The COVID Digest, 26Feb2022

CDC gives up on disease control and prevention

The week’s news has been intense on multiple fronts and COVID-19 isn’t even the biggest problem we’re dealing with this week. But that state of relevance in a much bigger news cycle combined with a State of the Union scheduled for Tuesday is precisely why Friday afternoon seemed like the right time for the United States Centers Disease Control and Prevention to give up on controlling or preventing a disease that has killed 900,000+ Americans. It was at that moment that any concern for protecting the immunocompromised, children under the age of 5, people with underlying medical conditions fell away. It was a moment when people who care deeply about narrowing disparities in health by race, rural versus urban, socioeconomic class, etc, were abandoned.

Last week, I talked about how the drumbeat to remove mask guidance was increasing because the masks remained as the most visible reminder that we are still in a pandemic due to continued policy failures and lack of imagination from all levels of our government. Further, I hypothesized that the push to remove the mask guidance was to distract us from accountability. If everyone thinks it’s time to move on, maybe they won’t kick over too many rocks into what the powers that be have done wrong. So I was surprised to be proven correct in such spectacular fashion as when the CDC Director, Rochelle Walensky said the following quote on a podcast this week. You can skip to 33:20 in the episode to hear this gem of a quote that I hope goes into a history book somewhere.

“I know people are tired. The scarlet letter of this pandemic is the mask. It may be painless, it may be easy, but it’s inconvenient, it’s annoying and it reminds us that we’re in the middle of a pandemic.” - CDC Director, Dr. Rochelle Walensky

The CDC Director who has repeatedly mismanaged public health communication in really key moments did it again, this time saying the quiet (political) part out loud. And while I would call for her resignation (again…), the reality is that the President would just choose another “yes man” megadonor to take her place. Plenty of folks are auditioning for the role. In fact, they’re the ones publishing op-eds responding to the change in guidance within minutes of the guidance going public with similarly rapid thanks from the White House Deputy Director of Strategic Communications and Engagement. It’s pretty impressive to have an op-ed on new guidance not only ready to go but also edited and formatted for publication within minutes. And for the White House to be ready on Twitter for that exact moment that it breaks.

The quote from Dr. Walensky makes plain that CDC has succumbed completely to political pressure. There is no interest whatsoever in preventing disease anymore, they’d really rather just move on. They are effectively a propaganda machine for the Biden Administration. Don’t like all these masks and 97% of US counties in the high transmission category? MOVE THE GOAL POSTS! Poof! Now only 30.7% are in the high transmission category and “most counties” no longer need to wear masks. Never mind that the new threshold for low levels of disease is 20x higher than it was previously. Pop the bottles of champagne! Because we have just ended the pandemic by lying with statistics. Dr. Patel shows this succinctly in the twitter thread below.

Instead, the CDC is recommending using hospitalizations as the metric for assessing how much disease is out there. And yeah, there has been some debate about which metric is best, but the expectation that there is a “perfect” metric in a sea of imperfect data is naïve at best. The challenge that comes with watering down the case data is that by the time you notice hospitalizations starting to rise, the momentum has been building for weeks. That momentum doesn’t dissipate quickly. This change also encourages states to stop reporting case numbers and test data (intentionally or not). So the combined effect is that hospitals will have less notice of the next surge. They won’t have staffing ready to go, elective surgeries canceled, etc. It is a gamble by the White House and the CDC that future waves of illness won’t result in quite so many hospitalizations. The problem is that the chips they’re gambling with are our lives.

The other problem with the CDC Director’s breathtakingly reckless choice of words is that a Scarlet Letter is something to be ashamed of. In the case of the classic novel, it was an “A” for adultery. She has clumsily made a mask into something society should point at and scorn. Even though masks are an effective prevention tool against a deadly disease, and literally the only protection that the immunocompromised and children under five have right now, the people who wear them will now be immediately recognizable, ridiculed, and further marginalized.

Declaring the pandemic over as CDC has will also make mask and test manufacturers less likely to make those products. It will make people less inclined to get vaccinated or boosted. The CDC leadership has given up all pretenses of caring about this preventable disease. The agency is actively sabotaging any effort to get things under control.

What we’re really talking about when we talk about “moving on” is that we have reached an “acceptable” level of death for American politicians, even as we have the highest cumulative death rate and highest death rate during Omicron compared to other large, high-income countries (see graphs from the New York Times below). We aren’t winning. Look at Japan and say with a straight face that there was nothing more we could do. The politicians and enablers who caused this are expecting you to look away, to forget what they’ve done.

And so as I sit with the world events playing out now with the war in Ukraine, I’m having a hard time holding two narratives in my head at the same time. In the context of Ukraine, we hear that one reason America can’t get involved (among other reasons) is because Americans don’t have the stomach to see dead soldiers returning from war. That price is too high to defend democracy. Trust me, as a military spouse I can verify that Americans don’t know the sacrifices that are made on their behalf. And I don’t want my husband or our friends and neighbors going to war either. But simultaneously we are told it’s time to move on and forget about the pandemic even though 1000 Americans are still dying every day. The pandemic has taught us that America actually has a pretty high tolerance for widespread death and destruction. We don’t value human life at all. We can choose to not go to war for a myriad of reasons. But concern about loss of life should not be one of them. Because if it is the justification, then I suspect 900,000 American families would like to raise their hand and ask why we didn’t care about their lives.

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This newsletter has been a bit of a rant so far. I’m sorry for that. It is hard not to be angry and cynical over all of this right now. But a lot of us did not go into public health to impress a politician. We did it to take care of communities. And so we need to figure out what we can do to continue to care for those communities, even as the infrastructure built to support that effort is failing. So here we go…