As the Republican National Convention wrapped up its opening day and the pandemic continued to ravage the nation, the Centers for Disease Prevention and Control quietly revised its website to call for less COVID-19 testing.
No press release.
No media briefing.
And no underlying scientific basis for the change.
That’s because the science of controlling the pandemic points in the opposite direction. Until August 24, so did the CDC. For Americans’ public health, the revision is a giant leap backward. An enraged medical community demands answers, and the country needs to know how it happened.
Why Does it Matter to Public Health?
A COVID-19 test reveals whether an individual is infected. That’s particularly important for those who have been exposed to the virus but don’t have symptoms. They could be pre-symptomatic and highly contagious. The CDC estimates that 50 percent of COVID-19’s spread occurs prior to the onset of symptoms for those who develop them. Or they could be among the estimated 40 percent of infected individuals who never develop any symptoms but nevertheless can infect others who get sick and even die.
A test is the only way to identify those pre-symptomatic and asymptomatic people, isolate them and trace their contacts with others. And that’s the only way to stop a pandemic.
Why Does it Matter to Trump?
As more testing increased the reported number of COVID-19 cases in the US, Trump didn’t like it. He said it made him look bad compared to other world leaders, almost all of whom did a better job controlling the pandemic and saving their citizens’ lives.
June 20-22: At his rally in Tulsa, Trump said, “[W]hen you do testing to that extent, you’re going to find more people; you’re going to find more cases. So I said to my people, slow the testing down please.” Immediately, critics flagged his remarks as absurd and medically and dangerous for any COVID-19 containment strategy. But when his advisers claimed that he was kidding, Trump responded, “I don’t kid, let me just tell you, let me make it clear.”
Week of July 3: The CDC updated its guidance to urge that anyone in recent contact with an infected person should get tested for COVID-19, specifically including those without symptoms. It emphasized “the potential for asymptomatic and pre-symptomatic transmission” as an important factor in spreading the virus.
“Anyone who thinks they may be infected — independent of symptoms — should get a test,” CDC Director Dr. Robert Redfield told ABC News.
Aug. 3: Dr. Scott Atlas, a radiologist with no expertise in infectious diseases or epidemiology, appeared on Fox News. He said that “people are kidding themselves” about the value of testing individuals who don’t have symptoms. For weeks, Dr. Atlas had been informally advising the White House after Trump saw him on Fox echoing Trump’s views on the need to reopen schools and railing against the “frenzy” of mass testing.
Aug. 10: Trump introduced Dr. Atlas as the newest member of the White House Coronavirus Task Force.
Aug. 24: The CDC quietly revised its online guidance to reduce COVID-19 testing. Where previously it had recommended testing for individuals with recent exposure to COVID-19 — even if they had no symptoms — the guidance now said the opposite:
“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.”
Who Did It?
Aug. 26: “The people in the trenches are horrified by this,” according to a person who works with the White House Task Force. “It gives the impression that asymptomatic people cannot transmit the disease, which is not true. Community spread is driven by asymptomatic people.”
- People at the top levels of the Trump administration pushed for the change, according to a health official close to the process: “It’s coming from the top down.”
- The New York Times reported that “the shift came as a directive to the Atlanta-based CDC from higher-ups in Washington at the White House and the Department of Health and Human Services.”
Later on Aug. 26: Assistant Secretary for Health and Human Services (HHS) Dr. Brett Giroir, the Trump administration’s COVID-19 “testing czar,” tried to explain the CDC’s abrupt reversal.
“There is no direction from President Trump, the vice president or the secretary [of HHS], about what we need to do, when,” Dr. Giroir began defensively. Then he named the medical experts who “discussed extensively” the new guidance that received final approval at an August 20 White House Task Force meeting: Dr. Atlas, Dr. Redfield, FDA Commissioner Dr. Stephen Hahn, and Dr. Anthony Fauci, the nation’s leading infectious diseases expert. Notably omitted from Dr. Giroir’s list was the White House coronavirus response coordinator, Dr. Deborah Birx.
Let’s call the roll:
- Dr. Atlas’ hostility toward widespread testing was a matter of public record.
- Dr. Redfield was muzzled. The CDC directed all questions about the change to HHS, which set off alarm bells, suggesting that HHS, not the CDC, initiated and ordered the change. But on July 23, Dr. Redfield had already compromised his personal reputation and his agency’s credibility: The CDC put its imprimatur on a public relations piece that HHS had written to help Trump push schools to reopen, even if they had not satisfied previously recommended CDC guidance.
