POST 44. September 1, 2020. CORONAVIRUS. “The CDC…modified its coronavirus testing guidelines…to exclude people who do not have symptoms of Covid-19.” (While Dr. Fauci was undergoing surgery.) A White House official said: “Everybody is going to catch this thing eventually..”

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“This is a story about four people named Everybody, Somebody, Anybody and Nobody. There was an important job to be done and Everybody was sure that Somebody would do it. Anybody could have done it, but Nobody did it. Somebody got angry about that, because it was Everybody’s job. Everybody thought Anybody could do it, but Nobody realized that Everybody wouldn’t do it. It ended up that Everybody blamed Somebody when Nobody did what Anybody could have.” (A)

“Speakers during Tuesday’s portion of the RNC repeatedly referred to the coronavirus pandemic in the past tense, as though it’s something the US has already overcome thanks to President Donald Trump’s leadership. In reality, the virus continues to ravage the country, and Trump hasn’t developed a plan to get things under control beyond blustering and buck-passing.

The worst offender was White House economics adviser Larry Kudlow, whose speech on Tuesday made it sound like the coronavirus was over.

“It was awful,” Kudlow said. “Health and economic impacts were tragic. Hardship and heartbreak were everywhere. But presidential leadership came swiftly and effectively with an extraordinary rescue for health and safety to successfully fight the Covid virus.” “(B)

“A White House official’s flippant response to concerns about the maskless crowds of attendees at the Republican National Convention—and the GOP’s ignoring of the coronavirus’s horrific toll—have sparked widespred outrage this week.

“Everybody is going to catch this thing eventually,” a senior White House official told CNN’s Jim Acosta Thursday.” (C)

“The Centers for Disease Control and Prevention quietly modified its coronavirus testing guidelines this week to exclude people who do not have symptoms of Covid-19 — even if they have been recently exposed to the virus.

Experts questioned the revision, pointing to the importance of identifying infections in the small window immediately before the onset of symptoms, when many individuals appear to be most contagious.

Models suggest that about half of transmission events can be traced back to individuals still in this so-called pre-symptomatic stage, before they start to feel ill — if they ever feel sick at all…

Prior iterations of the C.D.C.’s testing guidelines struck a markedly different tone, explicitly stating that “testing is recommended for all close contacts” of people infected with the coronavirus, regardless of symptoms. The agency also specifically emphasized “the potential for asymptomatic and pre-symptomatic transmission” as an important factor in the spread of the virus.

The newest version, which was posted on Monday, amended the agency’s guidance to say that people who have been in close contact with an infected individual — typically defined as being within six feet of a person with the coronavirus and for at least 15 minutes — “do not necessarily need a test” if they do not have symptoms. Exceptions, the agency noted, might be made for “vulnerable” individuals, or if health care providers or state or local public health officials recommend testing.” (D)

“CDC referred questions to HHS. In a statement provided Wednesday to CNN, HHS Assistant Secretary Dr. Brett Giroir said: “This Guidance has been updated to reflect current evidence and best public health practices, and to further emphasize using CDC-approved prevention strategies to protect yourself, your family, and the most vulnerable of all ages.”

HHS has not specified what change in “current evidence” may have driven the change.” (E)

“White House Coronavirus Task Force member Dr. Anthony Fauci said he was undergoing surgery and not in the August 20 task force meeting for the discussion on updated US Centers for Disease Control and Prevention guidelines that suggest asymptomatic people may not need to be tested for Covid-19, even if they’ve been in close contact with an infected person.

“I was under general anesthesia in the operating room and was not part of any discussion or deliberation regarding the new testing recommendations” at that meeting, Fauci told CNN Chief Medical Correspondent Dr. Sanjay Gupta.

“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,” said Fauci, director of the National Institute of Allergy and Infectious Diseases.

CDC was pressured ‘from the top down’ to change coronavirus testing guidance, official says

Fauci’s comments undercut claims by Adm. Brett Giroir, the administration’s coronavirus testing point person, who told reporters on Wednesday that the new guidelines had the White House coronavirus task force’s stamp of approval. Asked whether Fauci signed off on the guidelines, Giroir said, “Yes, all the docs signed off on this before it even got to the task force level.”

