How the Government Broke the CDC
Scenes from quarantine — Day 180:
It was, I believe, about three weeks into this pandemic that, late at night, I dragged Kevin downstairs and made him watch Contagion with me. Our pediatrician had recommended the movie to me years ago, praising it for its accurate and well-done handling of a pandemic scenario and for including solid science in its narrative instead of getting silly as many disease-outbreak stories have. At the time, I didn’t resist, precisely, but as a mother of small children with absolutely no medical training it was never a priority to sit down and consider what “might” happen beyond my control. However, finding myself suddenly in the middle of a pandemic, I was seized with a desire to know what would happen next and suddenly watching this movie became very important to me.
Oh, how naive I was back at the end of March/beginning of April! I believed what I saw on the screen, trusted the movie got things right, trusted that we would get the same swift, competent pandemic response any moment now. The science was, still is, decent. Six months in, the pandemic response in the movie seems about as fantastical as Harry Potter’s first year at Hogwarts.
Aside from the unfortunate Patient Zero and her family, nearly all of the central characters of Contagion are employees of the Center for Disease Control and Prevention (CDC), with a couple secondary characters working for the World Health Organization (WHO) and US Department of Homeland Security (DHS). I know you know these acronyms. They’re all familiar to all of us now. I just wanted to say the full names because the full names tell us what these organizations do. The Center for Disease Control is tasked with controlling disease — challenging in the best of circumstances, sure, but they have spent nearly three quarters of a century single-mindedly focused on that critical mission. Remember that later, it’s important.
To give a short summary of how Hollywood thought our pandemic response would go, after a woman dies mysteriously shortly after a business trip to Hong Kong, doctors at the local hospital somehow figure out it is a new, highly contagious, and often fatal disease. The CDC is informed immediately and the CDC director meets with an official from the DHS to (quickly) rule out the possibility that the virus is a bioweapon and then sends a member of the Epidemic Intelligence Service ( EIS — a completely real and totally bad-ass program run by the CDC to send highly-trained officers into the field to act as “disease detectives” and quickly and efficiently investigate any new or threatening disease outbreak) to Minneapolis (where our Patient Zero re-entered the US before her death) to contact trace, investigate, and lead the local public health response before a full outbreak erupts. When she is unable to contain the outbreak because she gets sick and dies from the virus, the narrative shifts back to the CDC which is racing to control the flow of information, educate the public, and commit resources to research and finding a vaccine.
While the public suffers through some basic supply disruptions (food, clean water) that lead to looting and violence, another scrappy medical researcher figures out a cell culture in which the virus can be grown and from there, they quickly (weeks or months, not years) figure out a vaccine. Perhaps the silliest and least scientific part of the movie is when the lead researcher skips human trials and instead injects the vaccine candidate in herself and deliberately exposes herself to an infected relative to prove that the vaccine works. Vaccine doses are manufactured (slowly), the world is vaccinated (eventually) and all wrongs are put right by the time the credits roll. Yay! The CDC saved the day!
My trust in the CDC was so unshakeable at the time that it simply did not occur to me months ago that they would not be at the forefront of beating back this pandemic, of controlling this disease. Historically, the CDC has always been apolitical, science-lead, and, like the US Postal Service, extremely well-liked by the American public. The trust I personally felt has, for most of the history of the CDC, been largely universal — it is a mark of this trust that in the movie, while a couple passing references are made to a “President”, we are never give a name, a party affiliation, and the issue of a pandemic is in no way politicized…and nobody who watched this movie, over the last nine years, ever questioned whether this apolitical, science-lead response was realistic.
The actual CDC (not the movie one) has made good use of this trust across its history to tirelessly inform and engage the US public on a wide array of significant public health issues without engaging in partisanship. Before 2020, the closest to political the CDC ever got was speaking out on the health impacts of gun violence and climate change and glowering a bit when their research was stymied and their findings were blocked from release.
Here in the real world, things have been really terrible for Hollywood’s third-favorite government agency (tied with NASA and after the CIA and FBI respectively) for a while. I’m not sure when the first warning signs were internally, whether alarms sounded inside the organization when the Trump administration systematically dismantled the Obama administration’s pandemic response preparations and let the PPE stockpile deplete and expire without replenishment. From the outside, as just a regular US citizen, I first noticed the silence.
A friend and I watched the somber, grey-haired woman bite her tongue again and again behind Donald Trump in the early daily press conferences and were so curious we looked her up. She is Dr. Anne Schuchat, Principal Deputy Director of the CDC and she was obviously in distress even back then. CDC guidance was slow in gaining public release, often confusing and contradictory when it did come out although that didn’t seem strange at the time. It was a completely new virus and we didn’t even know what we didn’t know. Still, the President drew upon models and projections by the Institute for Health Metrics and Evaluation (IHME), a health statistics research institute based at the University of Washington instead of the government’s own epidemiological modeling and projections that had been produced within the CDC. It was strange. Something was off.
