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As political leaders discuss relaxing social distancing restrictions and opening up the economy again, a majority of Americans are concerned about whether it is safe to do so. They have fundamental questions about how the nation is doing, what will happen after it opens up, whether we will be able to keep people safe, and could we have to shut down again.

As we struggle our way through this, an essential element is missing: strong, effective leadership from the Centers for Disease Control and Prevention, the premier public health agency in the world.

Since the beginning of the Covid-19 pandemic, the CDC has been inexplicably absent, and Americans are suffering and dying for it.

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The CDC has long been the steady, trusted source for high-quality national data and evidence-based guidance. But not this time, when its voice is needed the most.

While individual states oversee their public health departments, provision of health care, and actually implement policies and programs, the CDC has always provided the intellectual leadership, technical expertise, the expert guidance that states rely on to do their work. This federal agency coordinates efforts across states so they can learn from one another. And the CDC standardizes data and methods so we can get a true national picture of what is happening.

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Want to know how many tuberculosis cases there were in the U.S. last year? Ask the CDC. Want to know about health-care-associated infections? Ask the CDC. It knows.

But ask how many Covid-19 tests have been done, and the CDC’s doesn’t have an answer. Want a daily update on how many people are getting hospitalized for Covid-19? The CDC isn’t tracking it. Want to know if social distancing is making a difference? The CDC doesn’t know.

During this pandemic, when accurate, timely, nationwide information is the lifeblood of our response, the CDC has largely disappeared.

The performance of the world’s leading public health agency has been surprising, and by that I mean surprisingly disappointing. When the outbreak began, the CDC decided to forgo using the World Health Organization’s testing kit for Covid-19 and build its own. The test it shipped out to states was faulty, creating problems that stretched for weeks and slowed response as states waited for replacement tests.

During this critical time, early hot spots like Washington state and New York City were unable to test for the virus. During the inexplicable number of weeks it took to figure out what went wrong, we could have easily adopted the WHO test, which was developed in Germany and is being successfully used in 126 countries around the world. This setback in testing — driven by defects in the CDC’s Covid-19 test and other bottlenecks and regulatory hurdles — is a major contributor to our national lockdown and the fact that thousands of Americans have needlessly died of this virus.

Beyond its testing failure, the CDC has been slow and its response inadequate in another area where it has always excelled: evidence-based guidance. Throughout this pandemic, it has been slow in coming, confusing, and not necessarily evidence-based.

The agency was slow to suggest that we should end large gatherings. As masks for health care workers became scarce, it recommended that health care workers wear bandanas and scarves with zero evidence that these would protect workers from the virus. Investigative reporting has uncovered unclear and disorganized communication to state public health agencies. And the CDC’s restrictive early testing guidelines did not necessarily align with what was understood about disease symptoms and risks at the time.

Americans rely on the CDC for evidence-based guidance. We have not received it.

Effective leadership from the CDC starts with immediately collecting standardized data and updating it regularly — including weekends. Yet for four weeks, the CDC took weekends off from reporting any data on the pandemic until overwhelming criticism forced it to change course. Daily CDC briefings would help the American public understand the data: Not only do we need to know the number of infections, tests, hospitalizations, deaths, and ICU cases, we need CDC experts to put these numbers in context, explain trends and outliers, and keep us grounded in science. Daily updates from the CDC would allow all of us to better understand how we are doing, whether we are likely to run out of hospital capacity and when, what the bottlenecks are on testing, and how we get ahead of this outbreak.

It would be easy for the CDC to do this, but it hasn’t.

Most states are already reporting some of this information every day, though often in haphazard and incomplete ways. The CDC’s natural role is working with states to standardize data collection and reporting it in a way that would make timely, important information publicly available.

It should also commit to providing guidance based solely on evidence, not speculation. If we run out of masks, the CDC should state clearly that going without masks is harmful (as the evidence suggests), not that we should wear makeshift bandanas (for which there is no evidence). Committing to evidence-based guidance would be easy, since it is what the CDC has historically done. And it would be immensely helpful at this moment.

During any public health crisis — especially the largest one of our generation — the nation’s top public health agency needs to provide leadership. That’s what the American people expect and deserve. But so far the CDC has been absent from the fray, and its absence is being felt.

This must be a painful time for the many extraordinary career scientists who continue to work at the agency. But it’s a painful moment for the American people, too, and with deadly consequences. Real CDC leadership — clear, science-based guidance, effective coordination of states, and public transparency of data — is absolutely essential for confronting and getting clear of this crisis.

The CDC was once the world’s greatest public health agency. We need that CDC back, and we need it now.

Ashish K. Jha, M.D., is director of the Harvard Global Health Institute and professor of global health at the Harvard T.H. Chan School of Public Health.

  • I recently saw a Rachel Maddow show where she was on point about what has happened to the CDC. I was left stunned with my mouth open saying “WTF”? I think it was on Monday or Tuesday edition. Check it out!!!

