Cartoon – Employee Engagement Today
Category Archives: Data Integrity
America has to be ready for mail voting to avert an election crisis
America has to be ready for mail voting to avert an election crisis
Valid concerns have been raised about mail voting. In New York, the local election boards have taken weeks to count primary ballots received in the mail as a result of the coronavirus, leaving several races for Congress still unresolved. The problems have been blamed on the late decision to send out the absentee ballot applications, outdated ballot counting machines, and the sheer number of mail ballots. The New York case raises a serious alarm with the 2020 election approaching and many states considering more reliance on mail voting in the midst of the pandemic.
Adding to this sense of urgency, President Trump has declared, without evidence, that mail voting is an open invitation to fraud and will be used unfairly against him this fall. He has tweeted that mail voting would make this the “most rigged” election in history. Setting aside the fact that states have relied on absentee and mail voting to hold secure elections for many years, the stumbles in New York and the irresponsible fear mongering by Trump raise the potential of a very real crisis come this fall.
Consider the national disruption surrounding the 2000 election, which was decided for George Bush after a recount in Florida, a month of legal battles, and a controversial split Supreme Court decision. After you add the factor of a second wave of coronavirus cases in the fall and a sitting president shouting “rigged!” to the rafters, and you can understand why some analysts worry that the period following the 2020 election may be one of the most disruptive contests in our modern history.
A crisis foretold, however, can be a crisis averted. Instead of wringing our hands over the recent problems with mail voting in New York, we have to learn from them and from the multiple states that have implemented mail voting systems without problems or fraud. Then states can make common sense preparations to ensure the process goes as quickly and smoothly as possible to prevent a potential election crisis in November.
The fact that election boards were overwhelmed by an influx of absentee ballots in New York must be the rallying cry for dedicating more resources to efficiently implement mail voting systems. Reducing funds available for mail voting initiatives, as some Trump supporters have advocated, in this era when many people have to rely on these ballots or literally risk death, will only serve to suppress voting, which may be the point.
Consider the case of Ohio for a glimpse of what a proactive mail voting initiative looks like. At the urging of Governor Mike DeWine, Republican and Democratic lawmakers unanimously approved their all mail voting primary that was successfully concluded in April. Governors and state legislatures across the country have to learn from Ohio, and additional federal funds have to be made available to assist the efforts.
All those claims that mail ballots are subject to rampant tampering is not evidence that they are, and it suggests the need to educate voters on the issue. Members of the Armed Forces have relied on absentee voting with mail ballots since the Civil War. Trump himself has voted absentee by mail. Meanwhile, three states allow ounties to conduct elections completely by mail if they choose, five other states conduct elections almost entirely by mail, and more than two dozen other states permit their residents to cast absentee ballots by mail without having to provide a reason.
Over 250 million votes have been cast using mailed ballots since 2000, according to the Vote at Home Institute, and yet exhaustive analysis has identified only a tiny fraction of cases of fraud. None of those states that hold their elections almost entirely by mail has seen voter fraud scandals. The bipartisan group Vote Safe, chaired by former Governor Tom Ridge of Pennsylvania and former Governor Jennifer Granholm of Michigan, notes that several studies have consistently proven that mail ballots are secure and do not advantage one political party over the other. The team rightly emphasizes that the goal of ensuring the safety of voters as they exercise their rights during a raging pandemic is not a partisan issue.
Whether we improve our voting systems or defund them, the use of mail ballots will inevitably be much greater in the 2020 election than in years past. We can prepare for this eventuality and find innovative ways to deal with the challenges that arise, or we can shift our gaze from another crisis foretold and suffer the major consequences come November.
Winston Churchill noted that democracy is the worst form of government, except for all other forms that have been tried. In the midst of a pandemic across the country that has already claimed the lives of tens of thousands of Americans, exercising our right to vote by mail instead of in person may also seem like the worst solution, except for all other options.
Cartoon – Pandemic Management
How deadly is COVID-19? A biostatistician explores the question
The latest statistics, as of July 10, show COVID-19-related deaths in U.S. are just under 1,000 per day nationally, which is down from a peak average of about 2,000 deaths per day in April. However, cases are once again rising very substantially, which is worrisome as it may indicate that substantial increases in COVID-19 deaths could follow. How do these numbers compare to deaths of other causes? Ron Fricker, statistician and disease surveillance expert from Virginia Tech, explains how to understand the magnitude of deaths from COVID-19.
As a disease surveillance expert, what are some of the tools you have to understand the deaths caused by a disease?
Disease surveillance is the process by which we try to understand the incidence and prevalence of diseases across the country, often with the particular goal of looking for increases in disease incidence. The challenge is separating signal from noise, by which I mean trying to discern an increase in disease incidence (the signal) from the day-to-day fluctuations in that disease (the noise). The hope is to identify any increase as quickly as possible so that medical and public health professionals can intervene and try to mitigate the disease’s effects on the population.
