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WASHINGTON — Nearly a year ago, amid concerns about how to prevent transmission of the virus causing Covid-19, scientists were beginning to conclude that rigorous disinfection of surfaces — say, fogging them or deep-cleaning with bleach — was overkill.

Academics were warning that the risk of so-called fomite transmission was wildly overblown. In the fall, research from Israel and Italy found that the virus couldn’t even be cultured from surfaces in hospital infectious disease units. By February of this year, the editorial board of Nature was openly urging the Centers for Disease Control and Prevention to update its guidelines.

The CDC did so — last month.

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That so much time passed before the nation’s leading public health agency took a stand on an issue that seemed patently obvious to others was puzzling. But it was hardly an isolated incident.

After months of pleas from scientists, the CDC acknowledged last week that Covid-19 can be spread through small particles floating in the air — an acknowledgment that came more than a year after some experts began warning that the virus is airborne. Separately, it took three months after Covid-19 vaccines began going into arms before the CDC issued its first attempt at outlining the activities vaccinated people could safely undertake.

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When the CDC issued new guidelines recently on when people still need to wear masks, the guidelines were seen as so conservative that they prompted a primetime rant on “The Daily Show.”

“I know science is difficult … but who’s running messaging at the CDC?” asked the show’s host, Trevor Noah.

Some public health experts are asking the same question. Most experts interviewed for this story say the agency has struggled to take advantage of the latest scientific findings to communicate as rapidly as possible with the American public. And when the guidance is issued, it tends to be overly cautious.

The explanation does not seem to be, as it might have been under the Trump administration, political interference. Rather, “there is a certain mentality when it comes to [caution] that I believe has been detrimental,” said Leana Wen, an emergency physician and visiting professor of health policy at George Washington University.

Even defenders of the CDC’s approach admitted that the agency has been conservative, and at times slow.

“I admit it is a conservative approach, and they have historically always been very conservative,” said Georges Benjamin, executive director of the American Public Health Association, who largely defended the CDC and insisted that the agency has followed the science.

The CDC did not respond to a request for comment.

The issues facing the CDC aren’t altogether new. Two former CDC directors, Tom Frieden and Rich Besser, both acknowledged to STAT that the CDC has continually labored to quickly release guidance — though, like Benjamin, defended the agency.

“In every public health crisis the complaint is made that the CDC is too slow to make recommendations,” said Besser, who served as the acting CDC director in 2009. “It’s an issue that the CDC has always grappled with and will continue to grapple with.”

Still, public health officials say the conservative nature of the agency’s approach to Covid is a marked departure from how it deals with other major public health issues, like HIV and opioid use disorder.

There, public health officials by and large embrace harm reduction: giving honest advice on how to make risky behaviors safer, rather than discouraging activities altogether. For injection drug use, that means supporting needle exchanges and providing advice on cleaning syringes; for STDs, it means making sure those at outsized risk, like sex workers, have easy access to condoms.

When it comes to Covid-19, the CDC has often stressed simply avoiding certain activities.

“There’s still a lot of abstinence-only in their Covid guidances,” said Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security. “People somehow kind of walled off what they know about HIV, opioid use, and hep C … and we are the worse for it.”

Nowhere is the CDC’s “abstinence-only approach” clearer than in its advice on travel.

The evidence has been overwhelming for months: Americans, despite possible risks to themselves and their loved ones, are traveling during Covid-19.

Some 6.8 million Americans traveled via plane around Thanksgiving. The day before Christmas Eve was the busiest day at airports since the start of the pandemic. And by March, airports around the country were regularly serving 1 million travelers daily.

But the CDC repeatedly insisted Americans should not travel. It even discouraged vaccinated people from traveling in March guidance in which it laid out what vaccinated people can and cannot safely do.

