CDC gets a second opinion: Seven steps to heal our COVID-19 response
Back in March 2020, then-Centers for Disease Control and Prevention (CDC) Dir. Robert Redfield stated on multiple occasions that the new emerging coronavirus outbreak was under control. But a month earlier, top officials at the University of Nebraska Medical Center’s National Quarantine Unit, who were taking care of the initial 15 COVID-19 patients from the Diamond Princess cruise ship, told me they thought it already was spreading unchecked through communities.
Dr. Jeffrey Gold, chancellor at the University of Nebraska Medical Center, indicated that the virus appeared to be more contagious than the flu and, therefore, very difficult to contain.
The CDC had access to the same information. Granted, CDC officials were never allowed into China to see evidence of the virus’ origin or initial spread, but they did have enough information to know that this was a massive worldwide threat. Instead of taking charge of (or, perhaps, being allowed to take charge of) the national emergency declared by then-President Trump on March 13, they continued to cede power to the states.
At the same time, testing was anemic. The CDC sent test kits to more than 100 sites but most of them proved faulty. And even after that was addressed, testing continued to prove inadequate and frequently beset by long delays in getting results. In April, Adm. Brett Giroir, assistant secretary of the Department of Health and Human Services (HHS), was appointed testing czar; I felt he did a phenomenal job of trying to marshal resources. But testing still could never keep up with the virus, especially as rapid home self-testing didn’t become available until the end of 2020.
The CDC introduced monumental guidelines for lockdowns, masking, schools, phases of reopening. Yet, too often, it added more confusion and slowed implementation as its guidelines were either ignored, debated or changed too frequently for people to take them seriously.
The confusion surrounding CDC guidelines have never been truer than with the new vaccine guidelines. As of this writing, more than 30 million vaccine doses have been deployed by the government, but less than 15 million have made it into people’s arms. This delay in administration, while not directly the CDC’s fault, is due in part to the rigid interpretation of CDC guidelines — with some states adhering, some rebelling. The CDC needs to play a stronger role with a simpler, more coherent message.
Under the Biden administration, the CDC has an essential opportunity to play a more centralized leadership role. The Centers for Disease Control and Prevention — these very words signify what this organization should do. And now, led by Biden appointee Dr. Rochelle Walensky, a renowned Harvard virologist and Infectious Diseases chief at Massachusetts General Hospital, the CDC has the renewed opportunity to take the lead in battling the pandemic.
Here are the prioritizations that could make that happen, provided that the CDC under Walensky shows strong leadership:
Widespread rapid-screening tests that are self-administered (Lucira, Ellume and Abbott all make these products), which lead quickly to confirmatory testing, isolating and contact tracing.
Keep schools open with careful adherence to masking, personal distancing and testing.
No lockdowns. They strangle our economy, threaten our mental and physical health. And they do not work when the virus is this prevalent and spreads primarily within households. Rather, the CDC, led by Walensky, can analyze the sources of greatest spread (perhaps bars and movie theaters) and close them, while advising low-spread businesses (such as outdoor restaurants) on how to remain open with careful distancing.
Expanding the utilization of monoclonal antibodies for early treatment, to decrease the severity of infections and hospitalizations.
Most importantly at this juncture, as President Biden reveals a national vaccine program, Walensky must play a leadership role to integrate this plan with the states. With large mass vaccination centers opening, a public/private partnership involving pharmacies, clinics, hospitals and doctors offices is perhaps more important, as these are where most people are accustomed to getting their shots. Any guidance coming from the CDC on who gets vaccinated first must be accompanied by Plans B and C, so that perishable vaccines are not wasted. Guidelines should be intended to enable, not restrict. The new CDC director needs to focus on making sure that everyone across the country over the age of 65 is vaccinated as soon as possible, as this is the highest risk group for complications and death.
The CDC also must play a crucial role to encourage and enable widespread genetic testing of emerging variants. This has been inadequate, as have tests for immunity (neutralizing antibodies). Both need to become commonplace to help guide our response to, and eventual emergence, from the pandemic. It is possible to quickly re-engineer the vaccines, for example, if a resistant mutated variant emerges.
Finally, it is the CDC’s role to message consistently on the crucial importance of masking, distancing, limiting gatherings and travel, all in order to decrease viral spread. The CDC just published a big study demonstrating this. Now, Walensky and her team need to be our teachers, and we need to learn to listen.
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.
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