A critical tool in this effort is data. Often disease data is collected and aggregated by local and state public health departments and the Centers for Disease Control and Prevention from data that is reported by doctors and medical facilities. Surveillance systems then use this data and a variety of algorithms to attempt to find a signal amidst the noise.
Early on, many people pointed out that the flu has tens of thousands of deaths a year, and so COVID-19 didn’t seem so bad. What’s wrong with that comparison?
The CDC estimates the average number of flu-related deaths since 2010-11 is around 36,000 per year. This varies from a low of 12,000 deaths in 2011-12 to a high of 61,000 deaths in 2017-18. Thus, the number of COVID-19 deaths to date is three to four times greater than the annual average number of flu-related deaths over the past decade; it is 10 times larger when compared to the 2010-11 flu season but only about twice as large compared to 2017-18.
To make this a fair comparison, note that seasonal influenza mostly occurs over a few months, usually in late fall or early winter. So, the time periods are roughly comparable, with most of the COVID-19-related deaths occurring since late March. However, COVID-19 does not appear to be seasonal, and fatalities are a lagging measure because the time from infection to death is weeks if not months in duration, so the multiples in the previous paragraph will be greater by the end of the year.
Furthermore, while death rates have been coming down from a peak of more than 2,700 on April 21, 2020, the United States is now averaging just under 1,000 deaths per day as of July 10, and given the dramatic increase in cases of late, we should expect the fatality rate to further rise. For example, the University of Washington’s IHME model currently predicts slightly more than 208,000 COVID-19-related deaths by November 1.
So, by any comparison, the COVID-19 death rate is significantly higher than the seasonal influenza death rate.
What are some comparisons that could provide some context in understanding the scale of deaths caused by COVID-19?
As of this writing, more than 130,000 people have died of COVID-19, and that total could grow to 200,000 or more by fall. Those numbers are so big, they’re hard to grasp.
Michigan Stadium in Ann Arbor is the largest football stadium in the United States. It holds 107,420 people, so no football stadium in the country is large enough to hold everyone who has died from COVID-19 thus far. By the time bowl season comes along, assuming we have a football season this year, the number of COVID-19 fatalities will likely exceed the capacity of the Rose and Cotton bowl stadiums combined.
The state of Wyoming has a population of slightly less than 600,000 people, so it’s the equivalent of one out of every five people in that state dying in the last four months. By this fall, the COVID-19 death total will be the equivalent of fully one-third of the people in Wyoming dying.
The populations of Grand Rapids, Michigan; Huntsville, Alabama; and Salt Lake City, Utah are each just over 200,000 people. Imagine if everyone in one of those cities died over the course of six months. That’s what COVID-19 may look like by fall.
How do COVID-19 deaths compare to chronic diseases like cancer or heart disease?
Today, COVID-19 ranks as the sixth leading cause of death in the United States, following heart disease, cancer, accidents, lower chronic respiratory diseases and stroke. Heart disease is the leading cause, with just over 647,000 Americans dying from it each year. Alzheimer’s disease, formerly the sixth largest cause of death, kills just over 121,000 people per year. If the University of Washington IHME model’s current prediction of COVID-19-related deaths comes to pass, COVID-19 will be the third leading cause of death in the United States by the end of the year.
The American Cancer Society estimates that in 2020 there will be an estimated 1.8 million new cancer cases diagnosed and 606,520 cancer deaths in the United States. Lung cancer is estimated to kill about 135,000 people in the US in 2020, so the number of COVID-19 deaths is currently equivalent and will exceed it soon. Of course, it is important to note that the COVID-19 deaths have occurred in about the past four months while the number of lung cancer deaths is for a year. So, COVID-19 deaths are occurring at roughly three times the rate of lung cancer deaths.
What are some historical comparisons that you think are useful in understanding the scale of deaths from COVID-19?
The 1918 influenza pandemic was similar in some ways to the current pandemic and different in other ways. One key difference is the age distribution of deaths, where COVID-19 is concentrated among older adults while the the 1918 pandemic affected all ages. In my state of Virginia, only 8% of the people who died in the 1918 pandemic were more than 50 years old, compared to more than 97% for COVID-19.
The CDC estimates that the 1918 pandemic resulted in about 675,000 deaths in the United States, so slightly more than five times the current number of COVID-19 deaths. In October of 1918, the worst month for the influenza pandemic, about 195,000 people died – well more than all who have died so far from COVID-19.
As with any historical comparison, there are important qualifiers. In this case, the influenza pandemic started in early 1918 and continued well into 1919, whereas COVID-19 deaths are for about one-third of a year (March through June). However, today the United States’ population is about three times the size of the population in 1918. These two factors roughly “cancel out,” and so it is reasonable to think about the 1918 epidemic being about five times worse than COVID-19, at least thus far.
