“Today’s report from the independent Government Accountability Office confirms that eight months after this deadly virus reached our shores, President Trump is still refusing to implement a coherent national plan to contain the outbreak.

Instead, he has downplayed the threat, cast doubt on the science, and failed to lead — resulting in the death of 200,000 Americans. I agree with GAO that we need ‘timely and concerted actions’ to contain this virus, and I urge the Administration to heed GAO’s nonpartisan recommendations and finally show some leadership to protect Americans’ lives.”

Today’s GAO reports includes the following findings, among many others:

The Administration’s Refusal to Implement a National Plan on Testing Shortages.

• GAO reports that HHS officials “acknowledge that there are testing supply shortages,” and that FDA, FEMA, and multiple states also identified shortages. These shortages are causing delays in coronavirus testing results, which “have multiple serious consequences” and “can exacerbate outbreaks by allowing the virus to spread undetected.”
• Yet GAO found the Administration lacks “clearly defined roles and responsibilities” to address these shortages and recommended several changes, including developing a plan for federal action and coordination with stakeholders. In response, the Administration objected to GAO’s recommendations, denied the severity of the problem, and refused to take crucial corrective actions.

Incoherent Guidance on Reopening Schools.

• GAO found a “lack of cogent, clear, and consistent federal guidance” on reopening K-12 schools and found that “some federal guidance appears misaligned with CDC’s risk-based approach on school operating status.”
• In particular, GAO found that statements from the Administration “urging schools to reopen in person” and threatening to withhold funds from schools that did not, “do not appear to align with a risk-based decision-making approach and appear incongruent with the Secretary’s own statements that returning to in-person education is a state and local decision.”

Need for a National Plan on Vaccine Distribution.

• GAO called for the Administration to develop a “national plan for distributing and administering COVID-19 vaccine” that is “consistent with best practices for project planning and scheduling.” HHS, the lead agency working on developing a vaccine, “neither agreed nor disagreed” with this critical recommendation “but not noted factors that complicate the publication of a plan.”

Failure to Collect Adequate Data on Racial Disparities.

• CDC data “suggest a disproportionate burden of COVID-19 cases, hospitalizations, and deaths exist among racial and ethnic minority groups, but GAO identified gaps in these data.” GAO found serious shortcomings in CDC’s plan to address these gaps and called on the Administration to explain how it will work with stakeholders to gather this data and to determine whether the federal government can mandate data collection from states.

The Select Subcommittee on the Coronavirus Crisis has been calling on the Trump Administration to show stronger federal leadership to defeat the coronavirus for more than four months.

The director of GAO, Comptroller General Gene Dodaro, previously testified before the Select Subcommittee on the need to improve the federal government’s coronavirus response on June 26, 2020.

US CDC TESTING GUIDANCE

Several weeks ago, the US CDC published controversial SARS-CoV-2 testing guidance indicating that individuals with known exposure to COVID-19 cases “do not necessarily need” to be tested. Since then, information has emerged in various media reports that the guidance was drafted by officials at the Department of Health and Human Services (HHS) and the White House Coronavirus Task Force and did not undergo the traditional CDC review process before being posted to the CDC website.

On Friday, the CDC published another update that now recommends testing for all individuals with known exposure to COVID-19 cases. The update is very clear regarding individuals who have been within 6 feet of someone with known SARS-CoV-2 infection for at least 15 minutes: “You need a test.” Additionally, the update recommends that individuals with known exposure self-quarantine/isolate for 14 days, regardless of whether their test result is positive or negative.

In the weeks since the previous update, a number of experts have called for this kind change to the testing guidance, particularly in light of the current understanding of the role of asymptomatic and presymptomatic transmission in the pandemic. Notably, we are not aware of any new studies or information since the previous change that significantly affects our understanding of asymptomatic or presymptomatic transmission, so it appears that the most recent update is a correction to the previous guidance.

AIRBORNE & AEROSOL TRANSMISSION

On Friday, the US CDC updated its guidance regarding SARS-CoV-2 transmission, in particular with respect to droplet and airborne/aerosol transmission routes. The update emphasized the role of airborne/aerosol transmission, noting that aerosols are believed to “be the main way the virus spreads” and that “airborne particles” can remain suspended in the air for prolonged periods of time and travel distances beyond 6 feet.

This represented a major shift in how the CDC communicated regarding respiratory transmission of SARS-CoV-2, which previously focused on “droplet” transmission (ie, via larger respiratory particles). This morning, the CDC issued a statement that the information updated on Friday was a draft version of guidance that was published prematurely. The website was updated again today to revert to the previous iteration of the guidance (ie, that emphasizes droplet transmission as the primary route).*

The current website on SARS-CoV-2 transmission notes that the CDC is in the process of updating its guidance and that new language will be published “once [the] review process has been completed.” If the CDC shifts its focus to airborne/aerosol transmission as the primary concern for SARS-CoV-2, it is unclear if associated recommendations regarding mask use (which are less or minimally effective at reducing aerosols compared to larger droplets), physical distancing, face shields, or other solid barriers, or other mitigation measures will change as well

*This is the now removed guidance posted. The best evidence does and has supported the idea this is spread by aerosol. That’s the only way many superspreader incidents made sense.

Here’s simple guidance, Twitter-style: