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In Search of the CDC

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Burden Lundgren
June 8, 2020

There is an online petition nominating Dr. Anthony Fauci as People Magazine’s sexiest man alive. I haven’t voted, but I do admit to cheering when a reporter asked him for the “medical” point of view on a question, and Dr. Fauci promptly replied, “It’s not medical. It’s public health.”

The reporter who asked the question is not alone. Respected journalists consistently frame the pandemic issue as being medical or about health care. Moreover the “experts” continually interviewed by the media are nearly all clinicians trained in disease processes and their application to one patient at a time. That is their job. But epidemics by definition are not about one person at a time. They are population events with all the complications those entail. That is why public health is multi-disciplinary. Experts in epidemiology, statistics, mapping, laboratory sciences, surveillance, data systems, law, ethics, policy, communications and a host of others are needed. The media has concentrated on hospitals, but every hospital admission represents a failure in public health.

My history professors taught me to look not only at what happens, but also what does not happen, not only which actors are present, but also which actors are absent. And that brings up the most puzzling question of all. Where is the CDC—the Centers for Disease Control and Prevention? I am not the only one asking that. A May 16th editorial in the Lancet asked the same thing. The public faces communicating from the White House have been Drs. Fauci and Deborah Birx. Both are well-versed in public health because of their expertise in infectious disease, a subject that has a significant intersection with public health. The profession of public health was born from the need to address infectious diseases. But the good doctors represent The National Institutes of Health (research) and the State Department (diplomacy and security) respectively. The CDC is the nation’s public health agency. In fact, it is the world’s public health agency. Countries in every corner of the globe call upon CDC scientists to help them with the health of their populations.

But what have we heard from the CDC during the COVID pandemic? First, there was the issue of tests—the fact that the CDC had botched the development of a test for the virus. But who tasked them with making a new test when the World Health Organization (WHO) had already developed a perfectly serviceable test? Then there was the matter of masks. They are more of a danger than a help—no, we all should be using them. Surfaces are dangerous—well maybe not so much. Now there is the report that they are mixing the results of tests for the virus and tests for antibodies—a rookie mistake if there ever was one. The report CDC presented to Congress in May was 2 ½ pages. Nearly 3 months went by without a public CDC briefing. And the best that can be said for much of the utterly toothless CDC guidelines is that they are too little too late.   

Since the days of Bills of Mortality, counting the dead has been a core function of public health. The keeper of death counts in the United States is the CDC. Its Morbidity and Mortality Weekly Report (MMWR) is an outgrowth of federal surveillance reports dating from 1878. It’s the bible of health statistics. Media mortality reports aren’t citing the CDC as a source. They trust private sites as being faster and more accurate.

“Anyone who wants a test can get a test.” Not only is this statement untrue, it is wrongheaded. Viral tests are not a consumer good, and they are not valuable as a stand-alone effort. Tests have to be a step in a strategic plan. Not only does there seem to be no plan, but also the tests were publicly introduced following a medical model. Tests were for those who had symptoms. Indiana used testing in a random population sample to give an overall picture of the disease. New York does mass voluntary testing to identify high risk zip codes, even neighborhoods. Testing can also be targeted to protect at-risk populations: congregate living facilities and workplaces to protect inmates, patients and workers. Test—yes—but then what? It wasn’t until we were well into May that the public heard about contact tracing. Test, trace, isolate, repeat. This is an old methodology so successful that by initiating it early and aggressively, Vietnam has reported not one COVID-related death.

We are seeing what happens when a critically important federal agency fails in its purpose. The agency whose mission it is to protect our health needs to be competent, needs to be proactive and needs to communicate to the public regularly. The CDC, like public health departments nationally, has been regularly starved of resources by successive administrations—50,000 public health jobs lost since 2008. CDC scientists were pulled out of China in July, 2019. We now have the answer to the question as to what happens when the public agency that is supposed to address a specific problem is absent. The answer is over 100,000 deaths and counting.

Author: Burden S Lundgren, MPH, PhD, RN practiced as a registered nurse specializing in acute and critical care. After leaving clinical practice, she worked as an analyst at the Centers for Medicare and Medicaid Services and later taught at Old Dominion University in Norfolk VA. She has served as a consultant to a number of non-profit groups. Presently, she divides her time between Virginia and Maryland. She can be reached at [email protected].

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