In comparison to past wars, the U.S. has now had more deaths from COVID-19 than all the combat-related deaths in all the wars since the Korean War, including the Vietnam War and Operations Desert Shield and Desert Storm. In World War II there were 291,557 combat casualties. So the number of people who have died from COVID-19 thus far is about 45% of the WWII combat casualties. By the fall, it could be more than 70%.
Finally, note that the number of confirmed and probable deaths from COVID-19 in New York City (23,247 on July 10, 2020) is more than eight times the number who died in the 9/11 attack (2,753).
Covid-19 data is a public good. The US government must start treating it like one.
The US has failed to prioritize a highly effective and economical intervention—providing quick and easy access to coronavirus data.
Earlier this week as a pandemic raged across the United States, residents were cut off from the only publicly available source of aggregated data on the nation’s intensive care and hospital bed capacity. When the Trump administration stripped the Centers for Disease Control and Prevention (CDC) of control over coronavirus data, it also took that information away from the public.
I run a nonpartisan project called covidexitstrategy.org, which tracks how well states are fighting this virus. Our team is made up of public health and crisis experts with previous experience in the Trump and Obama administrations. We grade states on such critical measures as disease spread, hospital load, and the robustness of their testing.
Why does this work matter? In a crisis, data informs good decision-making. Along with businesses, federal, state, and local public health officials and other agencies rely on us to help them decide which interventions to deploy and when workplaces and public spaces can safely reopen. Almost a million people have used our dashboards, with thousands coming back more than 200 times each.
To create our dashboards, we rely on multiple sources. One is the National Healthcare Safety Network (NHSN), run by the CDC. Prior to July 14, hospitals reported the utilization and availability of intensive care and inpatient beds to the NHSN. This information, updated three times a week, was the only publicly available source of aggregated state-level hospital capacity data in the US.
With 31 states currently reporting increases in the number of hospitalized covid-19 patients, these utilization rates show how well their health systems will handle the surge of cases.
Having this information in real time is essential; the administration said the CDC’s system was insufficiently responsive and data collection needed to be streamlined. The US Department of Health and Human Services (HHS) directed hospitals (pdf) to report their data to a new system called HHS Protect.
Unfortunately, by redirecting hospitals to a new system, it left everyone else in the dark. On July 14, the CDC removed the most recent data from its website. As we made our nightly update, we found it was missing. After significant public pressure, the existing maps and data are back—but the agency has added a disclaimer that the data will not be updated going forward.
This is unacceptable. This critical indicator was being shared multiple times a week, and now updates have been halted. US residents need a federal commitment that this data will continue to be refreshed and shared.
The public is being told that a lot of effort is going into the new system. An HHS spokesman told CNBC that the new database will deliver “more powerful insights” on the coronavirus. But the switch has rightly been criticized because this new data source is not yet available to the public. Our concerns are amplified by the fact that responsibility for the data has shifted from a known entity in the CDC to a new, as-yet-unnamed team within HHS.
I was part of the team that helped fix Healthcare.gov after the failed launch in 2013. One thing I learned was that the people who make their careers in the federal government—and especially those working at the center of a crisis—are almost universally well intentioned. They seek to do the right thing for the public they serve.
In the same spirit, and to build trust with the American people, this is an opportunity for HHS to make the same data it’s sharing with federal and state agencies available to the public. The system that HHS is using helps inform the vital work of the White House Coronavirus Task Force. From leaked documents, we know that reports for the task force are painstakingly detailed. They include county-level maps, indicators on testing robustness, and specific recommendations. All of this information belongs in the public domain.
This is also an opportunity for HHS to make this data machine readable and thereby more accessible to data scientists and data journalists. The Open Government Data Act, signed into law by President Trump, treats data as a strategic asset and makes it open by default. This act builds upon the Open Data Executive Order, which recognized that the data sets collected by the government are paid for by taxpayers and must be made available to them.
As a country, the United States has lagged behind in so many dimensions of response to this crisis, from the availability of PPE to testing to statewide mask orders. Its treatment of data has lagged as well. On March 7, as this crisis was unfolding, there was no national testing data. Alexis Madrigal, Jeff Hammerbacher, and a group of volunteers started the COVID Tracking Project to aggregate coronavirus information from all 50 state websites into a single Google spreadsheet. For two months, until the CDC began to share data through its own dashboard, this volunteer project was the sole national public source of information on cases and testing.
With more than 150 volunteers contributing to the effort, the COVID Tracking Project sets the bar for how to treat data as an asset. I serve on the advisory board and am awed by what this group has accomplished. With daily updates, an API, and multiple download formats, they’ve made their data extraordinarily useful. Where the CDC’s data is cited 30 times in Google Scholar and approximately 10,000 times in Google search results, the COVID Tracking Project data is cited 299 times in Google Scholar and roughly 2 million times in Google search results.
