Kimberley Shoaf: Why are public health professionals across the country frustrated with CDC again?

The federal agency should do a better job of working with state and local health departments.

(Ron Harris | AP photo) Headquarters for Centers for Disease Control and Prevention in Atlanta, March 6, 2020.

Last week the Centers for Disease Control and Prevention announced yet another revision to the quarantine and isolation guidelines for COVID-19 disease.

Following President Joe Biden’s recent bout with COVID-19 and his experience with a rebound infection following treatment with Paxlovid, many public health professionals called for CDC to rethink the five-day isolation without a required test. I feel safe in saying that most public health professionals were expecting a tightening of recommendations. That is not what we got.

What we got instead was a press release outlining an elimination of quarantine for persons exposed to a known COVID case and a loosening of isolation standards. They did add that if someone with COVID experiences a rebound infection following Paxlovid use, they should restart isolation at Day 0. Thanks!

I am going to set aside, for a moment, the fact that I know of no new science that supports these new changes, other than the changes due to Paxlovid rebound. For me, the most frustrating part of this new guidance is that once again, state and local public health agencies find out about the changes through the media.

I was just about to start a meeting with our new cohort of contact tracers for our campus, getting ready for the start of the new academic year, when a colleague forwarded The New York Times article on the changes. I immediately went to the CDC website to find the changes. While the public facing website had been updated the previous day, the site for health departments was last updated October 2021.

I looked to see if there was an announcement through the Health Alert Network. Nothing there. The guidelines for K-12 schools were updated, but the guidelines for higher education are nowhere to be found on the website. This is not the way the public health system is supposed to work in the United States.

In the United States, the public health system operates within the Constitution under the police powers that are delegated to the states. In many states, those powers are subsequently delegated to local jurisdictions. It is these local health departments, which are closest to their populations, that are responsible for protecting and promoting the health of the people in their jurisdiction.

The CDC can be seen like FEMA or the U.S. Fire Administration. They are Federal Agencies that provide guidance and sometimes funding to those organizations on the ground at the local level who provide the day-to-day services.

When your house is on fire, your local fire department responds, not the U.S. Fire Administration. Similarly, when there is a public health emergency, your local public health department responds.

If our public health system is going to be able to meet the increasing demands of multiple simultaneous public health emergencies, as well as the daily public health needs of our communities, we need to be seen as partners of the CDC. As partners, the CDC should speak directly to us when it is about to change the guidance that we have to implement. At a minimum, it should update the directions for health departments at the same time as it updates the pages for the general public. Preferably it should update the health department pages first.

The CDC is not the health department for the general population of the United States, that job belongs to the over 3,000 state, territorial, local and tribal health departments.

Please, CDC, do not use the media to communicate to us. We deserve more respect than that.

Kimberley Shoaf

Kimberley Shoaf, DrPH, is a professor of public health at the University of Utah. She has 30 years of experience teaching, researching and working with state and local health departments in Utah and across the country about planning for and responding to public health emergencies. These comments reflect her own professional opinion and should not be construed as representing the opinions of the University of Utah.