Who should get tested for Covid-19? Depends who you ask.
The controversy sparked by the Centers for Disease Control and Prevention’s recent shift in guidance, saying asymptomatic people exposed to Covid-19 shouldn’t necessarily be tested, highlights a growing frustration for doctors and health officials: Differing guidelines, rules and practices determine how the country’s limited testing supply is allocated.
Shortly after the CDC issued its recommendations, the governors of New York, New Jersey and Connecticut called them “reckless” and said they won’t follow them. They’re “a recipe for community spread and more spikes in coronavirus,” according to the American Medical Association.
That leaves health-care providers, individuals, employers and schools to navigate the chaotic mix of federal, state and local recommendations and mandates in deciding what to do.
“You’re trying to do the best for your patients, trying to make sure you hit all the regulatory requirements,” said Kara Mascitti, an infectious disease physician at St. Luke’s University Health Network in Bethlehem, Pennsylvania and medical director for its infection prevention program. “Frankly, you feel like your head is spinning sometimes.”
Public-health experts say that deferring to state and local authorities, which has long been the White House strategy, is problematic for just that reason.
“Lack of guidance on a federal level creates mass confusion,” said Leana Wen, a physician who formerly served as Baltimore’s health commissioner and is a visiting professor of health policy and management at George Washington University. The CDC guidance change will result in “even more of a piecemeal approach” to public health, she said.
As the CDC dialed back testing recommendations, the Centers for Medicare and Medicaid Services issued new rules for nursing homes, for the first time requiring facilities test workers.
Covid-19 has killed almost 50,000 people in U.S. nursing homes, whose residents are particularly vulnerable to the virus. But testing practices have been inconsistent as CMS had merely recommended it and state policies varied widely.
For example, Michigan requires weekly tests for staff, as well as for residents in facilities where there were recent cases.
But repeated testing of asymptomatic residents strained labs and exacerbated waits for results, said Bart Buxton, an executive at McLaren Health Care, a Michigan health system. Processing delays mean some residents were tested again before earlier results were in, he said. But providers have to keep up with guidelines regardless.
“You’ve got all of that on top of a pressured supply line, and you’ve got chaos,” Buxton said. “We’re leading through chaos.”