We have all eagerly watched, and anxiously awaited, the critical communications of the prestigious Center for Diseases Control and Prevention (CDC) during the pandemic’s peak. However, the failure to make an accurate epidemiological assessment at the beginning of the COVID-19 pandemic, the initial failure to develop an efficient test and the surprisingly contradictory guidelines on Social Distancing for the citizenry eager to receive the experts’ guidance, have certainly baffled us.
In a review article of The New York Times Magazine, Jeneen Interlandi analyzed the core causes of those system failures in what was, and still is, considered the premier infection surveillance in the world, whose guidelines are respected by all countries. She begun by informing us that last November a group of academics and Public Health experts created, via regular Zoom meetings, the Covid Rapid Response Working Group to analyze the guidelines to open schools for physical interactions. The local communities were bitterly divided over whether to allow the access of students to their classrooms, even though the latter had not been sources of infection.
She said: “So far there was no national plan for how to move forward, The Centers for Disease Control and Prevention was advising everyone to wear masks and remain six feet apart at all times. But that guidance was a significant impediment to any full-bore reopening, because most schools could not maintain that kind of distance and still accommodate all their students and teachers. It also has left many questions unanswered: How did masks and distancing and other strategies like opening windows fit together? Which were essential? Could some measures be skipped if others were followed faithfully?”
Interlandi attributed this inertia and contradictions to a dangerous phenomenon that had plagued the agency for years already: extreme politicization. Not only the agency has shown baffling clumsiness in their public dealings but, what was much worse, it was immobilized by the meddling of the Trump administration; some reports were altered at the last minute to “comply” with the false mantra that “the epidemic was under control” and that we should trust that “Daddy knows best.” At the state and local levels, the draconian powers of Quarantine were used for blatant demagoguery by unscrupulous pundits of all stripes. In order to conceal their utter ineptitude, the authorities shifted the burden of guidelines’ design to the local authorities, so they could “take the rap” if anything went wrong. As one of our Neurology professors used to say: “the worst policy is no policy.”
The Covid Rapid Response Working Group, located at the University of Harvard, stepped into the public plate to design “actionable intelligence” based on humongous amount of raw data—on infectivity and hospitalization rates, morbidity and mortality rates, etc.—that they had collected and analyzed from multiple sources across the USA; they devised county-by-county risk assessment tools, national testing strategies and contact tracing protocols that fast filled the knowledge void. In particular cases, like the operational guidelines for hospitals, this nimble group moved much faster that the pachydermilian CDC, struggling to catch up with them.
Since its creation in 1946, the agency has had to walk a “fine line” when dealing with the states and local communities where most of their authorities and administrators have always been wary of having “too much federal interference” in a turf they always considered as their own. Moreover, even after great successes, once the light of the public attention was turned off ( and it always does as the limelight depends on our fickle attention span) the mendacious politicians took advantage of it by slashing its funds and cutting staff. The scarcity of funds triggered many vicious internal fights for their apportionment. Some insiders have confided that everybody was fending off for only their interests, compounded by the reality that agency chiefs were unwilling or unable to cooperate.
Interlandi paints a bleak picture of the constraining corset that this sprawling organization (with scientific teams and field offices all over the USA and the World) must forcibly wear at present. “Despite that scope, the agency has little authority. Its officers can’t compel individual states to participate in its initiatives, for example, nor to include CDC scientists in local outbreak investigations, nor to share much data with the agency—even in the middle of a pandemic. It can’t force people to wear masks, or force local leaders to close (or open) schools…Aside from a few quarantine powers, the most that the CDC can do is issue guidance, which is unenforceable and –as the past year has repeatedly shown—just as likely to be weaponized as meaningfully employed.”
The atomization of the institutional arrangements with the states and the extreme focus on foodborne-pathogens (rather than the airborne ones like the coronaviruses) hampered its ability to conduct the necessary genomic surveillance for the threat. There is a great variation in the surveillance capabilities of jurisdictions, sometimes focusing on different parameters that suit their public and political interests. In the beginning of the pandemic the CDC was notoriously absent from the scientific discussions carried out by many teams all over the globe. A sorry shadow of it past.
The Biden administration has already taken bold steps to modernize the bureaucratic structure of the CDC, starting with the demise of a few honchos blocking reform. It has proposed increased federal funding in the budget and allocated some surplus Covid 19 funds to it.
Will that be enough to modernize it?
When we needed them the most, the CDC’s opinions were notoriously absent from the public sphere. They have certainly shamelessly failed us, the citizens of the USA, and the rest of the World.
Stay distant. Stay safe. Stay beautiful.
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Don’t leave me alone.