A word of caution in the wake of an internal announcement by Centers for Disease Control and Prevention’s director, Dr. Rochelle Walensky, about the organization’s shortcomings and the need for essential reform in facing and handling the COVID pandemic and future pandemics.
It is too easy to scapegoat and too self-serving to hang people out to dry. It makes some people feel better but it isn’t always accurate or fair. It is not accurate or helpful in this case to talk about chopping off the head of the beast, especially when that head is a great infectious disease and public health expert.
Walensky’s admission that there needs to be an essential change in culture in light of an emergency like a pandemic is a refreshing one. Information needs to be presented to the American public in real-time, in a way that is not wonky but digestible. It needs to be fact-based and data-driven but also crystal clear so that the public is inclined to follow it. There needs to be more digitalization and more cooperation from the states.
She said it best to me in an interview for Fox News this past week:
“What I told our agency is, on that path to the finish line towards publication, we need to stop and pull over. We need to show our work. We need to inform policymakers. We need to update things along the way as we proceed to that finish line … We need practical, timely recommendations that take early peeks of the data and adjust along the way.”
She said they needed to be more timely in terms of “how quickly we can get our data out there. It doesn’t mean that we won’t go to peer-review publications. But much of the world has moved to preprint, providing online data. We need to do that.”
Walensky told me that the CDC needs to disclose what they don’t know as well as what they do. Though evolving information on masking and vaccines or closures was often convoluted and slow to change, it isn’t entirely the CDC’s fault if states and local municipalities rely on it too heavily or impose mandates based on guidance. Walensky told me that she believes vaccines changed the paradigm at schools, for example, and became a strong justification for keeping them open, even allowing the unvaccinated to attend. She also told me that she continues to believe that masks work to decrease spread, and in fact, I believe it too.
Masks have been a challenging message, she said. “What I will say is we have seen time and time again, data after data, that demonstrate that masks have decreased infection and that they work to decrease infection, especially higher quality masks.”
Of course, school closures caused harm in terms of socialization delays, mental health and nutritional problems, and did little to slow the spread of COVID. The CDC could have been more reactive to this information and pushed to keep schools open earlier in the pandemic. But Walensky was right to defend her policy change when the vaccines came out. “One of the first things I said as vaccinations were rolling out with some controversy was that we did have a capacity to get our kids back to school, even if our teachers, even if everybody wasn’t vaccinated. So this was always part of our vision to be able to get back to school and to get safely back to school.”
Was the CDC’s shift in focus from case numbers to hospitalizations too slow? Yes. But was it correct? Yes. The COVID vaccines are valuable at decreasing severity even if they are less effective at stopping the spread of the emerging omicron subvariants and the proper masks can help protect the most vulnerable, though neither reality should lead to mandates, especially now that COVID spread cannot be prevented with the current tools.
Widespread testing for any emerging infectious disease needs to be available much earlier, not gummed up by protocol or propriety even as the need for verifying quality and predictability remains real.
She said, “If there is a new diagnostic test, we are going to need to work quickly in order to get that out there. But when we have a new diagnostic test like we needed for COVID-19, we can’t sacrifice on making sure that that is the right test, which [was] among the challenges that we had early on.”
The CDC is limited by the amount of clinical and laboratory information it receives from the states. In the middle of the pandemic, greasing the wheels of information exchange is just as important as reforming from within. The CDC brought us crucial information on the effectiveness of vaccines for COVID and even natural immunity following infection. The delay and the clear connection between emerging science and public policy are what need to change. Walensky is also mindful of extending these tools more effectively and consistently to vulnerable communities, including in rural areas.
Scapegoating one leader or one essential organization is not the way to bring us to that point of connection. I am confident that Walensky’s judgments are based on science and forward-thinking public policy.
Marc Siegel, M.D., is a professor of medicine and medical director of Doctor Radio at NYU Langone Health. He is a Fox News medical correspondent and author of the new book, “COVID; the Politics of Fear and the Power of Science.”