The headquarters for Centers for Disease Control and Prevention is shown  in March.

The headquarters for Centers for Disease Control and Prevention is shown in March. Katherine Welles/Shutterstock.com

I’m a Public Health Researcher, and I’m Dismayed that the CDC's Missteps Are Causing People to Lose Trust in a Great Institution

The CDC has long been a trusted source of health information, keeping the public not only safe but calm in times of disease outbreaks. Public health officials fear now for its reputation.

The Centers for Disease Control and Prevention has been the premier U.S. public health agency since its founding on July 1, 1946.

The CDC is responsible for assuring the health of all Americans and promoting evidence-based public health practice. It also is responsible for researching the causes of death and illness as well as working on ways to prevent them. Americans have come to trust it for accurate information.

However, recent actions by the CDC have led many in public health to call into question the integrity of the CDC’s leadership as they ignore the science and bow to political pressure. Their actions have hurt public health efforts and led to confusion and mistrust by the public at large.

As an infectious disease epidemiologist, I have spent my career both in academia and in public health practice studying how viruses infect people and testing populations to determine current infection and immunity. I find the politicization of advice coming out of the CDC disturbing, to say the least.

The latest, most egregious non-science-based advice is a change in recommendation for who should get tested for COVID-19. Here’s what happened and why it matters so much – not just to public health experts, but to the public.

Testing is key to containing the virus

Public health experts have learned a great deal about the novel coronavirus and COVID-19 since the coronavirus first appeared.

They have learned, for example, that an estimated 4 out of 10 infected people will never show symptoms – but can unknowingly infect others.

In addition, infected persons who will go on to develop symptoms can spread the disease one to two days before those symptoms occur. These are two of the reasons the virus is so hard to contain.

Evidence suggests that widespread testing of people without symptoms would greatly reduce the spread of the virus by allowing people to know they’re infected and self-quarantine. Contacts of those asymptomatic cases can be identified and tested for the same reasons. This has been the CDC’s recommendation since studies first began to show asymptomatic transmission.

Then, the CDC on Aug. 24, 2020 changed course and recommended to test only those people who have symptoms for COVID-19.

Many public health experts were shocked. Testing only those who have symptoms will miss close to half of those who are infected.

Two days after the revised guidelines had been quietly changed on the CDC website, Director Robert Redfield clarified that those who come into contact with confirmed or probable COVID-19 patients could be tested even in the absence of symptoms.

That has always been the case, though.

In the meantime, the altered guidelines on the CDC website promote confusion and remain unchanged as of Aug. 31, 2020. Arizona, California, Connecticut, Florida, Illinois, Texas, New Jersey and New York have already announced they will not follow the new CDC testing guidelines, showing more understanding of the benefits of testing than our national public health institution.

Fauci had no voice in the matter

This new recommendation came from the White House Coronavirus Task Force, and the CDC fell in line. Dr. Anthony Fauci, a task force member and head of the National Institute of Allergy and Infectious Diseases, was undergoing surgery on his vocal cords when the task force met Aug. 20 and decided on the change.

The American Public Health Association has pointed out that the change was made without effective consultation with public health professionals working on the ground to control the pandemic. The World Health Organization continues to support testing of asymptomatic persons. Nearly every public health organization has called for a reversal.

It is a particularly confusing decision given that lack of access to adequate testing has been an ongoing issue and has led to serious barriers in getting control of the pandemic.

See no virus, have no virus?

Without test data, epidemiologists are flying blind. Not knowing who is infected, we do not have a picture of how many infected persons are in the community and how the virus is being transmitted.

Identifying those who may have been exposed to the virus is the whole rationale for contact tracing – find cases, identify contacts who may have been infected, ask them to self-quarantine, and test them for the virus. Testing is at the core of controlling infectious disease spread.

The thinking seems to be that if you don’t test, the number of cases will go down.

Clearly, this is true only in the political sense. Yes, the number of reported cases will decrease, but the number of infected persons will not. By not identifying those who are infected but don’t have symptoms, spread of the virus will increase as those who don’t know they are infected, infect others.

Trump has said that he “likes the numbers where they are” and said at a campaign rally in Tulsa that he would tell his people to “slow the testing down.”

[Deep knowledge, daily. Sign up for The Conversation’s newsletter.]

A series of tussles

The CDC has been in the midst of a political struggle many times during this pandemic.

