On Jan. 26, our country’s top public health expert on viral respiratory diseases, Dr. Nancy Messonnier of the Centers for Disease Control and Prevention, said in discussing the coronavirus then ravaging China, “We need to be preparing as if this is a pandemic.” A month later, she warned, “The disruption to everyday life might be severe.” Imagine how different the world would be today if the administration had heeded these words.
Like the rest of the country, I look at the daily toll of Covid-19 deaths with horror. The White House missed our first chance to limit the impact of Covid-19 in February by not expanding production of protective equipment, ventilators and testing. It also failed to communicate effectively, which would likely have accustomed and motivated Americans to practice physical distancing.
But it’s not too late to do better. A coherent national response decides on policy and then pushes all of government to follow that policy. This is a public health emergency, and public health officials can show us the way forward.
Our top experts are still where they have been for decades — at the C.D.C. If they guide our strategy, we can begin to get ahead of the coronavirus in this war.
If you open a medical textbook to any page, you can be sure that some of the world’s top experts on the condition discussed on it work at the C.D.C. The C.D.C. consists of a dozen centers plus the National Institute of Occupational Safety and Health, and has thousands of staff members stationed around the world.
It channels most of its funds to state and city health departments, and is the key partner for every state and for many countries. Its guidance on everything from newborn testing to vaccine schedules to traumatic brain injury is, with reason, the most trusted advice for health professionals and the public. Its more than 200 specialized laboratories set the standard for the world.
The C.D.C. was created to protect the country from infectious disease threats, whether naturally occurring or man-made. It has led the federal response to major health threats since it was founded 75 years ago — until now. Just when America most needs its guidance on the pandemic, the country’s top public health experts do not appear to be guiding, and are certainly not communicating, our response.
Because of this, there has been a failure to establish and carry out a science-based plan to reopen the country safely. That plan is best informed by C.D.C.’s public health expertise understanding and responding to the virus.
The pathogen, not politics, will set the terms of this contest, and it leaves us with three options: Continue sheltering at home until there is a vaccine, which could take a year or more; simply open the floodgates of activity and then face a repeat explosion of cases; or prepare vigorously, expanding our public health capacity so we can gradually lift restrictions and safely loosen the tap of activity, instead.
I believe the last option is our best option. Here’s what that will require from us:
Do the detective work
The C.D.C. leads the world in the classic disease detective work that is needed to understand and contain Covid-19.
Yes, the agency’s initial test kits failed. But for nearly two months C.D.C. has provided working tests to public health laboratories throughout the country; this doesn’t meet the need for testing in local communities, doctors’ offices or hospitals. The White House, many parts of the federal government, and commercial labs and hospitals need to make testing much more widely available. In a structured response, one knowledgeable and trusted spokesperson would regularly provide systematic information not only on the number of tests but the actual turnaround time from test to results. It’s now unacceptably slow in many areas.
In hospitals and communities, we are weeks if not months away from having sufficient test capacity. Testing for antibodies may help, particularly if people who recover from Covid-19 are immune from repeat infection and can safely work and travel. The C.D.C.’s National Center for Immunization and Respiratory Diseases, which Dr. Messonnier leads, has the laboratories, epidemiologists and experience to help determine the accuracy, role and implications of antibody testing.
Health care workers are the front line of our response, and they’re being sickened in droves. C.D.C.’s division of health care quality promotion has the world’s leading experts in health care safety. They can figure out how disease is spreading to these workers and collaborate with the Centers for Medicare and Medicaid Services and hospitals on how to stop it. They can also guide efforts to secure safe and attractive spaces to isolate infected people — and others they may have infected — if they don’t require hospitalization and cannot be safely cared for at home.
The C.D.C. should also guide what must become a giant public health effort to trace and track contacts of Covid-19 patients. In Wuhan, China, there were 1,800 contact tracing teams of five people, each led by an epidemiologist. The U.S. equivalent would number 300,000, working in the communities they live in and led by public health specialists. Recruits could include Peace Corps volunteers who were brought home when the pandemic spread, furloughed public employees, phone bank staff (since so much tracing work is done by phone), workers from health organizations, social service and nonprofit agencies, and recent graduates. Community and religious organizations, Meals-on-Wheels programs, businesses and others are well placed to provide services for cases and contacts who must remain in isolation or quarantine.
If this sounds like assembling an army, it is. Dr. Robert Redfield, the C.D.C.’s director, notes that the agency has begun this work, an encouraging sign. But the agency will need to accelerate its effort to establish the protocols, structure and supervision of this army and begin training the recruits now.
Guide with data
Disease surveillance is wartime intelligence, and C.D.C. conducts surveillance better than any other agency in the world. Its relevant centers, working with its Center for Surveillance, Epidemiology and Laboratory Services, began releasing more of this information recently, including emergency department visits, test results, hospitalizations and deaths. The C.D.C. needs to continuously improve the quality, geographic precision and timeliness of this information, including by publicly sharing data on emergency room visits — an early indicator of changing disease rates.
Working with hospitals, universities and state and local health departments, the C.D.C. must continue to investigate how to stop the virus and answer crucial unresolved questions, such as whether children commonly transmit infection, information that will guide decisions on when to allow schools to reopen.
The C.D.C. should also track broader physical and mental health effects of the pandemic: Are patients with chronic conditions continuing their medications? Is reduced access to primary care interfering with vaccination, prenatal care and other vital treatment? Are illness and death increasing among people affected by but not infected with the virus, for example patients who are no longer receiving regular care for chronic illness? Working with other federal partners, the C.D.C. can then act to reduce the outbreak’s side effects.
Instead of messages mixing hope, hype and hysteria, we need to hear simple, straightforward science. The C.D.C. website remains the best place to go for information about the pandemic, and following C.D.C. guidance is the best way to protect ourselves, our families and our communities.
Dr. Messonnier, along with Dr. Anne Schuchat, the principal deputy director of C.D.C. and previous director of the respiratory disease center, are our country’s top two experts on controlling respiratory viruses. I will feel safer when we are hearing from them regularly and when it is clear that they are guiding the national response.
This essential communication from the C.D.C. should be synchronized with a structured national incident management system that instills discipline and accountability at all levels — the best practice for epidemic management, and a practice that so far seems to remain lacking in the American response.
Prepare for the future
A new world is here. Hand sanitizers at building entrances, touch-free doors and elevators, health care that results in fewer infections of patients and staff, and similar measures are here to stay. Travel bans and quarantine of travelers will most likely continue until there is a vaccine. Vulnerable people may need to shelter in place even after others have re-entered our new world.
We must prepare the world so nothing like this ever happens again. That means hugely expanding funding for the C.D.C.’s disease detection and response activities at home and abroad. These programs are our eyes and ears for new pathogens. We must support C.D.C.’s Center for Global Health, along with other parts of the federal government and international partners, to close live animal markets in Asia and Africa — such as the one that likely produced this pandemic — and to fill thousands of life-threatening gaps in disease preparedness worldwide. We must commit to global solidarity and accountability fighting microbes.
The C.D.C. has the knowledge and expertise to limit the spread of the coronavirus, but it needs the authority and voice that’s been withheld from it the past three months.
It is not too late to limit the devastation of our nation’s health and economy. But the administration must support and follow the guidance of the C.D.C. — and it must do so now.
Tom Frieden, director of the Centers for Disease Control and Prevention during the Obama administration, when he oversaw responses to the H1N1 influenza, Ebola and Zika epidemics, is president and chief executive of Resolve to Save Lives, a global nonprofit initiative that is part of the global public health organization Vital Strategies.
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