“We worked on this all together to make sure that there was absolute consensus that reflected the best possible evidence, and the best public health for the American people,” Giroir also said earlier in the call, pushing back on the notion that the new guidelines were the result of political pressure. “I worked on them, Dr. Fauci worked on them, Dr. (Deborah) Birx worked on them. Dr. (Stephen) Hahn worked on them.”

The new CDC guidelines appeared to be the result of an idea raised to the task force by CDC Director Robert Redfield a month earlier, when a surge of coronavirus cases strained US testing resources and some members were looking for new messaging on how to stem excess testing.

Rather than continue to encourage anyone in close contact with a coronavirus-positive individual to get tested, Redfield suggested the CDC could relax the guidance, deeming a test unnecessary for otherwise healthy individuals not experiencing any symptoms, two sources familiar with the matter said. Experts worry that this will discourage the widespread testing of asymptomatic individuals that could help bring the pandemic under control.

The idea was met with immediate resistance from several task force members. In a coronavirus task force meeting Thursday, members debated the guidelines in-depth and in person, when Fauci was absent…” (F)

“In a brief interview, Dr. Fauci said he had seen an early iteration of the guidelines and did not object. But the final debate over the revisions took place at a task force meeting on Thursday, when Dr. Fauci was having surgery under general anesthesia to remove a polyp on his vocal cord. In retrospect, he said, he now had “some concerns” about advising people against getting tested, because the virus could be spread through asymptomatic contact.

“My concern is that it will be misinterpreted,” Dr. Fauci said.

The newest version of the C.D.C. guidelines, posted on Monday, amended the agency’s guidance to say that people who had been in close contact with an infected individual — typically defined as being within six feet of a person with the coronavirus and for at least 15 minutes — “do not necessarily need a test” if they do not have symptoms.

Exceptions might be made for “vulnerable” individuals, the agency noted, or if health care providers or state or local public health officials recommended testing.

Dr. Giroir said the new recommendation matched existing guidance for hospital workers and others in frontline jobs who have “close exposures” to people infected with the coronavirus. Such workers are advised to take proper precautions, like wearing masks, socially distancing, washing their hands frequently and monitoring themselves for symptoms.

He argued that testing those exposed to the virus was of little utility, because tests capture only a single point in time, and that the results could give people a false sense of security.

“A negative test on Day 2 doesn’t mean you’re negative. So what is the value of that?” Dr. Giroir asked, adding, “It doesn’t mean on Day 4 you can go out and visit Grandma or on Day 6 go out without a mask on in school.”

The guidelines come amid growing concern that the C.D.C., the agency charged with tracking and fighting outbreaks of infectious disease, is being sidelined by its parent agency, the Department of Health and Human Services, and the White House. Under ordinary circumstances, administering public health advice to the nation would fall squarely within the C.D.C.’s portfolio…

Mr. Trump has suggested that the nation should do less testing, arguing that administering more tests was driving up case numbers and making the United States look bad. But experts say the true measure of the pandemic is not case numbers but test positivity rates — the percentage of tests coming back positive.

As Dr. Giroir denied that politics was involved, he encouraged the continued testing of asymptomatic people for surveillance purposes — to determine the prevalence of the virus in a given community — and said such “baseline surveillance testing” would still be appropriate in schools and on college campuses.

“We’re trying to do appropriate testing, not less testing,” he said.”  (G)

“Susan R. Bailey, MD, president of the American Medical Association:

“Months into this pandemic, we know COVID-19 is spread by asymptomatic people. 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. When the Centers for Disease Control and Prevention updates a guidance, the agency should provide a rationale for the change. We urge CDC and the Department of Health and Human Services to release the scientific justification for this change in testing guidelines.”

Association of American Medical Colleges President and CEO David J. Skorton, MD, and Chief Scientific Officer Ross McKinney Jr., MD:

“The AAMC is alarmed at the changes to the CDC’s guidelines for SARS-CoV-2 (COVID-19) testing, which recommends that individuals who have been exposed to someone with COVID-19 do not need to be tested unless they show symptoms of the disease. This recommendation is irresponsible when we know that roughly 40 percent of SARS-CoV-2 transmissions come from an asymptomatic person. The revised guidance 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. The AAMC urges the CDC to return to its earlier testing recommendations, and we stand ready to discuss and work with our colleagues at the CDC to optimize future recommendations.”