It wasn’t until April 2 that the CDC changed its stance — sort of. The agency issued guidance that day saying “fully vaccinated people can travel at low risk to themselves.” But CDC Director Rochelle Walensky contradicted the guidelines almost immediately. During a press conference, Walensky said that she continues to “advocate against general travel overall.”

“In every public health crisis the complaint is made that the CDC is too slow to make recommendations. … It’s an issue that the CDC has always grappled with and will continue to grapple with.”

Rich Besser, former acting CDC director

Other CDC guidelines have been panned as unnecessarily restrictive.

The CDC’s new guidance on reopening summer camps, for example, recommends that everyone at a camp, including children older than 2 and fully vaccinated adults, wear masks at all times — even outdoors — except when swimming or eating.

The guidance seemed disconnected from the science, which has continually shown that the risk of catching Covid-19 outdoors is low compared to the risk of indoor transmission. It’s also thought that children — particularly young children — transmit the virus less efficiently than adults, though researchers are still studying Covid-19 dynamics in kids.

Former FDA Commissioner Scott Gottlieb called the guidance “byzantine.” Libertarian publications are equating it with the government recommending “that summer camps treat kids like prisoners.” Even Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, acknowledged last week that the guidelines “certainly are conservative” and “a bit strict.”

The CDC has faced similar criticism over its recent guidelines on when vaccinated and unvaccinated people need to wear masks.

That guidance recommends that vaccinated people continue to wear masks at crowded outdoor events, and at nearly all types of indoor gatherings. The unvaccinated are urged to wear a mask in nearly every situation, except when taking a walk outdoors or at a small gathering with fully vaccinated people.

Experts, like Emory University’s Carlos del Rio, have criticized the guidance as too timid, and everyone from talk show hosts, like Noah of “The Daily Show,” to public health experts, like Virginia Tech’s Linsey Marr, have complained that the guidance, with a color-coded chart attempting to explain when to wear a mask, is too confusing. Even those who vociferously defended the CDC in interviews with STAT admitted that the CDC’s masking guidelines could have been clearer.

“They were going in the right direction,” said Howard Koh, who served as assistant secretary for health during the Obama administration. “I expect that future versions of those graphics and recommendations will be simplified and updated sooner rather than later.”

Public health officials worry that the CDC is making it harder to beat back the Covid-19 pandemic by issuing guidance that is so timid, and doing it slowly.

Multiple experts told STAT that they fear the CDC’s recommendations are becoming irrelevant for most Americans. They worry, too, that guidelines, like the CDC’s advice on masking, so seriously underplay the benefits of getting vaccinated that they risk dissuading people from getting a shot in the first place.

“It looks like there’s still confusion, and what people are wanting from the CDC … is more certainty,” said Glen Nowak, a 14-year veteran of the CDC’s communications department who now teaches at the University of Georgia. Nowak added that people want certainty from the CDC rather than “what ifs,” and that they want to know “if you do believe in these vaccines, why do you show so much trepidation regarding these vaccines?”

Even former CDC director Frieden told STAT he believes the CDC “needs to be better at emphasizing with how sick and tired people are with restrictions,” though he largely defended the CDC’s guidelines.

“I have sympathy for the CDC,” said Frieden, who called making CDC guidance “an art and a science” that doing so “requires an encyclopedic knowledge of the data as well as a sensible way of interpreting the data and applying it to everyday life.”

“We want simplicity when there isn’t simplicity,” Frieden added.

Besser, the former acting CDC director, also acknowledged that certain CDC guidelines, including advice on what vaccinated people can safely do, were released later than he would have liked. He attributed the CDC’s slowness to a culture in which it “gets challenged in settings where the science is incomplete, or settings where the science may not exist at all.”

“It was one of the biggest challenges that I felt we had,” said Besser.

It’s clear vaccines are cutting transmission dramatically. But some “breakthrough” infections still do occur, and researchers are still trying to determine the level of risk posed to others by someone who is infected after vaccination. Some experts, Frieden included, still also worry fomites are a possible mode of transmission, and studies were still being published in peer-reviewed journals late last year claiming fomite transmission is possible, even if it’s not the dominant mode of transmission.