In May, it was revealed that CDC had been adding antibody tests, a marker of previous infection, to the number of PCR tests, a marker of current infection, performed. This made it appear that more tests to detect current infection had been performed than actually had.

In July, hospitalization data, historically reported to CDC and used by health departments and researchers throughout the country to understand the pandemic, disappeared from the CDC website as reporting switched to a private contractor. It reappeared a few days later, but this raised concerns this would hurt the ability of CDC to gather and analyze these data.

In another instance, the administration pressured CDC to rewrite its guidelines for safely reopening schools. It did this, even though once again, the guidelines did not reflect current scientific knowledge.

The world is now in the midst of the worst pandemic in over a century. The United States has 4.4% of the world’s population but 24% of COVID-19 cases. Plainly, we are not doing well, and lack of trust in CDC’s guidance as well as contantly changing messaging is hampering our efforts to control the virus. No wonder the public is confused about what they should be doing.

It does not bode well if we Americans can no longer trust the advice and guidelines emanating from our national public health entity, not just for control efforts in this pandemic but for future health concerns as well.

I answer questions about COVID-19 weekly on a radio call in show. A few weeks ago a caller asked me if we could trust the information coming out of the CDC. I never thought I would be in a position where I couldn’t give an unequivocal “yes.” When politics overcomes science, public health cannot fulfill its mission, and everyone will all suffer.

Editor’s note: Any views in this article reflect the opinion of the author and not of the University of Texas Health Science Center.

The Conversation

This post originally appeared at The Conversation. Follow @ConversationUS on Twitter.

X
This website uses cookies to enhance user experience and to analyze performance and traffic on our website. We also share information about your use of our site with our social media, advertising and analytics partners. Learn More / Do Not Sell My Personal Information
Accept Cookies
X
Cookie Preferences Cookie List

Do Not Sell My Personal Information

When you visit our website, we store cookies on your browser to collect information. The information collected might relate to you, your preferences or your device, and is mostly used to make the site work as you expect it to and to provide a more personalized web experience. However, you can choose not to allow certain types of cookies, which may impact your experience of the site and the services we are able to offer. Click on the different category headings to find out more and change our default settings according to your preference. You cannot opt-out of our First Party Strictly Necessary Cookies as they are deployed in order to ensure the proper functioning of our website (such as prompting the cookie banner and remembering your settings, to log into your account, to redirect you when you log out, etc.). For more information about the First and Third Party Cookies used please follow this link.

Allow All Cookies

Manage Consent Preferences

Strictly Necessary Cookies - Always Active

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data, Targeting & Social Media Cookies

Under the California Consumer Privacy Act, you have the right to opt-out of the sale of your personal information to third parties. These cookies collect information for analytics and to personalize your experience with targeted ads. You may exercise your right to opt out of the sale of personal information by using this toggle switch. If you opt out we will not be able to offer you personalised ads and will not hand over your personal information to any third parties. Additionally, you may contact our legal department for further clarification about your rights as a California consumer by using this Exercise My Rights link

If you have enabled privacy controls on your browser (such as a plugin), we have to take that as a valid request to opt-out. Therefore we would not be able to track your activity through the web. This may affect our ability to personalize ads according to your preferences.

Targeting cookies may be set through our site by our advertising partners. They may be used by those companies to build a profile of your interests and show you relevant adverts on other sites. They do not store directly personal information, but are based on uniquely identifying your browser and internet device. If you do not allow these cookies, you will experience less targeted advertising.

Social media cookies are set by a range of social media services that we have added to the site to enable you to share our content with your friends and networks. They are capable of tracking your browser across other sites and building up a profile of your interests. This may impact the content and messages you see on other websites you visit. If you do not allow these cookies you may not be able to use or see these sharing tools.

If you want to opt out of all of our lead reports and lists, please submit a privacy request at our Do Not Sell page.

Save Settings
Cookie Preferences Cookie List

Cookie List

A cookie is a small piece of data (text file) that a website – when visited by a user – asks your browser to store on your device in order to remember information about you, such as your language preference or login information. Those cookies are set by us and called first-party cookies. We also use third-party cookies – which are cookies from a domain different than the domain of the website you are visiting – for our advertising and marketing efforts. More specifically, we use cookies and other tracking technologies for the following purposes:

Strictly Necessary Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Functional Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Performance Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Social Media Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Targeting Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.