Science

‘They Let Us Down’: 5 Takeaways on the C.D.C.’s Coronavirus Response

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WASHINGTON — Long considered the world’s premier public health agency, the Centers for Disease Control and Prevention has fallen short in its response to the most urgent public health emergency in its 74-year history — a pathogen that has penetrated much of the nation, killing more than 100,000 people.

The agency made early missteps in testing and failed to provide timely counts of infections and deaths, hindered by aging technology across the U.S. health system. It hesitated in absorbing the lessons of other countries, and struggled to calibrate the need to move fast and its own imperative to be cautious. Its communications were sometimes confusing, sowing mistrust, even as it clashed with the White House and President Trump.

“They let us down,” said Dr. Stephane Otmezguine, an anesthesiologist who treated coronavirus patients in Fort Lauderdale, Fla.

The agency issued a statement saying it was “providing the best, most current data and scientific understanding we have.”

But a New York Times review of thousands of emails, and interviews with more than 100 state and federal officials, public health experts, C.D.C. employees and medical workers, documents how the Covid-19 pandemic shook longstanding confidence in the agency and its leader, Dr. Robert R. Redfield. These are some of the key findings.

As the virus began to spread in the United States in January, the C.D.C.’s response was hampered by an antiquated data system and a fractured public health reporting system across the U.S., relying in part on information assembled or shared with local health officials through phone calls, faxes and thousands of spreadsheets attached to emails.

The C.D.C. could not produce accurate counts of how many people were being tested, compile complete demographic information on confirmed cases or even keep timely tallies of deaths. Backups on at least some of these systems are made on recordable DVDs, a technology that was state-of-the-art in the late 1990s.

The overall result was an agency that had blind spots at just the wrong moment. The disconnect between hospital record-keeping systems, the C.D.C. and state and local public health departments delayed sharing critical information that could help patients.

“We got crappy data,” said Fran Phillips, Maryland’s deputy health secretary.

As the crisis deepened, tensions between the agency and the White House increased, with aides to Mr. Trump referring to the scientists at the C.D.C. as members of the “deep state” who were eager to wound him politically by leaking to the press.

At the same time, some C.D.C. employees watched with growing alarm as Mr. Trump, facing criticism for his administration’s response, repeatedly undermined the agency. And they paled at what they saw as meddling by politically motivated Trump aides.

Mr. Trump and his aides often expressed extraordinary skepticism about the virus and the steps that would have to be taken to curb it. He said the virus would disappear “like a miracle” even as C.D.C. scientists described it as a real threat. When the C.D.C. urged Americans to wear masks, he said, “I don’t see it for myself.”

Just before Memorial Day weekend, Mr. Trump ordered the C.D.C. to issue guidance that would allow churches to reopen. “I said, ‘You better put it out,’” Mr. Trump told reporters. “And they’re doing it.”

“I would expect the C.D.C. to coordinate with the White House,” said Lawrence Gostin, the director of a legal center at the World Health Organization and a former C.D.C. official. “But this is not team work. This is not coordination. This is confrontation.”

The culture at the C.D.C. — risk-averse, perfectionist and ill suited to improvising in a quickly evolving crisis — shaped its scientists’ ambitions and contributed to some of its failures as it tried to respond to the pandemic.

“It’s not our culture to intervene,” said Dr. George Schmid, who worked at the agency off and on for nearly four decades. He described it as increasingly bureaucratic, weighed down by “indescribable, burdensome hierarchy.”

Former officials said the C.D.C.’s culture locked some of the agency’s employees into a fixed way of thinking, helping to produce its first and most consequential failure in the crisis: its inability early on to provide state laboratories around the country with an effective diagnostic test.

The culture — along with the failure of the test — also contributed to the agency’s decision to restrict who could get tested in the early days of the crisis. When doctors in Washington State and elsewhere forwarded the names of about 650 people in January who might have been infected, the C.D.C. agreed to test only 256.

“If we were able to test early, we would have recognized earlier” the scale of the outbreak, said Dr. Jeffrey Duchin, the chief health officer in King County, Wash. “We would have been able to put prevention measures in place earlier and had fewer cases.”

  • Updated June 2, 2020

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      Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.

    • How do we start exercising again without hurting ourselves after months of lockdown?

      Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.

    • My state is reopening. Is it safe to go out?

      States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.

    • What’s the risk of catching coronavirus from a surface?

      Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.

    • What are the symptoms of coronavirus?

      Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

    • How can I protect myself while flying?

      If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

    • How many people have lost their jobs due to coronavirus in the U.S.?

      More than 40 million people — the equivalent of 1 in 4 U.S. workers — have filed for unemployment benefits since the pandemic took hold. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.

    • Should I wear a mask?

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    • What should I do if I feel sick?

      If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

The coronavirus pandemic underscored the need for Dr. Redfield to manage the mercurial demands of the president who appointed him and the expectations of the career scientists at the agency he leads.

White House aides saw Dr. Redfield as an ally, but his meandering manner irritated a president drawn to big personalities and assertive defenders of his administration. Although he is on the White House coronavirus task force, Dr. Redfield soon found himself eclipsed by Dr. Anthony S. Fauci, the nation’s most famous infectious disease specialist, and Dr. Deborah Birx, an AIDS expert and former C.D.C. physician.

While praising his friend as “a terrific, dedicated infectious disease doctor,” Dr. Gallo, who also co-founded the Global Virus Network, said in an interview that Dr. Redfield “can’t do anything communication-wise.”

Meanwhile, Dr. Redfield’s bonds with some of his own staff have frayed. One associate recounted him saying that the agency’s scientists had a “myopic” view of their roles, and characterized his relationship with his top deputy, Dr. Anne Schuchat, a career C.D.C. scientist deeply respected in the agency, as growing strained.

He has not been in Atlanta recently, shuttling instead between his home in Baltimore and the West Wing. One person familiar with his thinking described Dr. Redfield as feeling “a little bit on an island.”

As the national clearinghouse for critical public health information, the C.D.C. is supposed to provide medical guidance to health workers while offering easy-to-understand information for political leaders, business executives and the general public.

But the agency has struggled at times to provide clear and timely guidance, leading many to say they now look to universities, mailing lists or online research articles for detailed recommendations about how to safely care for infected patients.

After initially recommending that all doctors and nurses coming in contact with coronavirus patients wear N95 respirators, the C.D.C. announced that less protective surgical masks were “an acceptable alternative” except in some cases. The change angered health care workers like Lori Freeman, chief executive of the National Association of County and City Health Officials, who said that “mistrust crept in.”

As Miami Beach begins to reopen its economy, Mayor Dan Gelber said he wished the C.D.C. would provide more specific steps that cities should follow if cases surge again, adding, “It’s almost as if they just said, ‘Open up and figure out whether it’s a good idea or not afterward.”

An agency press officer said the C.D.C. has “issued countless guidance and recommendations based on the best available science and data,” pointing to 114 advisory documents for disaster and homeless shelters, retirement communities, taxis, pediatric clinics and other venues.

source: nytimes.com