Pressured CDC

Trump officials pressured CDC to change virus testing guidelines

Public health experts have questioned the scientific basis for the testing change.

By DAVID LIM and ADAM CANCRYN

Top Trump administration officials involved with the White House coronavirus task force ordered the Centers for Disease Control and Protection to stop promoting coronavirus testing for most people who have been exposed to the virus but aren't showing symptoms, according to two people with knowledge of the process.

Federal testing czar Brett Giroir denied those allegations Wednesday, telling reporters that the CDC ultimately decided to narrow the recommendations for who should be tested.

“The new guidelines are a CDC action,” Giroir said. “As always, the guidelines received appropriate attention, consultation and input from Task Force experts, and I mean the medical and scientific experts, including CDC Director [Robert] Redfield.”

The revised testing guidelines, which CDC released late Monday with no public notice, say it is up to state and local public health officials and health providers to decide whether people without symptoms or underlying risk factors need a test after high-risk situations — such as coming into contact with an infected person for more than 15 minutes.

The agency also now says it is up to local public health experts to decide whether testing is needed for people who attend a public or private gathering of more than 10 individuals when masks are not worn and social-distancing guidelines are not followed.

Anthony Fauci, the government's top infectious disease expert, said the change could send the wrong message. "I'm worried it will give people the incorrect assumption that asymptomatic spread is not of great concern," Fauci said in a statement read by CNN's Sanjay Gupta on-air Wednesday afternoon. "In fact, it is."

Fauci also told Gupta that he was under anesthesia having vocal cord surgery on Thursday when the task force met to approve the CDC guidance. Giroir told reporters that Fauci had worked on the recommendations, which he said were developed over the past month.

Other public health experts questioned the scientific basis for the testing changes, which they said could make it harder for the United States to contain its outbreak — especially with students heading back to schools and universities across the country in the coming weeks.

Time-honored techniques for stopping infectious disease outbreaks rely on testing to identify people are infected and tracing the people with whom they have come into contact and unwittingly exposed.

Carlos del Rio, executive associate dean at the Emory School of Medicine, told POLITICO the CDC guidelines do not make sense because individuals who have been in close contact with a confirmed case of Covid-19 for at least 15 minutes could potentially be infected and should be tested.

“Asymptomatic people transmit, and if you don’t isolate them and you don’t identify them, transmission will continue,” del Rio said. “I’m worried we are not diagnosing the people that we need to diagnose.”

New York Gov. Andrew Cuomo slammed the change as “political propaganda.” Officials in several other states, including California, Connecticut and Washington, said Wednesday that they would not alter their testing approach to match the new CDC guidelines.

“We will not be influenced by that change,” California Gov. Gavin Newsom said at a press conference. “We are influenced by those who are experts in the field and feel very differently.”

The CDC update comes as the Trump administration has increasingly shifted its testing focus toward settings like nursing homes and long-term care facilities, which officials argue are key sources of outbreaks and account for a disproportionate number of Covid-19 deaths.

The guidance posted Monday emphasizes the need for more regular testing of those living or working in nursing homes. And on Tuesday, CMS issued new rules that would require testing in nursing homes — though it remains unclear what the parameters will be for that mandate.

One person close to the CDC changes defended them as necessary to prioritize testing for those at higher risk of infection, arguing that demand has been stretched by people seeking out tests when it's unlikely they've been exposed to the virus.

Giroir argued the administration “does not expect” new CDC guidelines to decrease the volume of tests being conducted. With new tests soon coming onto the market, the number of people who can be screened “will go up significantly over the next couple of months.” That increase will come from “strategically done tests, not just tests done for the sake of being tested,” he added.

The testing czar also denied that politics motivated the CDC switch, despite President Donald Trump’s repeated arguments that U.S. case numbers are high because the country conducts many tests.

“There is no direction from President Trump, the Vice President [Mike Pence] or [HHS Secretary Alex Azar] about what we need to do when,” Giroir said. “This is evidence based decisions that are driven by the scientists and physicians, both within the CDC, within my office and the lab task force.”

Eleanor Murray, assistant professor of epidemiology at Boston University School of Public Health, pushed back against the idea that different localities should take varying approaches to testing of potentially infected people, saying “the epidemiology isn’t location dependent.”

“The only possible flexibility I could see at the local level on this is whether to just mandate everyone does the full quarantine or allow testing to try to rule out infection,” Murray said. “The new CDC guidelines aren’t replacing testing with quarantine though. They’re just ignoring transmission pre-symptoms.”

American Medical Association President Susan Bailey urged CDC and HHS to provide the scientific justification behind making the change to the testing recommendations.

"Suggesting that people without symptoms, who have known exposure to COVID-positive individuals, do not need testing is a recipe for community spread and more spikes in coronavirus," Bailey said.

The abrupt — and unannounced — changes have already intensified scrutiny of the CDC's independence, and the administration's broader coronavirus response ahead of the November election.

Rep. Rosa DeLauro — who chairs the House appropriations subcommittee overseeing the health department — slammed the new guidelines on Wednesday as "clearly political" and "unfathomable that the CDC is implementing guidelines that completely ignore the data.”

Scientists, not just politicians, are also sounding the alarm about the potential motives behind the CDC’s latest action.

“With all the things that the president has been saying about testing, it’s hard to not be suspicious and say ‘hey, they don’t want to test people because they’re really worried that more people are going to be diagnosed and that impacts the numbers.’ I really don’t know,” del Rio said.