CDC’s COVID Testing Guidance Spurs Confusion, Concern

The CDC released new guidance regarding recommendations for post-exposure COVID-19 testing. Here’s what this means for infection preventionists and public health.

Living during a pandemic such as the coronavirus disease 2019 (COVID-19) as an infection preventionist (IP) means getting used to a certain level of change. It’s only natural that such guidance will change as we learn and improve our understanding of the virus. More and more I find myself leaning into the fact that recommendations will change and it’s likely the only thing we can rely on. Unfortunately, though, it’s hard to remove the increasing political pressure that is being placed on the US Centers for Disease Control and Prevention (CDC).

Early last week, the CDC released new guidance on their site regarding recommendations for post-exposure COVID-19 testing. Per the CDC, “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 healthcare provider or state or local public health officials recommend you take one.”

Immediately, there was a flurry of concern regarding this message. From concerns of the language to political pressure, and even recommendations being made based off limited testing capacity, none of this was good. Here’s what this means though, for IPs and public health.

First, this doesn’t change the guidance of a 14-day quarantine post exposure for the general public. Really, this does little to encourage people to get tested during their quarantine period. A piece that is important to note though, is that often people might feel compelled to get tested during the quarantine period and if that’s too early, there might be a false sense of security. In general, we often don’t encourage testing prior to the average incubation period (5 to 6 days), but fear and stigma around the disease might drive people to get tested prematurely.

Testing is one moment in time and with limited access and/or delays in results, this can be problematic. The new guidance would be better spent reiterating that while people should get tested if they were exposed, that does not negate the need to quarantine for the full incubation period. Most importantly though, the last thing public health guidance should be doing is discouraging people from getting tested.

Reports that the CDC was “pressured from the top down” swirled as the public health and healthcare community raised alarm about this new testing. The CDC Director, Robert Redfield, did attempt to clarify this change, noting that “Everyone who needs a Covid-19 test can get a test. Everyone who wants a test does not necessarily need a test,”. Moreover: “The guidelines, he said, were intended to place ‘an emphasis’ on testing people with symptoms, as well as people in long-term care facilities and nursing homes and people who may be particularly vulnerable to the infection.”

Outside of the politics of this pandemic, this guidance is indeed worrisome. Instead of reiterating the need to quarantine and that testing wouldn’t change that guidance, the push to only test people with symptoms ignores those who are pre-symptomatic or asymptomatic but still able to transmit the disease. Overall, as we encourage testing for all, it’s important to remind people the continued need for infection prevention practices and that should they be exposed, testing can offer insight for that single day, but it doesn’t change the need for a 14-day quarantine.