Former Carlisle resident Birx praises Pa.'s COVID-19 response, encourages testing even as CDC rolls back guidelines

Sep. 4--Dr. Deborah Birx, the White House's COVID-19 response coordinator, said she has asked the Centers for Disease Control about "reordering" its guidance suggesting fewer asymptomatic people should be tested for the novel coronavirus, as she stressed the need for widespread testing.

Birx, who attended Carlisle High School, spoke to reporters Thursday afternoon at the Pennsylvania Emergency Management Agency headquarters in Harrisburg after meetings with state officials, saying Pennsylvania had done an admirable job containing recent COVID-19 case spikes.

Her tour of the commonwealth comes at a pivotal -- and sometimes contradictory -- time for COVID-19 testing, with the CDC rolling back its testing recommendations at the same time the President Donald Trump's administration seeks to distribute large quantities of antigen tests.

Part of her discussion with Gov. Tom Wolf on Thursday was "about how to best utilize the new antigen tests," Birx said Thursday, and also to gather information about what has worked in Pennsylvania heading into Labor Day weekend.

"Pennsylvanians have done a remarkable job and together need to get through Labor Day weekend protecting one another," Birx said.

This involves universal masking and limiting the size of gatherings, even the traditional Labor Day neighborhood barbecue.

"Ensure you're not having these large gatherings. Most of our cases now are coming from community events," Birx said, adding that asymptomatic transmission poses a particular threat.

"Just because they're a neighbor doesn't mean they couldn't be positive," Birx said. "If you've gone on vacation to a place that could be a hotspot, make sure you're wearing a mask around others and please make sure you're getting tested if you think you have been exposed."

But Birx's warnings about the risk posed by asymptomatic transmission are complicated by the CDC, which revised its guidance Aug. 24 to no longer recommend that asymptomatic persons get tested. That guidance includes if they have had close contact -- defined as being within 6 feet for 15 minutes -- with a confirmed COVID-19 positive individual.

For the average person outside a congregate care setting, "you do not necessarily need a test," even after close contact, according the CDC's latest revision.

"We've asked CDC to consider re-ordering that guidance," Birx said, noting that the end of the document does provide the caveat that more widespread testing may be needed in settings where the risk of asymptomatic transmission is higher.

Birx specifically praised Pennsylvania's response to recent case spikes in the Pittsburgh region, which she visited earlier Thursday.

"We wanted to go by and really talk to them about how they were able, as a community working together, to really bring their recent outbreak under control," Birx said.

Learning about those strategies is critical heading into the holiday weekend and with the return of many students to college campuses. While the initial outbreak in March and April was concentrated in urban areas, and caused largely by transmission in the workplace and on public transit, Birx said recent waves have been different.

"What we saw across the South over the last two months was very different," she said. "We think it was people going to vacation spots over Memorial Day -- not just weekend but week, really -- and spreading the virus across the South."

That outbreak was "silent" because it spiked cases among young people who didn't show serious symptoms, at least initially.

"If you wait until you see the first hospitalization, it was extremely widespread by that time," she said.

Pennsylvania has lagged behind other states in per-capita testing; but Birx attributed some of this to Pennsylvania's low overall case counts, which has reduced the number of people seeking tests. She said she spoke with Wolf about how to best use the antigen tests the federal government plans to distribute -- 150 million nationally, the Department of Health and Human Services said last week.

Antigen tests look for proteins given off by the novel coronavirus, Birx said, and are "less precise" than nucleic acid tests but effective when used on a larger scale.

Trump himself has cast doubt on the efficacy of widespread population testing, saying in June he had asked officials to "slow the testing down, please," although the White House later said he had been joking.

Birx also gave praise to modeling from the Children's Hospital of Pennsylvania, which helped to determine what mitigation efforts would best cut transmission in the commonwealth and beyond. The CHOP modeling was pointed to by Wolf as his rationale for limiting restaurant capacity to 25% and cutting alcohol-only service in bars.

Such restrictions, Birx said, have allowed transmission to subside while not totally locking down the economy.

"That model predicted that you could get what we call the replication number of the virus, you could get under R1, equivalent to sheltering in place," Birx said.

"It's no longer theoretic, it actually works," Birx said of the selective restrictions that have been used in different states across the nation. "They really helped us think through this and take new ideas into the field, because you can't keep locking down America."

Email Zack at zhoopes@cumberlink.com.

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