Opinion | The Highs and Lows of CDC’s 2021 COVID Messaging

On April 13, 2021, Tim Lahey, MD, MMSc, shared his perspective on why CDC’s pause on the Johnson & Johnson vaccine might be good for public health. As part of MedPage Today‘s review of the past year’s top events, Lahey follows up with his thoughts on other successes and failures of COVID-related messaging this year.

Periodically, I join a local conservative-leaning talk radio show to provide an update on COVID-19.

The talk show hosts are unswervingly gracious and most callers ask incredibly thoughtful questions.

Then there are the other calls.

“Tell me, Doctor,” one caller began, his voice dripping with accusation and disgruntlement. “Why do you insist on lying to us about…” after which he promoted unproven therapies for COVID-19 and alleged I was part of a secret pharmaceutical industry conspiracy to hide inexpensive treatments from the American public.

Keeping my voice friendly and even, I explained which treatments work and how we know the drug he mentioned does not. I clarified that I have no pharma ties and that, in fact, I am a part of a very public healthcare worker conspiracy to save lives.

My heart rate was still high when the next caller signed on to accuse me, politely, of underestimating the number of published cases of myocarditis after mRNA vaccination. He asked, “Don’t you think people have a right to the real data?”

During an ensuing commercial break, I did some quick online research and found the caller was right. Just days before, the CDC had updated its analyses of myocarditis cases arising after mRNA vaccination, meaning I had cited outdated figures on air.

When the talk show resumed, I thanked the second caller, described the new information in detail, and explained why listeners should get vaccinated nonetheless. I said it takes a team effort to keep track of the volcano of evolving evidence on COVID-19.

It would have been easy to view these two calls as the same. Neither caller was a big fan. Both made me squirm. Yet, one was abusive and detracted from clear public health information whereas the other was an entirely legitimate critique of my message.

Look for the Helpers

Fred Rogers, the beloved children’s television personality, is famous for suggesting how to find solace even in a crisis. “Look for the helpers,” he said. “You will always find people who are helping.”

This has been a true north star for me the past 2 years. When the stress, workload, and civic strife of the COVID-19 pandemic feels overwhelming, I picture gowned and N95’d nurses providing compassionate care to COVID-19 patients on our wards. I remember I stand alongside stalwart clinicians of many stripes in emergency departments, hospital wards, and intensive care units worldwide. Knowing their heroism makes it possible to get up and do it all again.

Sadly, some people look for the helpers — and then attack them.

Senators Rand Paul (R.-Ky.) and Ted Cruz (R.-Texas) called for the resignation of chief White House COVID-19 advisor Anthony Fauci, MD, while conservative commentator Lara Logan likened him to Nazi doctor Josef Mengele. Fox News pundit Tucker Carlson said CDC chief and world-renowned HIV scholar Rochelle Walensky, MD, MPH, “has no demonstrated record of success in anything.”

Abuse of public health and healthcare workers is not the exclusive province of career politicians or right-leaning talking heads. From Idaho to Missouri, public health and healthcare workers have reported worrisome episodes of abuse, and in July 2021, a CDC study recently showed that 23% of public health workers felt bullied over pandemic mitigation measures.

Helping Helpers Help More

Abusing public health leaders is likely to worsen a pandemic that has already killed over 800,000 Americans.

That danger should not stop us from voicing constructive critique from which we can all benefit, such as when I learned on air that I’d cited newly outdated mRNA vaccine safety numbers.

Jerome Adams, MD, MPH, the 20th U.S. Surgeon General, recently openly disagreed with Fauci over whether it’s important to define what “fully vaccinated” means. Adams’ point was on target, as was the way he phrased it. Adams started with respect, prefacing his remarks with, “I rarely disagree with Dr. Fauci.” Then he focused on the issue over which the two physicians disagreed without assassinating Fauci’s character or motivations.

Stars and Mud

In this vein of heartfelt praise and respectful critique, I chose the best and worst of this year’s CDC guidance on COVID-19. As the CDC has led us through diverse topics ranging from indoor ventilation to how to sneeze safely, we’ve witnessed messaging that was stellar and messaging that was clear as mud.

The CDC’s COVID-19 vaccine messaging has been stellar and hits all the highlights in their industry standard handbook on crisis communications. They have been clear, factual, prompt, cited risks and benefits, and given answers to frequently asked questions. To show transparency and allow deeper dives, the CDC held scientific deliberations in public and disseminated outstanding summaries of their risk/benefit analyses.

Runners up for best public health messaging this year included: clear and evidence-based CDC guidance on isolation and quarantine, and the profusion of studies published by CDC scientists on topics ranging from vaccine- versus infection-related COVID-19 immunity to a rapid report of the omicron variant and beyond.

Masking guidance, on the other hand, has been muddy at best.

First, we should cut the CDC some slack for not being clairvoyant. Nobody knew masks were needed early in the pandemic, so the CDC did not recommend them. Once it was clearer that masks could slow transmission, Fauci and others changed course and masking became a way of life. Far from being a sign of confusion, that reversal was just a sign that the smart people we pay to oversee pandemic responses were doing their jobs well. Similarly, more than a year later, after the CDC loosened masking guidance in the face of declining case rates, Delta surged and the CDC had to reverse itself on masking once again. That was them responding to events as they should. Unless we can provide the CDC with a crystal ball, we should give them our thanks for changing course when appropriate.

Yet, masking guidance from the CDC has been more confusing than the swirl of events required. The CDC does not clarify that evidence shows cloth masks are inferior to surgical masks, and they continue to promote cloth masks as an equally acceptable alternative. Their guide to mask selection offers no tips on whether or when to double mask or wear more protective N95 and KN95 masks, leaving many to seek information elsewhere or to make it up on the fly.

Runners up for muddiest messaging of the year include CDC Director Walensky’s surprise reversal of her advisors’ recommendations on booster shots for healthcare workers, White House press secretary Jen Psaki’s snarky dismissal of a reporter’s question about rapid testing, and continued CDC encouragement to clean home and work surfaces aggressively despite clear evidence that most transmission of SARS-CoV-2 is airborne.

The Long Game

When surge after surge of COVID-19 finally subsides into endemicity, we will celebrate the life-saving efforts of the CDC, the agency’s brilliant director Walensky, and the thousands of public health workers who worked tirelessly under intense strain and despite resource strangulation resulting from decades of poor planning. Another pandemic will come in time. I hope we face it with better civic dialog and public health messaging sharpened by the honest feedback of friends.

Tim Lahey, MD, MMSc, is an infectious diseases physician and ethicist at the University of Vermont Medical Center and Professor of Medicine at the University of Vermont’s Larner College of Medicine.

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