California Gov. Gavin Newsom:

“I don’t agree with the new CDC guidance, period, full stop. It’s not the policy in the state of California. We will not be influenced by that change. We’re influenced by those who are experts in the field who feel very differently,” the governor stated during an Aug. 26 news briefing, as reported by KABC-TV.

New York Gov. Andrew Cuomo said his state won’t be following the new guideline, according to an Aug. 26 interview with MSNBC. Mr. Cuomo said CDC officials suggested to New York Health Commissioner Howard Zucker, MD, that the change in guidelines was more of a “political position” and not a scientific one…

Heather E. Gantzer, MD, Chair of the Board of Regents of the American College of Physicians

“The American College of Physicians, representing 163,000 internal medicine physicians (internists), related subspecialists and medical students, strongly supports the use of science, based on the best available evidence, in the fight against COVID-19. Public health agencies should not be subjected to pressure or be influenced to issue policies that are not based on evidence and expert recommendations of their own scientists. This can have a detrimental effect on the public’s trust and adherence to evidence-based guidelines.”

“The recent revision of the CDC’s COVID-19 testing guidelines of asymptomatic individuals lacks transparency and clarity, sending a confusing message to both physicians and the public on appropriate and necessary testing that will ultimately help to mitigate the spread of COVID-19. Asymptomatic patients contribute to the spread of COVID-19. The ability to conduct widespread testing using a rapid and accurate test is critical to appropriately manage the spread of SARS-CoV2. ACP recommends that in the absence of currently effective vaccine or treatment options available for COVID-19, state and local authorities should prioritize a strategy of case finding, screening and surveillance to track and reduce further spread. ACP believes that the United States should urgently expand health system capacity to diagnose, test, and conduct contact tracing (with privacy protections).”” (H)

“Two organizations that represent thousands of local public health departments in the United States sent a letter to senior Trump administration officials on Friday asking that they “pull the revised guidance” on virus testing and restore recommendations that individuals who have been exposed to the virus be tested whether or not they have symptoms.

The letter — addressed to Dr. Robert R. Redfield, director of the Centers for Disease Control and Prevention, and Adm. Brett P. Giroir, an assistant secretary of health at the Department of Health and Human Services — was sent by the leaders of the National Association of County and City Health Officials, and the Big Cities Health Coalition. The organizations’ leaders wrote that their members were “incredibly concerned” about the changes…

The letter sent on Friday said, “As public health professionals, we are troubled about the lack of evidence cited to inform this change. CDC’s own data suggest that perhaps as many as 40 percent of Covid-19 cases are attributable to asymptomatic transmission. Changing testing guidelines to suggest that close contacts to confirmed positives without symptoms do not need to be tested is inconsistent with the science and the data.”

The letter went on to say that while the new guidance allows local or state health officials to make exceptions, it “will make their ability to respond to the pandemic even harder,” allowing skeptical officials or members of the public to blame and question them. “This revision and its resulting impact is adding yet another obstacle for public health practitioners to effectively address the pandemic.””  (I)

“The director of the Centers for Disease Control and Prevention, seeking to clarify recommendations on coronavirus testing that incited an uproar, said that “testing may be considered for all close contacts of confirmed or probable Covid-19 patients.”

But his clarification may have further confused the issue.

The statement by the director, Dr. Robert R. Redfield, was issued to some news outlets late Wednesday, and more broadly Thursday morning, after a storm of criticism over new C.D.C. guidelines. Those guidelines asserted that people who had been in close contact with an infected individual — typically defined as being within six feet of a person with the coronavirus for at least 15 minutes — “do not necessarily need a test” if they do not have symptoms.

Administration officials said that “not necessarily” needing a test was consistent with “may be considered” for one. But experts said the shift in language was leaving patients, doctors and state and local public health officials — who rely on the C.D.C. for guidance — perplexed.

“‘May be’?” asked Dr. Carlos del Rio, an infectious disease expert at Emory University. “I want a little more than that in a recommendation. ‘May be’ doesn’t help.”…

In his statement, Dr. Redfield sought to explain: “Testing is meant to drive actions and achieve specific public health objectives. 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.”

The clarification does not change the new guidelines, which remain on the C.D.C.’s website. But it is unusual. Public health experts say clear, consistent communications are essential to fighting an infectious disease outbreak, and in interviews several said that statements from the C.D.C. and Dr. Redfield had fallen far short of that goal.