“I still don’t like to touch the lobby button of elevators,” Frieden said. “I think we were too concerned about it last year and I think we may minimize it too much this year.”

Defenders of the CDC insist it’s better for the agency to be cautious than it would be for it to get ahead of the science — and then being forced to walk back recommendations.

“The CDC wants to avoid making any sweeping new recommendations today that might have to be walked back tomorrow,” said Koh. “They’re being extremely cautious and I respect them for that.”

But those frustrated with the CDC’s approach insist that waiting for more certainly just isn’t an option.

“If their advice is too disconnected from reality, and if they are too slow, then they make themselves irrelevant,” Wen, the George Washington professor said. “I understand that they’re in a difficult position. However caution and indecision also comes at a price.”

  • …”though researchers are still studying Covid-19 dynamics in kids.” That means there still is a lot of unknowns about transmission in kids. And it shows. I now have two grand-daughters with Covid (under 2 yrs and barely 6 yrs) – it came from Kindergarten, was spread in the day-home (10 children under 7 yrs). The dayhome providers, several parents, whole families (adults in age-group awaiting vaccination) are now quarantined until May 31. So I fully side with a CDC that choses to be safe rather than sorry. The “freedom” in the US, with so many not yet or never getting vaccinated will perpetually give new variants great opportunities. And the pandemic will simply never end. Kudos to the CDC.

  • The CDC’s recommendations indicating that fully vaccinated individuals do not need to wear a mask is, as an American… and as a scientist…simply heartbreaking.

    If you really want to know the truth about the ‘current’ understanding of COVID19, go directly to the scientific data itself. All peer-reviewed scientific data that has been formally accepted and published by scientific journals can be searched on PubMed (https://pubmed.ncbi.nlm.nih.gov/). However, politically correct COVID messaging is sadly having an impact in the scientific review process. If you seek the real truth, one should review data on the preprint process servers: https://www.biorxiv.org/ and https://www.medrxiv.org/ where all scientific content is free. Since the onset of the pandemic, most investigators are actually posting their scientific manuscripts and research findings on these servers in order to provide real-time access of their data to the International scientific community. Most of the articles will undergo the peer-review process and be published in scientific journals. However, some will not be.

  • Reverse logic like this is one reason why people are not getting vaccinated and why we will he dealing with Covid for years to come. If this person, or any of the previous people who replied worked in an emergency department, maybe you would see the idiocracy in what is being said here.
    The CDC is following science…far better than are the uneducated masses of the US. When kids get Covid, we don’t know what will kill them—is it ARDS, cardiomyopathy, or will they only need lung transplants in 10 years from now? We have next to zero imaging on kids with Covid because we avoid scanning kids! Ever see an xray show all of the lung scarring that a CT scan does…? (No. Because xrays don’t have that ability. The difference is quite huge)
    Do we know anything about what Covid does to anyone 2-3 years let alone 20 years after you get it? No.
    Should 1 or a few small or even medium-sized trials or retrospective studies showing reassuring data change national healthcare guidelines…? Not when the unknown risk is still so high. Mr. Florko, you should really think about the impact any published article can have on people’s false ideas of security. How many people have you personally diagnosed with Covid this year? Or declare dead? It’s in the hundreds for me. The most frustrating thing is how people get so MAD when they get diagnosed. They all seem soooo confused because “I was being really good”. News flash— We still know only very very little about the virus. The CDC should keep doing its work and only move on things it has ample evidence for. Peoples’ emotions and stupid ideas like traveling over the holidays does not make that OK. Clearly none of you had to work in a hospital during the December/January surge. Traveling is how so many people ended up dying this winter, and if you truly don’t know that, then you have no business acting like you know what is going on.

