In another piece of guidance, the CDC tells people who have recovered from Covid-19 that they can leave their homes after five days — and while they are abroad for the next five days, they should avoid being around more than 80% of the US public.
Dr. William Schaffner, a CNN consultant for four decades, said it was “unlikely, unreasonable, and unrealistic” to think that Americans would follow any of the agency’s suggestions.
“Make recommendations about public health — it’s not a platonic ideal,” Schaffner added. “They have to work in the real world.”
Such out-of-touch advice was a hallmark of many of the CDC’s recommendations long before the pandemic began, said current and former health officials, and physicians who worked with the CDC on health guidance, and the agency needs to do work. better.
“As we say in Tennessee, this dog is not going to hunt,” said Schaffner, an infectious disease expert at Vanderbilt University Medical Center.
Over the past few weeks, the agency has faced criticism for issuing guidelines that were confusing or seemed counter-intuitive. In this case the criticism is different. What’s worrying is that CDC staff, while hardworking, smart and well-meaning, don’t always think about whether Americans will — or even can — follow their advice.
CNN asked CDC Director Dr. Rochelle Walinsky about two pieces of guidance. In a statement, Walinsky said the agency has “prioritized academics over athletics due to the increased risks involved in some extracurricular sports. When followed, our school guidelines have been incredibly effective. In the fall, 99 percent of schools were able to stay open during a delta wave.” severe from COVID.”
Part of the problem, Schaffner and others say, is that CDC scientists sometimes get stuck in a bubble.
“You have geeks — literally science — writing this stuff,” said Dr. Otis Brawley, who worked with the CDC on cancer guidance while he was the chief medical officer of the American Cancer Society from 2007 to 2018.
“I really feel for the people at the CDC,” he said. “They are damned if they do, and damned if they don’t.”
CDC School Guidance
The CDC gives football and wrestling as examples of high-risk sports and says that “high-risk extracurricular activities are those in which increased exhalation occurs, such as activities that involve singing, screaming, banding, or exercising, especially when performed indoors.”
While schools have made great efforts to curb the spread of Covid-19, Paul Imhoff, president of the Association of School Principals, told CNN, he does not know of any schools that have canceled activities such as football, band or choir. Such activities are “important to the mental health of students,” he said.
“As schools make decisions about choral, band, and wrestling, it’s about making sure our kids are healthy in every way,” said Imhoff, a school principal in Ohio. “I think everyone is doing their best to take care of the whole child.”
In her statement to CNN, Walinsky said the CDC “developed our school guidelines knowing that principals, teachers, and parents were looking to us at CDC to get their children back into the enriching environment of the classroom and it was our priority to get our children back to school safely,” adding “Vaccines are available for school-age children, which adds another layer of protection and enhances school guidance.”
However, Schaffner questioned why the CDC advised schools to eliminate extracurricular curricula that include yelling when children yell on a regular basis.
“I could hold your hand and say, ‘Let’s walk through three grammar schools. “What we see is kids screaming in the hallways. It’s what kids do,” said Schaffner, a communications representative on the Centers for Disease Control and Prevention’s Immunization Practices Advisory Committee.
CDC Isolation Guidelines
The Computational Epidemiology Laboratory at Boston Children’s Hospital estimates that more than 80% of Americans have at least one condition on the Centers for Disease Control and Prevention’s list, according to an analysis by the group for CNN.
Schaffner questioned the practicality of avoiding 80% of the people around you.
“How do you know if people have heart disease or diabetes? How are you supposed to find out? Can you identify everyone who is pregnant, has sickle cell anemia, or former smokers?” He said, considering some of the conditions on the Centers for Disease Control and Prevention’s list for those to avoid.
When asked about advice at the briefing, Walinsky said the agency is asking people to “avoid members of your family or others who may be immunocompromised, and to avoid visiting grandma or a nursing home.”
Round red tomatoes
When considering the Centers for Disease Control and Prevention’s school and isolation guidelines, Glenn Novak considers the foodborne disease outbreak that occurred in 2008, when he was the CDC’s chief of media relations.
It wasn’t clear exactly what made people sick, but one potential culprit was tomatoes, so Nowak says agency scientists wanted to tell Americans to stop eating tomatoes.
Nowak says he’s told scientists this is pretty broad, considering tomatoes are a very popular food. He says he’s asked his colleagues to be more specific — is there a particular type or source of tomato that Americans should avoid?
Nowak said that when he worked at the CDC from 1999 to 2012, scientists repeatedly developed guidelines without thinking about the next step: Is it possible to follow the advice we wrote? If so, what exactly does someone need?
“It’s always been a challenge,” said Novak, co-director of the University of Georgia’s Center for Health and Risk Communications. “It came through a lot of circumstances.”
“Scientists and experts find it difficult to see the world through the lens of ordinary people,” he added.
One way to change this lens is to seek input from outside groups, but this has been more difficult during the pandemic, when the agency has had to move more quickly. Spokespeople for the Association of Supervisors and the National Association of High School Administrators said the CDC had not reached out to them to consult with them about guidance related to school sports and extracurricular activities.
A federal health official familiar with how the Centers for Disease Control and Prevention (CDC) is developing its guidelines said the agency should also make better use of communications specialists.
“There is simply no seat at the communications table when it comes to actually developing guidance,” the official said, adding that CDC communications specialists “will take into account whether the guidance being developed is really practical.”
The official asked to speak anonymously because they were not authorized to speak on this issue.
Brawley noted that the pandemic has posed unusual challenges when issuing guidance.
Under normal circumstances, he said, experts would first collect all relevant studies on a particular topic and then discuss – sometimes for months – the best advice for the public, and also consult third parties for their input.
“When I was at the American Cancer Society, when we sat down to write guidelines about lung cancer, it took a group of about 14 people a year to come up with the formulation. Then we tested the formulation on focus groups, working with doctors and nurses and lay people trying to see if we were communicating more effectively. active”. “The CDC doesn’t have the time to do that.”
There is an alternative to the way the CDC issued its guidance, said Brawley, now a professor at Johns Hopkins University. For example, if schools are not willing to cancel soccer or choir, the CDC can make clear that these activities are high-risk, without directly advising against them.
He said it would be important to explain the research showing that these are high-risk activities, something the CDC is not doing on its site right now.
“I would put the studies down, because I have a feeling that a large portion of the average American population doesn’t appreciate how we came up with these rules. This isn’t just two people in Atlanta putting these rules out in offices at the Centers for Disease Control and Prevention. The rules are based on real observations in the residents of Atlanta. real.”
But he added that the CDC could still be criticized for its guidance, at least from some people.
“There is no way the CDC can win,” he said.
CNN’s Danielle Hermann and Jamie Gombrecht contributed to this report.