“What we need from the C.D.C. is clear, specific, directive guidance,” said Dr. Leana Wen, a former health commissioner of Baltimore. “It shouldn’t be a Rorschach blot that we’re looking at, and everybody’s getting a different response by looking at the same guidance.”

Dr. Wen said she was concerned about the effect of the rule on insurance coverage for testing. Insurers have been chafing against the mandate to pay for all tests without requiring a co-payment from patients. Gregg Gonsalves, an assistant professor of epidemiology at the Yale School of Medicine, said the new guidance suggested the administration was “not going to support asymptomatic testing with new money or allow Medicaid to pay for it.”

“I don’t think the C.D.C.’s decision forbids states from covering tests beyond the C.D.C.’s authorization, but it might give states cover to save money by making cutbacks,” said Stan Dorn, a senior fellow at Families USA, a nonpartisan health consumer advocacy group.

One person close to the C.D.C. and the White House said the new guidelines were put in place in part to make them comport with testing for other infectious diseases, like Zika, and in part because of a sense among administration scientists — as well as doctors and insurers — that “too many people were getting tested out of fear and emotion.”

The flap came as the Trump administration announced the purchase and production of 150 million rapid tests to be distributed across the country. White House officials said the administration had teamed with Abbott Laboratories to produce inexpensive and easy-to-use BinaxNOW tests.

In the new testing guidelines, posted on Monday, the C.D.C. said close contacts of Covid-19 patients “do not necessarily need a test” unless they are vulnerable or their doctor or a state or local public heath official recommended it.

In an interview on Wednesday, Dr. Anthony S. Fauci, a member of the task force and the government’s top infectious disease expert, said he was concerned that the guidelines could be misinterpreted. Dr. Fauci had signed off on an early version of the rule but was undergoing surgery for removal of a polyp on his vocal cord when it was completed last Thursday…

In the statement, Dr. Redfield said the agency was “placing an emphasis on testing individuals with symptomatic illness, individuals with a significant exposure, vulnerable populations including nursing homes or long-term care facilities, critical infrastructure workers, health care workers and first responders, or those individuals who may be asymptomatic when prioritized by medical and public health officials.”

Dr. Redfield also said that anyone — even people who tested negative — exposed to someone who is or may be infected should “strictly adhere” to public health guidelines, like social distancing, wearing a mask, avoiding crowded indoor spaces and frequently washing their hands.” (J)

“Six months into the pandemic, testing remains a major obstacle in America’s efforts to stop the coronavirus. Some of the supply shortages that caused problems earlier have eased, but even after improvements, test results in some cases are still not being returned within a day or two, hindering efforts to quickly isolate patients and trace their contacts. Now, the number of tests being given has slowed just as the nation braces for the possibility of another surge as schools reopen and cooler weather drives people indoors.

“We’re clearly not doing enough,” said Dr. Mark McClellan, the director of the Duke-Margolis Center for Health Policy and the commissioner of the Food and Drug Administration under former President George W. Bush.

The downward trend may turn out to be only a short-term setback: The nation reported more than 800,000 tests on Thursday and Friday. There are also limitations to the data, which is largely drawn from state health departments, some of which have recently struggled with backlogs and other issues. It may not include tests done in labs not certified by the federal government.

But according to the figures available, tests were declining in 20 states this week, and data collected by the Department of Health and Human Services showed a similar overall trend nationally.

Without a vaccine or a highly successful treatment, widespread testing is seen as a cornerstone for fighting a pandemic in which as many as 40 percent of infected people do not show symptoms and may unknowingly spread the virus. Testing a lot of people is crucial to seeing where the virus is going and identifying hot spots before they get out of hand. Experts see extensive testing as a key part of safely reopening schools, businesses and sports.

The nation’s testing capacity has expanded from where it was only a few months ago, but public health experts believe it must grow far more to bring the virus under control.

The Harvard Global Health Institute has suggested the country needs at least 1 million tests per day to slow the spread of the virus, and as many as 4 million per day to get ahead of the virus and stop new cases. Some experts view that goal as too ambitious, and others say the benchmark should focus not on a particular number of tests but on the percent of people testing positive.

Yet there is broad consensus that the current level of testing is inadequate and that any decrease in testing is a worrisome move in the wrong direction.

