The Demise of the CDC

This past year, the Centers for Disease Control burst into prominence in American life. It was a defining moment for this institution, one in which its reputation for excellence could have shown brightly. It did not. In our view the exact opposite occurred. The CDC destroyed its credibility in multiple ways:

• It overestimated the severity of COVID-19. Some of the models used by the CDC predicted over 2 million deaths in the US.
• It tried to hide that miscalculation by exaggerating death counts.
• It extended masking and social distancing guidelines far beyond any logical point of effectiveness.
• It illegally issued “edicts” rooted in politics rather than science – the best example being a nationwide moratorium forcing landlords not to evict tenants who can’t pay rent (overturned earlier this month by a Federal Judge).

State Governors and Legislatures are the primary entities with both legal and enforcement power to impose health related restrictions on the population. The CDC has limited legal authorities, and little power to enforce the authorities they do have. Nearly all of the CDC’s power to influence people’s behavior in a health emergency comes from the trust, respect, and confidence the public has in their expertise.

As with any institution whose credibility relies solely on the competence and accuracy of the advice it gives, any doubts arising in that competence can have a hugely damaging effect. Organizational self-awareness is critical if this begins to happen. Adapting quickly and smartly if skepticism does arise is even more critical. The leadership of the CDC failed dismally on both these counts in the past twelve months. It didn’t matter who was President at the time. The CDC’s public messaging on COVID-19 was arbitrary, inaccurate and laced with arrogance.

When COVID-19 first appeared in the US more than a year ago, emergency measures were justified because there were many unknowns about the severity/deadliness of the virus. However, by the spring of last year, knowledge of the general character of the virus took shape. We knew it was much closer to an influenza type illness than, say, an Ebola type illness. We knew it affected the older population more severely than everyone else. We also knew it was statistically absent in children.  Those three real world observations alone presented the opportunity for an intelligent and sensible mitigation strategy – concentrate protective measures on the known vulnerable population while at the same time minimizing the consequences of those measures, as well as panic, to the less vulnerable in the population.

As we all know now, the “guidelines” put forth by the CDC were not tailored at all in the above fashion. They were instead uniform and inflexible across the entire population. Everyone, regardless of their vulnerability to the virus, was subject to the same restrictions. This made little sense at the time and was the point where our first real doubts about the CDC’s fitness for this crisis crept in. The result of their policy was disastrous to the lives of people who were never at serious risk. For untold millions, that included loss of employment, inability to access ongoing preventative medical care, depression, and even suicide. Worse, it was accompanied by the devastation of thousands of small businesses and the livelihoods of their employees and owners. This tremendous sacrifice was calamitous overkill compared to the actual harm inflicted by the virus. Thankfully, several state governors saw the illogic of the CDC’s policies and began distancing their states from strict adherence to CDC guidelines. By the spring of this year, many states were no longer enforcing any CDC guidelines at all regarding COVID-19 although some businesses within those states still chose to do so on their own.

Rather than revising guidelines and policy to adapt to the increasingly obvious reality that COVID-19 was not as deadly as initially thought, the CDC doubled down by intentionally exaggerating the death rate from the virus. In March of 2020, the CDC began counting COVID-19 deaths differently from how it had counted disease deaths for the previous 17 years.¹ Speaking at the White House in April 2020, Dr. Birx said – “if someone dies with COVID-19, we are counting that as a COVID-19 death.” The key wording here is “dies with”, not “dies of”. That meant that even if someone died of a much more obvious cause, say a car accident or heart attack, if they happened to have COVID-19 at the time, their death was recorded as a COVID-19 death. This is in stark contrast to how deaths from influenza are recorded every year. With influenza, physicians use their best judgement in determining the proximate cause of death, either the virus itself or another pre-existing injury/illness that was more lethal than the virus. That physician judgement was removed for COVID-19 deaths. The only purpose for the CDC fudging the death numbers was to try and save face as it became clear their initial assessment of the virulence of the virus was overestimated and would not match their models. The CDC even states on their website that only 6% of all COVID-19 deaths in the US are the result of COVID-19 alone with no other contributing injury or illness.

Things went from bad to worse for the CDC when they shed all pretense of objective science with their nonsensical position on hydroxychloroquine as a COVID-19 therapeutic. Both in the US and around the world, hydroxychloroquine, if administered early enough, has been shown in many cases to shorten the course and lessen the severity of a COVID-19 illness. The CDC needlessly entered the political fray with an atypical and foolish advisory against the use of this drug. Before being vilified by the CDC and the media, hydroxychloroquine was a well-known therapeutic that is FDA approved and has been safely used worldwide for over 65 years. It was no coincidence that their decision to do this came simultaneously with President Trump’s advocacy for hydroxychloroquine.

Up until just recently, the CDC has persisted with its guidance for everyone to wear masks and maintain social distance. It was as if the vaccines (more than 90% effective) and proven therapeutics didn’t even exist or were incapable of mitigating masking and distancing measures. Only now, with the inescapable reality of COVID-19 infections and deaths being so low for months, and a growing number of state governors signing legislation that completely contravenes CDC guidelines, has the CDC taken the brave leap forward in saying vaccinated people don’t need to wear masks or social distance. The expression “after the ship has sailed” immediately comes to mind.

When any outbreak occurs, a lot of caution is to be initially expected from the CDC given its primary function. But the CDC’s position of extreme caution on COVID-19 has not been scientifically justified for quite some time, especially given the harm that position continues to cause the rest of society. In fact, their guidelines on COVID-19 have been so out-of-step for so long, they’ve graduated from defying science to defying common sense. For an organization whose purpose is to be a trusted expert authority, this is rock bottom.

The CDC should never have allowed itself to become a political tool of the Administrations of either President Trump or Biden, and especially not of the media. It should have expertly and quietly advised federal and state government officials of its concerns. The job of those elected leaders is then to weigh the CDC’s expert information together with a host of other factors (public safety, local economy, children’s education, hospital readiness, ability to work remotely, etc.) in determining the best course of action overall for dealing with the pandemic. As we have seen, it is a huge mistake to overweight one single variable in such a multi-factored equation (CDC guidelines in this case).

We are sad to see such a revered institution lose its stature so fast. We put the blame squarely on extremely poor leadership. We believe that the more than ten thousand public health professionals working at the CDC do good and important work and don’t deserve the stigma of incompetence brought onto them by their leadership. It will take a long time for the CDC to regain our trust. If, God forbid, another much more virulent virus hits the US in the future, there is now the real danger of complacency. A large portion of the US population will be convinced the CDC is crying “wolf” again.

¹A study from the bulletin of Science, Public Health Policy, and the Law, on March 24, 2020