Sharing reliable data is one of the most economical and effective interventions the United States has to confront this pandemic. With the Coronavirus Task Force daily briefings a thing of the past, it’s more necessary than ever for all covid-related data to be shared with the public. The effort required to defeat the pandemic is not just a federal response. It is a federal, state, local, and community response. Everyone needs to work from the same trusted source of facts about the situation on the ground.
Data is not a partisan affair or a bureaucratic preserve. It is a public trust—and a public resource.
U.S. blows past coronavirus record with more than 70,000 new cases in one day
Record numbers of covid-19 fatalities were reported in Florida, Texas and South Carolina on Thursday, and officials throughout the Sun Belt are worried that hospitals could soon reach a breaking point.
Here are some significant developments:
- Masks are now mandatory in more than half of U.S. states — with the governors of Arkansas and Colorado the latest to issue face-covering orders. Major retailers phased in new mask policies, and Maryland Gov. Larry Hogan (R), chairman of the National Governors Association, said that masks should be mandated in states across the country.
- Larry Fink, the chief executive of investment firm BlackRock, said that if states moving forward with reopening plans required masks, the economy would recover much sooner.
- Atlanta Mayor Keisha Lance Bottoms (D) blasted Georgia’s Republican governor, Brian Kemp (R), for suing to stop block her city’s mask ordinance, accusing him of “putting politics over people.”
- An unpublished report from the White House Coronavirus Task Force suggests that nearly 20 hard-hit states should enact tougher public health measures.
- Real-time coronavirus tracking data temporarily disappeared from the Centers for Disease Control and Prevention’s website, sparking an outcry.
- President Trump faces rising disapproval and widespread distrust on coronavirus, according to a new Post-ABC poll.
- India on Friday surpassed 1 million confirmed coronavirus cases, becoming the third country to cross that threshold, behind the United States and Brazil..
Disappearance of covid-19 data from CDC website spurs outcry
Governors join calls for delay of administration plan to shift control from the CDC as Trump administration pledges to make data available to the public.
And on Thursday, the nation’s governors joined the chorus of objections over the abruptness of the change to the reporting protocols for hospitals, asking the administration to delay the shift for 30 days. In a statement, the National Governors Association said hospitals need the time to learn a new system, as they continue to deal with this pandemic.
The governors also urged the administration to keep the information publicly available.
The disappearance of the real-time data from the CDC dashboard, which was taken down Tuesday night before resurfacing Thursday morning, was a ripple effect of the administration’s new hospital reporting protocol that took effect Wednesday, according to a federal health official who spoke on the condition of anonymity to discuss internal deliberations.
Without receiving the data firsthand, CDC officials were reluctant to maintain the dashboard — which shows the number of patients with covid-19, the disease caused by the virus, and hospital bed capacity — and took it down, the federal health official said. The CDC dashboard states that its information comes directly from hospitals and does not include data submitted to “other entities contracted by or within the federal government.” It also says the dashboard will not be updated after July 14.
The dashboard “was taken down in a fit of pique,” said Michael R. Caputo, the assistant secretary for public affairs at the Department of Health and Human Services. “The idea CDC scientists cannot rely upon their colleagues in the same department for data collection, or any other scientific work, is preposterous.”
This week, the CDC, the government’s premier public health agency whose medical epidemiologists analyze the hospital data, also stopped producing reports about trends in the pandemic that had gone twice a week to states, and six days a week to officials at multiple federal agencies. Adm. Brett Giroir, an assistant secretary in the HHS who oversees coronavirus testing, was unhappy that the CDC hospital report stopped Wednesday and Thursday mornings, according to the federal health official.
Caputo said that the administration’s goal is to maintain transparency, adding that conversations were still taking place between HHS officials and the CDC on a plan to keep producing the dashboard updates and the reports. “We expect a resolution,” he said.
Another HHS spokesperson said the CDC might create a new dashboard, based on a wider set of information.
During a conference call for journalists Thursday on coronavirus testing, Giroir did not acknowledge his displeasure with the reports’ discontinuation. But he said: “Those data are really critical to all of us. … I wake up in the morning and first thing I do, I look at the data. I look at midday. I look at it at night before I go to bed. … We drive the response based on that.”
The CDC site had been one of the few public sources of granular information about hospitalizations and ICU bed capacity. About 3,000 hospitals, or about 60 percent of U.S. hospitals, reported their data to the CDC’s system.
The president of the American Medical Association, Susan R. Bailey, spoke out Thursday on the uncertainties about access to data. “[W]e urge and expect that the scientists at the CDC will continue to have timely, comprehensive access to data critical to inform response efforts,” she said.
