The COVID-19 pandemic in the U.S. has been defined by the Centers for Disease Control and Prevention’s muddled messaging about how to stop the spread of the novel coronavirus. But did it have to be that way? FiveThirtyEight’s Maggie Koerth went in search of the answer to that question and found that the CDC’s impulse toward caution was always going to make it hard to combat COVID-19. Politics certainly didn’t help, either.
You can find a lightly edited version of the transcript of the episode and listen to it below.
Dr. Anne Schuchat: Everything we look at with this virus seems to be a bit scarier than we initially thought.
Dr. Anthony Fauci: We really don’t have what we need, but we’re still going full blast by drawing money from other areas … When the president asked for $1.9 billion, we needed $1.9 billion.
Maggie Koerth: That was Dr. Anne Schuchat, former principal deputy director at the CDC, and Dr. Anthony Fauci, whose voice you probably recognized. You might have thought they were talking about COVID-19, but they weren’t. They were talking about Zika.
Dr. Margaret Chan: The experts agree that a causal relationship between the Zika infection during pregnancy and microcephaly is strongly suspected though not yet scientifically proven.
Dr. Sonja Rasmussen: The first suspicion that Zika was linked to birth defects was seen in Brazil, when doctors started seeing that there was a large number of babies being born with severe microcephaly, which is an abnormally small head. And in April, CDC confirmed that Zika is a cause of microcephaly and other birth defects.
Maggie Koerth: That’s Dr. Sonja Rasmussen speaking about the Zika virus back in 2016. She served in different leadership roles at the Centers for Disease Control and Prevention, or CDC, and co-authored the paper that unambiguously identified Zika as a cause of birth defects.
Dr. Sonja Rasmussen: It was the biggest thing I had ever done, I’d never said anything was definite. I was always waffling … And suddenly here I was saying something was definitely causing birth defects. And I do remember, truly, that day feeling like I was jumping off the high dive, you know, like, headfirst? … We wanted so badly for people to always trust us.
Maggie Koerth: When people’s lives are at stake, when they’re scared and confused about a new disease, they need a trusted source of information. In the U.S., that’s the CDC. Yet even when it seemed obvious that Zika was causing birth defects, the CDC delayed giving a definitive answer. When it finally did, it was criticized for moving too slow by some … and too fast by others.
We’ve seen the same trends with COVID-19. The CDC waffled on whether we could stop wearing masks once we’d been vaccinated, whether the disease was airborne, and who should have access to testing. The agency wants to be certain, so it typically waits for a critical mass of scientific evidence before making declarative statements. That takes time. Yet the communication to the public in this pandemic seemed to be worse than normal, and resulted in a huge loss of public trust.
Over the past month, I spoke to nearly a dozen scientists who all agreed the CDC could have done better. But the root causes of the CDC’s shortcomings will be hard to fix.
I’m Maggie Koerth, filling in for Anna Rothschild, and this is PODCAST-19 from FiveThirtyEight.
Dr. William Schaffner was an epidemic intelligence service officer at the CDC, and now, as the medical director of the National Foundation for Infectious Diseases, he works with the CDC’s Advisory Committee on Immunization Practices. He told me that for every public health issue …
Dr. William Schaffner: There are economic, social and cultural dimensions to them, which obviously involve the political leadership. You can’t do public health, at any time, without recognizing that public policy involves partnership in some form with the political structure that exists at that time. It’s like being a tightrope walker.
Maggie Koerth: Back in 1976, the government had to decide who to vaccinate against a potentially looming swine flu pandemic. Some experts thought the threat of the pandemic was low, but the CDC believed the risks were high and they advocated for a mass-vaccination campaign — which was, of course, expensive.
Gil Eyal: The campaign that was trying to balance the risk calculations.
Maggie Koerth: Gil Eyal is a professor of sociology at Columbia University.
Gil Eyal: You know, trying to balance the fear that this could be really catastrophic, with the worry that, you know, that it’s going to be one of those cases where you cry wolf.
Maggie Koerth: At the time, President Ford was running for election and didn’t want to be responsible for a pandemic. So, he went with the CDC’s recommendation: The campaign vaccinated 45 million people in 10 weeks. However, this particular flu strain turned out to have a low transmission rate, and the pandemic never happened. In that case, the political calculus backfired, and the CDC bore the cost of reduced public trust. That’s exactly what Dr. Fauci hoped wouldn’t happen with this pandemic. Here he is speaking at the Aspen Institute in February of 2020.
Dr. Anthony Fauci: Is there a risk that this is going to turn into a global pandemic? Absolutely, yes. There is. And that’s why we always follow, “At present, the risk is really relatively low. But we are taking this very seriously. And the situation could change.” What would it be if we got up and said, “OK, hi. We really, really got a big risk of getting completely wiped out” and then nothing happens, then your credibility is gone.
Maggie Koerth: Now, Dr. Fauci is not part of the CDC, but his comments highlight the social and political consequences of being overly aggressive. And the fear of doing that is a perennial problem for the CDC.
