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Trump test chief defends new CDC guidelines after blowback

Emma Court and Jacquie Lee
Bloomberg

The U.S. Centers for Disease Control and Prevention’s shift in guidance on COVID-19 testing away from asymptomatic individuals this week alarmed many public-health experts who say it’s a wrong turn that could restrict how many tests are performed.

Brett Giroir, a top Trump administration official overseeing coronavirus testing, fired back on the criticism during a Wednesday briefing, telling reporters that the change wasn’t influenced by the White House and is intended to clarify to the public the limitations of such screenings, not to reduce how many tests are conducted.

Assistant Secretary for Health Admiral Brett P. Giroir speaks during a House Select Subcommittee hearing on the Coronavirus, Friday, July 31, 2020,

The new recommendations say testing may not be needed for asymptomatic close contacts and those who attended large, risky gatherings but lack symptoms. Giroir said that in areas with high virus rates, many people without symptoms will be tested at surge screening sites, which he contrasted with someone in a “place where it’s 1% positive saying I want to get tested today, tomorrow and the next day.”

“I’m really not sure how people could interpret that if they actually read them because what we’ve tried to do is put more responsibility on public health officials,” he said.

CNN reported on Wednesday that the CDC guidance change was due to pressure from Trump administration officials, citing an unidentified official. New York Governor Andrew Cuomo called the move “political propaganda” and an effort by President Donald Trump to bring down the number of cases with less testing. But Giroir said that the guidelines had been a joint effort, with the involvement of top health officials including Anthony Fauci, who has been one of the most prominent administration voices on the virus.

Giroir said that the final draft was circulated on Thursday at a White House Coronavirus Task Force meeting. Fauci, director of the National Institute of Allergy and Infectious Diseases, was in surgery that day though and didn’t attend the meeting, NIAID said.

“He does recall quickly reviewing a version of the guidelines that circulated at some time before the Aug. 20 meeting,” according to the NIAID statement. “Without having the benefit of the discussion that took place on Aug. 20 at the Task Force meeting where the guidelines were finalized, but now reading them carefully, he has some concern that the revised guidelines could be interpreted as lessening the importance of asymptomatic spread of virus in the community.”

The Centers for Medicare and Medicaid issued guidance on Tuesday regarding testing nursing home staff and residents that differs from the CDC recommendations, saying that anyone working or living at a nursing home will have to get tested for COVID-19 regularly.

Although the CMS guidance didn’t specify how often staff should be tested, nursing homes will likely have to test them at least once a month. Frequency could rise to once a week if positivety levels in nearby communities are between 5% and 10% and twice a week if positive cases are above 10%, the head of the agency said.

Nursing homes also have to offer residents testing after there’s been an outbreak or if they’re showing symptoms, the new guidelines say. Facilities that fail to comply could face hundreds of dollars per day in fines.

The CDC’s recommendations for nursing home testing already include a section on reopening facilities that close after an outbreak. In that scenario, “initial viral testing of each resident (who is not known to have previously been diagnosed with COVID-19) is recommended because of the high likelihood of exposure during a pandemic, transmissibility of SARS-CoV-2, and the risk of complications among residents following infection.”

DOJ inquiry

COVID-19 has ravaged nursing homes around the country, and the elderly make up a substantial portion of virus deaths in the U.S. Some reports, including an analysis of state data by USA Today, say nursing home residents have made up 40% of coronavirus deaths.

On Wednesday, the Department of Justice announced that it was seeking data from four Democrat-led states on deaths at nursing homes to see whether an investigation into whether their policies requiring facilities to re-admit patients diagnosed with Covid caused spikes in cases and deaths.

The CDC guidance reflects a shift in tone by the federal government and some states that began earlier this summer, as lengthy delays in getting test results made headlines. In mid-July, for instance, Giroir recommended only testing individuals with symptoms and front-line workers, and Florida asked labs to prioritize tests for symptomatic individuals. Major commercial labs report that test results have become speedier in recent weeks, with turnarounds of a few days on average.

Yet public health experts said the new guidance, released as part of an unpublicized update to the CDC’s website, could in fact cut down on testing.

“This makes no sense,” wrote Leana Wen, a physician who formerly served as Baltimore’s health commissioner and led Planned Parenthood and is a visiting professor of health policy and management at George Washington University, in a tweet late Tuesday. “We need more testing, not less.”

Howard Forman, director of the Yale School of Public Health’s health-care management program, called the shift “insane and counter to all the best evidence that we have about how testing is supposed to work and appears to work.”

“We need to identify asymptomatic infected individuals as soon as feasible and isolate them and begin contact tracing when feasible,” he said in an email.