New guidance from the Centers for Disease Control and Prevention indicates it may no longer be necessary to get tested after being in close contact with a person infected with COVID-19.

It’s a nearly 180-degree shift from previous guidance and an about-face experts worry may be confusing.

“The CDC, I believe, is allowing individual health departments and states to tailor testing guidance based on the local availability of tests and needs,” said Dr. Manoj Jain, an infectious disease expert in private practice and Memphis Mayor Jim Strickland’s medical adviser in the pandemic.

“I think it can be confusing to the public, but for our public here, the answer is clear that we have plenty of testing capacity. My medical opinion is if we have the capacity available, then we should be doing more testing,” Jain said.

The CDC now says that people who have been within 6 feet of a positive case for at least 15 minutes and do not have symptoms “do not necessarily need a test” unless they are members of a vulnerable group or are directed to do so by health care providers or local or state public health officials.

“A negative test does not mean you will not develop an infection from the close contact or contract an infection at a later time,” the new guidance states. “You should monitor yourself for symptoms.” 

Schools must notify at-risk contacts within 12 hours, send weekly updates

Those with symptoms, even if they do not get tested, need to self-isolate for at least 10 days and at least 24 hours after the symptoms are gone.

CDC, which made the changes to its website on Monday, Aug. 24, did not give an explanation.

The issue is problematic, said Dr. Stephen Threlkeld, who is treating COVID-19 patients at Baptist Memorial Hospital-Memphis.

“Personally, I find it a bit confusing and slightly distressing,” he said.

“In general, changing guidelines tends to confuse people. And probably the most distressing thing to me about it was that when asked why these guidelines were changed, the guys in the CDC essentially said, ‘Ask the folks over at Health and Human Services.’

“That’s kind of the political arm of this,” and even more difficult, Threlkeld said, is that CDC generally supplies data to show why a change is necessary.

Coronavirus: New guidance says children don’t need to be screened

The change, he said, lessens the “aggressiveness with which we test folks,” although he did note the guidance pertains to asymptomatic people.

Guidance where “some assembly is required and not available in all states,” Threlkeld said, “is difficult for people to digest and to understand, including me.”

At St. Jude Children’s Research Hospital, Dr. Diego Hijano says schools and universities reopening means lots of potential close contacts.

“Clearly, if someone has been exposed, you’d like to know if they’ve been infected so they can be removed from the population and further transmission can be avoided,” said Hijano, assistant faculty member of St. Jude’s Department of Infectious Diseases.

“It is unclear where the recommendation is coming from. But the testing of asymptomatic individuals remains an important component in dealing with the situation.” 

Jain says the change is a reflection of varying levels of testing capacity across the nation.

“The CDC is leaving it up to local states to decide, and that is largely because of the availability of tests,” he said.

Alisa Haushalter, head of the Shelby County Health Department, agrees.

“As new guidance emerges, we will update locally,” she said.

A similar situation already exists here. If a case is reported in a school, she says, testing for contacts is recommended but is not mandated. 

One of the pitfalls of less testing is that it can slow down contact tracing – identifying all the people a positive person was around two days before showing symptoms.

“We do know that with close contacts of individuals who are positives, there is over a 10% positivity rate,” Jain said.

“That is high. If someone had a 10% chance of being positive, you would want to know and then put them into isolation, and find out their contacts as well.”

No provisions in place to alert general public to COVID-19 cases in schools

When that is done, health officials “have the ability to get a head of the virus. That’s the way to do it,” Jain said.

Methodist Le Bonheur Healthcare notes that recent research shows 20% - 45% of people who test positive will never become ill.

“Those numbers are similar to what we are seeing across our own hospital system,” Methodist said in an email. “These numbers show that the coronavirus continues to be prevalent in the Mid-South amongst people who are asymptomatic.

“Everyone must remain relentless in fighting its spread by wearing masks, practicing social distancing and washing their hands.”

Across Baptist’s 22-hospital system Wednesday, 450 people were hospitalized with COVID-19, 75 of them in ICU. But even while hospitalizations at Baptist and across the country are down slightly, Threlkeld has said repeatedly that with school and associated activities beginning, this is not the time to be loosening protocols on distancing and other public health measures.

The effect of the change in guidance is that it leaves municipalities and even schools to “make their own decisions,” Threlkeld said, noting that local flexibility is OK.

“It’s OK to have exceptions to guidance, but it’s nice to have the guidance,” he said, noting that from the beginning, the U.S. has done too little testing, “not too much.”

Threlkeld worries that relaxing rules about when to be tested will leave people thinking they don’t need to bother.

“I think most epidemiologist and virologists would sort of agree, if you’re heavily exposed to someone, it’s still probably a good idea to get tested.”

Shelby County in a matter of weeks will have capacity to test 10,000 people a day through a network of drugstores, safety-net clinics, hospitals and public health department clinics that have banded together to increase testing.

“We should be testing asymptomatic folks,” Jain said. “We should be testing asymptomatic contact folks, and obviously, we need to be testing symptomatic people.” 

It can be done in different ways, including though a surveillance model, where samples from a school or workplace are taken. If they show benchmark level of positives, then every person at the site is tested, he said.

In counties and states that do not have enough capacity, testing asymptomatic people is not always possible.

“We have been very innovative,” Jain said. “Our labs have been incredible in pushing ahead with all these types. I think we should use testing as a tool to make our schools and workplaces safe.”

Less than a month ago, testing in Shelby County was backlogged with supply shortages that happened to coincide when disease levels were also peaking. Most testing centers were only accommodating people with symptoms. Lines were long. It was taking 5-10 days to get results back.

Since then, the number of positive daily cases has dropped nearly in half. And all testing centers in the county are now operating at less than 70% capacity.