Syracuse, N.Y. – Onondaga County Executive Ryan McMahon on Thursday expressed concerns about controversial new guidance from the CDC that questions the need for coronavirus testing of people without symptoms, even if they were in close contact with an infected individual.
The biggest problem, McMahon said, is that the federal guidance will encourage health insurers to deny payment for testing when patients don’t have symptoms.
“Insurance companies are going to use that as a crutch not to pay for testing,’’ he said. “That would be my interpretation if I was them.’’
Onondaga County has encouraged widespread testing for Covid-19 regardless of whether people have symptoms, first in senior living centers and then for the public at large. That strategy has helped county health officials contain the virus, McMahon said.
“That’s an important tool for us. It’s worked. It’s worked well,’’ he said.
The CDC’s new policy attracted widespread criticism after it was released Monday. In response, the CDC’s director, Dr. Robert Redfield, appeared to backtrack late Wednesday by saying that testing “may be considered’’ for asymptomatic people who have been in close contact with Covid-19 patients. The written guidance on the CDC website had not changed as of early this morning, creating more confusion.
The new guidance may inhibit people from getting tested, McMahon said. Without an insurance payment, the bill can be $100 or more.
McMahon said the new guidance should not impact testing for teachers and other school employees the county is conducting this week, because the county has promised to cover any cost not borne by insurance. Some 120 employees from the LaFayette and Onondaga Central districts were tested Wednesday, the first day of testing that will occur over two weeks.
New developments in technology may soon lower the cost of getting tested, McMahon said. Already, schools and others are using saliva pool tests to screen large groups, which is much cheaper than individual diagnostic tests. And the FDA on Wednesday approved a new $5 antigen test from Abbott Laboratories that provides results in 15 minutes.
But nasal swab tests that are individually processed in labs using polymerase chain reaction (PCR) technology remain the gold standard, McMahon said.
Dr. Stephen Thomas, chief of the Infectious Disease Division at Upstate Medical University, said he is not in favor of giving PCR tests to everyone who asks. But he, too, was surprised that the CDC recommended against testing for asymptomatic individuals who have been in close contact with someone who tested positive.
Containing the virus’ spread requires anyone at high risk of exposure to be tested, Thomas said.
“That person should self-quarantine for a couple days, monitor health, and then about five to seven days after the exposure, they should be tested,’’ he said. “There is science and evidence to support that. I am finding it very difficult to understand why the CDC would have changed their guidance.’’
Thomas recommends waiting a few days after exposure to be tested, because PCR tests yield up to 40% false negatives within the first few days after someone is infected.
Indiscriminate use of PCR tests has “limited value,’’ Thomas said, and can contribute to shortages of tests and delays in lab processing. He said he advocates more targeted testing based on symptoms, contact with infected persons or other medically approved reasons.
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