In this pandemic, the agency faced an even bigger issue: political interference. Leaked documents from September 2020 revealed that Health and Human Services officials appointed by then-President Trump had attempted to modify some of the CDC’s COVID reports because the information didn’t agree with Trump’s views of the pandemic or his plans for dealing with it. Administration officials wanted the report to include the number of deaths from other causes like suicides and heart attacks in order to downplay the number of deaths from COVID. Separately, the White House was pressuring the CDC to limit press conferences and essentially excluded the agency from its own briefings.
Maggie Koerth: At the same time, experts told me that the Trump-era CDC wasn’t working with outside experts like it had in the past. Usually, the executive branch helped the CDC and other agencies work together to build what’s called a Team B — outside experts who were brought in to critique CDC research and analysis and offer alternative perspectives. The experts I spoke to didn’t know why those groups weren’t formed but said it had a major impact on the quality of our response. For example, if the CDC had collaborated better with health care facilities, that would have made the rollout of certain treatments easier for the neediest patients to get.
Multiple experts told me that due to political interference, the CDC found itself isolated from the rest of the scientific community and from the public. Nobody could talk to the CDC — and the CDC wasn’t talking to anyone else, either.
Dr. Richard Besser: So without CDC, it created space for a lot more voices. And social media provides just a major outlet for people to be able to communicate.
Maggie Koerth: Dr. Richard Besser served as acting director of the CDC during the H1N1 pandemic back in 2009. But social media has changed a lot since then.
Dr. Richard Besser: And you have people with hundreds of thousands of followers who have driven a lot of the conversation. What you have is, I think, social media amplifying the divide between those who, who support a public health approach and those who support a more political approach. By that I mean, really, viewing public health as the enemy of the economic recovery and the health of the nation.
Maggie Koerth: Some experts think that this politicization wasn’t just divisive — it also hurt the quality of our scientific research. Dr. Vinay Prasad is a hematologist-oncologist and professor at the University of California, San Francisco. His work has focused on how medical norms change in response to new evidence. He said social media raised the stakes of COVID decision-making. For example, masking became a political, almost moral issue. So much so that we didn’t appropriately research the nuances of when masking works the best.
Dr. Vinay Prasad: No scientist would, would claim that it’s a binary thing, masks always work perfectly, you know, or they never work at all. The truth might be something in between, which is maybe below a certain age, the person is not able to wear it with enough adherence, that there is some diminishing returns. Maybe it works when the case rates are 10 per 100,000, but in 1 per 100,000 maybe it doesn’t work. You know, maybe there’s some interaction between the prevalence of the virus. You know, after this whole pandemic, I don’t think we will know anything more about it than in the beginning. And I think that’s quite tragic.
Maggie Koerth: Again, this murky space where we don’t have extensive peer-reviewed scientific evidence isn’t where the CDC thrives. Here’s Dr. Besser.
Dr. Richard Besser: Because if you don’t have the science, it can be hard to tell people what they want to know, which is well, “How risky is this behavior? How risky is it for somebody to not wear a mask if they’ve been fully vaccinated?” CDC wanted to make sure that the vaccines were really effective against the variants and that there was room in hospitals in case they called it wrong. Well, if you’re waiting on studies for that, and wanting those studies to be really high-quality science, it’s going to take you a while to get that guidance. When new guidance would come forward, it seemed like it had dropped from the sky. Because we hadn’t been brought along the journey. We hadn’t seen what the agency was learning.
Maggie Koerth: Without understanding where the CDC’s most recent masking guidance came from — that vaccinated people can drop masks indoors — many felt blindsided by that change. And without knowing the “why” of CDC decisions, it made it hard for us to trust the agency from the beginning.
So, what does all this mean for the future of the CDC? And … for us? Are we better-positioned for the next pandemic? Most of the researchers I spoke to didn’t really think so.
Dr. Schaffner thinks for there to be real reform, the CDC needs external advice.
Dr. William Schaffner: I would prefer to include some people from the outside, to do an after-action report. … I don’t think the CDC is very good at this. … If you’re not really looking hard for problems, you won’t find them. If you don’t find anything, you won’t be able to address them.
Maggie Koerth: But Eyal thinks our current collective experience will improve our reactions to future CDC guidance.
Gil Eyal: You know, if this thing happens a year or two or three years from now, the U.S. population will be in some sense similar to the Chinese population.
Maggie Koerth: Eyal said China was able to react the way it did to COVID-19 because they went through SARS.
Gil Eyal: And SARS was this trauma that was imprinted. However polarized we are right now, I wouldn’t exclude the possibility that the next time around, people will act on the memory… on the memory of, you know, what happened.
Maggie Koerth: But that works only if we are taking the time now to notice what went wrong and make sure that that, too, is part of our collective memory.
That’s it for this episode of PODCAST-19. I’m Maggie Koerth. Our producer is Sinduja Srinivasan. Chadwick Matlin is our executive producer. Thanks for listening. See you next time.