“There is a reasonable disagreement about what that number ought to be, but all of them are way ahead of where we are right now,” said Dr. Ashish Jha, director of the Harvard Global Health Institute. “There is no expert that I know of that thinks that our testing infrastructure right now meets the needs of the American people.”

Adm. Brett P. Giroir, the assistant secretary for health and the Trump administration’s virus testing czar, said that conducting millions of tests per day was not realistic. The administration has asked states to test at least 2 percent of their populations each month, or the equivalent of about 220,000 people per day nationally, which Admiral Giroir said would be enough to identify rising hot spots.

“We are doing the appropriate amount of testing now to reduce the spread, flatten the curve, save lives,” he told reporters on Thursday…”  (K)

“On March 15, as the novel coronavirus was beginning to surge in the United States, Dr. Anthony S. Fauci accomplished a rare Washington feat: He appeared on all five major Sunday talk shows.

But the White House worried that Dr. Fauci might upstage (and sometimes contradict) President Trump, and soon his media handlers were no longer approving his high-profile interview requests.

So Dr. Fauci found another way to get his message out: He said yes to pretty much every small offer that came his way: academic webinars, Instagram feeds and niche science podcasts, as well as a few celebrity interviews…

Whether by design or not, Dr. Fauci has effectively circumvented efforts by the White House to mute him. Since Mark Meadows took over as chief of staff on March 31, White House communications officials have approved very few requests from major outlets. But there is no such review process for smaller ones, like the weekly podcast of the Journal of the American Medical Association, or the KC O’Dea radio show.

In recent weeks, Dr. Fauci has been joining as many as five such shows a day. On Aug. 13, he appeared on Mr. O’Dea’s show, which serves the Raleigh-Durham, N.C., market; a podcast affiliated with the Walter Reed National Military Medical Center; “The Pat McCrory Show with Bo Thompson”; a National Geographic special on pandemics; and a local Fox affiliate in High Point, N.C. He also appeared on “NewsHour,” the PBS evening news show.

His appearances are widely watched by reporters from larger outlets, who then quote him in their news reports….

Journalists with major news broadcasts are frustrated they can’t book Dr. Fauci during a public health emergency. Margaret Brennan, the host of CBS’s “Face the Nation,” told her audience in July that the White House had not approved any interviews with Dr. Fauci since March, inhibiting public understanding of the pandemic. “We will continue our efforts,” she said. Mary Hager, the executive producer of the show, said they asked for Dr. Fauci and other government scientists every week.

“We have this genius and this gold mine of a guest,” she said. “And we can’t use him to his absolute maximum capacity at a time when people are dying.””  (L)

“If you were world-renowned in your field, contributed decades to improving public health, were given commendations by multiple presidents and medical organizations for your work, led the country through major pandemics, would you want to stay in a role where you were suddenly constantly criticized and undermined by your current administrator and were receiving death threats?

Anthony Fauci MD, Director of the National Institute of Allergy and Infectious Diseases is in that position. The Trump administration has continually tried to silence or discredit Fauci…

Fauci has a stellar reputation both academically and in the federal government. As per Trump’s administration, if you have scientific evidence that disagrees with the administration’s stance, you are punished. Trump’s administration had talking points for reporters that refuted Fauci’s statements and his credibility. An op-ed was written by a high-ranking Trump administration official with the purpose of making the public question Fauci. Fauci has been omitted from Trump’s Covid-19 briefings…

If more government officials don’t speak out in support of Fauci and condemns the Trump administration’s undermining of his work and silence about threats made against Fauci, the US is at risk of losing one of the country’s foremost experts on pandemics. This means that the public is losing a well-regarded voice of reason and factual, science-based information.

While Fauci has not directly stated that he is considering leaving his position, it would be understandable that the stress from threats, constant undermining and disrespect would make anyone reconsider staying at their position.” (M)

“The United States signed a $750 million deal with Abbott Laboratories for 150 million rapid coronavirus tests, the White House announced Thursday.

“By strategically distributing 150 million of these tests to where they’re needed most, we can track the virus like never before and protect millions of Americans at risk in especially vulnerable situations,” Department of Health and Human Services Secretary Alex Azar said in a statement.

On Wednesday, the Federal Drug Administration granted the company emergency authorization for its new COVID-19 test.

The test called BinaxNow can deliver results in 15 minutes without using lab equipment and would cost $5.” (N)


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