“The Centers for Disease Control and Prevention has
been the premier U.S. public health agency since its founding on July
1, 1946. The CDC is responsible for assuring the health of all
Americans and promoting evidence-based public health practice. It also is
responsible for researching the causes of death and illness as well as working
on ways to prevent them. Americans have come to trust it for accurate information.
“However,
recent actions by the CDC have led many in public health to call into question
the integrity of the CDC’s leadership as they
ignore the science and bow to political pressure. Their actions have hurt
public health efforts and led to confusion and mistrust by the public at large.
“As
an infectious disease epidemiologist, I have
spent my career both in academia and in public health practice studying how
viruses infect people and testing populations to determine current infection
and immunity. I find the politicization of advice coming out of the CDC
disturbing, to say the least.
“The
latest, most egregious non-science-based advice is a change in recommendation
for who should get tested for COVID-19. Here’s what happened and why it matters
so much – not just to public health experts, but to the public.
Testing is key to containing the virus
“Public
health experts have learned a great deal about the novel coronavirus and
COVID-19 since the coronavirus first appeared. They have learned, for example,
that an estimated 4 out of 10 infected people will
never show symptoms – but can unknowingly infect others. In addition, infected
persons who will go on to develop symptoms can spread the disease one to two days before those symptoms
occur. These are two of the reasons the virus is so hard to contain.
“Evidence
suggests that widespread testing of people without symptoms would greatly reduce 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 for the same reasons. This has
been the CDC’s recommendation since studies first began to show asymptomatic
transmission.
“Then,
the CDC on Aug. 24, 2020 changed course and recommended to test 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 had been quietly changed on the CDC
website, 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, 2020. Arizona, California, Connecticut, Florida, Illinois,
Texas, New Jersey and New York have already announced they will
not follow the new CDC testing guidelines, showing more understanding of the
benefits of testing than our national public health institution.
Fauci had no voice in the matter
“This
new recommendation came from the White House Coronavirus Task Force, and the
CDC fell in line. Dr. Anthony Fauci, a task force member and head of the
National Institute of Allergy and Infectious Diseases, was undergoing surgery on his vocal cords
when the task force met Aug. 20 and decided on the change.
“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. 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.
See no virus, have no virus?
“Without
test data, epidemiologists are flying blind. Not knowing who is infected, we do
not have a picture of how many infected persons are in the community and how
the virus is being transmitted.
“Identifying
those who may have been exposed to the virus is the whole rationale for contact tracing – find cases, identify
contacts who may have been infected, ask them to self-quarantine, and test them
for the virus. 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.’
A series of tussles
“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
world is now in the midst of the worst pandemic in over a century. The United
States has 4.4% of the world’s population but 24% 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. No wonder the
public is confused about what they should be doing.
“It
does not bode well if we Americans can no longer trust the advice and
guidelines emanating from our national public health entity, not just for
control efforts in this pandemic but for future health concerns as well.
“I
answer questions about COVID-19 weekly on a radio call in show. A few weeks ago, a
caller asked me 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 all suffer” (The Conversation).
Catherine Lynne Troisi, Associate
Professor of Management, Policy, and Community Health and Epidemiology,
University of Texas Health Science Center at Houston
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