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Category Archives: Integrity
Cartoon – Importance of Transparency
US coronavirus data will now go straight to the White House. Here’s what this means for the world
Led by physicians, scientists and epidemiologists, the US Centers for Disease Control and Prevention (CDC) is one of the most reliable sources of knowledge during disease outbreaks. But now, with the world in desperate need of authoritative information, one of the foremost agencies for fighting infectious disease has gone conspicuously silent.
For the first time since 1946, when the CDC came to life in a cramped Atlanta office to fight malaria, the agency is not at the front line of a public health emergency.
On April 22, CDC director Robert Redfield stood at the White House briefing room lectern and conceded that the coronavirus pandemic had “overwhelmed” the United States. Following Redfield at the podium, President Donald Trump said the CDC director had been “totally misquoted” in his warning that COVID-19 would continue to pose serious difficulties as the US moved into its winter ‘flu season in late 2020.
Invited to clarify, Redfield confirmed he had been quoted correctly in giving his opinion that there were potentially “difficult and complicated” times ahead.
Trump tried a different tack. “You may not even have corona coming back,” the president said, once again contradicting the career virologist. “Just so you understand.”
The exchange was interpreted by some pundits as confirmation that the CDC’s venerated expertise had been sidelined as the coronavirus continued to ravage the US.
In the latest development, the New York Times reported this week the CDC has even been bypassed in its data collection, with the Trump administration ordering hospitals to send COVID-19 data directly to the White House.
Diminished role
When facing previous public health emergencies the CDC was a hive of activity, holding regular press briefings and developing guidance that was followed by governments around the world. But during the greatest public health emergency in a century, it appears the CDC has been almost entirely erased by the White House as the public face of the COVID-19 pandemic response.
This diminished role is obvious to former leaders of the CDC, who say their scientific advice has never before been politicised to this extent.
As the COVID-19 crisis was unfolding, several CDC officials issued warnings, only to promptly disappear from public view. Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, predicted on February 25 that the virus was not contained and would grow into a pandemic.
The stock market plunged and Messonnier was removed from future White House press briefings. Between March 9 and June 12 there was no CDC presence at White House press briefings on COVID-19.
The CDC has erred during the pandemic, most significantly in its initial efforts to develop a test for COVID-19. The testing kits proved to be faulty – a problem compounded by sluggish efforts to rectify the situation – and then by severe delays in distributing enough tests to the public.
But many public health specialists are nevertheless baffled by the CDC’s low profile as the pandemic continues to sweep the globe.
“They have been sidelined,” said Howard Koh, former US assistant secretary for health. “We need their scientific leadership right now.”
What does it mean for the world?
The CDC being bypassed in the collection of COVID-19 data is another body blow to the agency’s standing.
Hospitals have instead been ordered to send all COVID-19 patient information to a central database in Washington DC.
This will have a range of likely knock-on effects. For starters, the new database will not be available to the public, prompting inevitable questions over the accuracy and transparency of data which will now be interpreted and shared by the White House.
The Department of Health and Human Services, which issued the new order, says the change will help the White House’s coronavirus task force allocate resources. But epidemiologists and public health experts around the world fear the new system will make it harder for people outside the White House to track the pandemic or access information.
This affects all nations, because one of the CDC’s roles is to provide sound, independent public health guidance on issues such as infectious diseases, healthy living, travel health, emergency and disaster preparedness, and drug efficacy. Other jurisdictions can then adapt this information to their local context — expertise that has become even more essential during a pandemic, when uncertainty is the norm.
It is difficult to recall a previous public health emergency when political pressure led to a change in the interpretation of scientific evidence.
What happens next?
Despite the inevitable challenges that come with tackling a pandemic in real time, the CDC remains the best-positioned agency – not just in the US but the entire world – to help us manage this crisis as safely as possible.
In the absence of US leadership, nations should start thinking about developing their own national centres for disease control. In Australia’s case, these discussions have been ongoing since the 1990s, stymied by cost and lack of political will.
COVID-19, and the current sidelining of the CDC, may be the impetus needed to finally dust off those plans and make them a reality.
U.S. passes 4 million coronavirus cases as pace of new infections roughly doubles
The rapid spread of the virus this summer is striking, taking just 15 days to go from 3 million confirmed cases to 4 million. By comparison, the increase from 1 million cases to 2 million spanned 45 days from April 28 to June 11, and the leap to 3 million then took 27 days.