  • The finger pointing is worthy. The reasons are unknown to the public. Not interested in a political panel investigation. I’d like an independent investigation by a nongovernmental audit. It’s no secret that there is little money for public policy in our neoliberal world. Most of this is incompetence is probably due to the politicization of everything. But I’d guess too that the US has lost substantial scientific leadership as we outsource more and more core competencies courtesy of mass political fraud and corruption from both parties. I see this where the US dominated is my scientific area of expertise and now is a feeble, irrelevant shell in the global arena. It’s been a long time since this nation led in the sciences. None of this is any surprise to me. This is far more insidious than just the failure at the CDC. It’s systemic in America.

  • If they open USA we are doomed trump needs to be impeached for his statement we beening told not to go out for the next 2 weeks now our governers telling us they gonna open little by little this is crazyyyyy now we can’t trust our leaders no soical. Distance is beening practice at alllll so much I could tell but I cant

  • Perhaps if the CDC listened to scientists instead of bureaucrats they’d be able to validate a simple RT-PCR test before shipping it out blindly. For every scientist who retires 3-4 administrator, communication specialists, or program directors are hired in their place. Science is a dying art at CDC.

  • The still-counting delay in tests is because the Don pushes for America’s own tests. The CDC’s Robert Redfield was visibly upset when Trump visited in golf clothes and cap and down-played the severity of Covid-19. Daily CDC briefings are impossible as Trump wants all of the limelight (hopefully no more after the insane idea of internal use of sanitizers). The absence of the CDC is because it is muzzled by America’s “leader” who also fires anyone at will.

    • Gord P, shame on you. People are dying yet your still choose to play politics. It seems like you are a CDC employee.

      CDC commits and unforgivable blunders with the test kits failure and setting a strict criteria for testing. CDC should be disbanded and a new body outside of HHS with should be created. A CDC that can truly functions as a body that protect the American people.

      The current CDC made an unforgivable failures that will cost the country hundreds of thousands of life.

      Wall Street Journal already run an article about Alex Azar role and the about the test fiasco. It was Azar who made the decision not to use WHO and to make theit own test. The also try to cover up the failure of the test.

      So please, bring your senseless policy somewhere else.

      Actually, it is good that he fire government officials at will. He should fire Alex Azar and some people in the coronavirus task force.

      While we are on that, there should be a law that allows firing of government workers. Unfortunately, it is hard to fire a federal employee.

    • Jean, I am an entrepeneur, not a CDC employee. Lots of mis-information has been issued, from all directions, institutions and mouths. On top of that, the overpowering attitude and meddling by the Boy at the Top has mis-directed anti-Covid efforts, delayed meeting the need for PPEs, tests, staff, etc. He has hampered so much potential progress in the US, it’s despicable, and it is costing lives. The CDC is hard at work, behind the scenes without an elephant in the room, invisible as it is boxed in a corner.

    • In the federal government, misleading science and/or misinformation scandals are nearly always attributable to politics. NIH seems to be exceptional, but it’s work and grants are also (cleverly) externally peer-reviewed which insulates them from Congressional pressure. CDC – does most of its vetting internally.

      While I was at NIH, the several times I worked with CDC, the staff seemed to do journeyman quality work and seemed well-managed. As I earlier stated, starting with Bush/Cheney, political agendas of the appointers and appointees became increasingly evident at CDC, and of course at DOD (WMD analysis was gagged by Cheney). It is only getting worse with Trump.

  • As a state public health laboratory director for over 30 years (SC and NV) I have worked with CDC constantly. I also spent two years at CDC. Since day 1 of the coronavirus episode I have been asking the same questions. The competent staff at CDC has always been a guiding light. Where is the snag?

    • The “snag,” as I saw it from my perch at NIH was and still is those political appointees placed in charge. Francis Collins types they were not. Epi research is more art than science because they rely upon unreliable data. We do not yet have national standards for ME training vis a vie cause of death reports (suicide is a great example).

      However, when the CDC director Frieden started condemning vaping based on personal opinion and inconsistent with the refereed science – that is when CDC finally lost me. Back then, the only credible research addressing vaping safety was a huge Cochrane meta-analysis attesting to its relative safety contrasted with cigarettes. Subsequently, both CDC and FDA’s corporate doctor, Gottlieb, responded to the little epidemic of vaping deaths caused by device malfunctions and tainted fluids by suggesting a discussion of eliminating flavoring was in order. They also justified a teen ban based on a few small animal studies showing nicotine slowed brain development – a ridiculous stretch anecdotally refuted by the very many of us senior scientists who smoked while pursuing our MDs and PhDs.

  • First the CDC inexplicably told us to forget N95s and go with droplet masks. The old CDC would never have given such a weak justification for a significant change in recommendations, nor would they have tried to slip it past the health care community without making a major announcement.

    Now, Trumpian notes are being inserted into what used to be straightforward and dispassionate information. A few days ago I read CDC’s new information about the two COVID (+) cats in the U.S. The brief mentioned that if pets had to be tested it wouldn’t affect the availability of tests for humans. And then this:

    “The U.S. government remains committed to increasing nationwide COVID-19 testing for Americans. In fact, the United States has conducted more than four million COVID-19 tests for humans, which is more tests than the following nations combined: France, the UK, South Korea, Japan, Singapore, India, Austria, Australia, Sweden, and Canada.”

    I knew when I read that that we’d lost the CDC as we know it.

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