came after debate amongst the task force. Ultimately, Giroir claims the guideline revision was a “CDC action” and that the decision was made before it had even come across the President’s desk. CDC Director Robert Redfield was skeptical of the new guidelines, but seems to have yielded to the direction of Giroir.
This is not the first time the Administration appears to have had a hand in CDC decision making. In May, the White House requested revisions for the CDC’s economic reopening guidelines, as they were too restrictive. Shortly after reopening, cases spiked from twenty thousand to fifty thousand per day and deaths increased from about three hundred and fifty to over a thousand per day. Similarly, plans to release guidelines for returning to schools this fall by the CDC were delayed after the President criticized the guidelines as impractical. This pattern of influence can be seen in the Food and Drug Administration as well, with the White House deregulating the approval processes for Covid-19 tests.
Several Democratic governors have taken to social media expressing defiance and disdain for the new CDC guidelines. California Governor Gavin Newsom and Washington Governor Jay Inslee stated that their states would continue to test people exposed to confirmed cases. New York Governor Andrew Cuomo went as far as to say “[he] consider[s] it political propaganda.”
Testing is meant to identify those with the virus to prevent them from spreading it to others. Before the revision, those who came in contact with an infected person were encouraged to get tested to see if the virus had been transmitted. Catching those who were asymptomatic was crucial to stopping the spread.
Now the CDC has revised its position, suggesting that those in contact with an infected person do not need to get tested if they do not exhibit symptoms. The figure below shows that in the early days of infection, virus particles in the body are much higher. This means that the infected person is most contagious before they show any symptoms. This makes the CDC revision even more dangerous, as those who are now less likely to get tested are those that pose the most danger to others.
This new guideline does not slow the spread of the virus, but accelerates it. With the reopening of K12 schools and universities, this revised guideline may carry serious consequences. As seen with the economic reopening of the summer, as people venture back into society, the disease spreads. To counter the spread, schools are relying on robust testing and spread prevention. With relaxed testing guidelines for asymptomatic people, we could see a stark increase in cases with symptoms across the country.
Rather than decrease testing, we must increase it. The way to beat the virus is to test every American frequently to find out who is contagious. To carry out this mission, there needs to be an affordable and accessible antigen test. One test of promise is an antigen test developed by Abbott Laboratories.
This new antigen test, which received emergency use authorization from the Food and Drug Administration, offers diagnosis results in fifteen minutes. Antigen tests measure the body’s reaction to the virus, rather than the virus themselves. They detect those who are the most contagious, rather than specifically testing if one is sick. A healthcare worker takes a nasal swab from the patient and inserts it into a test card, which reads the results. The test is highly portable and is easy to administer.
The tests are promising, but far from ideal. To eradicate this disease, tests need to be very cheap—roughly fifty cents—or even free. They need to be widely available, saliva based and home based: not requiring a healthcare administrator. The New England Journal of Medicine recently found that there was “greater variation…in [nasal] swab specimens than in saliva specimens,” meaning saliva based tests may even result in more accurate testing. Abbott’s antigen test is a promising start, but there are still these improvements to strive for.
Past the testing phase, we must have strong mitigation policies that mirror foreign Covid control, but have American Characteristics. The US must require mandatory reporting if positive. Political committees in California have been floating this as a policy proposal to decrease contact between the contagious and the healthy. The bill would require employers to notify employees, the California Department of Public Health, and the Occupational Safety and Health Division of any positive Covid test in the workplace. Failure to report could result in a misdemeanor and fine upwards of ten thousand dollars. The bill has passed the state legislators and moves to the Governor’s desk for approval.
Further, there must be a greater emphasis and investment for assisted isolation. While contact tracing is important, enforcing compliance is expensive and unrealistic. If we can provide medical and social support to those who are contagious or infected, it will minimize the need for contact tracing. Assisted isolation could include isolating a whole family if one or more of the children are sick; they are provided food, medical assistance, financial support, and more in order to prioritize the isolation of the virus. If the infected person is living alone, there could be similar assistance. If they are with roommates, they can be taken to single isolation in the hospital.
The success of this public venture would fall to the CDC. They would need to set up the infrastructure to aggregate data on an individual and family basis, then they use that data to coordinate the isolation process case by case. As it stands, the CDC and the White House seem to be more concerned with reducing the number of tests, returning people to the economy, and moving forward without worry about the consequences.