Wither the CDC
What will happen to our trust in science as a result of crisis mismanagement?
In times of crisis and stress, we can find some emotional relief by clinging to long-trusted anchors. Sometimes these are individuals in our lives whom we count on for wisdom and good advice. An emotional anchor can also be an institution to which we are attached, like a religious congregation or advocacy group. It can even be a more remote agency that we have always trusted to come through for us when an emergency looms.
In the case of the novel coronavirus pandemic, many people look to the U.S. Centers for Disease Control and Prevention (CDC) for expert guidance and action. After all, ever since its founding in the 1940s to deal with malaria in the Southeastern part of the country, the CDC has always seemed to rise to the occasion every time an infectious disease threatened us. CDC was there to help eliminate malaria, yellow fever, and typhoid from the U.S., get control over tuberculosis, prevent swine flu outbreaks in the 1970s, and figure out what is behind Legionnaires disease. In the 1980s when the first mysterious cases of a disease that wiped out part of the human immune system arose, CDC’s work to identify the ways the AIDS virus (HIV) was spread was truly impressive and lifesaving.
That is only a partial list of the many accomplishments that made CDC the world’s leading public health agency, the agency to which Americans and people all over the world turned to keep us safe from emerging pathogens. We felt certain that the CDC operated primarily on the basis of science, with a minimal political agenda.
Blunders and Missteps
That is what makes the recent blunders and missteps by CDC so threatening. An agency with veritable “parent figure” status is letting us down. According to a 2018 article in The Atlantic, the trouble began several years before COVID-19. That year, the Trump-appointed CDC director, Brenda Fitzgerald, turned out to have “eyebrow-raising investments in companies directly related to” her work at CDC, including in four of the five biggest tobacco companies in the world. The Atlantic article pointed out that “One of the centers’ chief public-health objectives is to end smoking. In fact, the only real public-health position on tobacco usage is that it should be eliminated entirely … the CDC’s chief holding even a penny of tobacco stock, let alone a portfolio that includes almost all the major companies, runs counter to that goal.”
The article then goes on to recount threats of cuts to the CDC budget that have rendered the agency “defensive” and compromised its ability to meet international threats like Ebola and Zika. Every year, in fact, the Trump administration has proposed cuts in the CDC budget. These never actually occur because Congress pays no attention, but it cannot help CDC morale to know that the chief executive wants the agency to shrink.
Perhaps this is at least partially responsible for the problems CDC has had in responding to the COVID-19 pandemic. It has been noticed, for example, that its current director and other leaders have been absent from the forefront of press conferences about COVID-19 held by the administration. Isn’t the CDC the one institution above all others we want to hear from when an epidemic sweeps the country?
Right from the start of the pandemic, instead of taking the lead and using its powerful blend of scientific talent and cutting-edge laboratories, CDC seems to have dropped the ball. It is reported to have delayed testing the first individual in California who developed non-travel-related COVID-19 in February. This delayed recognition that community spread of the virus was already occurring in the U.S. Then, CDC sent out test kits for the virus that turned out to be flawed and yielded spurious results. According to The Washington Post, the problem arose because of contamination of the test kits in the CDC laboratory manufacturing them. At first, CDC refused to acknowledge the problem and it took a recommendation from the Food and Drug Administration (FDA) to convince CDC to stop the process and correct the problem. Waiting for an accurate viral test further delayed our getting on top of the pandemic.
Now that accurate tests are available for the virus that causes COVID-19 (called SARS-CoV-2), we should be able to estimate the rate of infection in the U.S. by knowing how many people are currently infected (the numerator) and how many people have been tested (the denominator). Once again, however, CDC has blurred the issue by making an obvious mistake: conflating two tests that give different information about SARS-CoV-2 infection. The test for the current viral infection is the one usually done by swabbing the nose with a special six-inch probe. The sample is then sent to a laboratory where a type of laboratory process called PCR is done to detect the presence of the virus. If it is positive, the person tested is currently infected with SARS-CoV-2. This test seems to be relatively accurate at this point.
The other test detects antibodies to the virus in people who have previously been infected. At the time of writing this commentary, the antibody, or serology, test, is still of questionable accuracy and it is not entirely clear what the presence of antibodies means. In order to be useful in preventing future infection in someone who has already had COVID-19, antibodies must be able to neutralize the virus and must be able to do so over a relatively long period of time, for 2-3 years for example. Even when the accuracy of the serology (antibody) test is optimized and if the detected antibodies do indeed confer long-term protection against reinfection, the test gives very different information than the direct viral test using the swab. One tells you if you are infected now, the other if you were previously infected. Conflating the two tests, as CDC did, inflates the number of tests for infection that are actually being done and produces misleading information. Exactly how the CDC could have made such a basic error is unclear, as is the slow pace they seemed to have taken to correct it.
The Invasion of Politics
CDC issued guidelines for reopening some businesses and other gathering places during the last week of May that are strict but well-informed and reasonable. The White House, however, apparently disagreed with the CDC guidance on reopening houses of worship. Recommendations to limit choir activities were quietly removed from the CDC guidelines and references put in about preserving First Amendment rights. Surely, singing in a choir has got to be one of the ripest places to spread viral infections, with people crowded together forcefully emitting breaths into the ambient air. There doesn’t seem to be any First Amendment issue with recommending that for now places of worship refrain from that part of their worship service—after all, they had been mostly worshiping via teleconference without anyone gathering for several months to this point. Here we see again how politics seems to invade the CDC’s work and overwhelm its dedication to science.
One of us (Jack) was funded by the National Institutes of Health to conduct research on the AIDS virus shortly after that epidemic began in the 1980s. He remembers how he and his colleagues were dazzled by the speed with which the CDC figured out how HIV is transmitted. Years before the first antiretroviral drug to control HIV infection was introduced, CDC epidemiologists saved countless lives by notifying the public that sharing bodily fluids, intravenous drug administration, and infected blood transfusions were the modes of HIV transmission.
We need a strong CDC that is devoted to science to resume its lead role in controlling emerging infectious diseases. Without that, one major source of comfort and reassurance during a crisis is severely compromised. We cannot afford to be bereft of our emotional anchors at a time like this.