    • 😱😱😱😱😱
      Many differences now from Nov/Dec/Jan, predominantly the number of vaccinated people and dramatically decreased case numbers, hospitalizations, and deaths.
      Cant imagine what patient care in 2020 was like. Thankfully, it’s now time to begin to look forward, IMHO.

    • You mean like we have been dealing with Influenza for years? Perhaps your alarm at this virus’ devastation is framed by the very population you are pointedly exposed to (ER profession). You see people all day who come to you because they are sick from this disease, but how many do you not see who have been exposed to, contracted, and recovered from it? No doubt it is devastating for some, but not all. We may not have seen the lung scarring a CT can show, likewise we haven’t seen the long term emotional, psychological, and physical scarring the mask mandates (and CDC continued push for) have wreaked on our youth. Thankfully many of us have not seen the faces of the parents when they find out their previously healthy, happy, thriving child has committed suicide after dealing with the social isolation, educational fallout from forced online learning, and decline of physical well being once their clubs, classes, sports, and extracurricular activities have been curtailed. That would be the hardest thing of all to witness. Please show me the ample evidence that masks are effective in preventing the spread of this virus? I can find ample evidence that when children are exposed to viruses and bacteria their immune systems kick into gear and produce antibodies that will serve them for a lifetime. If they are not exposed to those pathogens, then they won’t produce the antibodies.
      Do we know anything about what masking does to children who are developing language, social skills, gross motor activities, etc.? Or babies who are seeing adult humans with most of their faces covered? What effect does that have on their social and language development?
      And clearly you personally are emotionally affected by the sights you have seen in your profession of treating the sick. It must have seemed like a war zone in your ER and thank God you were there and willing to persevere in treating those patients with a disease yet unknown to mankind. I would also like to hear from the physicians who have had similar/different sights, experiences, outcomes in their exposure to this disease. Sadly, and shockingly, what we have seen is continued censorship of those doctors. We are not going to advance far in dealing with this virus as long as we continue to shut down honest, professional dialogue, push mandates that have not only proven to be ineffective in the short term, but potentially harmful in the long term, and refuse to acknowledge that this is not the most dangerous pathogen to ever cross this planet thus necessitating measures that are draconian to a healthy society. Assessing risk factors and categories, continue researching vaccination options, allowing for physicians to prescribe “alternative” therapies that have been safely used for decades, and honestly educating the public so that they can make fully, informed decisions and choices in their daily lives is what is needed. Remember, first and foremost: Do No Harm!

  • New technologies are available to create
    Safe indoor air, a 99.99% viruses and bacteria free space. A proactive approach
    to maximize its utilization is expected and supported by government agencies

  • The Monday-morning quarterbacks have weighed in: “The CDC is/was too conservative. And they got some things wrong. And they repeatedly reversed themselves. How does any of this make my life easier?”

    Give us a break. Of course, the CDC is conservative. Of course, the CDC gets things wrong, etc. The CDC is SUPPOSED to be conservative, and all of us get things wrong. We should be thanking the folks at the CDC, not pillorying them, especially after all the horses have left the barn.

    • No, the CDC should be leading the charge and on the forefront of shaping policy instead of sticking by disproven beliefs that were put in place at the onset of the pandemic. I thought we were supposed to be following the science which shows many of our restrictions are unnecessary. They have lost their credibility.

    • Teen suicide has more than doubled. Millions of people put out of work. Thousands of businesses closed permanently. No guidance given on how to stay healthy to improve your odds getting over a viral infection. Only supporting big Pharma, not giving any credence to natural and less expensive prescription alternatives. I’m sorry, the CDC and big tech are responsible for thousands of deaths in this pandemic. Shame on them for spreading lies and falsehoods and withholding the truth of Medical Science. The CDC and big tech has only been a mouthpiece for political science.