Trump’s cancellation of the in-person portion of the Republican National Convention planned for next month in Jacksonville, Fla., represented a remarkable reversal. He had insisted for months on a made-for-television spectacle that would have packed people close together in a state that is now an epicenter of the resurgent pandemic.
On Thursday, he conceded that was not going to work. “The timing for this event is not right,” Trump said during the latest of somber, solo White House briefings this week. “It’s just not right with what’s been happening.”
Florida reported 173 deaths on Thursday, its highest single-day count of new deaths, and also reported more than 10,200 new coronavirus cases.
In a scathing statement blaming the surge of new cases on Trump’s “failure to care,” presumptive Democratic nominee Joe Biden said the president “quit on this country and waved the white flag of surrender.”
Meanwhile, nearly every public health metric suggests America is badly losing its fight against the virus.
Positivity rates have reached alarming levels in numerous states, hospitalizations are soaring, and more than 1,100 new coronavirus deaths were reported across the United States on Wednesday, marking the first time since May 29 that the daily count exceeded that number, according to Washington Post tracking.
The rolling seven-day average of infections has doubled in less than a month, reaching more than 66,000 new cases per day Wednesday. The U.S. death toll now exceeds 141,000.
As a result, many businesses appear to be pulling back after their attempts to resume more normal operations proved premature, and an additional 1.4 million American workers filed for unemployment benefits last week. It was the first time since March that new claims rose. Another 980,000 new Pandemic Unemployment Assistance claims — the benefits offered to self-employed and gig workers — were also filed.
Congress, meanwhile, struggled to confront the crisis. Senate Republicans killed Trump’s payroll tax cut proposal on Thursday, widening an unusual rift with the White House over the cost and contents of the latest national coronavirus relief package.
Senate Majority Leader Mitch McConnell (R-Ky.) had planned to roll out a $1 trillion GOP bill Thursday morning, but that was canceled amid the intraparty conflicts.
Administration officials then floated a piecemeal approach, involving several different aid bills, but ran into opposition from lawmakers in both parties.
Trump’s briefing Thursday afternoon, his third of the week, reflected an effort to increase popular support for his management of the coronavirus outbreak, which even many of his allies have criticized. About 2 out of 3 Americans disapprove of Trump’s handling of the pandemic, a new poll found.
Trump dismissed or played down the risk of the virus for months after it had begun spreading in the United States and has been a self-described cheerleader for rapid reopening of businesses and schools shuttered to help slow its spread.
The survey of 1,057 adults in the United States, conducted by the Associated Press-NORC Center for Public Affairs Research, also showed that 3 out of 4 Americans, including a majority of Republicans, support mandatory face coverings when people are outside their own homes.
Democrats overwhelmingly favor mask mandates, at 89 percent. The majority of Republicans — 59 percent — also support them.
Ninety-five percent of Democrats and 75 percent of Republicans say they wear face coverings when leaving home. Overall, more Americans — 86 percent — are wearing masks compared with in May, when 73 percent were doing so.
Trump resisted wearing a mask in public until earlier this month, despite calls to set a good example from the top. He now calls it patriotic to wear a mask, though he still does not wear one consistently and says people should decide for themselves. Trump carries a black-cloth version in his pocket, which he says is sufficient for those instances when he is close to people who have not been screened for the virus.
Trump’s shift may reflect a growing consensus in favor of masks, although it is not clear that opposition to them has ebbed among some of the president’s strongest political supporters.
The business community is struggling, too. American Airlines and Southwest Airlines posted big quarterly losses between April and July in their earnings reports released Thursday, projecting that travel demand will not rebound anytime soon.
In American’s second quarter, revenue dropped more than 86 percent, to $1.6 billion, from nearly $12 billion a year ago, according to a Securities and Exchange Commission filing. The company posted a net loss of nearly $2.1 billion, attributing it to stay-at-home orders, border closures and travel restrictions.
“As a result, we have experienced an unprecedented decline in the demand for air travel, which has resulted in a material deterioration in our revenues,” the company said in the earnings report. “While the length and severity of the reduction in demand due to Covid-19 is uncertain, we expect our results of operations for the remainder of 2020 to be severely impacted.”
Southwest posted revenue of $1 billion in its second quarter, an almost 83 percent dip compared with a year ago. The company also posted a net loss of $915 million.
