CDC creating more confusion than calm, but it could be worse

The Centers for Disease Control and Prevention (CDC), touted as the nation’s leading public health government agency, is struggling. Over the past two years since the COVID-19 pandemic began, the agency has demonstrated a lack of consistency and at times, poor judgment bordering on general ineptness, which has exacerbated the nation’s COVID-19 response. 

There are several areas where the CDC has fallen woefully short in helping the nation move forward during the pandemic. Here is a report card on several domains within their rubric of activities.

Data: (Grade C-) Data are needed to make informed decisions. How data are collected is critical. For example, without consistent templates for collecting data, state public health departments were left on their own to define what constitutes COVID-19 deaths. Data on how the different vaccines performed and the proliferation of breakthrough infections was slow to materialize. More recently, with the omicron variant surge, the key markers for community spread are hospital admissions for COVID-19, not infections. Knowing the vaccination history of every COVID-19 hospitalized patient is critical to assess the COVID-19 landscape and gain insights into how the nation may need to move forward with the available vaccines. The CDC Data Tracker provides much-needed data now; it took an unacceptable amount of time to get this repository in place with the data that researchers need to inform the state of the pandemic.

Communication: (Grade: F) Communication always begins at the top. CDC Director Rochelle Walensky is an outstanding infectious disease physician and scholar. Yet, she entered her current role ill equipped to provide a consistent and calming voice. For example, messages on booster shots that were in conflict with the White House created fodder for political adversaries and pandemic skeptics that fomented misinformation about the vaccines. Her recent comments on omicron deaths created a stir among conspiracy theorists. Her current effort to engage media consultants is an attempt to right the communication ship, something that she needed to do when she took the CDC director position almost one year ago.

Vaccination policy: (Grade B) The COVID-19 vaccines have been remarkably effective to dampen the most severe outcomes from COVID-19, namely hospitalization. The hope was that they would be more protective against infections and provide a longer horizon of protection before the need for a booster. Much of this confusion grew out of uncertainty surrounding how the vaccines would perform in the population. The widespread number of breakthrough infections cast a shadow of doubt around the CDC and trust in what they communicated about the vaccines. However, much of the performance of the vaccines was out of their control. What was within their control was how they communicated such information.

Nonmedical countermeasures: (Grade C) Physical distancing, hand hygiene and face masks were the key tools available prior to the vaccines to suppress the spread of the virus. Among them, face masks became the lightning rod of controversy. The perception that cloth masks were ineffective, coupled with the former president’s disdain for face masks created a communication debacle. Only once the highly contagious omicron became the dominant variant did it become apparent that face masks that meet National Institute for Occupational Safety and Health (NIOSH) standards are necessary to serve as an effective breathing barrier. Examples of such masks include N95, KF94 and KN95. The CDC is moving closer to recommending such high-quality masks. Regrettably, these such masks were needed for everyone since the pandemic began. The limiting factor has been their lack of supply. 

Infection isolation management: (Grade C-) The most recent controversy has been reducing the quarantine period from 10 days down to five days for those infected but asymptomatic or with mild symptoms. Some health experts question the sagacity of such guidance, since it assumes that such infected people cannot transmit the virus after five days, which remains unclear. The reason for this change in guidance is that the country is on the cusp of being unable to function with so many people infected and unavailable to provide essential services in the health care and service industries.  

It is easy to kick those who are down and out. In defense of the CDC, the first year of the pandemic occurred under an administration that was more interested in downplaying the impact of the virus and controlling their message for political purposes. The second year has been under an administration that has been more measured and focused on the public health risks. Nonetheless, the CDC has continued to fumble the ball, with health agencies in Israel and the UK leading with meaningful data and insights instead of the United States. 

The most important question now is: Where does the CDC go from here? A change in leadership will not solve the problem, since many of the issues exposed during the pandemic are systemic.

Perhaps what our nation must rethink is how to ease the politics out of public health. The strategies and tactics of public health must be protected from the political whims of the national political leadership and that bipartisan support is needed to rethink how our nation invests in public health. One place to begin such a transition is not making the CDC director a political appointee.

Without substantive structural changes, the CDC will continue to be mired in a veil of uncertainty about its role and what it can accomplish. This serves no one’s interests, Republican, Democrat or independent, since a virus has no political leaning and can infect anyone with unpredictable consequences. The family and friends of the 840,000 people who have died prematurely with or from COVID-19 and the 120,000 people currently hospitalized can vouch for that.  

Sheldon H. Jacobson, Ph.D., is a founder professor of Computer Science and the Carle Illinois College of Medicine at the University of Illinois at Urbana-Champaign. He applies his expertise in data-driven risk-based decision-making to evaluate and inform public health policy.