CDC’s missteps causing people to lose trust
The Centers for Disease Control and Prevention has been the premier U.S. public health agency since its founding in 1946.
However, recent actions by the CDC have led many in public health to call into question the integrity of its leadership as they ignore the science and bow to political pressure. As an infectious disease epidemiologist, I have spent my career studying how viruses infect people. I find the politicization of advice coming out of the CDC disturbing, to say the least.
The latest, most egregious non-sciencebased advice is a change in recommendation for who should get tested for COVID-19. We know that an estimated 4 out of 10 infected people will never show symptoms — but can infect others while others are infectious one to two days before symptoms occur. This makes the virus so hard to contain.
Evidence suggests that widespread testing of people without symptoms greatly reduces the spread of the virus by allowing people to know they’re infected and self-quarantine. Contacts of those asymptomatic cases can be identified and tested. This has been the CDC’s recommendation since studies first began to show asymptomatic transmission.
Then, the CDC on Aug. 24, changed course and recommended testing only those people who have symptoms for COVID-19.
Many public health experts were shocked. Testing only those who have symptoms will miss close to half of those who are infected.
Two days after the revised guidelines quietly came out, Director Robert Redfield clarified that those who come into contact with confirmed or probable COVID-19 patients could be tested even in the absence of symptoms.
That has always been the case, though. In the meantime, the altered guidelines on the CDC website promote confusion and remain unchanged as of Aug. 31. Arizona, California, Connecticut, Florida, Illinois, Texas, New Jersey, and New York have already announced they will not follow the new CDC testing guidelines.
The American Public Health Association has pointed out that the change was made without effective consultation with public health professionals working on the ground to control the pandemic. The World Health Organization continues to support testing of asymptomatic persons. Nearly every public health organization has called for a reversal of the testing guidance revision.
It is a particularly confusing decision given that lack of access to adequate testing has been an ongoing issue and has led to serious barriers in getting control of the pandemic.
Testing is at the core of controlling infectious disease spread.
The thinking seems to be that if you don’t test, the number of cases will go down.
Clearly, this is true only in the political sense. Yes, the number of reported cases will decrease, but the number of infected persons will not. By not identifying those who are infected but don’t have symptoms, spread of the virus will increase as those who don’t know they are infected, infect others.
Trump has said that he “likes the numbers where they are” and said at a campaign rally in Tulsa that he would tell his people to “slow the testing down.”
The CDC has been in the midst of a political struggle many times during this pandemic.
In May, it was revealed that CDC had been adding antibody tests, a marker of previous infection, to the number of PCR tests, a marker of current infection, performed. This made it appear that more tests to detect current infection had been performed than actually had.
In July, hospitalization data, historically reported to CDC and used by health departments and researchers throughout the country to understand the pandemic, disappeared from the CDC website as reporting switched to a private contractor. It reappeared a few days later, but this raised concerns this would hurt the ability of CDC to gather and analyze these data.
In another instance, the administration pressured CDC to rewrite its guidelines for safely reopening schools. It did this, even though once again, the guidelines did not reflect current scientific knowledge.
The United States has 4.4 percent of the world’s population but 24 percent of COVID-19 cases. Plainly, we are not doing well, and lack of trust in CDC’s guidance as well as constantly changing messaging is hampering our efforts to control the virus.
I answer questions about COVID-19 on a radio call-in show. A few weeks ago a caller asked if we could trust the information coming out of the CDC. I never thought I would be in a position where I couldn’t give an unequivocal “yes.” When politics overcomes science, public health cannot fulfill its mission, and everyone will suffer — not just during this pandemic but for future health concerns as well.