The most remarkable moment of national frustration over the Centers for Disease Control and Prevention’s coronavirus guidelines began two days before the agency’s controversial new mask guidance was even announced.
“Dr. Walensky, I used to have the utmost respect for the guidance from the CDC,” Sen. Susan Collins (R-ME) told Dr. Rochelle Walensky, the agency’s director, last week, in detailing her belief that the CDC has been slow to keep up with the science. “I always considered the CDC to be the gold standard. I don’t anymore.”
That exchange, during a hearing of the Senate Health Committee over the CDC’s confusing—and at times contradictory—criteria on public mask-wearing, was followed only days later by a stunning about-face: Vaccinated people could ditch masks virtually anywhere, according to the CDC.
And Collins, for one, thinks the timing is more than a little suspicious.
“Doesn’t that tell you something, that it must have been underway at the time?” Collins told The Daily Beast on Tuesday. “Wouldn’t you think the CDC would respond by saying, ‘We agree that the science has caused us to take a second look, we’re in the process of that, and we expect that we will have something to say on this issue shortly’?”
Collins’s reaction typifies the recurrence of a common concern during the Trump administration: that public-health guidelines were being guided by something other than sound scientific consensus. This time, however, experts are less worried about presidential tangents involving bleach and sunshine than they are that the whiplash between excessive caution and reckless abandon could undermine public health messaging.
“I think it’s premature—I would even say reckless,” said Zenei Cortez, president of the California Nurses Association, whose state is one of the few not to swiftly implement the new recommendations. “We believe the CDC is putting our lives at risk.”
The CDC did not respond to a request for comment for this story.
Cortez, like several medical professionals The Daily Beast interviewed, noted that there is as yet no national policy for verifying who has received the two shots and nor has an appropriate amount of time passed before the nation moves on from mask use. And, like others, she worried it would contribute to public confusion.
“They think the pandemic is over,” Cortez said, of the people she had already seen shedding their masks. “It’s not over.”
Walensky’s tenure has also suffered from what Collins characterized as “confusing, conflicting” guidance emanating from both Walensky and the CDC. On Wednesday, appearing before a Senate Appropriations subcommittee, Walensky attested that vaccinated people do not spread the coronavirus.
“Data have emerged again that have demonstrated that even if you were to get infected post-vaccination, you can’t give it to anyone else,” she told Sen. Roy Blunt (R-MO).
Yet the CDC’s most recent online recommendations for the fully vaccinated, viewed even as she spoke, describe the risk of transmitting the disease only as “reduced” after inoculation. And that update links to a science brief from early April that states, “Vaccinated people could potentially still get COVID-19 and spread it to others.”
It wasn’t even the first time Walensky seemed to diverge from her own agency on that specific issue. In a March 29 appearance on The Rachel Maddow Show, Walensky declared “vaccinated people do not carry the virus, don’t get sick.” This triggered an outcry from scientists who insist that data about whether the inoculated can transmit COVID-19 remained inconclusive. The CDC eventually walked back this claim, saying that Walensky “spoke broadly,” and added, “It’s possible that some people who are fully vaccinated could get COVID-19. The evidence isn’t clear whether they can spread the virus to others.”
Professor Lawrence Gostin, director of the O’Neill Institute for National and Global Health Law at Georgetown University, was unnerved by the new guidance released last week. Data on the rates of indoor and outdoor infection have remained largely unchanged, while only a third of Americans are fully vaccinated—leaving the abrupt policy pivot scientifically inexplicable, he argued.
Worse, a public trend toward demasking could encourage the unvaccinated to strip away their face gear.
“Their guidance has been head-spinning and head-scratching,” Gostin told The Daily Beast. “It’s very unlikely this new guidance is going to encourage somebody who hasn’t gotten a vaccine to get a vaccine. It’s much more likely that it will encourage the unvaccinated to take off their masks. In fact, most people perceive what the CDC has done as mask guidance, not vaccine guidance.”
It was far from the first time a shift in the Biden-era CDC’s guideposts provoked confusion and complaints.
In February, despite Biden’s push to swiftly reopen schools and relieve struggling students and overwhelmed parents, the CDC maintained that educational institutions should keep six feet of social distancing in place—even though it meant leaving most instruction online. In response to questions from reporters, Walensky insisted that “we really do believe that you need full, six feet of physical distancing.”
Then, on March 19, the CDC announced that three feet of social distancing in schools was sufficient.
In announcing the easing of outdoor mask standards last month, Walensky asserted that “less than 10 percent of documented transmission in many studies has occurred outdoors.” The comment attracted criticism from The New York Times, which noted that outdoor infections are in fact far, far rarer than that statistic would indicate.
Meanwhile, the CDC’s summer camp guidance has remained unchanged since late April, mandating that campers and staff stay masked and socially distant “at all times,” even in the open air. Experts New York magazine interviewed characterized these rules as “cruel” and “irrational,” and the standards earned Walensky further ire from Collins during her Senate testimony.
Yet Walensky fiercely defended the policy, noting she’d held her own son back from attending his beloved summer retreat last year.
Walensky gets personal responding to criticism from Sen. Collins, who said CDC has lost its credibility because of overly cautious guidance on returning to school and camp. pic.twitter.com/KnfjJGO6mE
— Emily Kopp (@emilyakopp) May 11, 2021
“I want our kids back in camp,” Walensky insisted days before telling vaccinated people, who do not include young children, they could go without masks. “The camp guidance is intended to get our kids to camp and allow them to stay there.”
