In alarming move, CDC says people exposed to COVID-19 do not need testing [Updated]

Second update 8/26/2020 3:00pm: In a press briefing Wednesday afternoon, Admiral Brett Giroir—Assistant Secretary for Health at the Department of Health and Human Services and lead for COVID-19 diagnostic testing efforts—emphatically defended the changes to the CDC’s testing recommendation, saying that it came from public health experts at the CDC and was evidence based. There was “no direction” from the president, vice president, or other top Trump Administration officials, he said.

As for the changes themselves, Adm. Giroir said the decision to not recommend testing for COVID-19 exposed individuals without symptoms was intended to avoid testing too early after an exposure. This could provide a negative result before an infection has had enough time develop and register as positive on a test, thus giving an exposed person a false-assurance of being uninfected.

It’s still unclear why the CDC did not instead provide a recommended time-frame for asymptomatic testing after an exposure, particularly given that some infected people may never develop symptoms. A positive test result is necessary to ensure COVID-19 patients receive proper care, isolation instructions, and appropriate follow-up. Identifying patients through testing is also critical for contact tracing. After a person tests positive, contact tracers can inform people who may have been exposed to the COVID-19 positive person before they tested positive and/or went into quarantine.

First update 8/26/2020 1:15pm: An unnamed official with the Centers for Disease Control and Prevention has told CNN that the change to the agency's testing recommendations occurred under pressure from the upper ranks of the Trump Administration. "It's coming from the top down," the official said.

Original story: In a mindboggling and dangerous move, the Centers for Disease Control and Prevention this week quietly reversed its recommendation on COVID-19 testing for those exposed to the virus. Now, the CDC says that exposed but symptomless people do not need to be tested.

The change immediately alarmed and outraged public health and infectious disease experts. It is well established that SARS-CoV-2—the pandemic coronavirus that causes the disease COVID-19—can cause completely asymptomatic infections in some and spread from other infected people before they develop symptoms (so-called "pre-symptomatic transmission"). In fact, some modeling studies have suggested that pre-symptomatic transmission may account for nearly half, or even more, of SARS-CoV-2 spread.

That information previously spurred the CDC to recommend testing for anyone that was known to have—or even suspected to have—close contact with an infected person (that is, be within six feet for 15 or more minutes).

“Testing is recommended for all close contacts of persons with SARS-CoV-2 infection,” the agency said on its website as recently as August 22. “Because of the potential for asymptomatic and pre-symptomatic transmission, it is important that contacts of individuals with SARS-CoV-2 infection be quickly identified and tested.”

But that evidence-based recommendation has vanished. In its place, the agency now says that exposed or potentially exposed people “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.”

When Ars reached out to the CDC to ask why the recommendation was changed and what evidence supported the new recommendation, the agency told Ars to direct questions to the Department of Health and Human Services. It noted that HHS intends to hold a press conference at 2pm ET today on testing. We will update this post with any pertinent information from that conference.

In other news related to CDC's guidances, the agency this week also provided new recommendations for customer-facing employees of retail and service businesses, such as restaurants and gas stations. The CDC warns these employees about the risk of violence from people who refuse to follow recommended or required health measures.

"Workers may be threatened and assaulted as businesses try to put into place COVID-19 prevention policies and practices (e.g., mandatory use of masks, social distancing, and limits on the number of customers allowed in a business)," the CDC says. The agency advises employees not to argue with people who make threats or appear violent. Instead, employees should report threatening incidents to a manager or supervisor and seek a safe area if needed.