Governors, hospital officials and state health officers were given scant notice of the change in the reporting system. Two top administration health officials said in a letter to governors early this week that some hospitals were not complying with the previous protocols, suggesting that states might want to consider bringing in the National Guard to help gather the information. Hospital industry leaders vehemently protested that characterization, as well as the idea that they should be assisted by the National Guard in the midst of a pandemic.
HHS and CDC officials have said the protocol was changed to streamline reporting of data that is used, among other things, to determine the federal allocation of therapeutics, testing supplies and protective gear. Instead of reporting to the long-standing CDC system, hospitals must send data about covid-19 patients and other metrics to a recently hired federal contractor, called TeleTracking, or to their state health departments.
At least some state health departments that have been collecting data for their hospitals and sending it to Washington have already said the switch will make it impossible for them to continue, at least for now. The changed protocol includes a requirement that hospitals send several additional types of data that some state systems are not equipped to handle, state health officials said.
The Pennsylvania Department of Health sent a notice to hospitals Tuesday night saying that its platform was not ready to accommodate the new federal requirements, so that hospitals needed to report every day to both the state and to TeleTracking.
Charles L. Gischlar, spokesman for the Maryland Department of Health, said the reporting change “is a heavy lift for hospitals.”
The new system “exceeds the capacity of the current statewide system” to which hospitals had been reporting, he said, so the state no longer can send consolidated information to the federal government. As a result, he said in a statement, hospitals must provide data individually to the government.
Administration’s war on the public health experts
A pandemic would normally be a time when public health expertise and data are in urgent demand — yet President Trump and his administration have been going all out to undermine them.
Why it matters: There’s a new example almost every day of this administration trying to marginalize the experts and data that most administrations lean on and defer to in the middle of a global crisis.
Here’s how it has been happening just in the past few weeks:
- The administration has repeatedly undermined the Centers for Disease Control and Prevention. Most recently, Trump has criticized the CDC’s school reopening guidelines, Education Secretary Betsy DeVos declared that “kids need to be in school,” and the administration has reportedly ordered hospitals to bypass the CDC in reporting coronavirus patient information.
- It has repeatedly undermined Anthony Fauci. Trump distanced himself on Wednesday from an op-ed attack by White House trade adviser Peter Navarro, but longtime Trump aide Dan Scavino also called the infectious diseases specialist “Dr. Faucet” in a Facebook post accusing him of leaking his disagreements. And the White House gave a opposition research-style list of the times Fauci “has been wrong” to the Washington Post and other media outlets.
- Trump himself undermined public health experts generally with his retweet of former game show host Chuck Woolery’s “everyone is lying” tweet — which blamed “The CDC, Media, Democrats, our Doctors, not all but most, that we are told to trust.”
- Trump has made numerous statements suggesting, over and over again, that we wouldn’t have as many COVID cases if we just tested less. (From his Tuesday press conference at the White House: “If we did half the testing we would have half the cases.”)
The impact: The result is that the CDC — which is supposed to be the go-to agency in a public health crisis — is distracted by constant public critiques from the highest levels. And Fauci, “America’s Doctor,” is the subject of yet another round of stories about whether Trump is freezing him out.
- “The way to make Americans safer is to build on, not bypass, our public health system,” Tom Frieden, a former CDC director under Barack Obama, said in a statement to Axios about the efforts to sideline the agency.
- “Unfortunately, as with mask-up recommendations and schools reopening guidance, the administration has chosen to sideline and undermine our nation’s premier disease fighting agency in the middle of the worst pandemic in 100 years,” Frieden said.
- And Fauci, in an interview with The Atlantic, said of the efforts to discredit him: “Ultimately, it hurts the president to do that … It doesn’t do anything but reflect poorly on them.”
The other side: The White House insists there’s no problem. “President Trump has always acted on the science and valued the input of public health experts throughout this crisis,” said White House deputy press secretary Sarah Matthews.
- Trump campaign communications director Tim Murtaugh closed ranks with the experts as well. “President Trump has said repeatedly that he has a strong relationship with Dr. Fauci, and Dr. Fauci has always said that the President listens to his advice,” he said.
- And Department of Health and Human Services spokesman Michael Caputo declared that “the scientists and doctors speak openly, they are listened to closely, and their advice and counsel helps guide the response.”
- “Frankly, when it comes to this tempest in a teapot over Dr. Fauci, I blame the media and their unending search for a ‘Resistance’ hero, for turning half a century of a brilliant scientist’s hard work into a clickbait headline that helps reporters undermine the president’s coronavirus response,” Caputo said.
Between the lines: Murtaugh deflected several times when asked whether there was a deliberate strategy to marginalize the CDC and the experts: “The President and the White House have consistently advised Americans to follow CDC guidelines. The President also believes we can open schools safely on time and that we must do so.”
- However, one administration official said there were parts of the CDC school reopening guidelines that were impractical, and noted that kids can also suffer long-term harm by staying out of school too long.