Trump also took a small step back from his insistence that schools should open on time this fall, conceding instead that some schools might need to delay in-person learning. Many school districts have already announced that decision.
Trump has been critical of guidance from the Centers for Disease Control and Prevention, saying it made it too tough for schools to reopen, and promised new guidelines would be issued. On Thursday, the CDC released several documents emphasizing the benefits of in-person school, in line with Trump’s messaging. Some of the guidance was written by White House officials rather than experts at the CDC, people familiar with the process said. They spoke on the condition of anonymity to discuss internal decision-making.
The new guidelines for school administrators mention precautions outlined in previous documents, but they appear to drop specific reference to keeping students six feet apart — something many schools find almost impossible to do if they are fully reopened. This document also suggests that schools consider closing only if there is “substantial, uncontrolled transmission” of the virus, and not necessarily even then.
Florida Gov. Ron DeSantis (R) echoed Trump in making a case for students to return to classrooms, despite the state’s teachers union suing over an order forcing schools to fully reopen. Meanwhile, a new poll showed that most parents would prefer to delay the start of in-person school.
During an appearance on “Fox & Friends,” DeSantis said that schoolchildren are “by far at the least risk for coronavirus, thankfully.”
“We also know they play the smallest role by far in transmission of the virus, and yet they’ve really been asked to shoulder the brunt of our control measures,” said DeSantis, a close Trump ally who had volunteered his state for the Republican convention next month.
DeSantis said that the “evidence-based decision” is for all parents to have the option of in-class instruction for their children if they choose. He said those who are not comfortable with sending their children back to school could continue distance learning.
The role children play in spreading the virus is still being studied, with experts saying that results are not definitive. A South Korean study found that children over the age of 10 were as likely to transmit the virus as adults, while those under 10 were less likely to spread it.
Deborah Birx, the White House coronavirus response coordinator, said Wednesday on Fox News that the United States is launching a study of its own, adding that the data “really needs to be confirmed here.”
Among the most visible American institutions searching for a path forward is the sports industry. Major League Baseball began a pandemic-shortened season on Thursday, playing in empty stadiums amid questions about whether the sport can make it through October without having to abort. It is as much a science experiment as a championship pursuit.
Players are prohibited from spitting or high-fiving. Foul balls that wind up in the stands will remain there.
Anthony S. Fauci, the nation’s leading infectious-disease expert, threw out the first pitch for the Washington Nationals home opener against the New York Yankees. Nationals star outfielder Juan Soto tested positive for the coronavirus on Thursday and missed the game.
Meanwhile, Japan marked a year’s delay of the Olympic Games on Thursday. Tokyo was to host the 2020 Summer Olympics starting Friday. A 15-minute ceremony in Tokyo’s newly built $1.4 billion Olympic Stadium started the countdown to the delayed games, now set to begin on July 23, 2021. The city also marked a new daily record in reported cases on Thursday, with 366.
A poll this week by Japan’s Kyodo News Agency found that fewer than 1 in 4 people in Japan even want to host the games anymore. One-third of respondents said the games should be canceled, while 36 percent expressed interest in postponing them for more than a year.
Fauci on coronavirus: ‘I don’t really see us eradicating it’
Anthony Fauci, the nation’s top infectious diseases expert, said Wednesday he doesn’t think COVID-19 will ever be fully eradicated but noted it can be controlled.
“I don’t see this disappearing the way SARS 1 did,” Fauci said during a livestreamed event hosted by the TB Alliance, a nonprofit focused on finding better tuberculosis treatments.
The SARS outbreak that started in 2003 lasted several months and mostly affected Asian countries before eventually vanishing. But in the process the disease sickened more than 8,000 people in 29 countries and claimed 774 lives.
Because COVID-19 is more contagious, it has had a far greater impact, with more than 15 million cases worldwide, including 618,000 deaths.
“It is so efficient in its ability to transmit from human to human that I think we ultimately will get control of it. I don’t really see us eradicating it,” Fauci said.
President Trump has repeatedly said the virus will eventually disappear, even though that is rare for most infectious diseases.
Fauci, who is a member of the White House coronavirus task force, recently responded to Trump’s characterization of him as “a little bit of an alarmist” on the pandemic by saying he prefers to think of himself as “a realist.”
During Wednesday’s interview, Fauci described ways that the U.S. can get the coronavirus under control.
