Better COVID-19 Testing Data Needed, CDC Chief Tells House Members
June 4, 2020
WASHINGTON -- The U.S. has not met all of its testing goals for COVID-19, but that's not entirely the federal government's fault, CDC Director Robert Redfield, MD, told a House committee Thursday.
"The day CDC got in the lane to make a public health test, the private sector had to be in the lane to make a test for the rest of America," Redfield said in response to a question from Rep. Jaime Herrera Beutler (R-Wash.). "It took weeks and weeks before the private sector stepped up ... That has to change." Redfield was the sole witness at a hearing convened by the House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies.
Redfield noted that the CDC had developed a COVID-19 test within 10 days of the SARS-CoV-2 genetic sequence's publication, and although there were problems with some CDC tests, "that's not a flawed test; it works perfectly. The only limitation was that to get that test, state labs had to send the blood to the CDC. Within 5 weeks of getting the sequence, we had testing available in public health labs; I think that's still an accomplishment."
Herrera Beutler was not impressed; she also put the total time at 6 weeks. "That 6 weeks was the 6 weeks we had to get ahead of this virus," she said. "That was lead time."
Redfield also expressed concern about his agency's lack of access to timely information. "We need data," he said, noting that in April 2018, shortly after he started at his CDC director job, "we had a briefing about opioid deaths ... I asked what time period the data was through, and they said March 2015." And it's not just a problem at the federal level, he continued. "I have states still collecting data with pen and pencil ... All of these things would be enhanced so much if we had a real-time actual data system across this nation."
Rep. Nita Lowey (D-N.Y.), who chairs the full Appropriations Committee, asked Redfield why the CDC hadn't established COVID-19 testing benchmarks for each state to meet. "The virus doesn't recognize state lines, and we can't fully protect one state if other states aren't holding up their end of the bargain," she said.
"We worked with each state to develop independent plans and benchmarks; those plans are now under review," Redfield responded. However, when it comes to testing, "I am personally saddened that there is only a handful of state labs that have the capability to do what needs to be done," he added. "We're in the process of doing those plans with each of the states, but it's a critical time to invest heavily in state labs so they have the resilience" they need.
In response to a question from Rep. Bonnie Watson-Coleman (D-N.J.), Redfield said he didn't know what the goal should be for the percentage of the U.S. population that should be tested.
While the hearing was happening, officials from the Department of Health and Human Services were announcing new reporting requirements going into effect Aug. 1 for public and private labs performing COVID-19 tests; results must now include data on age, race, ethnicity, sex, patient zip code, and type of test performed.
The new requirements will "support decision-making by federal, state, and local public health officials, and inform clinicians and public health officials about the performance of tests in real-world conditions," Adm. Brett Giroir, MD, assistant secretary in the Department of Health and Human Services, said on a call with reporters. The White House put Giroir in charge of ensuring that testing capacity is adequate.
Mask wearing was a point of disagreement for committee members. "There is now a 'cult of masks,'" said Rep. Andy Harris, MD (R-Md.). "In fact, we don't know a whole lot about whether a mask is better or worse than a cloth face covering or a face shield," although it appears that surgical masks are a little more protective than cloth ones, he said.
There is clearly a benefit to having an infected person wear a mask, Redfield said, because it reduces the amount of infectious virus going across the 6-foot social distancing space. "But the real issue is to reserve the medical/surgical masks for the medical/surgical first responder community."
In contrast, Lucille Roybal-Allard (D-Calif.) said she was concerned that "U.S. culture continues to be a barrier to universal acceptance of these recommendations; mask wearing has unfortunately become very politicized." She asked Redfield why he initially recommended mask-wearing as optional, and what fears he has regarding the spread of the virus.
When the outbreak originally happened, Redfield said, and the U.S. had 12 cases in January and February, "we did about 800 contacts in follow-up and two were confirmed to be positive," with both cases being in spouses and both symptomatic. "We had the view from our Chinese colleagues and our experience that this was a symptomatic disease." Only later did the CDC learn that there was a significant amount of asymptomatic infection and transmission. "When that knowledge base came, we realized that we had an important public health tool we could take advantage of," namely, recommending that people wear masks to reduce asymptomatic or presymptomatic transmission.
However, "we're very concerned that our public health message isn't resonating," he added. "We continue to be concerned how to penetrate the message with different groups.... We do think [masking] is an important public health tool, and we're going to continue to figure out how to get the public to embrace it."
Staff writer Molly Walker contributed reporting for this story.
