The CDC needs to be reorganized from top to bottom ... Part 1 (Trump's Disdain)

Last update: Saturday 1/22/22

Ever since the CDC issued its confusing guidance last week that cut isolation times in half for most people, it has come under pressure from the media and anonymous sources inside the Biden White House to deliver clearer "messaging", with most of this pressure focused on the CDC's director, Rochelle Walensky. 

For examples, consider the following reports:

• "CDC director, under fire for confusing guidance, seeks to reshape messaging", Lena H. Sun and Tyler Pager, WashingtonPost, 1/8/22
• "For C.D.C.’s Walensky, a Steep Learning Curve on Messaging", Sharon LaFraniere, Sheryl Gay Stolberg and Noah Weiland, NY Times, 1/6/22
  
• "CDC director turns to media consultant as Covid-19 messaging frustrations mount", Kaitlan Collins, Jeremy Diamond and Kevin Liptak, CNN, 1/7/22

These reports elicit something akin to, but not quite deja-vu. When Trump was president, the media blamed him for pressuring the CDC's director into making politically motivated bad judgments; now it blames the new director, a Biden appointee. Why isn't it obvious that the CDC itself is the persistent culprit in both administrations?

President Trump didn't give a damn about the CDC

Bob Woodward, editor/reporter for the Washington Post. reported that during his February 2020 interview with President Trump, the president disclosed that he had been briefed that the coronavirus would present him with the biggest domestic challenge during his four year term in office. He further disclosed that he believed this warning. 

Indeed, with guidance from Dr. Fauci he quietly launched what would become known as "Operation Warp Speed" in January 2020, an intensive effort to develop vaccines within nine months, instead of the 18 to 36 months normally required. If the pandemic proved to be as bad as predicted, Warp Speed's timely production of approved vaccines would guarantee his reelection. Indeed, the first vaccines were approved in December 2020 ... a few weeks after Election Day.

• "Trump’s ‘Operation Warp Speed’ Aims to Rush Coronavirus Vaccine", Jennifer Jacobs and Drew Armstrong, Bloomberg, 4/29/20
• "Woodward book: Trump says he knew coronavirus was ‘deadly’ and worse than the flu while intentionally misleading Americans", Robert Costa and Philip Rucker, Washington Post, 9/9/20
• "FDA authorizes Pfizer-BioNTech vaccine, first approved in the U.S.",  
  Carolyn Y. Johnson, Laurie McGinley, Paulina Firozi, Kim Bellware, Erin Cunningham, Hamza Shaban, Miriam Berger and Lateshia Beachum, Washington Post, 12/10/20
• "F.D.A. Authorizes Moderna Vaccine, Adding Millions of Doses to U.S. Supply", Denise Grady, Abby Goodnough and Noah Weiland, NY Times, 12/19/20

Warp Speed was a brilliant success, but as noted above, the first vaccines were not approved until a few weeks after Election Day, too late to help Trump evade a narrow defeat in an election that garnered record turnouts of voters for both parties. 

The point here is that President Trump paid scant attention to anything the CDC recommended throughout 2020, and even mocked some of its recommendations, e.g., wearing cloth masks. He did so because of his confidence in Dr. Fauci's prediction that vaccines could be developed faster than anyone had previously believed was possible. President Trump was convinced that this was his ace in the hole, his get-back-in-the-White-House-free card. 

Had President Trump met his responsibilities as the federal government's chief executive officer, he would have sacked the incumbent Director of the CDC after any one of the three colossal blunders described in the next section of this note. Then he would have charged the former director's replacement, hopefully a highly experienced "turn around artist", with making a top-to-bottom reorganization of the CDC his or her Number 1 management objective. This radical reorganization would have produced the CDC the nation desperately needed to guide its efforts in its total war against the lethal coronavirus and saved hundreds of thousands of lives. 

Unfortunately the president didn't seem to grasp the catastrophic consequences of the CDC's incompetence until the stock market tanked, unemployment applications exceeded 30 million, and he encountered scores of freezer trucks loaded with the bodies of hundreds of deceased victims of the virus in his old neighborhood in the Queens borough of New York City.

• "Coronavirus News: President Trump shaken by scenes from NYC's Elmhurst Hospital", WABC, 3/30/20

The CDC's biggest blunders during the Trump administration

The first two blunders had large, but limited impact. The fallout from the third -- the ultimate manifestation of the CDC's fatal addiction to "one size fits all" national guidance -- is still with us.

• Defective coronavirus tests (January 2020)
  The kits the CDC sent out in January 2020 were contaminated because the CDC's production facilities were contaminated, a management shortfall. Weeks were lost as the CDC tried and failed to correct its error. Eventually a contractor produced valid kits.
  
  The initial shortage of kits caused the CDC to restrict initial testing to persons who had connections with China. These restrictions impeded the U.S. capacity to detect community spread of the disease. Although the virus made limited entry via China, most of the large scale spread came from Europe by way of the New York-Connecticut-New Jersey tri-state area.
  
