Since the first days of the coronavirus, we have known we need tests—lots of them. Even then, scientists suspected that like many viruses, including the flu and HIV, SARS-CoV-2 could spread via asymptomatic people; current estimates by the Centers for Disease Control and Prevention are that as many as 40 percent of infected people could be asymptomatic. Based on best practices for managing infectious disease, experts recommended that tests should be administered not only to those showing symptoms of COVID-19, but also people who aren’t, especially if they have spent time around COVID-positive people.
But in a quick and quiet reversal this week, the CDC amended its guidelines to state that asymptomatic people do not necessarily need to be tested—a move that has muddied the waters on what should be very straightforward science.
On Monday, the CDC revised testing guidelines on the agency’s website, which began circulating in science circles on Twitter. By Tuesday, the New York Times reported on the changes. The first reaction from many was confusion: As far as any reporters or scientists could tell, there was no new or even evolving science that spurred the change. Professional societies like the Infectious Diseases Society of America and the American Medical Association have released statements expressing concern that walking back testing of asymptomatic people would further kneecap public health officials’ efforts to control COVID in the community. Allowing anyone to get tested can uncover cases in asymptomatic people who might unknowingly spread the virus to others, so decreasing access to tests also decreases the tools public health officials can use to identify outbreaks. In some states, testing levels are already woefully low; the positive test rate in one Iowa county, for instance, has risen above 30 percent for several days this week, suggesting a serious need for increased testing. (For reference, the World Health Organization made recommendations in May that governments should only consider reopening if positivity rates remained below 5 percent for at least two weeks.) By testing only symptomatic people, the U.S. would have no hope of understanding the true impact of community spread. It would also majorly hinder efforts by contact tracers, who typically call up all contacts of an infected person to encourage them to get tested, so that chains of infection can be uncovered and then broken.
The story has only grown more complicated as the week has gone on. On Wednesday, CNN broke the news that the decision to change these standards was made at an Aug. 20 meeting—as Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, was undergoing vocal cord surgery. “I was undergoing general anesthesia in the operating room and was not part of any discussion or deliberation regarding the new testing recommendations,” Fauci told CNN. The change came “from the top down,” according to a federal health official interviewed by CNN, a move that appears to align with President Donald Trump’s continued insistence on reducing testing. However, Health and Human Services Assistant Secretary Brett Giroir denied claims that the decision was politically driven, and says that Fauci and other scientists like White House coordinator on the coronavirus Deborah Birx and FDA Commissioner Stephen Hahn signed off on it.
On Thursday, there seemed to be a glimmer of hope for public health experts when CDC Director Robert Redfield said in a statement to some news agencies that “testing may be considered for all close contacts of confirmed or probable Covid-19 patients.” The New York Times initially framed that statement as Redfield “walk[ing] back” the new CDC guidelines, but the CDC’s website was not changed. Soon after the Times’ posted the news, Department of Health and Human Services spokesperson Michael Caputo called the Times’ Sheryl Gay Stolberg to say that Redfield’s statement was a clarification that “amplifies the policy. It in no way changes the policy,” according to a tweet from Stolberg. In essence, Redfield had just offered a more positive spin on the statement on the CDC’s website, which says “you do not necessarily need a test” if you are asymptomatic and have been exposed to someone with COVID-19.
For a statement intended as a clarification, Redfield’s words only add to the confusion. Consistent with the federal government’s (lack of) response throughout the pandemic, these guidelines leave it to local and state officials to make the call, rather than organizing a nationwide response. The revised guidelines leave enough wiggle room in their interpretation to allow cities, states, or organizations that want to ramp down testing to do so, even if it flies in the face of scientific consensus. Governors including Kentucky’s Andy Beshear, New York’s Andrew Cuomo, Connecticut’s Ned Lamont, New Jersey’s Phil Murphy, and California’s Gavin Newsom publicly declared that their states would not be changing their guidelines to align with the CDC’s. But more COVID-skeptical leaders may take this as permission to dial down testing, which could have dangerous results.
The quick and quiet changes around these guidelines also continue to erode public trust in officials and institutions. Many Americans think of the CDC as a science agency it can trust; these apparently politically driven changes have led many to question the legitimacy of its future decisions. Conservative sports commentators and political pundits have pointed to the changes as evidence that asymptomatic testing was unnecessary to start with, and that the CDC’s revised guidelines reflect scientific reality, when in fact many experts continue to emphasize asymptomatic testing as a crucial component of mitigating the spread of the virus.
Amid these changes, Politico reported Thursday that Trump may announce the acquisition of 150 million rapid coronavirus tests, which show results within 15 minutes. Experts have long said that rapid tests could be a game-changer for detecting community spread, allowing health care workers, students, athletes, and travelers to go about their business safely by monitoring their health via frequent tests. But that works best if everyone can access these quick tests, and we don’t yet know whether that will be the case: The details of this rapid test rollout have yet to be announced, and it’s unclear whether the revised CDC guidelines might reduce asymptomatic people’s access to them. In the best-case scenario, millions of widely and readily available rapid tests could obviate any decrease in testing that results from the CDC’s guideline changes. But given the federal government’s current lackluster track record with testing—its initial failed rollout of tests and a general lack of national coordination—it will take significant effort to ensure such a system is a success.