By midsummer, people seemed used to the fact that the CDC was not allowed to have full participation in this crisis, let alone take control to set policy, guide research, and mitigate the outbreaks exploding like cherry bombs across the map. The Trump administration and Trump personally put heavy pressure on the CDC to revise school guidelines to prioritize in-person schooling as the pandemic raged on. The director of the CDC, Dr. Robert Redfield, made some attempts to stand his ground based on the data scientists within his agency were providing, but ultimately the guidelines were changed to prioritize in-person schooling when possible. Four previous CDC directors appointed under both Democratic and Republican leadership released an open statement decrying the politicization of scientific research and the open undermining of the CDC. The current administration, petty as ever, simultaneously restructured the public health data reporting to go to the Department of Health and Human Services directly instead of having it collected by the CDC as has been the norm for decades.
A month later, the CDC abruptly changed its testing guidelines to prioritize testing symptomatic patients only and stated that asymptomatic patients do not need to be tested. This caused a furor in the health community as it is the asymptomatic and pre-symptomatic that are driving the ongoing transmission of COVID-19 around the country. Testing only symptomatic individuals puts any hope of containment firmly out of reach. The policy change came, by Dr. Redfield’s own admission, under pressure from the White House coronavirus task force and Dr. Anthony Fauci, the only member of the taskforce that anybody trusts, immediately released a statement that the guidance had pivoted abruptly while he was under general anesthesia for an unrelated medical procedure. SOMEONE literally waited until he was unconscious to slip through that change!
The outcry was so great that Redfield walked back the position within the week, although the language on the CDC website is still not as unconditionally clear as they were prior to this policy change. And the damage was already done. The New York Times ran an article with an absolutely astonishing headline that neatly sums up where we are: “It Has Come to This: Ignore the C.D.C.” Written by a former director of the National Institutes of Health and the president of the Rockefeller Foundation (a long running philanthropic foundation that is throwing massive funding at accelerating COVID-19 vaccine and testing development), the article argues that states need to step up their own coronavirus mitigation and containment efforts. Bluntly, the CDC cannot be trusted or relied upon to give the much-needed guidance to steer us through this crisis, to control this disease.
As we struggled to grapple with how we got to this terrible place where even the CDC’s words have no meaning, last week we began to get answers to what went so horribly wrong. This time, the New York Times had emails from Michael Caputo, a Trump-appointed Department of Health and Human Services spokesman (who abruptly went on indefinite medical leave just as these emails came to light) and his chief science advisor, Dr. Paul Alexander (who was dismissed shortly after Caputo’s departure) all focused on the same goal — to browbeat top CDC officials into falling in line with White House-directed policy and silence absolutely everything else.
Among the emails, which indicated that absolutely nothing could get released by the CDC without Caputo smudging it all up with his grubby fingers, were some directly and pointedly attacking Dr. Anne Schuchat (remember? The patiently suffering CDC Deputy Director we saw at those press conferences months ago?) for “…her aim..to embarrass the president” by such shocking actions as advocating widespread mask-wearing, suggesting that children could be infected and sickened with COVID-19, and stating that there is “too much virus” in this country at the height of this summer’s pandemic peak.
Between them, Caputo and Alexander pushed the director of the CDC to reprimand Dr. Schuchat, moved to punish the CDC’s communications team from reaching out to the media with information and consistently attempted revisions of the CDC’s Morbidity and Mortality Weekly Reports to correct the “pseudoscientific” information that the scientists were including in them. This is the first time in the history of the CDC that these internal bulletins were ever politicized. It made as much sense as trying to politicize the box scores from a Major League baseball game (for those who are not into baseball statistics, it’s…a row of numbers with boxes around them).
Lest you think that the problem was limited to just Caputo and Alexander and things will be better now that they are gone, rest assured that this interference, muffling, and dismantling is coming all the way from the top. On Friday, the CDC updated its guidelines to acknowledge the risks of airborne transmission of COVID-19 at distances greater than 6 feet. Scientists around the world have put forward extremely good evidence of this in several studies over the last few months and have been pushing for a clear acknowledgement from the WHO, so this is not particularly new or shocking information. On Monday, however, the language was taken down again. Apparently, someone in the highest levels of our government finds airborne transmission to be politically dangerous.
It is hard to ignore the CDC given its long history and it’s vast body of scientists and researchers who have proudly built long careers within the agency because of their desire to meld science with public service and to work towards the well-being of millions of strangers. Nobody accidentally falls into a career at the CDC — it is always the result of years of study and unquenchable passion for the agency’s mission. Now, when the purpose that thousands had sacrificed for and waited their whole careers to step into had finally arrived, the CDC is divided into the top officials who are hustling to protect both their own jobs and those of their underlings from an onslaught of threats in the faint hope that they can somehow thread the needle and get SOME good information out there and the lower-level doctors, scientists, and researchers who are being silenced and suppressed in their work and are, at best, forced to spend long hours outside their jobs voluntarily getting what information and guidance they can out informally to their communities to help mitigate the dangerous and destructive policies being handed down from non-scientific members of the executive branch.
I don’t have any answers here. The Trump administration and the GOP-led Senate are systematically dismantling and destroying our judiciary, our Postal Service, all of our social safety nets, our health infrastructure, and much of our education and research infrastructure, as though each is a butterfly they are swiping for with a large net, then pulling out to crush with their bare fingers. Six months into the pandemic CDC is horribly battered, bent, broken, not by the ravages of the virus but by the crushing fingers of our own government. We have spent our whole lives trusting that the CDC would be there, a benevolent force in a malevolent world, but it may not survive this.
I just wanted to put this all in one place, so that when we look back later, we can see what happened.
