Fatal consequences of inconsistent CDC vs FDA self-test guidance

Last update: Saturday 8/13/22 

The CDC and the FDA recently issued separate guidance about the number of negative tests that persons should give themselves before they end their quarantine. Unfortunately their recommendations were inconsistent and will probably lead to confusion, a confusion that may have fatal consequences for persons age 65+ (and/or persons having other comorbidities)

Regular readers of this blog know that the CDC data leaves no doubt that the primary victims of COVID have been persons age 65 or older, a group that has borne 75 percent of all COVID deaths while representing only 16  percent of the total U.S. population

Unfortunately the virus has also distorted lives of younger persons who have frequent in-person contact with loved ones in the most vulnerable 65+ age group. Until the pandemic is "over" these caring young folk must adhere to mitigations that minimize their chances of becoming infected in order to minimize their chances of passing their infection on to their older loved ones.

One of the most important decisions that these younger people face is what to do if they have reason to believe that they have been in close contact with infected persons. The first part of the decision is easy: get tested asap and go into quarantine asap. 

Nowadays, most people will administer a self-test. So their next decisions will land them in the cross hairs of the conflicting guidance from the FDA and the CDC. What should they do if their self-test is negative? 

The CDC offered new "streamlined" guidance on 8/11/22, and here's what it said

• "CDC streamlines COVID-19 guidance to help the public better protect themselves and understand their risk", CDC, 8/11/22 
  
  
• "... Recommending that instead of quarantining if you were exposed to COVID-19, you wear a high-quality mask for 10 days and get tested on day 5 ..."
  
  If you test positive on day 5, " you stay home for at least 5 days and isolate from others in your home.  You are likely most infectious during these first 5 days. Wear a high-quality mask when you must be around others at home and in public ... If after 5 days you are fever-free for 24 hours without the use of medication, and your symptoms are improving, or you never had symptoms, you may end isolation after day 5.

In other words, if a person is concerned about close contact with an infected person, they should just wear a mask and get tested on day 5. If the test is negative, they can visit their elderly love ones (or loved ones with other vulnerabilities). But if they test positive on day 5, they should isolate at home for 5 days. If they feel OK five days later, they can leave isolation and visit their vulnerable loved ones. No additional tests are recommended. In either case, they need only be tested once.

By contrast, on the same day, 8/11/22, the FDA provided new guidance that is far more risk averse:

• "At-Home COVID-19 Antigen Tests-Take Steps to Reduce Your Risk of False Negative", FDA, 8/11/22
  
  
• According to the FDA, people should "perform repeat, or serial, testing following a negative result on any at-home COVID-19 antigen test, to reduce the risk an infection may be missed (false negative result) and to help prevent people from unknowingly spreading the SARS-CoV-2 virus to others. The FDA recommends repeat testing following a negative result whether or not you have COVID-19 symptoms." (Note that the emphatic bold print occurs in the FDA announcement.)

In other words, younger persons should visit their vulnerable loved ones if and only if they obtain two or three successive negative self-tests. 

Whose guidance will concerned younger persons follow? Hopefully, they will follow the FDA out of an abundance of caution ... but they should not have to make this choice. That's why the nation employs highly paid experts to formulate consistent pandemic guidance.

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