CDC Reverses Guidelines on Asymptomatic Testing for COVID-19, Potentially Increasing Test Volumes for Clinical Laboratories

After declaring asymptomatic COVID-19 testing unnecessary, the CDC reverses course, recommending testing for asymptomatic individuals with exposure

The US Centers for Disease Control and Prevention (CDC) made headlines across the country in late August 2020 when it changed the guidelines for testing asymptomatic individuals for COVID-19. The changes revised testing recommendations for asymptomatic people, that they not be tested for SARS-CoV-2, even after a potential exposure to someone known to be infected, according to details released Aug. 24.

While this change was met with both positive and negative responses in the medical and scientific community, the public response in the media was primarily negative. Some experts recognized the change as a way to preserve testing resources, while others saw it as reducing the collection of critical COVID-19 data.

“Months into this pandemic, we know COVID-19 is spread by asymptomatic people,” said Susan Bailey, MD, President of the American Medical Association, in a statement. “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.”

Under criticism from the press, public, and members of Congress, the CDC quietly changed testing guidelines Sept. 18, 2020, to once again recommend testing for asymptomatic individuals with a potential exposure to SARS-CoV-2.

Clarification Point Added to CDC SARS-CoV-2 Testing Guidelines

The CDC added this bulletin point “clarification” to the summary of changes of the guidelines: “Due to the significance of asymptomatic and pre-symptomatic transmission, this guidance further reinforces the need to test asymptomatic persons, including close contacts of a person with documented SARS-CoV-2 infection.”

“If you have been in close contact, such as within 6 feet of a person with documented SARS-CoV-2 infection for at least 15 minutes and do not have symptoms, you need a test,” CDC guidelines for asymptomatic individuals now state. “Testing is recommended for all close contacts of persons with SARS-CoV-2 infection. Because of the potential for asymptomatic and pre-symptomatic transmission, it is important that contacts of individuals with SARS-CoV-2 infection be quickly identified and tested.”

While the revised CDC guidelines now recommend testing for asymptomatic individuals with a known exposure, these guidelines continue to recommend that those without symptoms who have not been exposed to COVID-19 not receive a test unless recommended by their healthcare provider.

Possible Good News for Clinical Laboratories?

Clinical laboratories will find these guidelines a potential source of good news. The first revision of the CDC guidelines had the potential to lead to decreased SARS-CoV-2 tests. As the COVID-19 STAT Intelligence Briefings Service reported at the time, this could have had a significant impact on COVID-19 test volumes, specifically, a loss of potential revenue from these tests. The reversal of the asymptomatic testing guidelines may benefit clinical laboratories from a business standpoint moving forward.

Aside from the potential test volume implications, these guidelines may also provide data that leads to better understanding of the spread of COVID-19 and can help to identify hotspots and transmission events closer to real time. This will allow a better response to changes as they occur.

The CDC changes will likely benefit both clinical laboratories and the public, but the vacillation in testing guidance at the highest levels continues to highlight the lack of a cohesive national testing strategy.