Autumn and the fall of CDC

Science is not enough to address the grave U.S. public health crisis created by the novel coronavirus pandemic. Leadership — embodying science and vision — is critical. Historically, the Centers for Disease Control and Prevention has provided that leadership.

This fall, the nation looks certain to face enormous health challenges needing clear guidance. Yet the United States has no national plan for action. Though the CDC has a celebrated legacy of leading successful responses to viral pandemics, it has been sidelined under the Trump administration. With every hour of delay in taking the lead, however, there is less and less light on the pathway to health. 

The CDC has been essentially silenced since Feb. 26 after Nancy Messonnier, director of the Center’s Immunization and Respiratory division, warned that the coronavirus’s “disruption to everyday life may be severe.” Her alert proved all too true.

The health crisis looming this fall looks to be even more serious. The nation confronts a convergence of four major challenges: the continuing surge of the COVID-19 pandemic, the return of the annual influenza epidemic, clusters of vaccine-preventable infections, such as measles, and problems created when victims of national disasters shelter together in crowded structures. 

This is exactly what the CDC has been able to do in the past. Here are some of the plans it should be laid out to address each of these impending problems:

1. For COVID-19: We should already have implemented national mandates for physical distancing and masks. To combat the continuing evidence of aerosol transmission, new considerations for clean air in schools and offices are crucial. This could include opening windows and doors, increasing the number of total volume air exchanges per hour, installing HEPA filters to remove viruses, and safely placing UV lights to kill viruses quickly in closed rooms. Importantly, the recommendations must be in concert with what we know. The recent White House-imposed softening of CDC guidelines for testing asymptomatic people — including those exposed to infected contacts — is confusing and harmful. The agency must resist political bullying and stand up for science.

2. For influenza: There should be a wide-ranging multi-media campaign, online, on television and in print promoting vaccination, emphasizing the up to 60 percent effectiveness for adults and children will contribute to herd immunity for influenza,  and promoting access for high-risk populations to be given once a day antivirals during the epidemic rise, with over 80 percent effectiveness as a preventive measure. 

3. For vaccine-preventable infections: With a 60-80 percent recent decline in receipt of childhood vaccines for measles, mumps, German measles and whooping cough — a strong program for vaccination for these infections needs to be promoted now, along with effective responses to vaccine reluctant parents. 

4. For natural disasters: With the emergence of the year’s first hurricanes and forest fires, there should be discussions of ways to limit transmission of COVID-19 and influenza in shelters and other crowded venues for the victims. While offering leadership and science, the CDC could convey empathy, an understanding that real people are suffering. The numbing facts of over 6 million cases and over 185,000 deaths fail to convey the reality of lives disrupted. The country needs CDC’s leading voice of empathy.

Founded in 1946, The CDC has an envied public health history,  explaining the transmission pathways of various virus pandemics, then leading successful responses: polio in the 1950s, the beginning and end of smallpox in the 1960s, the emergence of Ebola in the 1970s, HIV in the 1980s, and more recently SARS and MERS. With COVID-19, they’ve retreated from their mission.

The U.S. is desperate for leadership, and most will follow gladly. It’s not too late for CDC to begin to restore its reputation. Look what millions already have done on their own in the last few months with lockdowns, isolation, physical distancing, masks, and economic pain. This Fall, the CDC faces enormous challenges needing clear guidance as we enter the harsh winter of their indecisions.  

Richard P. Wenzel is an infectious disease epidemiologist at Virginia Commonwealth University in Richmond. He is editor-at-large of The New England Journal of Medicine. Wenzel also serves as emeritus professor and former Chair of the Department of Internal Medicine at VCU, and has been President of both the Society of Healthcare Epidemiologists of America and The International Society for Infectious Diseases.