Healthcare providers say they plan to stick to their current COVID-19 testing protocols despite recent federal guideline changes that recommend not testing asymptomatic individuals who have been exposed to the virus.
The Centers for Disease Control and Prevention on Monday said asymptomatic people do not"necessarily need a test" if they were within six feet of a COVID-19 positive person for at least 15 minutes. Previously, the agency recommended testing any close contacts of COVID-19 patients, due to potential asymptomatic and pre-symptomatic transmission.
According to the agency's COVID pandemic planning scenarios,up to half of virus transmissions have been reported to occur before patients experience symptoms.
"In Illinois, the current CDC guidelines are not going to jibe with what the state expects us to do," said Dr. Richard Freeman, executive vice president and regional chief clinical officer at Loyola Medicine in Chicago. "We are obviously going to continue to go by the state mandate rather than the CDC guidelines."
Illinois and several other states require healthcare providers to test individuals who report being exposed to the virus even if they are asymptomatic. The CDC on Monday said asymptomatic individuals who have been exposed should get tested based on provider or public health department recommendations.
Freeman said all visitors, patients and staff to Loyola are required to wear masks and take body temperatures tests. COVID-19 tests are administered to those admitted to the hospital and anyone getting an elective procedure. In the system's outpatient clinic sites, anyone can get tested upon request if they have been exposed to the virus. Since the start of the pandemic, Loyola has completed more than 50,000 COVID-19 tests.
Mandates aside, Freeman said it just made more sense for asymptomatic people exposed to the virus to get tested. The policy helps reduce the risk of spreading the disease and better track virus transmission trends.
"I think there is some concern that the CDC in their current update may be out in front of the rest of us," Freeman said. "Maybe it will be that it will eventually be what happens, but we're not quite ready to make that leap yet."
The revised guidance have been roundly criticized by public health experts who have expressed concerns the recommendations could lead to less testing at a time when COVID-19 cases, hospitalizations and deaths continue to climb. More than 5.7 million cases were reported as of Thursday, according to the CDC. More than 178,000 people have died from the virus.
Dr. Ross McKinney, chief scientific officer for the Association of American Medical Colleges, said his organization is recommending its more than 400 teaching hospitals not to comply with the new guidelines. Reducing the number of tests could hinder virus surveillance efforts and make it difficult to determine if dips in reported cases are due to fewer transmissions or less testing.
"I hope there isn't broad uptake of this approach," McKinney said. "You wouldn't find the asymptomatic people who are spreading it if you follow this advice."
CDC did not respond to requests for comment on the guideline changes.
It's possible the guildeline change was an attempt to stop individuals from seeking a test too soon after they were exposed, according to Dr. Lisa Maragakis, senior director of infection prevention at Johns Hopkins Health System in Baltimore. Individuals who are tested less than 10 to 14 days after exposure are more likely to get a false negative.
But Maragakis said the CDC guidance did not make the false negative concern clear and failed to mention the importance self-isolation after testing to prevent further spread. Maragakis said Johns Hopkins plans to continue conducing its testing protocols and not comply with the new CDC recommendations.
"Most of us are puzzled by why the guidance changed," Maragakis said. "To really get on top of community transmission and stop the viral transmission that we are seeing in so many communities across the country we need more testing, not less."
Stakeholders have been left wondering why the agency changed the recommendations, and some speculate there might have been political considerations.
HHS Assistant Secretary Adm. Dr. Brett Giroir on Wednesday denied allegations that the changes were politically motivated. President Donald Trump in June called testing a "a double-edged sword," and called on health officials to slow down testing.
"Let me tell you, right up front that the new guidelines are a CDC action," Giroir said to reporters.