At a particularly crucial time in the pandemic, the Centers for Disease Control and Prevention have a courier problem.
The CDC and its director, Dr. Rochelle Walensky, have come under increasing criticism for statements and guidance that have been revised or backtracked.
The United States faces something of a conundrum. Millions of Americans get vaccinated every day, and state and local governments are easing restrictions. Meanwhile, as the number of cases increases in some parts of the country, public health experts worry about the possibility of a fourth increase.
There are no easy answers.
“One of the most important things we say in public health is that you have to have a very simple message,” said Dr. Wafaa El-Sadr, professor of epidemiology and medicine at Columbia University. “But we are in a situation where the message is very complex.”
The problems began last week with what were perceived as mixed messages about the state of the pandemic and what is safe for people who have been fully vaccinated.
Walensky warned on March 29 of an “imminent doom” due to recent increases in the number of cases across the country. In an interview with MSNBC the same day, he raised his eyebrows by suggesting that “vaccinated people are not carriers of the virus.” Many researchers criticized the comments, saying it is too early to know for sure what effect vaccines may have on transmission. The CDC backtracked its statement a few days later.
The agency then relaxed its travel guide for people who are fully vaccinated, but in light of the steady increase in the number of cases and the fact that the majority of the U.S. population is not yet vaccinated, Walensky He said, “I would advocate against travel in general in general.”
The recent swing caused confusion and frustration, and muddied public health messages in what some experts say is a precarious time. The CDC is coming under fire at an unstable time as it tries to rebuild trust that has eroded over the past year, in large part due to political interference from the Trump administration.
“Whether it’s a public health agency or a communication campaign of any kind, the erosion of trust is incredibly damaging,” said Alison Buttenheim, associate professor of nursing and health policy at the University of Pennsylvania.
He said Walensky’s comments about vaccinated people and transmission “weren’t very thoughtful,” but added that missteps in public health messages can be salvaged if handled transparently.
Others have been less understanding.
“Messages from the CDC on Post-Vaccination Restrictions it’s been a disaster“Tweeted Dr. Vinay Prasad, associate professor of epidemiology and biostatistics at the University of California, San Francisco.
The missteps highlight the enormous challenges of public health messages during the pandemic, when science unfolds in real time and developments often occur at a breakneck pace. Developing public health guidelines in such circumstances makes it difficult to address the nuances, especially as the pandemic evolves and the situation changes.
“People want an answer that is black or white: Is this risky or not?” said Sandra Albrecht, assistant professor of epidemiology at Columbia University. “But risk is a spectrum, it depends on the context, the circumstances, the individual, the geography. There are so many factors that contribute to risk that it is really difficult to deliver a single line of public health messages for everyone.”
And conversations about risk become more challenging as “pandemic fatigue” sets in. A recently released Gallup poll found that concerns about contracting the coronavirus have fallen to record lows, with just 35 percent of Americans saying they are very or somewhat concerned about contracting the coronavirus. virus.
Albrecht and Buttenheim saw the difficulties of communicating risk and guidance early in the pandemic. Last year, they came together to create Dear Pandemic, an online project to answer questions from the public in an easily digestible way and help people navigate the flood of information about Covid-19.
One of the main goals of the project is to fill the gaps between official guidance with facts and context.
“A lot of what we’ve done is discuss the reasons and motives behind the public health messages that come from the CDC, because the public gets confused,” Albrecht said. “Part of what we do is explain the rationale and the evidence to support a certain line of recommendation.”
Early in the pandemic, for example, Albrecht and Buttenheim attempted to address why the CDC and the World Health Organization reversed the course of recommendations for people to wear masks in public.
“As scientists and public health professionals, we understood why that change occurred and why it was necessary, but the reasons for that change were not adequately communicated to the public,” Albrecht said. “That caused a lot of confusion and gave rise to conspiracy theorists.”
Loren Lipworth, an epidemiologist at Vanderbilt University Medical Center, said the events of the past year have highlighted how important it is for the CDC and public health professionals to be open about where the science lies and manage expectations. of people on how things can change. .
“The CDC needs to be honest and transparent and share as much as they can in terms of evaluating the evidence, but they also need to be cautious enough when we’re at a point where we can’t say something yet,” he said.
The balance is especially important now, when increases in infections in some states threaten to erase hard-won gains in stopping the spread of the virus.
And as the number of cases increases and variants of the virus spread across the country, how people and communities respond in the coming weeks could alter the trajectory of the pandemic in the United States, Lipworth said.
“We are very fortunate to have these vaccines, and that is definitely our way out, so we have real cause for optimism ahead,” he said, “but this is definitely not the time to lower our guard.”