The White House discussed changing CDC guidelines about testing asymptomatic people while Fauci was under anesthesia

• The CDC no longer recommends tests for people without coronavirus symptoms, even if they've potentially been exposed to the virus.
• The agency updated its guidelines on Monday after the White House Coronavirus task force approved the change.
• But one of the task force's key members, Dr. Anthony Fauci, was in surgery while the group met on Thursday.
• "I was under general anesthesia in the operating room and was not part of any discussion or deliberation regarding the new testing recommendations," Fauci told CNN.

The Centers for Disease Control and Prevention instituted a major change to the nation's coronavirus testing guidelines on Monday.

The agency previously recommended tests for anyone with recent or suspected exposure to the virus. Now it suggests that people who aren't showing symptoms don't require a test — even if they've had contact with an infected person.

Two federal health officials told the New York Times on Wednesday that higher-ups in President Donald Trump's administration had pressured the CDC to alter its testing guidelines. Later that day, CNN reported that Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, had been absent for a conversation about whether the testing criteria should change.

Fauci was in surgery on August 20, when the White House Coronavirus Task Force held a meeting to discuss the change in strategy.

"I was under general anesthesia in the operating room and was not part of any discussion or deliberation regarding the new testing recommendations," Fauci told CNN Chief Medical Correspondent Dr. Sanjay Gupta. "I am concerned about the interpretation of these recommendations and worried it will give people the incorrect assumption that asymptomatic spread is not of great concern. In fact it is."

US Health and Human Services Assistant Secretary Dr. Brett Giroir told CNN on Wednesday that the guidelines had "been updated to reflect current evidence and best public health practices."

But overwhelming evidence continues to suggest that asymptomatic cases are a key part of coronavirus transmission in the US. The CDC currently estimates that asymptomatic cases represent around 40% of the nation's COVID-19 infections.

In a May editorial in the New England Journal of Medicine, researchers at the University of California, San Francisco, called asymptomatic spread the "Achilles heel" of coronavirus mitigation strategies. Without testing asymptomatic patients, they said, the US might struggle to contain its outbreak.

Conflict between the White House and CDC has alarmed health experts

In recent months, many public-health experts have expressed concern about the CDC being hamstrung by political pressure.

In May, a CDC official told the Associated Press that the White House had ignored the agency's guidelines for reopening public places in favor of a more aggressive reopening strategy. The CDC's daily press briefings were also placed on an abrupt, three-month hiatus after Dr. Nancy Messonnier, director of the agency's National Center for Immunization and Respiratory Diseases, warned in March that the virus would inevitably spread throughout the US.

"They need to stop muzzling scientists," Dr. Leana Wen, a public-health professor at George Washington University who previously served as Baltimore's Health Commissioner, said of the White House's pandemic response.

Now experts fear that scientists are being ignored yet again.

"The CDC's changing testing recommendations discovered today appear to represent yet another disturbing example of mixed and inconsistent health messaging from the administration throughout the pandemic," Dr. Howard Koh, a professor at the Harvard TH Chan School of Public Health, said in a statement.

He added: "No new science, data, or research have been offered to justify such a change. Moreover, no basic explanations have yet been offered to health professionals or the general public."

Failure to test asymptomatic cases already allowed the virus to spread

The US currently ranks fourth in the world in terms of coronavirus testing per capita with around 205 average daily tests per 100,000 people. In total, more than 73 million people in the US have been tested so far.

But the nation's testing capacity declined in August as diagnostic companies struggled to return results quickly and California reported a major backlog of testing data. This presented a challenge for contact tracers, who were already struggling to identify new cases before they went on to infect others.

Ideally, public-health experts say, the US would get to a point where every person could receive a coronavirus test. But President Donald Trump has referred to testing as "a double-edged sword" that reflects poorly on the US.

"I personally think testing is overrated, even though I created the greatest testing machine in history," Trump told the Wall Street Journal in June. He added that a rise in testing leads to a rise in cases, which "makes us look bad."

But experts say the nation's 5.8 million cases reflect the scale of its outbreak. In fact, researchers estimate that the official case count would likely be 10 times larger if the US had tested more at the start of the outbreak when a shortage of accurate tests meant only patients with severe symptoms were eligible.

"We have already seen how limiting testing to only symptomatic individuals does not work to reduce contagion," Zenei Cortez, president of the National Nurses United, said in a statement on Wednesday. "It has cost many lives."