Our thought bubble, by Axios White House reporter Alayna Treene: The responses make it clear that the White House and the Trump campaign don’t want to advance the narrative that they’re deliberately battling with America’s health experts, or that there’s any kind of strategy behind it.
The bottom line: When the history of this pandemic is written, it will show that the public health experts who were trying to fight it also had to deal with political fights that made their jobs harder.
White House tells hospitals to bypass CDC on COVID-19 data reporting
Hospitals will begin sending coronavirus-related information directly to the Department of Health and Human Services (HHS), not the Centers for Disease Control and Prevention (CDC), under new instructions from the Trump administration.
The move will take effect on Wednesday, according to a new guidance and FAQ document for hospitals and clinical labs quietly posted on the HHS website.
Previously, hospitals reported to the CDC’s National Healthcare Safety Network, which the agency describes as the nation’s most widely used health care-associated infection tracking system.
The CDC tracked information including how many beds are available, the number of ventilators available and how many COVID-19 patients the hospitals have.
Beginning Wednesday, hospitals will report the same data but will bypass the CDC and send it to HHS directly.
According to HHS, the goal is to streamline data collection, which will be used to inform decisions at the federal level such as allocation of supplies, treatments and other resources.
But the move comes amid concerns that the White House has been sidelining the CDC and after Trump administration officials attacked Anthony Fauci, the nation’s top infectious disease expert and a member of the White House coronavirus task force.
Trump sidelines public health advisers in growing rift over coronavirus response
%2Farc-anglerfish-washpost-prod-washpost%2FKH6QH7FVNYI6VGQ52PNRZPQHZY.jpg&w=908)
The adviser, Paul Alexander, criticized the agency’s methods, and said its warning to pregnant women “reads in a way to frighten women . . . as if the President and his administration can’t fix this and it is getting worse.”
As the country enters a frightening phase of the pandemic with new daily cases surpassing 62,000 on Wednesday, the CDC, the nation’s top public health agency, is coming under intense pressure from President Trump and his allies, who are downplaying the dangers in a bid to revive the economy ahead of the Nov. 3 election. In a White House guided by the president’s instincts, rather than by evidence-based policy, the CDC finds itself forced constantly to backtrack or sidelined from pivotal decisions.
The latest clash between the White House and its top public health advisers erupted Wednesday, when the president slammed the agency’s recommendation that schools planning to reopen should keep students’ desks six feet apart, among other steps to reduce infection risks. In a tweet, Trump — who has demanded schools at all levels hold in-person classes this fall — called the advice “very tough & expensive.”
“While they want them open, they are asking schools to do very impractical things. I will be meeting with them!!!” Trump tweeted Wednesday. Within hours, Vice President Pence had asserted the agency would release new guidance next week.
“The president said today we just don’t want the guidance to be too tough,” Pence told reporters. “And that’s the reason next week the CDC is going to be issuing a new set of tools.”
Analysts say the deepening divide is undermining the authority of one of the world’s premier public health agencies, which previously led fights against malaria, smallpox and HIV/AIDS. Amid the worst public health crisis in a century, the CDC has in recent months altered or rescinded recommendations on topics including wearing masks and safely reopening restaurants and houses of worship as a result of conflicts with top administration officials.
“At a time when our country needs an orchestrated, all-hands-on deck response, there is simply no hand on the tiller,” said Beth Cameron, former senior director for global health security and biodefense on the White House National Security Council.
In the absence of strong federal leadership, state and local officials have been left to figure things out for themselves, leading to conflicting messaging and chaotic responses. Trump’s decision to pull the U.S. out of the World Health Organization further undermined efforts to influence global strategies against the coronavirus, including how vaccines will be distributed.
The CDC, meanwhile, is increasingly isolated — a function both of its growing differences with the White House and of its own significant missteps earlier in the outbreak.
Those stumbles include the botched rollout of test kits likely contaminated at a CDC lab in late January, which led to critical delays in states’ ability to know where the virus was circulating. And the CDC’s initial decision to test only a narrow set of people gave the virus a head start spreading undetected across the country.
During a May lunch with Senate Republicans, Trump told the group the CDC “blew it” on the coronavirus test and that he’d installed a team of “geniuses” led by his son-in-law Jared Kushner to handle much of the response,” according to two people familiar with the lunch who spoke on the condition of anonymity.
“There is a view the CDC is staffed with deep state Democrats that are trying to tweak the administration,” said one adviser who also spoke on the condition of anonymity to reveal private conversations.
White House officials, who see the president’s reelection prospects tied to economic recovery, also say they’ve been deeply frustrated by what they view as career staffers at the agency determined “to keep things closed,” according to a senior administration official who spoke on the condition of anonymity to reveal internal deliberations.
