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August 27, 2020

Philly won't follow CDC's controversial new COVID-19 testing guidelines

Health department says residents with asymptomatic exposure should still be screened

Illness Coronavirus

Philadelphia residents are advised to get tested for COVID-19 after known exposure to someone who has tested positive. Even if there are no symptoms reported, a test is still recommended. The CDC changed its policy earlier this week, but Philadelphia will not follow the federal guideline.

Philadelphia health officials will continue to recommend that anyone exposed to a person with COVID-19 be tested for the coronavirus, regardless of whether they are asymptomatic, Health Commissioner Dr. Thomas Farley said Thursday.

The clarification came after the U.S. Centers for Disease Control and Prevention updated its COVID-19 testing guidelines Monday. The revised guidelines state that asymptomatic people exposed to the virus "do not necessarily need a test" unless they are vulnerable to severe complications or otherwise advised by a doctor or local health official.

"I just want to be clear," Farley said. "Here in Philadelphia, we are not changing our recommendations."

Philadelphia's current guidelines state that residents should get tested if:

• You have been exposed to someone with COVID-19 (wait until 7 days after exposure to ensure test accuracy)

• You have symptoms of COVID-19, including cough, shortness of breath or two of the following symptoms: fever, chills, muscle pain, sore throat, new loss of taste or smell

• You have traveled to a state where there are high numbers of recent transmission.

Farley reiterated that anyone exposed to COVID-19 should get tested even if they have no symptoms. They should wait seven days to ensure that they do not get a false negative result.

"It's particularly important for people who have been exposed to be tested as the case rates go down," Farley said. "Testing those people who were exposed is even more important. We want to identify as many people with the infection as possible, so that we can do contact tracing and stop the chain of transmission."

The new CDC guidelines faced swift backlash this week from infectious disease experts who warned that the revision could hinder contact tracing just when it is most effective.

"This is key to contact tracing, especially given that up to 50% of all transmission is due to people who do not have symptoms," said Dr. Leana Wen, an emergency physician at George Washington University and a previous health commissioner in Baltimore. "One wonders why these guidelines were changed – is it to justify continued deficit of testing?"

Dr. Anthony Fauci, the leading infectious diseases expert in the U.S., said he was concerned that the updated guidelines would give people the incorrect assumption that asymptomatic spread is not of great concern. Fauci was undergoing a medical procedure when the White House Coronavirus Task Force moved to implement the guidelines. He said he was not consulted about the change. 

Philadelphia has seen case numbers steadily fall over the course of August, dropping below 100 per day during the past week. Severe outcomes from COVID-19 have likewise plummeted, though a slight increase in deaths this month is likely linked to the rise in cases that occurred in July, Farley said.

Even as cases fall, the city is now testing about 3,000 people per day and hopes to bring that number up to 5,000.

"We want to increase testing, not decrease it," Farley said.

As the cold weather months approach, Farley made clear that respiratory infections tend to be nastier in the fall and winter. The U.S. hasn't yet seen how COVID-19 will behave during the fall and winter.

"Most respiratory viruses do get worse in the late fall and winter," Farley said. "So, whereas all the numbers are going in the right direction right now — and we're very pleased to see that — it is quite possible things could get worse in the future despite all the work that we're doing."

If conditions in the city move in the wrong direction, Farley said more restrictions will be a possibility.

"I wouldn't rule out anything," Farley said. "We really don't know what this virus is going to do once we get to the late fall and winter. It's such a new virus that it would really be the first winter it's seen in the United States. We certainly wouldn't want to go to a full lockdown, but anything is possible."

The health commissioner explained why there is heightened concern about the months ahead.

"When it gets cold, the air is dry — and in dry air, it's easier for these respiratory droplets to linger and transmit from one person to another. Other respiratory viruses start to increase in September, and they peak around January and February. We can see the effect of this on this virus at any time, or not at all."

Philadelphia reported 88 new cases of COVID-19 on Thursday, bringing the citywide total to 33,343 since the start of the pandemic. There were no new fatalities reported. The death toll stands at 1,749, including 875 nursing home residents.

The test positivity rate fell just under 3% of about 3,200 test results received on Thursday.

Among the new cases, the city is beginning to see a drop off in the influx of younger residents testing positive for COVID-19. Only 42% of new cases reported Thursday were under the age of 40, compared to more than 50% a few weeks ago.

Philadelphia remains on track to reopen indoor dining and theaters on Sept. 8, with restrictions outlined by the health department.

"We've had some questions about other sorts of services and other sorts of venues," Farley said. "We want to be clear that a restaurant can operate and provide food without entertainment, or theater can provide entertainment but no food or drink. You can't do both."

Indoor gatherings in Philadelphia are still capped at 25 people, while outdoor gatherings are capped at 50 people.

Farley emphasized that a key finding of the city's contacting tracing program is the many people seem to know how they were exposed to COVID-19.

"What we're learning from our interviews with cases when we do contact tracing is that people very often know exactly how they got exposed," Farley said. "Almost half knew the person who they believe exposed them, and they typically were household members, relatives or friends that they got together with at social gatherings. 

"The message for people is that if you get together with people outside your household, even if it's your relatives and friends, wear a mask. That's a high risk situation."

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