Leading COVID or leading from behind?

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Minutes after the Centers for Disease Control and Prevention (CDC) published his new orientation On Thursday that those fully vaccinated against COVID-19 can now (mostly) leave their masks both indoors and outdoors, Twitter and other social media were backlit.

Some people posted the first details of their first unmasked smile, others put on T-shirts that said “Fully vaccinated (not an anti-mask).” Others still pledged to wear masks and many wondered how many people would be maskless liars.

Meanwhile, many public health experts also commented. Some see the new direction as a sudden and misguided pivot in the direction, while others welcomed what they see as progress.

The agency has caught its lumps during the pandemic. Initial problems with test distribution in March 2020 it caused the blockade of almost the entire nation. In July, the Trump administration withdrew the CDC ability to track hospitalization data. In August, other federal officials posted contradictory test guidelines on the CDC website what their own scientists were saying.

While all of these incidents took place under then-President Donald Trump, the CDC led by President Joe Biden has not been without its problems. In April, the agency issued guidelines for meeting outdoors which many found frustratingly confusing and sadly late compared to the actual behavior of the people.

Now comes the new guide to interior masks, which is a strong change from the recommendations CDC has been offering for some time. It all makes many wonder if the CDC are leaders, supporters, or out of touch.

So it may not be a surprise a recent survey of the Robert Wood Johnson Foundation and Harvard found that only 52% of Americans claim to have great confidence in the CDC.

Medscape Medical News asked them to ponder how the “new” CDC led by Rochelle Walensky, MD, MPH is doing compared to CDC under the previous administration and to get their best advice on how the agency can move forward to manage the pandemic.

Different expert opinions

“We have more people unvaccinated than vaccinated and we declare victory,” said Cheryl Healton, DrPH, dean of the NYU School of Global Public Health. With incubations of variants and hundreds of people dying every day from COVID, “this is still a lot of infection and there are still a lot of deaths.”

He will continue to wear a mask. “I’m making it a role model right now. Because I’m very concerned that a lot of people who aren’t vaccinated don’t wear the mask in various places. Who’s at risk? Other people who haven’t been vaccinated.”

While Healton laments the unwillingness of the unvaccinated to accept science, he asked, “Should they die for it? I don’t think so.”
“What’s happening with the CDC is that it’s a kind of transition from precaution to abandonment of precaution,” said Lawrence Gostin, a professor of global health law at Georgetown University and director of the Center for Disease Control. ‘World Health Organization on World Health Law. The abrupt change in CDC guidelines, he said, “speaks to the idea that they are succumbing to public and political pressure.”
However, other experts applauded the updated advice. “The new orientation is something many of us were looking forward to,” said Amesh Adalja, MD, a scholar at the Johns Hopkins Center for Health Security in Baltimore.

Past and present

“I would say that Biden’s CDC, Walensky’s CDC, has been characterized by being very prudent, [taking] the baby’s footsteps, but the baby’s footsteps in the right direction, “Adalja said.” But they are still baby steps. I think many of us [public health experts] I would like the CDC to be more aggressive about the value of vaccines and show more confidence in vaccines. “

I would welcome the CDC to be much bolder and more proactive about what vaccinated people can do. “

Healton said that ” The CDC is improving a lot under this administration, because it is first and foremost politicized. He also adheres a lot to the science of transmission. The latter policy is an example of a policy change that was integrated into the new data with respect to transmission.

“Specifically, [it looked at] what a chance someone [vaccinated] is to become infected and likely to infect someone else [if infected]. The answer to these questions is low and low. “

Thus, although the change of direction is based on science, Healton said that “what I think is wrong did not make me clear enough in a public statement the impact of saying that vaccinated people should not carry none “There is no way to determine if those without a mask are vaccinated,” he said.

The CDC is the gold standard in the public health sciences and “I think we still are,” Gostin said. “But I think public confidence in the CDC is falling, frankly. I think it was certainly caused primarily by the censorship imposed by the Trump administration.”

But it still happens, he said. He noted the mixed reactions of experts to the new council. In the past, he said, when the CDC issued new guidelines, the entire scientific community would be ready. “This is not happening now.”

Navigation the way forward

“You want CDC to be ahead of people and be aggressive, so they’re one step ahead of what people do, so the targeting is really operational,” Adalja said. By the time the recent travel guidelines came out, he said, many vaccinated people no longer wore an outdoor mask or were already traveling.

Adalja also argues with what he calls an “abstinence” approach with the guidelines of COVID-19, which he said the CDC adopted at the start of the pandemic.

He compared it to the early days of HIV, where abstinence was first preached, until the CDC went to what he considers a more realistic and productive approach: harm reduction. “With COVID 19, it was basically just about abstinence [previously]. Only in the last few weeks have you started to see a little softening. “

Adalja said the harm reduction method is better than abstinence. Harm reduction means knowing people where they are, dealing with reality. “This is something that would have been helpful at first,” he said. “A lot of acronyms [over advice given] he was driven only by this abstinence [approach]. Instead of saying ” don’t do this [activity] never, the CDC should say, “That way something is done more safely.”

As a result of the previous focus on abstinence, “you had a group of people who thought it was Mardi Gras every day and another group of people who didn’t leave home,” he said.

Adalja sees the new mask guide as a big step. “Then, he said, the CDC should reopen schools.” They need to come out strong about personal learning in schools. If you have bars and casinos open, you can be sure to open schools. I think a lot of people have myopia, they just look at COVID and they don’t look at the overall picture of what’s going on psychosocially with these kids outside of school. “

The CDC is not able to communicate health messages, experts agreed. “What I would like CDC to do is try to invest in healthcare communication,” Gostin said. “Don’t just hire scientists, hire health communicators, teachers, community leaders, anthropologists. In other words, they need to make their messages clear, clear and understandable to the public so that citizens have confidence in them.

“Right now they look more like a think tank on academic science. They do science and communication is a later thought. That needs to change. That’s part of the reason we have such a huge hesitation.”
“For me, it’s very sad to see this constant erosion of trust in the CDC,” Gostin said. “They’re just world-class scientists who work hard and have a lot of compassion.”
Healton agreed that a strong public health message is crucial. “What has yet to come out the door is a national public education campaign that promotes vaccination.” She cited the Truth Initiative, the campaign that helped reduce teen cigarette use from 23% in 2000 to 5% in 2020. She was the president and CEO of the initiative (now known as Legacy) for 14 years.
The message that would also help, Adalja said, is for the CDC to communicate that we are not reaching the zero COVID point.

Instead, he said the CDC should communicate to the public messages such as “This will be COVID in two years.”

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