The Knox County Health Department is continuing to offer free coronavirus testing to people without symptoms in contrast to new federal guidance that says asymptomatic testing is not necessary.
The department has not changed its guidance and says anyone is welcome to get tested.
The Centers of Disease Control and Prevention quietly revised its testing guidance this week, which media reports showed was based on pressure from the White House. The CDC no longer recommends testing for asymptomatic people who have been exposed to COVID-19 through a close contact.
“We recommend that contacts do get tested at this time,” Charity Menefee, Knox County Health Department’s director of emergency preparedness, said at a press conference Thursday. “Anyone else who wants to get tested can continue to get tested with us.”
The change from the CDC provoked confusion and dismay from health experts locally and nationwide.
“I didn’t necessarily totally understand the CDC’s rationale,” said Dr. James Shamiyeh, a member of the Knox County Board of Health. “From a contact tracing perspective, the whole point of testing is to create a web of potential contacts that you can investigate.”
Dr. James Hildreth, an immunologist and expert in viral diseases who leads Meharry Medical College and is a member of the Nashville coronavirus task force, was more strident in his opposition to the changes.
“The recommendation of not testing those without symptoms should be ignored,” Hildreth wrote in a tweet this week. “Pre-symptomatic/asymptomatic transmission is a major driver of virus spread.”
In a statement to the Tennessean on Thursday, Hildreth said that the decision was “clearly not grounded in science.”
The state government has yet to respond to the change in CDC guidance. State-run testing sites have offered asymptomatic testing since April. Gov. Bill Lee has repeatedly encouraged all Tennesseans to go get tested if they want to, for any reason.
“When in doubt get a test,” Lee said last April.
Lisa Piercey, the Tennessee Department of Health commissioner, said in April that due to the rapidly changing understanding of COVID-19 it is important for every Tennessean who feels sick to get tested, regardless of traditional coronavirus symptoms.
Local data supports this position. In a report this week, Knox News outlined that many COVID-19 patients did not present with traditional symptoms.
Some patients who died from the disease had fairly mild symptoms early on, only to rapidly deteriorate. In one tragic, case a man in his 70s originally had no symptoms, only to develop fever, respiratory distress and die this July (see page 12 in the document below)
It is unclear what Knox County health officials will do if the state adopts the CDC’s new guidelines. While Knox County is not obligated to follow state health department guidelines, local officials try to follow those recommendations closely.
“We generally try to follow as much as we can what the Tennessee Department of Health recommends,” said Meneffee, “We’re in a doughnut hole surrounded by a lot of counties that all follow Tennessee Department of Health guidance.”
The CDC reversal was immediately condemned by public health experts nationwide.
“Our work on the ‘silent’ spread underscores the importance of testing people who have been exposed to COVID-19, regardless of symptoms,” said Alison Galvani, director of the Center for Infectious Disease Modeling and Analyisis at Yale School of Medicine. “This change in policy will kill.”
The backlash was so severe that late Wednesday, CDC director Dr. Robert Redfield appeared to walk back the policy in a written statement to several news outlets, including the New York Times.
“Testing is meant to drive actions and achieve specific public health objectives,” Redfield wrote. “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.”
But the guidelines revised Monday have yet to be changed.
The change appears to be politically motivated. In the days after the shift, the New York Times, Politico and CNN reported that the CDC was pressured by the White House to make the change. Science news outlet STAT News reported that the new guidelines were crafted at the White House.
The change was made without input from Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Disease. In an interview with CNN he said that he was having surgery at the time when the recommendation was being finalized.
“I was under general anesthesia in the operating room and was not part of any discussion or deliberation regarding the new testing recommendations,” Fauci, told CNN.
“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,” he said.
When asked whether Knox County would follow CDC guidance if it was revealed to be political and not based on science Charity Menefee affirmed their commitment to science-based decision making.
We do always try to follow the science and data and we will continue to do so.” said Menefee.