    • Here’s what they could have done so they didn’t make so many drastic guidelines and then walk a bunch of them back.
      “Still, public health officials say the conservative nature of the agency’s approach to Covid is a marked departure from how it deals with other major public health issues, like HIV and opioid use disorder.

      There, public health officials by and large embrace harm reduction: giving honest advice on how to make risky behaviors safer, rather than discouraging activities altogether. For injection drug use, that means supporting needle exchanges and providing advice on cleaning syringes; for STDs, it means making sure those at outsized risk, like sex workers, have easy access to condoms.

      “There’s still a lot of abstinence-only in their Covid guidances,” said Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security. “People somehow kind of walled off what they know about HIV, opioid use, and hep C … and we are the worse for it.”

  • What I fail to understand is why the CDC (an organization tasked with disease control) continues recommending children wear masks in the face of overwhelming evidence that they are not vectors or largely victims of Covid. The mask wearing does prevent them from being exposed to and forming antibodies against normal germs they would otherwise encounter. And that’s just the immunological aspect. When you consider the social, psychological, and emotional impact continued mask requirements has on our children’s development, it should have many asking questions. This doesn’t seem to be so much about disease control as just control.

    • While indoor bars were opening up for adults to mingle, outdoor playgrounds were still roped off for months. It makes no sense. Children have been victims in this.

    • The CDC is smarter than hordes of lay-people, and it can not just react to singular scientific findings. It will always be slower than the populus wants. Kids spread Covid – and adult “recipients” are worse off.
      …”though researchers are still studying Covid-19 dynamics in kids.” That means there still is a lot of unknowns about transmission in kids. And it shows. I now have two grand-daughters with Covid (under 2 yrs and barely 6 yrs) – it came from Kindergarten, was spread in the day-home (10 children under 7 yrs). The dayhome providers, several parents, whole families (adults in age-group awaiting vaccination) are now quarantined until May 31. So I fully side with a CDC that choses to be safe rather than sorry. The “freedom” in the US, with so many not yet or never getting vaccinated will perpetually give new variants great opportunities. And the pandemic will simply never end. Kudos to the CDC.

  • The CDC has made themselves irrelevant. They are slow to follow medical science because they are raptured in Political Science. The exaggerations and falsehoods they have published are literally killing America! Teen suicide has more than doubled since they recommended universal masking! (The WHO says there is “No Direct Evidence” to support the use of masks in preventing the spread of a respiratory virus. Decades of research also support the ineffectiveness of masks in preventing viral illness). Less expensive, Rx and OTC remedies to treat COVID-19 and simple advice on staying healthy have been ignored and purposely pushed aside for more expensive IV remedies and vaccines. I have personally managed over 265 patients who had COVID-19. 0% mortality. Wake up America! Stand up for our Kids!

  • There is objective evidence that the teachers’ unions were involved with bogus CDC guidance on school openings. The idea that the CDC hasn’t been politicized by the Biden administration is absurd on its face.

  • I got covert and was hospitalized for 3 day.i got a call from the health department which ststed that i had to quarantine for 10 day and thsf was all…do i need to be tested again and how long before i can get vaccinated.

    • Do you need to get vaccinated for COVID-19 if you have already had COVID-19? It’s your choice! I’ve had several patients who have actually felt worse with the vaccination than when they had the disease. The notion of vaccinating someone for a disease they just got over is unique to COVID-19, and frankly, quite absurd. You have natural immunity! Nevertheless, if you feel you want it, you can still get the vaccine. It’s your choice.

  • Wow. I read a single reference to political interference under the Trump administration in the whole article. And that seems to be the only line that some of the commenters saw.

    • Because it’s a huge, provable lie to appease the religious Left readership. It should be called out.

    • A lot of the previous administration’s “political interference” now proves to be appropriate policy. But, they will never get credit for that or the vaccine developments.
      Vaccinated JoeB said the vaccine “was not available” before he took office.
      Guess that’s why he still wears two masks-he got saline injections in December.🤦‍♂️

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