- Dr. Hahn didn’t speak publicly about the change. Neither did Dr. Birx.
- Dr. Fauci didn’t even attend the August 20 meeting. When CNN’s Dr. Sanjay Gupta asked him about it, he said, “I was under general anesthesia in the operating room and was not part of any discussion or deliberation regarding the new testing recommendations….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.”
Also on Aug. 26: Across the country, doctors and epidemiologists blasted the CDC’s reversal:
- The American Medical Association called the CDC change a “recipe for community spread.”
- The Association of American Medical Colleges warned that the new guidelines were “irresponsible” and “will result in less testing at exactly the time when we need more testing in order to control the pandemic.…These CDC guidelines go against the best interests of the American people and are a step backward in fighting the pandemic.” (Emphasis in original)
- The Infectious Diseases Society of America called for the “immediate reversal of the abrupt revision.”
Aug. 26 at 10:00 pm: Amid growing criticism, the CDC released a statement under Dr. Redfield’s name purporting to “clarify” the new guidance. It added more confusion:
- “Everyone who needs a COVID-19 test, can get a test. Everyone who wants a test does not necessarily need a test; the key is to engage the needed public health community in the decision with the appropriate follow-up action.” (Emphasis in original)
The statement also noted that the new guidelines were “coordinated in conjunction with the White House Coronavirus Task Force,” asserting that they “received appropriate attention, consultation and input from task force experts.” Importantly, the CDC website didn’t change a single word of its new guidance: A person exposed to someone with COVID-19 still did “not necessarily need a test.”
Aug. 27-28: Physician groups and public health organizations across the country continued to denounce the new guidance:
- The Society for Healthcare Epidemiology of America “vehemently” disagreed with the new guidelines and urged the CDC to rescind them.
- The American Public Health Association was “deeply concerned” with the “dramatic shift from previous federal guidelines” and worried that “this change was the result of political pressure.”
- The American Academy of Pediatrics urged the CDC to reverse its “inexplicable decision” because it was a “dangerous step backward in our efforts to control this deadly virus.”
The National Association of County and City Health Officials and the Big Cities Health Coalition, representing the nation’s nearly 3,000 local health departments and 30 of the country’s largest, most urban departments, respectively, wrote directly to Drs. Redfield and Giroir. They were “incredibly concerned with both the impact and the process of the guidance change” and urged reversal because it is “inconsistent with the science and the data.” And they dispelled the Trump administration’s claim that the new guidance somehow empowered local public health officials:
- “While it has been touted that this is to empower these leaders, in many ways, CDC’s guidance change will make their ability to respond to the pandemic even harder. Our members have stressed the vital importance of testing all close contacts and to do so with clear and consistent messaging. Without clear data backing up the rationale behind the revision, this change has put them in a position to say they will not be following the CDC guidelines.”
Who Will Tell Americans the Truth?
Trump wanted fewer tests. Now he’ll get fewer tests. The new guidance gives cover to colleges, schools and workplaces that don’t want to test, contact trace, or close when they get outbreaks. It creates confusion for medical and public health professionals and adds new doubts about insurance coverage for COVID-19 testing.
But superficially, and for a short time, any decline in newly confirmed infections could fuel the false hope that the pandemic is receding. Trump can use such illusory progress as another deceptive COVID-19 talking point, just as early voters begin to cast ballots in September.
Reducing the number of tests won’t reduce the number of COVID-19 illnesses, hospitalizations or body bags. It will do the opposite, just as insufficient testing in the US caused irreparable damage at the outset of the pandemic. Trump’s early denials of COVID-19’s seriousness, combined with his failure to implement a nationwide testing program, started America down the road to its current catastrophe: The US has only four percent of the world’s population but more than 20 percent of the world’s COVID-19 deaths.
According to the latest projection that the White House has often cited, by December 1, the country will have a total of 317,000 COVID-19 fatalities and the virus will become the leading cause of death in the United States.
The CDC’s new guidance repeats Trump’s earlier “see no evil” tragedy. Once again, individuals who are unaware of their infections will unwittingly infect others. Many more will get sick and some will die as the pandemic rages uncontrollably — but more surreptitiously — throughout the land.
Eventually, the truth behind the CDC’s reversal will come out. But given the staggering public health implications, sooner would be far better than later because the health of millions hangs in the balance. To rephrase Trump’s plea four years ago:
“Potential CDC whistleblowers, if you’re listening…”