The COVID Digest, 19May2022

CDC is forced to admit things are kind of bad

America is currently on fire with COVID-19. The map below comes from the CDC’s Community Transmission Levels map. It uses a combination of recent case rates and test positivity to predict the likelihood of catching COVID-19 in each county. This is the map we used before the “fields of green” community levels map that CDC announced just after the peak of the Omicron wave.

The Community Levels map was made to estimate the difficulty one would find in accessing normal standards of medical care due to the impact of COVID-19 on hospital systems. As recently as May 12, the CDC was celebrating that 90% of the population in the US lived in a county with a low or medium level (medium is actually pretty serious).

CDC @CDCgov

As of May 12, 2022, more than 90% of the U.S. population lives in a location with a low or medium #COVID19 Community Level. Find your COVID-19 Community Level: bit.ly/36RiqiR.

Meanwhile on that same day, the community transmission level map is shown below. You can compare the map below to the current one at the top. Things have gotten worse in a week.

The Community Levels map has been pretty widely ridiculed by public health professionals. This week, public pressure forced CDC to change the Community Levels map and their messaging. After all, when you show the country in a carpet of green, it’s hard to convey the importance of wearing a mask. It’s also difficult to convince Congress that you need more money for vaccines, therapies and other mitigation efforts.

Rochelle Walensky, MD, MPH @CDCDirector

32% of the U.S. population is in a location with a medium or high COVID-19 Community Level. Communities should encourage the use of prevention strategies, including masking and increasing access to testing and treatment, based on community levels. bit.ly/3MpA6Sr

So now the CDC Director is tweeting the opposite message of what the agency was saying a week ago. Turns out that more than 30% of the US population is in a county with a medium or high risk of difficulty accessing normal standards of medical care. Rather than bright green, the low level counties are shown in a pale blue-green to help the yellow and orange counties stand out more. What all of this does, however, is chip away at the overly-optimistic position that “everything is fine” and “COVID is endemic.” Endemic disease means the absence of a surge and low levels of disease. The CDC Director encouraged masking, but stopped short of any meaningful guidance to limit disease transmission. The current US COVID-19 strategy is to feed Americans into the disease chipper. There are no brakes on COVID-19 at this time. Transmission is happening, unimpeded.

Part of this isn’t really up to the CDC Director. There have been substantial efforts in states across the country to limit public health law. But I think we’d all be lying if we didn’t acknowledge that decisions at CDC over the past 2+ years (by appointees of both political parties) have badly damaged public trust. The words of the CDC Director simply do not carry the same weight that they did before the pandemic.

Unfortunately, the consequences of spending hard-earned institutional credibility for political gain are especially worrisome this week. There have been cases of a rare disease called monkeypox discovered in multiple countries. The news on this is moving fast. The most recent, credible news source that I could find at the time of this writing indicates cases found in France, Italy, Sweden, UK, US, Canada, Spain and Portugal.

I have to stress the importance of using credible sources as we learn about this emerging threat. The people you’ve been following for COVID-19 most likely are NOT knowledgable in this area. Not all viruses are the same, after all. And if your favorite epidemiologist’s subspecialty is nutrition, it might not be the right time to gather their expertise on an orthopoxvirus or coronaviruses, for that matter. In fact, I am not going to write about monkeypox in this newsletter except to point you to some better experts in this area. My list is short for now, but I’m happy to add to it as I discover more. There is a lot we don’t know right now.

• World Health Organization

• Dr. BK Titanji

• Centers for Disease Control and Prevention

My limited view on the monkeypox situation from a larger perspective for now is that the timing is especially awful. But that’s the nature of emerging infectious disease - there is NEVER a convenient time or place for it to happen. That’s why it is important to fully fund efforts for global health and emerging pathogens. But we are experiencing this new threat at a time of profound public distrust of CDC at a time that we really need their leadership. The question is whether anyone will listen anymore?

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My Ph.D. is in Medical Microbiology and Immunology and I am Chair of the Division of Natural Sciences and Mathematics at the University of Saint Mary. I've worked at places like Creighton University, the Centers for Disease Control & Prevention and Mercer University School of Medicine. All thoughts are my professional opinion, do not represent the views or opinions of my employer and should not be considered medical advice.