June 16, 2021 ~ New York Times ~ Jeneen Interlandi

Can the C.D.C. Be Fixed?

Covid-19 has shown the glaring weaknesses of the world’s premier public health agency — and just how much work it would take to reform it.

In November, an independent team of academics and public-health experts who called themselves the Covid Rapid Response Working Group gathered on Zoom to puzzle over what had by then become the pandemic’s most vexing challenge: how to make all schools safe for full-time, in-person learning as quickly as possible. Schools had not proved to be a hotbed of coronavirus transmission, but beyond that the research was complicated, and communities were divided about how to balance the risks. Some people wanted a full reopening, immediately, no exceptions. Others were terrified to return at all.

So far, there was no national plan for how to move forward. The Centers for Disease Control and Prevention was advising everyone to wear masks and remain six feet apart at all times. But that guidance was a significant impediment to any full-bore reopening, because most schools could not maintain that kind of distance and still accommodate all their students and teachers. It also left many questions unanswered: How did masks and distancing and other strategies like opening windows fit together? Which were essential? Could some measures be skipped if others were followed faithfully?

The C.D.C. seemed incapable of answering these questions. From the pandemic’s earliest days, the agency had been subject to extreme politicization and troubled by what looked, at least from the outside, like pathological clumsiness. Scientists there had been far too slow to detect the virus, to develop an accurate diagnostic test for it or to grasp how fast it was mutating. Their advisories on mask-wearing, quarantine and ventilation had been confusing, inconsistent and occasionally dead wrong. And during the Trump administration, agency leaders stood by while politicians and political appointees repeatedly undermined the agency’s staff. Scientific reports were blocked or altered. Quarantine powers were used to achieve political goals. Dangerous strategies for controlling the virus were not only promoted but actively employed. And state and local leaders were left to fend for themselves — to decide which of the agency’s recommendations to follow or modify or ignore.

The Covid Rapid Response Working Group, at the Edmond J. Safra Center for Ethics at Harvard, was one of several independent organizations that stepped in to help fill the gap. In the last year, these groups, run mostly out of academic centers and private foundations, have transformed reams of raw data — on transmission rates and hospitalization rates and death tolls — into actionable intelligence. They have created county-by-county risk-assessment tools, devised national testing strategies and mapped out national contact-tracing programs. In many if not most cases, they have moved faster than the C.D.C., painting a more accurate picture of the pandemic as it unfolded and offering more feasible solutions to the challenges that state and community leaders were facing.

When it came to the question of school reopenings, the Covid Rapid Response Working Group found itself going in circles. It was possible to control the spread of infections indoors; hospitals did it all the time. But when it came to schools, where the risk was much lower, everyone seemed to be at a loss. Why was that? What, exactly, made hospitals so different? “It makes no sense,” Thomas Tsai, a surgeon in the group, said. “Hospitals are not special. We don’t use magic. We just use basic infection control.” He explained what that meant: Teams of specialists create detailed protocols based on what the risks are and what the evidence says about how to avoid those risks. They update and adjust their practices as information evolves, and they conduct routine trainings with all hospital staff members (not just doctors or administrators) so that everyone knows exactly what to do. It was all very standard, he said. It did not even require an advanced degree, just a basic understanding of disease transmission, an awareness of a given hospital’s particular situation and a few people who knew how to connect the two and could train others to do the same. School systems did not have any of those tools, Danielle Allen, head of the Safra Center, pointed out. Nor did they have a clear path to making those connections. But maybe the group could chart that path for them? What would that take?

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