Americans navigating the COVID-19 pandemic during the latest virus surge say frequent changes in federal guidelines don’t make their lives any easier.
Since the Centers for Disease Control and Prevention slashed isolation recommendations from 10 to five days, many people are confused: Should they quarantine or isolate? For how long? With or without testing?
They aren’t alone in being frustrated.
Prominent health experts who have stood by the CDC and its science-based decisions since the beginning of the pandemic are now criticizing the agency for poor communication.
“The CDC can’t do anything until it acknowledges it has a messaging problem,” said Peter Pitts, president and co-founder of the Center for Medicine in the Public Interest, a patient advocacy group. “Americans don’t understand what they need to understand. So they can’t always do the right thing as quickly as possible.”
Where’s the science?
The agency’s “messaging problem” can be divided into three main issues, health experts said, the biggest of which is inconsistent transparency.
On every policy update, the CDC must back up its decision with clear data and translate the science so the general public can understand it, said Thomas Hipper, associate director of the Center for Public Health Readiness and Communication at Drexel University’s Dornsife School of Public Health.
Announcing the new isolation guidelines Dec. 27, the CDC said “the change (was) motivated by science demonstrating that the majority of SARS-CoV-2 transmission occurs early in the course of illness.”
Officials failed to specifically cite the science, Hipper said.
“Simply announcing the change and trying to explain it without the clear rationale leaves you exposed to questioning,” he said. “Letting the public see those imperfect choices helps justify why the decision was made.”
The CDC did not respond to USA TODAY’s request for comment.
CDC Director Rochelle Walensky explained at a media briefing Friday and again Monday during a Senate committee hearing that the recommendations were based on “over 100 studies collected over the past two years.”
By that time, Hipper said, the damage was done.
“We saw the policy decision was communicated, and then there was a vacuum,” he said. “The decision absent of that information was getting picked apart.”
A big part of transparency would involve more opportunities to speak directly to the news media, Hipper said.
Some health experts have been critical of Walensky for not including other CDC scientists in media briefings. The CDC director said Friday she’s conducted “over 80 briefings” since taking office, but most were alongside White House personnel.
Friday’s news conference was the first in months that was exclusively held by the agency with other CDC experts available for questions. Walensky said she’s committed to conducting more.
“The press is great at poking holes in the policy that they’ve come up with or elevating concerns,” Hipper said. “That access to agency experts that folks want to hear from and trust is really critical.”
Stakeholders are not involved
Health experts said the second issue contributing to the CDC’s messaging problem is that local health departments and national organizations feel left out of the agency’s decision-making.
Not including these stakeholders in the conversation could lead to more criticism and distrust, said Dr. Julie Morita, executive vice president of the Robert Wood Johnson Foundation and a member of the advisory committee to the CDC director.
The American Medical Association, one of the most prominent physician organizations in the country, released a sharply worded statement on the CDC’s isolation and quarantine guidelines, calling them “confusing” and “counterproductive.”
“According to the CDC’s own rationale for shortened isolation periods of the general public, an estimated 31% of people remain infectious 5 days after a positive COVID-19 test,” said AMA President Gerald E. Harmon. “With hundreds of thousands of new cases daily and more than a million positive reported cases on Jan. 3, tens of thousands—potentially hundreds of thousands of people—could return to work and school infectious if they follow the CDC’s new guidance.”
The association said this could be remedied by requiring a negative coronavirus test to end isolation, which the CDC did not include in its guidelines.
“AMA is a stakeholder and should be gaged by public health as new guidance comes out,” Morita said. “If they’re given this proactively, then they can become part of the communication engine versus being critical of what’s being said.”
Some state health leaders also expressed skepticism about the CDC guidance.
The Michigan Department of Health and Human Services said it wouldn’t adopt the recommendations until it reviewed “the supporting evidence … while awaiting additional information … specifically for special populations and in high-risk settings.”
“The high transmissibility of the omicron variant underscores the importance of Michiganders practicing the COVID mitigation practices that are known to reduce spread and risk,” said the statement issued Dec. 29.
This disconnect could have been avoided if there was better communication and transparency between the CDC and state health departments, Hipper said.
“We all want to be on the same page here,” he said. “(Communication) folks on the state and local level need to be able to get that clear guidance from the CDC, so they can convey the same concept.”
‘It’s OK if you don’t always get it right’
Finally, experts said, the CDC has left itself open to charges that it lacks accountability.
The agency has reiterated the science of the pandemic is evolving, and although that is true, health experts said the CDC still needs to acknowledge its errors in that space of inherent uncertainty.
“It humanizes this effort, and it would go a long way in building back trust,” Hipper said. “There’s nothing wrong in acknowledging that, ‘Hey, we didn’t get everything right, but we’re committed to getting it as right as we can.'”
Walensky tried to do this during Friday’s briefing, but Pitts said she fell short.
“She came across to me as being extremely defensive, and people turn off when they sense that the person in front of the camera isn’t accepting responsibility,” Pitts said. “It was an opportunity missed and a real teaching moment.”
Admitting one’s shortcomings is not an easy thing to do, Hipper said, but people often respond well to it, and it would help the CDC’s image.
“It’s OK if you don’t always get it right,” he said. “It’s something the public understands and appreciates.”
The CDC doesn’t exist in isolation. It depends on other agencies, the private sector and ultimately the American people to effectively carry out its pandemic strategy, experts acknowledged.
“There’s no value in placing the blame. … The problem wasn’t totally created by the CDC, and it won’t be solved by the CDC,” Pitts said. “It’s going to take a team effort.”
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