‘We need a major overhaul’

The CDC has long been considered the crown jewel of American public health, with great thinkers dedicated to investigating disease and coordinating the nation’s efforts to prevent it. But it has also been repeatedly criticized for being cowardly and slow to act in a crisis.

Much of the problem is a lack of funding and government authority, said Shelley Hearn, a professor of health policy and management at Johns Hopkins University. For example, the CDC cannot require doctors or states to report disease case counts or other vital information, she noted.

Hearn said Varensky would not change that.

“If the pandemic has shown anything, it’s that we need to radically change the way we protect our health,” she said.

Complicating matters is the fact that both Republican and Democratic administrations have put pressure on the CDC to live in harmony with the White House. This is nothing new, but now other scientists and public health experts are taking to social media for more speculation.

Then came the general division of the country.

The American Public Health Association’s Benjamin said some politicians and others have repeatedly undermined the CDC’s message. The director of the CDC “hasn’t had this kind of prank in the past,” he said.

too slow

In early 2020, the U.S. Centers for Disease Control and Prevention (CDC) was slow to send out test kits to help state labs identify the earliest coronavirus infections. The agency’s kits are flawed in design and contaminated.

CDC officials initially focused on the risk of spreading infection from China, but were slow to learn how much of the coronavirus came from Europe.

The agency has also been criticized for being too slow, not advising people to wear masks, not recognizing that the virus can be airborne, and not ramping up systematic testing to detect new variants.

In 2020, the Trump administration has been accused of political interference in its efforts to control CDC information, potentially contradicting the White House’s description of how the crisis unfolded.

Varensky, an infectious disease expert known for his communication skills, has vowed to restore public trust under President Joe Biden.

This week marks the anniversary of Walensky’s tenure as director of the CDC, which is still sometimes criticized for moving slowly.

For example, the U.S. Centers for Disease Control and Prevention updated its website last week to acknowledge that N95 masks are more protective than other types of masks and are a better choice for most people — something that has long been obvious to scientists.

“Then why is its guidance late again and again?” Lawrence Gostin, a public health law expert at Georgetown University, asked on Twitter.

On Wednesday, Biden defended the CDC: “The information is confusing in a way — it’s because scientists are learning more.”

too fast

Public health experts point out that the fast-moving pandemic has forced the CDC to reverse decisions that made sense at one point but later became problematic.

One example: For much of the pandemic, the CDC recommended that Americans wear masks when near others. But last spring, Varensky changed the guidelines, saying that people who are fully vaccinated can stop covering up in most cases.

Walensky said the decision was driven by an increase in vaccinations and a decline in COVID-19 cases, hospitalizations and deaths. Her call was described as a sensible motivation to get more people vaccinated.

“If we didn’t follow the science[at the time]and said we needed to keep wearing masks, I think we would lose credibility,” she said last week.

Still, the change surprised senior administration officials and some medical experts, who said it was premature.

Within a few weeks, the delta variant caused a new wave of viruses. An outbreak in Massachusetts in July demonstrated that the variant was able to spread among vaccinated people, so Walensky advised vaccinated people to re-wear masks in places where the delta is fueling infection.

“We saw data from Barnstable County on Friday,” she said. “We have new guidance on (next) Tuesday.”

Even public health leaders who expressed strong support for Walensky lamented the way some of the CDC’s recommendations were communicated — without background briefs or documents that adequately detail the scientific evidence.

Adriane Casalotti of the National Association of County and City Health Officials said that in some cases, local health officials learned of the guidance changes through news reports and then worked to incorporate them.

An agency official who was not authorized to discuss the matter and spoke to The Associated Press on condition of anonymity said the CDC has become cautious about informing others beforehand because such information has repeatedly leaked to the media.

But this creates another problem.

Last month, the agency cut the recommended quarantine period for Americans infected with the coronavirus from 10 days to five days, provided they don’t have any symptoms. Without warning of the changes, states scrambled for more details.

Dr. Natasha Baghdasarian, Michigan’s chief medical officer, explained why the state delayed adopting the CDC recommendation: “We posted a page” and many unanswered questions.

Varensky acknowledged that the recommendations were hasty, but insisted that they were for good reason.

She said the agency had decided the change was necessary given the study showing that infectivity decreased after five days. But Valensky felt she had to react to growing reports that medical institutions and other businesses were struggling to maintain staffing amid a surge in omicron.

With the predicted outbreak of infections, she said, “we need to act quickly given the situation we’re about to face.”

Some observers say the CDC is in an unwinnable position: It has been criticized for waiting for medical evidence to accumulate and for acting quickly on a lack of data.

Hearn sympathized.

“No one is used to watching a learning curve like this,” she said. “It’s not normal.”