Intended for healthcare professionals


Covid-19: White House told CDC to stop recommending tests for asymptomatic contacts

BMJ 2020; 370 doi: (Published 01 September 2020) Cite this as: BMJ 2020;370:m3386
  1. Owen Dyer
  1. Montreal

The White House and its coronavirus task force were the driving force behind changes to the testing guidelines put out by the US Centers for Disease Control and Prevention (CDC), which public health experts warn could facilitate the spread of covid-19.

The new guidelines,1 issued on 24 August, reverse a previous recommendation that anyone who came into close contact with people known to be infected should be tested. The CDC now recommends, “If you have been in close contact (within 6 feet) of a person with a COVID-19 infection for at least 15 minutes but do not have symptoms, you do not necessarily need a test unless you are a vulnerable individual or your health care provider or State or local public health officials recommend you take one.”

Brett Giroir, the assistant secretary of health responsible for testing, confirmed on 26 August that the impetus for the change had come from the White House. He said that the decision was based on the potential harm resulting from exposed people being tested too soon, getting a negative result before the disease had time to incubate, and developing a false sense of security from that.

“All the docs” on the White House coronavirus task force had signed off on the changes, said Giroir, naming the task force coordinator Deborah Birx, the Food and Drug Administration chief Stephen Hahn, the infectious disease expert Anthony Fauci, and a new addition, Scott Atlas, a physician from the conservative Hoover Institute at Stanford University who has argued for a swifter reopening of the economy.

“Incorrect assumption”

But on 27 August Fauci denied having been consulted. “I was under general anaesthesia in the operating room and was not part of any discussion or deliberation regarding the new testing recommendations,” he told CNN after undergoing a routine elective procedure.

He added, “I am concerned about the interpretation of these recommendations and worried it will give people the incorrect assumption that asymptomatic spread is not of great concern. In fact, it is.” Similar concerns were voiced by Tom Frieden, former CDC chief.

Marc Short, chief of staff of the task force leader Mike Pence, gave a different rationale for the change than Giroir, telling CNN that it was an attempt to tackle the backlog in delivering test results, which he suggested was particularly severe among asymptomatic patients.

But public health experts broadly agree that the testing backlog has eased significantly in the past two weeks. Critics of the change worry that its real goal is to reduce case numbers for political reasons, particularly to hinder the detection of outbreaks in schools, where large numbers of cases are likely to be asymptomatic.

Reopening schools is a priority for President Trump, who has frequently disparaged widespread testing, commenting once that it “makes us look bad.” At a rally in Tulsa in June he said that he had “asked my people” to “slow the testing down, please,” and last month he told reporters at the White House, “When you test, you create cases.”

Political ends

The Infectious Diseases Society of America joined the HIV Medicine Association in calling for “the immediate reversal of the abrupt revision” to CDC guidelines. The Association of American Medical Colleges said that it was “alarmed” by the guideline changes, which, it said, “go against the best interests of the American people.”

Critics also alleged that health policy was being bent to political ends when the FDA gave emergency approval last week for convalescent plasma, which has not been proved in randomised controlled trials. Trump announced the approval at a speech opening his party’s convention on 24 August. Hahn, the FDA commissioner, later had to walk back a claim that the treatment improved survival by 35%.

Several Democrat run states, including California and New York, said that they would not apply the new testing guidelines. “The only plausible rationale is they want fewer people taking tests because, as the president has said, if we don’t take tests you won’t know that people are covid positive and the number of covid positive people will come down,” New York’s governor, Andrew Cuomo, told reporters. He said of Trump, “It fosters his failed policy of denial.”

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