Trump believes the CDC is “ineffective” and a “waste of time,” but doesn’t blame CDC Director Robert Redfield and generally likes him, said another official speaking on the condition of anonymity. “He just thinks he is a poor communicator,” the official added.
Joe Grogan, former head of the White House Domestic Policy Council, said Redfield had fans inside the White House who work on “addiction issues, on life issues, on HIV issues,” among other topics.
But he said Redfield has few political appointees to help him run a complex agency. “How do you run a place like that with … [few] appointees?” Grogan asked.
HHS Secretary Alex Azar called the director “a key scientific guide for the President and his administration, a trusted source for the American people, and a closely engaged partner of state and local governments.”
But Redfield is not a voice in coronavirus task force meetings, and “is never really in the Oval [Office] with the president,” said another senior administration official, who also spoke on the condition of anonymity to discuss the internal dynamics.
Even Redfield’s supporters say he has failed to be an effective advocate for the agency.
“Bob Redfield’s commitment to public health is completely strong,” said William Schaffner, a veteran infectious-disease specialist at Vanderbilt University. But he said Redfield lacks the standing, deftness, and communication capacity to persuade skeptical audiences, including those in the White House, that protecting public health and fostering economic recovery are not opposing goals.
Redfield, for his part, downplayed Trump’s criticism of the CDC school reopeniing guidelines after a coronavirus task force briefing Wednesday, saying the agency and the president were “totally aligned.”
“We’re both trying to open the schools,” he said.
White House spokesman Judd Deere also disputed big differences, saying in a statement the White House and the CDC “have been working together in partnership since the very beginning of this pandemic to carry out the President’s highest priority: the health and safety of the American public.
“The CDC is the nation’s trusted health protection agency and its infectious disease and public health experts have helped deliver critical solutions to save lives. We encourage all Americans to continue to follow the CDC’s guidelines and use best-practices they have learned, such as social distancing, face coverings, and good hygiene, to maintain public health and continue our Transition to Greatness.”
But some health experts were indignant the agency had been ordered to rewrite guidance to reopen schools to “make it easier and cost less” — a demand that effectively “turns science on its head,” said Tom Inglesby, director of Johns Hopkins University’s Center for Health Security.
“CDC should be giving their best judgments on how to lower risks to make schools safer,” he said. “That’s their job. If they aren’t allowed to do that, the public will lose confidence in the guidance.”
Why are they ‘not shouting “fire”?’
The diminished role of the 74-year-old agency has bewildered infectious-disease experts, as well as members of the public seeking guidance.
After six states set one-day case records on July 3, Carlos del Rio, executive associate dean at Emory University’s School of Medicine, tweeted at Tom Frieden, a former CDC director, “Tom, where is @CDCgov ? Why are they not out there shouting ‘fire’?”
Frieden shot back: “They are still there, still doing great work, just not being allowed to talk about it, not being allowed to guide policy, not being allowed to develop, standardize, and post information that would give, by state and county, the status of the epidemic and of our control measures.”
Jeffrey Duchin, the health officer at Seattle and King County health department, added: “Agree. Muzzled, neutered and exiled.”
The agency has been largely invisible. After more than three months of silence, it resumed briefings for the public last month. There have been two.
By comparison, when the H1N1 swine flu pandemic hit the United States in the spring of 2009, the CDC held briefings almost every day for six consecutive weeks.
During this outbreak, the agency’s regular briefings ended abruptly after White House officials were angered when a top CDC leader warned that Americans could face “significant disruption” to their lives as a result of the virus’s spread to the United States.
CDC officials say they are still getting their message out, pointing to more than 2,000 documents providing pandemic-related information about reopening and staying safe for dozens of groups and venues, including funeral home directors, amusement parks, and pet owners. Each Friday, the CDC also posts CovidView, a weekly report of selected data and trends on testing, hospitalizations, and reported deaths.
But the information is posted without additional explanation or analysis.
“I want to hear a real person give me three minutes based on these findings,” said del Rio, also a global health and infectious-disease professor at Emory. “I want to see them in the news, being interviewed, giving us the data.”
Scientists at the CDC and former colleagues speak of deep frustration and low morale over its inability to fully share and explain scientific and medical information.
Researchers are fearful for their jobs and want to protect the integrity of the data they release. “If you want to say something, you’re thinking, ‘what’s the White House going to say and how are they going to use it,’ ” said one longtime scientist who spoke on the condition of anonymity for fear of retaliation.
The lack of briefings has fostered misunderstandings at times. In early April, for instance, when the agency reversed its position and recommended the use of cloth face coverings, CDC scientists gave no public briefings explaining why they made the change.
“It’s not rocket science,” said Nancy Cox, a virologist and former CDC official who led the influenza program for 22 years and was part of the agency’s response during the 2009 H1N1 swine flu pandemic. “But the reasoning behind those changes should be explained as clearly as possible and then you can get everyone on board.”