“I think with a good combination of good public health measures, a degree of global herd immunity and a good vaccine, which I do hope and feel cautiously optimistic we will get, I think when you put all three of those together we will get very good control of this. Whether it’s this year or next year, I’m not certain,” he added.
“We’ll bring it down to such a low level that we will not be in the position we are right now for an extended period of time.”
Cartoon – Rebuilding Trust
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.
Fauci has been an example of conscience and courage.
But for rash, foolish irresponsibility, I’d nominate the opposition research paper recently circulated by the White House in an attempt to discredit the National Institute of Allergy and Infectious Diseases’ Anthony S. Fauci. As reported by The Post, the document recounted a number of instances — on community transmission, asymptomatic transmission and mask wearing in particular — where Fauci’s views have shifted over time. As far as I know, this official record is unique: A White House attack on the government’s leading infectious-disease specialist during a raging pandemic. It indicates an administration so far gone in rage, bitterness and paranoia that it can no longer be trusted to preserve American lives.
From a purely political standpoint, it is understandable that the administration would want to divert attention from its covid-19 record. Trump’s policy of reopening at any cost is exacting a mounting cost. Five months into the greatest health crisis of modern U.S. history, there are still serious problems with supply chains for protective equipment. There are still long wait times for testing results in many places. The contact tracing process in many communities remains (as one health expert described it to me) “a joke.” More than 132,000 Americans have died.
Rather than addressing these failures, Trump has chosen to sabotage a public official who admits their existence. Rather than confronting these problems, Trump wants to ensure his whole administration lies about them in unison. The president has surveyed America’s massive spike in new infections and thinks the most urgent matter is . . . message discipline.
It is true that a number of Fauci’s views on the novel coronavirus have evolved (though some of the administration’s charges against him are distorted). But attacking a scientist for making such shifts is to willfully misunderstand the role of science in the fight against disease. We do not trust public health officials during an emerging pandemic because they have fully formed scientific views from the beginning. We trust them because 1) they are making judgments based on the best available information and 2) they have no other motive than the health of the public. If, say, health officials were initially mistaken about the possibility of asymptomatic transmission, it is not failure when they change their views according to better data. It is the nature of the scientific method and the definition of their duty.
In the inch-deep world of politics, amending your view based on new information is a flip-flop. In epidemiology, it is known as, well, epidemiology.
Meanwhile, the president is failing according to both requirements of public trust. Trump is not making judgments based on the best available information. And he clearly has political goals that compete with (and often override) his commitment to public health. The president is hoping against hope that the public will forget about the virus until November, or at least about the federal role in fighting it. To apply a veneer of normalcy, he is holding public events that endanger his staff and his audience and is planning a Republican convention that will double as a petri dish.
It now seems likely that the most decisive moment of the American pandemic took place in mid-April when new cases began to stabilize around 25,000 a day. Even four or six more weeks of firm presidential leadership — urging the tough, sacrificial application of stay-at-home orders — might have reduced the burden of disease to more sustainable levels, as happened in Western Europe. And this would have relieved stress on systems of testing, tracing and treatment.
But Trump’s nerve failed him. Instead of holding firm, he began siding with populist demands for immediate opening, pressuring governors to take precipitous steps and encouraging skepticism about basic public health information and measures. This may well have been the defining moment of the Trump presidency. And he was weak, weak, weak.
It is typical for Trump to shift blame. But in this case, the president has selected his fall guy poorly. Fauci has been an example of conscience and courage in an administration that values neither. When Trump encourages a contrast to his own selfishness and cravenness, he only damages himself.
White House goes public with attacks on Fauci
Tensions between the White House and Anthony Fauci, the government’s top infectious diseases expert, are spilling into the open as officials openly attack the doctor for his public health advice during the coronavirus pandemic.
Fauci’s advice has often run contrary to President Trump’s views, and the attacks on Fauci have begun to look like a traditional negative political campaign against an opponent. Yet this time, the opponent is a public health expert and career civil servant working within the administration.
Dan Scavino, deputy chief of staff for communications, shared a cartoon on his Facebook page late Sunday that depicted Fauci as a faucet flushing the U.S. economy down the drain with overzealous health guidance to slow the spread of the pandemic.
The cartoon, which shows Fauci declaring schools should remain closed and calling for “indefinite lockdowns,” did not accurately portray what Fauci has advised in public.
Adm. Brett Giroir, the administration’s testing czar, downplayed any riff within the White House coronavirus task force before offering some criticism of Fauci.