For Collins, this followed the same disconcerting misalignment between the CDC’s policy positions and the latest data. The threat, she warned, is that it will breed further public skepticism of the agency’s instructions.
“It concerns me because I want the science to be driving this,” added Collins. “And the reason that’s so important is many of the CDC recommendations are ones that we should be following. If people lose confidence in the CDC’s guidelines, because they’re not updated to reflect the latest science, then they’re going to disregard all of them.”
Gostin called for “cutting [Walensky] some slack,” and argued she was likely subject to intense political pressure, as numerous interest groups push for a general reopening. Most of the failures, he asserted, owe to a lack of educational and communications infrastructure at the CDC.
However, Walensky has hardly made her situation easier with her public statements.
On April 23, Walensky asserted at a White House briefing that the “CDC recommends that pregnant people receive the COVID-19 vaccine," citing a study from the New England Journal of Medicine. The CDC’s actual advice, which it reiterated the following day, was in fact more cautious: “pregnant people are eligible and can receive a COVID-19 vaccine.”
To this day, the CDC’s guidance for the pregnant and breastfeeding remains that “based on how these vaccines work in the body, experts believe they are unlikely to pose a risk for people who are pregnant. However, there are currently limited data on the safety of COVID-19 vaccines in pregnant people.”’
Libertarian Reason magazine even argued that Walensky misrepresented a study she cited while defending her use of the “less than 10 percent” figure for outdoor transmission.
Dr. Eric Feigl-Ding, a Twitter-famous epidemiologist and veteran of the Harvard T.H. Chan School of Public Health, recalled his initial reaction to Walensky’s remarks on the Maddow interview.
"Immediately I knew that had to be walked back,” he said. “It just wasn’t true.”
Feigl-Ding acknowledged that some real-world studies have shown the mRNA-based Moderna and Pfizer vaccines are largely effective at preventing people from passing COVID-19 to others. But further trials are needed, he argued, and evidence is still lacking on the efficacy of the Johnson & Johnson vaccine against asymptomatic transmission.
Emerging variants are increasingly contagious, even as vaccines massively reduce the risk of death and hospitalization, and “breakthrough” cases are rare but remain a danger. Worse, millions of people—in particular children under 12—are as yet unvaccinated. And, like Gostin and Cortez, Feigl-Ding noted there is no way of knowing if the unmasked person in the supermarket is fully inoculated or is simply a disbeliever.
“If I let down my guard, one of these anti-masker/anti-vaxxer people could transmit it to me and I could carry it asymptomatically and transmit it to an immunocompromised family member,” he warned.
Like Gostin, Feigl-Ding said he was inclined to be charitable to Walensky, given the difficulty and complexity of her job. But he fretted that the CDC was setting policy unsupported by science. He called the three-foot standard in schools “a joke,” which he argued is based on flawed early data.
In truth, Feigl-Ding said, the safety of going out vaccinated and unmasked varies based on a person’s situation. Most outdoor activity is extremely safe—but congested events, such as the open-air religious ceremonies in COVID-stricken India, remain dangerous. People who live alone or in a small household and have limited daily interactions are unlikely to have or cause any ill effect once their doses have taken effect. Frontline workers, who may live in multigenerational homes, run a far greater risk.
"The answer is, it depends. But people don’t want to hear, ‘It depends.’ They want ‘What’s the bottom line, give it to me in 15 seconds,’” he said. "The CDC is having trouble weaving through all that.”
Dr. Scott C. Ratzan, an international public health expert with the City University of New York, agreed. He defended Walensky’s overall performance, but argued the CDC needed to aggressively improve its public-facing online presence, including with rapidly updated transcripts and frequently-asked-questions on its website to resolve areas of public confusion. Most importantly, he echoed Gostin’s call for the agency to hire more social scientists and outreach professionals.
“There is a field of health communication, and there are people who have been writing, researching, engaging,” he said. “I believe we all want to help and get out of this better: nobody wants to be the critic or the Monday morning quarterback. So the more we can figure out the ways to engage in this 24-hour communication world, the more we can move in the right direction with data, evidence, and the way we communicate it to the public.”
Within the White House—where news of the lifted mask mandate for vaccinated workers prompted a complex-wide de-masking last Thursday afternoon—the swift about-face was seen less as a sign of communications breakdown than as a strict observance of the administration’s arms-length rule on proposals from the COVID-19 task force. Given the previous administration’s frequent mixing of politics and pandemic response, one person familiar told The Daily Beast, the White House is not keen on being seen as agitating in favor of any particular guideline changes.
“The administration has been very clear about leaving those decisions up to the experts,” the person said.
The White House defended Walensky and the new recommendations at a press conference Monday, maintaining both had been straightforward and easily comprehensible.
“What this guidance provides is information to the public about what they can do to be safe,” press secretary Jen Psaki told reporters. “So the guidance is actually pretty clear, but it gives people the information and the power to be able to protect themselves. If you get vaccinated, you go through your two doses, your two weeks past your doses, you no longer need to wear a mask.”
Nonetheless, by that afternoon, Politico reported that—in reaction to criticism and the impending departure of two top officials—Walensky planned to streamline the agency’s COVID-19 chain of command and improve internal communications. And Dr. Anthony Fauci, chief medical adviser to the president, admitted to Axios on Tuesday that many people were “misinterpreting” the latest guidance.
He added, “It’s not their fault.”