In the CDC’s absence, academic medical centers, public health and professional disease groups have filled the void by holding coronavirus briefings and providing analysis of key issues, data and research studies. Frieden, the president of Resolve to Save Lives, a New York nonprofit, has also been posting long Twitter threads analyzing the weekly CDC data released on Fridays.
Speaking ‘with an unfettered voice’
Alarmed at the agency’s diminished role, nearly 350 public health organizations sent a letter Tuesday to Azar urging him to advocate for the CDC. The agency must be allowed to speak based on the best available science “and with an unfettered voice,” said John Auerbach, president and chief executive of Trust for America’s Health, a public health nonprofit that led the effort.
House Democrats echoed those concerns in a separate letter to Azar last month. Reps. Diana DeGette of Colorado and Frank Pallone Jr. of New Jersey, who chairs the House Energy and Commerce Committee, said they were troubled by reports that administration officials are considering narrowing the CDC’s mission and embedding more political appointees at the Atlanta-based agency.
Traditionally the CDC has one political appointee, the director. Now it has Redfield and five other political appointees, including two advisers who were added in recent weeks.
“Now more than ever, the American people need a robust and effective CDC that is not repeatedly undermined by others in the administration, including the President and the Vice President,” the letter said.
White House Chief of Staff Mark Meadows views the agency as a problem and has criticized the CDC repeatedly to other administration officials, said a senior administration official.
White House and HHS officials are discussing what the CDC’s “core mission needs to be,” said one adviser familiar with the talks who spoke on the condition of anonymity to comment on policy deliberations. The discussions were first reported by Politico.
Over the years, the agency that was founded to fight malaria now works on virtually every aspect of public health. “It has tried to be everything to everyone,” the adviser said, suggesting the agency might need to refocus more narrowly.
On the global front, administration officials are also weighing a $2.5 billion initiative called the President’s Response to Outbreaks that would move a significant portion of national and international pandemic responses to the State Department, according to a draft obtained by The Post. Details were first reported by Devex.
“There is no clear leadership role for CDC” in this plan, said Jennifer Kates, a senior vice president for global health and HIV policy at the Kaiser Family Foundation. “In global health, you need an engaged CDC.”
Taken together, the administration efforts seem “designed to position CDC to the margins,” said one federal health official who spoke on the condition of anonymity for fear of retaliation.
‘Boogeyman where there aren’t any’
The report that drew the email attack, accusing the agency of undermining the president, had provided detailed but incomplete information about pregnancy risks related to the coronavirus. It found pregnant women with covid-19 were more likely to be hospitalized, admitted to an intensive care unit, and to need ventilator support than infected women who are not pregnant.
The sender, Alexander, a specialist in health research methods, is a senior adviser to Michael Caputo, a longtime Trump ally who was recently appointed assistant HHS secretary for public affairs , which includes the CDC.
The email was directed to Redfield and Caputo.
Even amid the intense criticism of the agency, the email “crosses the line,” said the official, who was aware of the content.
Like all of the CDC’s reports, the analysis itself noted several limitations. One key one that researchers acknowledged was that they did not have data to indicate whether the pregnant women were hospitalized because of labor and delivery, or because they had covid-19.
Administration officials are “seeing political boogeymen where there aren’t any,” the federal health official said, adding that such narratives could further hamper the U.S. response.
“It could feed the fire to limit the flow of scientific data and communication to the general population,” the official said. “People are getting sick and dying. Can we just focus on the science?”
Alexander said in his email that the lack of data about why women were hospitalized was a “key issue.”
“The CDC is undermining the President by what they put out, this is my opinion and sense, and I am reading it and can see the subtle and direct hits,” he wrote.
Alexander, also a part-time assistant professor at McMaster University in Hamilton, Ontario, did not respond to emails and telephone calls seeking comment.
Caputo said in an interview that he agreed with Alexander. The CDC represents itself as the gold standard for public health agencies, he said, “but in the case of pregnancy analysis, it wasn’t even bronze.”
He called CDC’s track record “spotty” and “questionable,” pointing to Zika diagnostic testing errors in 2016.
“In many cases over the years, regardless of administration, the CDC has undermined presidents and themselves,” Caputo said, referring to leaked drafts of CDC guidances. “Who says the CDC is the sole font of wisdom when it comes to detecting and fighting deadly pathogens?”
Experts say that even with some big unanswered questions, the pregnancy findings represent the best available evidence and are important. The lack of data reflects decades of long-neglected national surveillance on pregnancy.
“I don’t think this is frightening women,” said Denise Jamieson, who heads the obstetrics and gynecology department at Emory University and Emory Healthcare. True, the report “suffers from completeness of data,” she said. But now doctors can be more confident that pregnant women are more likely to have severe disease and use “this really important information” to counsel patients, she said.
HENRY KOTULA 