“I respect Dr. Fauci a lot, but Dr. Fauci is not 100 percent right and he also doesn’t necessarily, and he admits that, have the whole national interest in mind,” Giroir told “Meet the Press” on Sunday. “He looks at it from a very narrow public health point of view.”
There have been tensions between Trump and Fauci throughout the pandemic. The president has repeatedly downplayed the severity of the virus, broken with the advice of his own public health experts and painted rosy but at times misleading pictures of the U.S. response. Fauci, who has served four decades in his current post, has offered blunt talk on the dangers of the pandemic that has directly contradicted the president from time to time.
But the latest criticisms mark a shift as the White House has begun publicly undermining one of the leading public health voices in the administration at a time when multiple states are struggling to get new outbreaks under control.
White House trade adviser Peter Navarro, whom the president tapped to manage the use of the Defense Production Act, said he personally proceeds with caution before heeding Fauci’s advice.
Trump said last week that Fauci is a nice man but that he’s “made a lot of mistakes.”
A White House official this weekend sent media outlets a lengthy list of “mistakes” Fauci has made since the pandemic began, like his comment in March that there is no need for people to wear masks.
That comment came before scientists knew people could spread the virus without showing symptoms, and Fauci, the Centers for Disease Control and Prevention (CDC) and other experts now urge people to use face coverings in public.
Public health experts have leaped to Fauci’s defense on Twitter, noting that Fauci is one of the most respected health experts in the world, having worked for six presidents and researched HIV/AIDS, Ebola, Zika and a variety of other infectious diseases.
“When studies show that, opposite from SARS & MERS, COVID19 is most infectious soon after infection & less infectious later, we recognize asymptomatic transmission and importance of masks,” tweeted Tom Frieden, the former director of the CDC.
“That’s called science, not a mistake. The real, deadly mistake is not listening to science.”
Ashish Jha, director of the Harvard Global Health Institute, tweeted, “His track record isn’t perfect. It’s just better than anyone else I know. Sidelining Dr. Fauci makes the federal response worse. And it’s the American people who suffer.”
Polls still show the public trusts Fauci more than Trump for accurate information on the virus, with Democrats more likely than Republicans to believe the infectious diseases expert.
White House press secretary Kayleigh McEnany during a “Fox & Friends” interview Monday insisted Fauci’s recommendations were reaching Trump, while saying he represented only “one viewpoint” among many considered by the president.
“The point of the task force is to be a whole of government look at what is best for this country,” McEnany said when asked about the status of the relationship between Trump and Fauci. “Dr. Fauci is one member of a team, but rest assured, his viewpoint is represented and the information gets to the president through the task force.”
Still, Fauci’s public appearances became few and far between as his dire warnings about the state of the pandemic in the U.S. increasingly clashed from more hopeful messages coming from the White House.
Fauci also told the Financial Times last week that he hadn’t briefed Trump in two months, in which time a growing number of states have experienced significant surges in cases.
Fauci was not present at the White House coronavirus task force media briefing last week, events that have become rarer even as the COVID crisis grows worse.
And while he was a regular on cable news in the early days of the pandemic, his appearances have dwindled, a fact he said last week could be because of his “honesty.”
While Fauci has warned that the U.S. could hit 100,000 new COVID-19 cases per day if steps aren’t taken to alter the trajectory of the outbreaks, Trump has tied the rise in cases to increased testing.
While Fauci attributed outbreaks in some states to reopening too quickly after the spring lockdowns, Trump and his top allies have mostly stood by their decision to push governors to jump over checkpoints set by the White House.
Fauci has refuted the president’s claims that the rise in cases is solely tied to increased testing and that 99 percent of cases are “totally harmless.”
And as Trump touted a falling COVID-19 death rate, which is actually now increasing, Fauci has said the U.S. shouldn’t take comfort in the “false narrative,” noting the disease can cause other severe health outcomes.
Fauci’s warnings grew more urgent last week when he warned that the U.S. is “facing a serious problem” and the pandemic has become politicized.
“And you know from experience historically that when you don’t have unanimity in an approach to something, you’re not as effective in how you handle it,” Fauci said in an interview with FiveThirtyEight. “So I think you’d have to make the assumption that if there wasn’t such divisiveness, that we would have a more coordinated approach.”
Trump sidelines public health advisers in growing rift over coronavirus response
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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 