September 2, 2020

COVID-19 White House Task Force Changes Guideline on Testing

Back in March, when the threat of COVID-19 became real to most Americans, the Academy focused immediately on the impact it would have on our members and on people with, or at high risk of acquiring, HIV.  Thankfully, research to date has shown that having HIV does not increase one’s risk of acquiring COVID-19.

In one Spanish study of 77,000 people with HIV, 236 were diagnosed with COVID-19 – an incidence rate comparable to that of their general population. According to the American Journal of Managed Care, this tells us that “the risk for COVID-19 diagnosis is not higher in HIV-positive persons than in the general population.” While this is good news, our concern remains focused on HIV as a domestic crisis that is being complicated in many ways by COVID-19.

From the beginning, we have been monitoring the national strategy for handling the new pandemic, and are appalled at the change in CDC policy adopted late last month. For the last six months, the CDC has recommended COVID-19 testing as appropriate for people with recent or suspected exposure, even if they are asymptomatic. Last July, the NIH announced grants for Rapid Acceleration of Diagnostics program (RADx) to increase testing specifically to, “detect people who are asymptomatic.” A failure to test someone who might have been exposed was seen as a potential delay to treat which, in turn, could facilitate viral spread.

On August 24, the CDC website quietly reversed its previous position – now declaring that people who are asymptomatic for COVID-19 do not need COVID-19 testing even if they have recently been in close contact to someone known to have the disease. On August 26, CDC Director Robert Redfield said in a public statement that, under the new strategy, “everyone who needs a COVID-19 test can get a test,” Washington Post reported. Redfield added, however, that “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.”

Not surprisingly, this change has generated outrage in much of the medical community. Susan R. Bailey, president of the AMA, said that, “Suggesting that people without symptoms, who have known exposure to COVID-positive individuals, do not need testing is a recipe for community spread and more spikes in coronavirus.”

Brett Giroir, Assistant Secretary of Health and Human Services, claimed on August 26 that “all the docs” on the Task Force had signed the new guidelines, but that was incorrect. Dr. Anthony Fauci, a task force member and director of the National Institute of Allergy and Infectious Diseases, was absent and undergoing surgery at the time. CNN reported that Fauci expressed concern afterwards, “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!” Fauci concluded.

Reuters reports that, as of August 28, eight states (Arizona, California, Connecticut, Florida, Illinois, Texas, New Jersey and New York) have all announced that they reject the CDC’s new guidance and will continue to test asymptomatic people exposed to COVID-19 as needed.

View the latest Policy Update here.