A friend of mine, posted in the Philippines, sent me a link to a New York Times story about the CDC. Apparently, the Trump Administration is removing the CDC from the role of receiving data on COVID-19 from hospitals and providing information back to them, to the states, and to Health and Human Services to guide the response to the pandemic. My friend was shocked at what seemed like a power grab.
According to the story (take a healthy dose of salt here), the Administration’s Coronavirus Task Force was becoming increasingly frustrated at the pace and accuracy of data being submitted to CDC. As the virus resurges, frustration with the CDC is natural but not necessarily legitimate.
CDC has always been hamstrung by lack of clear authority in public health practice. Their authority stops at the gates of CDC Headquarters in Atlanta. The states are free to go their own way. Think of it this way: When we could go to restaurants, we all knew our roles. The wait staff were to try to understand our desires within the framework of the menu and type of restaurant. The kitchen staff was to execute those orders along with modifications needed, e.g. food allergies and personal tastes. Therefore, we as customers do not get to order a ham sandwich in a vegan restaurant. Unlike our restaurant example, the CDC does not have that clarity because confusing lines of authority and overlapping roles have been baked into the agency.
In a global pandemic, what are they to do? During the Ebola Crisis, they worked under White House guidance to address the minor impact of the virus here and assist in the major impact in west Africa. They did what they do best, provide great scientific guidance. However, while they can generally provide resources to the 50 states and territories for information and guidance, they are not a national public health agency. Each state has its own independent public health department. CDC cannot even commandeer state resources like the military can federalize the National Guard.
So, in a real sense, the CDC has been hamstrung in the event of a major catastrophe. Consider the difference with Ebola. That outbreak delivered 11 cases of infected people to the US (nine who were infected in Africa and came here for treatment or were unaware of their disease status and, only two infected within the US) — a modest if worrisome statistic. At the time, the White House recognized early that it needed to provide support and authority to respond to the crisis and coordinated across the variety of agencies, including CDC, to marshall resources and conduct screenings. Executive action supported coordination and clarity of authority that the CDC lacked by statute and convention. In other words, leadership.
Conversely, COVID-19 has reached into every state with more than 3.4 million cases (and counting). More than 130,000 Americans have died from the virus (again still counting). The CDC has made its share of mistakes, but the larger issues in the response lay above its pay grade. After the Ebola crisis, the Obama White House set up a group to monitor and respond to pandemics under the NSC, but the Trump Administration disbanded them in 2018 — well before our current outbreak. As the crisis ramped up, Trump formed a new White House Task Force to set policy and coordinate response. They might have worked well, but the participation of Donald Trump frustrated the clarity of guidelines and the coordination of resources. The Task Force became a very bad running joke by the time Trump delivered his advice on ingesting bleach and other disinfectants to cure the virus.
The lack of actual leadership was compounded as the outbreak leveled off for a time in June, before it resumed its growth in a different set of states. Trump was worried that the lockdown was going to damage his reelection prospects and began to chafe at the reluctance of state governors to lift those restrictions. He noted that the increase in testing seemed to exaggerate the number of actual cases — based on a false premise that testing did not reveal but caused the numbers to increase. He wanted things to open up and said so, often and loudly. A number of GOP governors took direction from him and a couple of weeks later saw their infection rates zoom upward.
So, where are we at the moment? The virus as resumed its upward march nationally with new epicenters outside the Northeast. Future lockdowns are problematic because of confusion over the efficacy of wearing masks (you should) and the economic pain of shuttering businesses. Trump has clearly indicated his desire for data that looks better for his electoral chances as he continues to trail his likely rival for November. He has shown no proclivity for actually leading, only for seeming to be in charge.
In this context, we have to consider the Administration’s attempt to sideline CDC as an effort to cook the books. (Of course, there’s a private company in the wings with a no-bid contract to provide the data services.) At best, these efforts add another lane for data from hospitals, but at worst they confuse the situation and offer an opening for an “alternative” interpretation of the data.
We must remember that we are officially in the age of “alternative facts”–– and data.