Listen, I’m a huge believer in listening to scientists.
Implementing lessons from the scientific process is, by a significant distance, the best way to make policy in our country. More Americans should trust in science, not fewer, and the Centers for Disease Control and Prevention is perhaps the highest profile organization of scientists we have.
Even with all of those caveats, the CDC screwed some things up this past year.
In general, the agency has been too conservative and slow in making new guidance during a quickly moving pandemic. What has resulted is that the CDC’s messaging to the public hasn’t reflected what scientists know about the coronavirus, leading to a hodgepodge of conflicting information and advice out there. Some of the CDC’s recommendations have been outright counterproductive and, in the end, have cost lives.
In particular, here are three instances when the CDC could have acted more effectively.
Acknowledging and emphasizing airborne disease spread
Look, this has been pretty clear for a long time now: The coronavirus is capable of airborne spread without close contact between two people. Airborne droplets can linger in the air indoors and infect any number of people from one superspreading host subject.
The evidence is obvious and has been for a long time. In March 2020, experts were already talking about the role of airborne coronavirus spread. Last May, I wrote an article called ”How the coronavirus spreads in those everyday places we visit,” covering various examples of this: In a bus, one infected passenger spread the virus to dozens of other passengers. The famous Skagit County Choir incident. Gyms have been places of high spread, even with distance between exercisers. Planes. Office buildings. Sports venues. Restaurants. All saw spread often, significantly outside of 6 feet.
The CDC acknowledged that the virus can be spread through small particles floating in the air last week. In May 2021.
Meanwhile, significant portions of the scientific community have moved well past that. They now believe that floating airborne particles are the primary way the disease spreads, not just as a secondary transmission possibility. In a letter titled “Ten scientific reasons in support of airborne transmission of SARS-CoV-2″ in The Lancet last month, epidemiologists came together and argued that “although other routes can contribute, we believe that the airborne route is likely to be dominant” for spreading the coronavirus. Given the overwhelming evidence they presented in favor of their argument, I’m inclined to believe them.
How did the CDC get so attached to the “close contact” paradigm? A wonderful historical science paper tells the story of the history of epidemiology with regards to infectious disease modeling. Essentially, the 3- to 6-foot distance was the result of some pretty sketchy studies in the late 1800s. And the purported difference between spread via cough or sneeze droplets and aerosolized particles suspended in the air was mostly the result of coincidence, rather than based in research.
Just imagine how different our world could have looked with better recommendations. Rather than closing beaches and parks, we could have been encouraging people to do activities in which they were safer — outdoors. Rather than disinfecting random surfaces, we could have spent money on ventilation and filtration in our homes and businesses. So many people went to “socially distanced” gyms, restaurants, etc., thinking they were safe when in reality they were putting themselves in harm’s way.
The CDC should have recognized the weakness of its foundations: that the 6-foot rule and assumptions about close contact were based on old scientific research that simply wasn’t as good as modern experiments. Changing the recommendations now is a full year too late.
The mask debacle
This turned out to be the highest profile of the CDC’s mistakes, but I think it’s the most understandable one.
In March of last year, Dr. Anthony Fauci famously went on the television show “60 Minutes” and said “there’s no reason to be walking around with a mask.” A month later, the CDC seemingly flip-flopped and recommended general mask-wearing for the public.
I’ve covered the reasons for the sudden change, and they are explicable. Fauci was trying to protect the mask supply for those who needed it most: health care workers. That makes sense — for health care workers. It doesn’t make logical sense for the rest of the general public: If masks work for doctors, they should work for others, too. One wonders if demand would have been greater, earlier, if supply would have caught up quickly, too.
There also wasn’t the randomized, controlled, large-scale trial for mask-wearing among the general public during a pandemic that the CDC was looking for. There were a lot of studies that certainly pointed toward the efficacy of masks, but we hadn’t had the chance to test masks in a large-scale pandemic, so the CDC essentially punted on the issue for several high-profile weeks.
Here’s the problem: Masking is a highly visible issue. To explain the difference between aerosolized and droplet spread, you have to get in the weeds a bit. On the other hand, if one day a scientist tells you not to wear a mask, and a month later he tells you to wear a mask, it’s a huge and obvious material shift.
The CDC had two better options here. Both involved being more transparent with the public.
The first would have been to lead with the truth about the shortage of personal protective equipment. “We need masks for doctors and nurses right now. Hold on for a minute, and petition your politicians to spend money to get these masks manufactured more quickly.”
The second would have been to lead with the state of the evidence: “There are studies showing masks are effective for doctors, but we don’t know yet for regular people. Wearing one can’t hurt, though, so wear one if you have one. Hang tight while we do more research, and, in the meantime, petition your politicians to spend money to get these masks manufactured more quickly.”
They went with option No. 3, which was: “Tell the American people they didn’t need to wear masks.” That was a bad idea — a trust-breaking twisting of the truth for many.
An abstinence-only approach to late-pandemic life
If you hear people talking about CDC recommendations for pandemic life now, it’s probably not with the greatest level of respect. That’s probably partially due to the mistakes above, but also because there’s a certain level of elitist detachment about what the CDC currently advises people do.
The STAT News article on the subject has a few great examples. First: travel.
Americans, clearly, have been traveling for months. You need only to scan your Instagram or Facebook feed to see this; or for a more objective source, you can look at traffic at the Salt Lake City International Airport. Travel is back to roughly 75% of normal.
But for months, the CDC recommended that no one travel at all, not even vaccinated people. On April 2, the CDC then said that vaccinated people could travel at low risk to themselves, though the CDC’s director contradicted the advice in a news conference that same day.
Or how about the CDC’s recommendations for summer camps? The CDC recommends that everyone at a camp wear a mask at nearly all times, even the vaccinated, even children, even outdoors. This is wild overkill — even Fauci acknowledged it was “a bit strict” on the “Today” show.
The CDC isn’t always so out of touch with the reality of American behavior when making recommendations. For example, for diseases like HIV, the CDC gives advice on cleaning syringes and exchanging needles. For sexually transmitted diseases, it works to get high-risk people to take preventive measures like wearing a condom. But with this pandemic, the agency has been inexplicably reluctant to make those kinds of compromises that would likely reduce overall harm.
For example, a plan for communicating what additional privileges fully vaccinated people could get should have been in the works for the majority of 2020. That way, when the vaccine came out, there would be clear and obvious incentives that would have driven more people to sign up. In my impromptu survey a couple of weeks ago, I learned that many Utahns aren’t getting vaccinated for no reason at all; they just haven’t really been given a reason to go through the errand.
That vaccinated people can travel, go to summer camp, watch their sports teams play, and go to outdoor events with large groups of people, and so on, should have been communicated early and often to the general public.
Instead, guidelines were hastily thrown together in the past few weeks and received laughs when they were issued. In the absence of reasonable advice, people either created their own rules — rules often based on convenience, not evidence — or haven’t bothered getting vaccinated at all.
—
You can see the connecting theme of all of this: The CDC took too long in adjusting its previous norms, creating new recommendations, and sharing them with the public.
Of course, you certainly don’t want a CDC that answers to every half-baked study out there — a CDC with 1,000 diet pill recommendations would be worse than useless. But you do want a relatively nimble CDC that reflects what’s going on in the real world, not the orthodoxy of months and years past.
For the benefit of the country during the next public health crisis, it’s important that the CDC improve its processes in adapting with the latest research, and communicating it effectively with the American public. Doing so would save lives.
Andy Larsen is a data columnist. He is also one of The Salt Lake Tribune’s Utah Jazz beat writers. You can reach him at alarsen@sltrib.com.
Follow @andyblarsen