Recent actions by leaders at two federal agencies at the forefront of the U.S. response to the covid-19 pandemic are deeply concerning. Officials at the Centers for Disease Control and Prevention and the commissioner of the Food and Drug Administration have acted this week in ways that appear to abandon or misrepresent available evidence, to the detriment of our nation's efforts to fight this deadly disease.
On Monday, the CDC modified its guidelines for covid-19 testing to state that most people who do not have symptoms do not need to get tested, even if they have been exposed to the virus. The revised guidelines include exceptions for vulnerable people, health-care providers, and residents of states with stricter guidelines. Previously, the agency recommended that everyone, whether symptomatic or not, seek testing after coming in close contact with a person infected with covid-19.
How does this change line up with what we know about the disease? By the CDC's own estimate, up to 40 percent of people infected with the virus that causes covid-19 never develop any symptoms. We know that people who are infected but asymptomatic can be infectious. The virus spreads through contact, so there is no scientific justification for advising anyone who has been in contact with an infected person that getting tested is unnecessary because of the absence of symptoms.
Reducing testing will have serious consequences. If asymptomatic people with covid-19 do not get tested, they will not know to self-isolate, which will lead to more spread. Less testing will lead to less effective contact tracing, and consequently, less effective mitigation of its immediate and long-term impacts on Americans. And many may misinterpret the change in the CDC's guidelines to mean that asymptomatic people cannot spread the disease, which will lead to reduced adherence to safety precautions. If Arkansans follow these new guidelines, much of our investment as a state in contact tracing will be wasted.
The CDC has said states can recommend testing for asymptomatic people, and thankfully, Gov. Asa Hutchinson has said Arkansas will continue to make that recommendation. But this action by the CDC appears to be either an abdication of any attempt to have a national strategy to track the spread of this virus or, alternatively, an admission of failure to have a national plan to make adequate testing available.
News agencies have reported that according to unnamed federal health officials, the change was made under political pressure from the administration of a president who has said publicly, and reiterated, that he would like to see less testing done. The CDC has denied the charge, but at this writing I have not seen a scientific justification provided by the agency.
The explanation of the revision on the agency's website is not much help: "Diagnostic testing categories have been edited to focus on testing considerations and actions to be taken by individuals undergoing testing." That sentence should be studied in English classes as a lesson in obfuscation.
Also this week, FDA Commissioner Stephen Hahn said during an event Sunday at the White House with Donald Trump that treating covid-19 patients with convalescent plasma, recently authorized by the agency, would save the lives of 35 percent of people treated. Hahn was referring to findings in an unpublished study that actually found a much smaller reduction in mortality: 3 to 5 percentage points.
Hahn later said he had confused relative risk reduction with absolute risk reduction, but the notion that a person with Hahn's extensive background as a researcher would make such a blunder is, frankly, hard to swallow.
The immediate effect of Hahn's misstatement was to create irrational exuberance and allow the Trump administration to take credit for an exaggerated claim of progress in the fight against covid-19. But an important tool in that fight is public understanding; we depend on our government agencies to provide information based on the best available evidence, impervious to the prevailing political winds.
There is no doubt that this pandemic is unprecedented in our time, and we can expect to see, and have seen, missteps in the nation's response. But we are nearly six months into our response, and we know more now.
The recent actions by leaders of the CDC and the FDA threaten to undermine our confidence in these institutions. We need to be able to trust our federal agencies to act in the interests of the health of the American people, not in the interests of anyone's political career.
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Joe Thompson, MD, MPH, is president and CEO of the Arkansas Center for Health Improvement and was Arkansas' surgeon general under Govs. Mike Huckabee and Mike Beebe.