August 26, 2020

CDC's new guidelines call for less coronavirus testing. That could be 'dangerous,' some experts say.

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    CDC on Monday revised its coronavirus testing guidelines to exclude recommendations for testing people who were exposed to the novel coronavirus but are not exhibiting symptoms of Covid-19, sparking concern among experts—including one who called the move "potentially dangerous."

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    US new coronavirus cases near 5.8M, deaths top 178K

    The announcement comes as U.S. officials as of Wednesday morning had reported a total of 5,792,900 cases of the novel coronavirus virus since the country's epidemic began—up from 5,754,100 cases reported as of Tuesday morning.

    Data from the New York Times shows that Guam, the U.S. Virgin Islands, and eight states—Connecticut, Hawaii, Iowa, Kansas, Maine, North Dakota, South Dakota, and Wyoming—saw their average daily numbers of newly reported coronavirus cases rise over the past 14 days.

    According to the Times, data indicated that Hawaii, Puerto Rico, the U.S. Virgin Islands, and some other U.S. territories in the Caribbean are now among the United States' coronavirus infection hot spots. In addition, a Wall Street Journal analysis of data from Johns Hopkins University found that rural regions in Illinois are emerging as coronavirus infection hot spots. According to the analysis, eight smaller, nonmetropolitan counties in Illinois have experienced the fastest growth in new coronavirus cases per capita in the state over the past two weeks.

    Overall, though, the Times' data shows that the average daily numbers of newly reported coronavirus cases over the past two weeks remained mostly stable in Illinois and 18 other states: Alaska, Indiana, Kentucky, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, New Jersey, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, Rhode Island, Utah, and Vermont.

    In addition, the Times' data shows that Puerto Rico, Washington D.C., and 23 states saw their average daily numbers of newly confirmed coronavirus cases decrease over the past 14 days: Alabama, Arizona, Arkansas, California, Colorado, Delaware, Florida, Georgia, Idaho, Louisiana, Maryland, Nebraska, Nevada, New Hampshire, New Mexico, Oregon, South Carolina, Tennessee, Texas, Virginia, Washington, West Virginia, and Wisconsin.

    U.S. officials as of Wednesday morning also had reported a total of 178,410 deaths linked to the coronavirus since the country's epidemic began—up from 177,198 deaths reported as of Tuesday morning.

    According to the Times' data, eight states saw their average daily numbers of newly reported deaths linked to the coronavirus rise over the past 14 days: Arkansas, Delaware, Idaho, Kentucky, Minnesota, Oklahoma, Rhode Island, and Tennessee.

    CDC updates testing guidelines to exclude people without Covid-19 symptoms

    Over the past few months, spikes in new coronavirus cases throughout the United States have led to shortages of coronavirus tests and testing supplies and have strained the country's capacity to process the tests. Still, public health experts resoundingly have called for the country to continue ramping up its testing capacity and the numbers of coronavirus tests conducted as a way to help get America's coronavirus epidemic under control. Experts also have urged for testing people who may have been exposed to the coronavirus but who are not showing symptoms of Covid-19, the disease caused by the virus, because evidence has suggested that asymptomatic patients likely contribute to the virus' spread.

    However, CDC on Monday updated its guidelines to exclude people who do not show symptoms of Covid-19 from its coronavirus testing recommendations, even if they've been exposed to someone with a known coronavirus infection.

    According to the Times, CDC's guidelines previously recommended coronavirus testing "for all close contacts" of people who have been infected with the novel coronavirus, irrespective of whether those contacts were showing symptoms of Covid-19. CDC in the guidelines had noted that "the potential for asymptomatic and pre-symptomatic transmission" is a critical component in the novel coronavirus' spread, the Times reports.

    But CDC in its newly update guidelines states that people who have been in close contact with a person infected with the coronavirus "do not necessarily need a test" if they're not exhibiting symptoms of Covid-19. The agency said such individuals instead should monitor themselves for Covid-19 symptoms and "strictly adhere to CDC mitigation protocols, especially if [they] are interacting with a vulnerable individual."

    CDC recommended some exceptions to the new guidance, however. For instance, CDC said people who were exposed to the coronavirus and are "vulnerable" to developing a severe case of Covid-19 could be tested even if they're not experiencing symptoms. In addition, CDC said exceptions could be made when health care providers or state or local public health officials recommend a person undergo testing.

    Experts say the change could be 'dangerous'

    Public health experts were quick to lambast CDC's updated recommendations, citing the importance of detecting coronavirus infections before the onset of Covid-19 symptoms to help contain the pathogen. Specifically, experts pointed to research suggesting that many people who transmit the virus to others do so before they start developing symptoms of Covid-19, as the virus appears to be most contagious during that time, the Times reports. Further, CDC has estimated that about 40% of people infected with the coronavirus may never experience symptoms of Covid-19, though they still may spread the virus to others.

    Krutika Kuppalli—an infectious disease physician in Palo Alto, California—called CDC's updated guidance "potentially dangerous," and explained that limiting testing to people with clear Covid-19 symptoms means "you're not looking for a lot of people who are potential spreaders of disease."

    "I feel like this is going to make things worse," Kuppalli said. "If people are getting exposed, and they're not getting tested, and they're not isolating, that's a huge problem."

    Daniel Larremore, a mathematician and infectious diseases modeler at the University of Colorado Boulder, said of CDC's update, "I think it's bizarre." Larremore added, "Any move right now to reduce levels of testing by changing guidelines is a step in the wrong direction."

    Susan Butler-Wu, a clinical microbiologist at the University of Southern California's Keck School of Medicine, said she is afraid people might misinterpret CDC's newest guidance and incorrectly assume that people without Covid-19 symptoms do not spread the novel coronavirus to others. And Angela Rasmussen, a research scientist at Columbia Public Health, said, "It seems as though this new guidance is actively discouraging people from seeking testing, even if they have a known exposure. We need more testing, not less."

    Trump admin officials respond

    According to NBC News, CDC declined a request to comment on the update and referred all media inquiries to HHS.

    Brett Giroir, HHS' assistant secretary for health and the official overseeing the Trump administration's coronavirus testing efforts, in an email to NBC News wrote that the guidance was "updated to reflect current evidence and best public health practices," though NBC News reports that it wasn't clear exactly which guidance Giror was describing.

    According to the Times, an HHS spokesperson said CDC did not update the guidelines in response to coronavirus testing or capacity shortages. "Testing capacity has massively expanded, and we are not utilizing the full capacity that we have developed," the spokesperson reportedly told the Times. "We revised the guidance to reflect current evidence and the best public health interventions," the spokesperson added (Maher, Wall Street Journal, 8/25; Romero/Mazzei, New York Times, 8/25; Associated Press, 8/26; Wu, New York Times, 8/25; Farzan et al., Washington Post, 8/26; Edwards, NBC News, 8/25; New York Times, 8/26; CDC testing overview, 8/24).

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