Fauci, Other Health Officials Plan for More, Not Less COVID-19 Testing

Alicia Ault

June 23, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

US public health officials said they have not been ordered to slow down novel coronavirus testing efforts, despite claims from President Donald Trump that he had given such orders and that he believes increased testing is a mistake.

Trump said at a campaign rally in Tulsa on June 20 that he had asked officials to slow testing down, according to the Washington Post and other media sources. Then today, he tweeted, "Cases are going up in the US because we are testing far more than any other country, and ever expanding. With smaller testing we would show fewer cases!"

But today, the nation's top health officials refuted the President at a House Energy and Commerce Committee hearing examining the Trump administration's response to COVID-19.

"None of us have ever been told to slow down on testing," said Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases. "We're going to be doing more testing, not less," he said, adding that more testing — specifically enough to conduct surveillance — is necessary, "if you want to get your arms around and understand exactly what's going on in community spread."

"All of us have been and continue to be committed to increasing readily timely access to testing," said Robert Redfield, MD, director of the Centers for Disease Control and Prevention (CDC). He agreed that surveillance testing is especially important going forward, in part because it is a way to determine how many people are asymptomatic. 

The United States has now performed about 27 million COVID-19 tests, averaging 500,000 tests per day, said Admiral Brett P. Giroir, MD, Assistant Secretary for Health at the US Department of Health and Human Services (HHS). Giroir, who coordinates testing for the federal government, said the aim was to conduct 40 to 50 million tests a month by the fall.

Rep. Diana DeGette (D-CO) asked Giroir if Trump had asked him to conduct fewer tests. "Neither the President nor anyone at the Administration has instructed or suggested we should do less testing," he said. "We are proceeding in just the opposite — we want to do more testing of higher quality," he said.

Giroir and Redfield also both confirmed that the CDC had developed a test that could simultaneously detect influenza A, influenza B strain, and SARS-CoV-2, the virus that causes COVID-19. The agency will seek an emergency use authorization for the diagnostic. "CDC is developing that test for the public health system, but in parallel the private sector now is also in advanced development," Redfield said.

HHS and the Food and Drug Administration (FDA) are working with multiple manufacturers to have a test available at the point of care and in labs, Giroir said.

Rising Cases "Disturbing"

Fauci described the progress against COVID-19 as a "mixed bag," noting that the United States has been "hit badly." The New York metro area had done well in bringing cases down, he said.

"However, in other areas of the country we are now seeing a disturbing surge in infections," due in part to an increase in community spread, he said. "That is something that I'm really quite concerned about," Fauci said.  

He said it was crucial to have the manpower to run a system of testing, contacting, tracing, and isolating those infected, so officials can understand where the cases are coming from. "The next couple of weeks are going to be critical in our ability to address those surges that we're seeing in Florida, in Texas, in Arizona, and in other states," Fauci said.

DeGette asked if it might be seen as a potential positive if the cases were mostly in younger people, who she understood did not become as ill or need hospitalization as often.

Fauci said it was too early to draw conclusions. "Deaths always lag considerably behind cases," he said. "The concern is if those cases that infect people who end up getting sick and going to a hospital, it is conceivable you may see deaths going up," Fauci said.

FDA, CDC: No Political Interference

Republicans and Democrats questioned the officials about progress on a potential COVID-19 vaccine.

Trump has promised a vaccine by year's end — enabled by his administration's Operation Warp Speed program — which has caused some to worry that a product might get a rushed approval, in part to boost the President's reelection chances.

Fauci said he did not think the timeframe was unreasonable. "I feel cautiously optimistic that we will be successful in getting a vaccine," he said. While there's never a guarantee, Fauci continued, early data were promising. He said one vaccine would be starting phase 3 human trials in July. "There is a reasonably good chance that by the very beginning of 2021 that if we're going to have a vaccine, we'll have it by then," Fauci said.

He said regulators should not approve a vaccine for emergency use unless it met FDA criteria. "I would be very disappointed if we jumped to a conclusion before we knew that a vaccine was truly safe and truly effective," he said, adding that he would not want to live with the "perpetual ambiguity of not knowing."

FDA Commissioner Stephen Hahn, MD, said that politics would not sway an approval decision. "We will rely on the science and the data when it's available to us," he said. 

Rep. Anna Eshoo (D-CA) asked if the agency had been subject to pressure from the Trump administration — especially on approving the emergency use of hydroxychloroquine. Hahn said no. "I can tell you that I have not felt political pressure at the FDA to make any decision in any specific direction," he said.

At one point, Redfield was asked by Rep. Kathy Castor (D-FL) how often he had met with or had spoken with Trump in the past few weeks. He would not answer, saying, that "as it relates to direct interactions, I'm going to keep those between myself and the President."

Eshoo chided the public health officials for not pushing back on what she said was Trump's failed leadership, which she said had led to confusion and division in the American public. "I know the agencies are talking to each other," she said, adding, "I consider that a whisper, because the American people are not hearing you speak out."

She honed in on Redfield. "I urge you to speak out. You're a doctor. Put on your white jacket and speak weekly to the American people," she said.

Rep. Tony Cardenas (D-CA) picked up on the topic later, asking why the agency had not been holding regular media briefings to inform the public about the latest evidence-based information, as the CDC had done in previous epidemics.

Redfield said the agency had put out 1500 guidance documents. Before he could go any further, Cardenas interrupted.

"The President has proven very clearly that when you get in front of a podium, and you actually have a press conference, you have a higher likelihood you're going to reach more people," Cardenas said.

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