  -- "C.D.C. Labs Were Contaminated, Delaying Coronavirus Testing, Officials Say", Sheila Kaplan, NY Times, Sunday 4/19/20 ... This story also covered by the Washington Post, Sunday 4/19/20
  
  
• Flip-flopping on masks (February/March 2020)
  In a telebriefing on 2/12/20, the CDC stated that the "CDC does not currently recommend the use of face masks for the general public. "
  -- "Transcript for CDC Telebriefing: CDC Update on Novel Coronavirus", CDC,, 2/12/20
  
  A few weeks later, the CDC reversed its guidance:
  -- "C.D.C. says all Americans should wear masks. Trump says the rule is voluntary.", NY Times, 4/3/20
  
  This reversal was the first of many CDC flip-flops. At the time of this first flip-flop there was no scientific evidence for or against wearing masks. Many months later, a substantial number of studies had accumulated that, taken together, provided indirect evidence that widespread wearing of masks in a community was associated with tangible reductions to the incidence of new Covid infections. 
  
  -- Comprehensive reviews of scientific research on face masks -- "Face masks: what the data say", Lynne Peeples, Nature, 10/6/20 ... and the more recent "An evidence review of face masks against COVID-19", Jeremy Howard et al., Proceedings of the National Academy of Sciences, 1/28/21
  
  Unfortunately, the CDC's flip-flop inflicted lingering damage on its credibility. The CDC had made an initial judgment call against wearing masks, then reversed its position to a wiser judgement. Judgement calls are rational, but they are not science. And judgement calls should never be proclaimed with the dogmatic certainty that the CDC has brought to every subsequent call it has made for us to wear masks or to stop wearing masks.
  
  
• Locking down the entire country (March/April 2020)
  By far, the CDC's biggest blunder during the course of the pandemic so far was its attempt to lock down the entire country at the same time, all fifty states and territories, the most catastrophic invocation of its addiction to a "one size fits all" strategy, a strategy not based on any kind of science, an irrational strategy that was doomed to abysmal failure. Acting on the CDC's recommendation, President Trump issued a proclamation that declared that the coronavirus outbreak was a national emergency on March 13, 2020, then posted Coronavirus Guidelines for America.
  
  Lockdown theory
  Here's the logic behind a national lockdown. Assume that a person who is infected can no longer transmit the virus to anyone else after about three weeks. If everyone who was infected went into quarantine for three weeks, all of them would have recovered at the end of the quarantine period. Given a lack of test kits, only a small percentage of the population could be tested and proven to be infected. So the safe option would be to send everyone into quarantine for three weeks. When the three weeks quarantine was over, everyone would have recovered ... with some important exceptions.
  
  Persons  in a household who were infected when the quarantine began might infect other members of their household on any day during the quarantine. But if the quarantine lasted six weeks, instead of three weeks, even the persons infected during the quarantine would have recovered after six weeks.
  
  Another group of important exceptions included persons who had "essential" jobs performing services that provided life support for everyone who was in quarantine. Essential workers might transmit the virus to each other and to other members of their households who were in quarantine. However it would be reasonable to assume that the level of infection throughout the nation would be much lower at the end of the six week quarantine than before it began, even if new infections occurred among the essential workers and their households.
  
  Most importantly, the number of infected persons who became sick enough to be hospitalized would not increase during the six week quarantine to levels that would overload our hospitals. That's the theory. So what went wrong?
  
  
• Why the U.S. lockdown failed 
  The national lockdown was effective in the few states that were hard hit by the virus by March 20, 2020 when the lockdown began; and it was most effective in the New York-Connecticut-New Jersey tristate area that became the global epicenter of the pandemic. See the following New York Times map that showed the distribution of the virus on March 31, 2020. Note that there were fewer than 20,000 known cases of infection in all fifty states.
  
  
  
• 
  
  Just about everyone in the infected states knew someone who knew someone who had been infected and many knew someone who knew someone who had died. Most of the residents stayed home because the virus was a grim reality. By the end of April 2020, the infection curves were flattened in those states; the hospitalization curves declined; and the death curves declined. 
  
  Unfortunately, the lockdown was a miserable failure in the other states because, as can be sen from the NY Times map (above), the virus had yet to make noticeable appearance in those states. Therefore most of the residents in uninfected states did not stay home because they did not know anyone who knew anyone who had been infected, hospitalized, or died until weeks or even months after the lockdown was ended. The virus was not real to them. Indeed, many suspected that the virus was a hoax. Nevertheless enough people in uninfected states stayed home, perhaps 30 to 40 percent, enough to inflict severe damage on the local economies in those states.  
  
  -- "A Striking Disconnect on the Virus: Economic Pain With Little Illness", Michael H. Keller, Steve Eder and Karl Russell, NY Times, 6/6/20

The CDC needs to be reorganized from top to bottom ... Part 2 (Biden's Turnaround Artist)  

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Links to related notes on this blog:

• "Avoiding the CDC's systemic blunders and flip flops -- UPDATED (again)", Last update: 1/7/22