The Centers for Disease Control and Prevention has struggled to communicate concisely and clearly over the course of the COVID-19 pandemic, to say the least. And judging by its garbled messaging in the weeks since Omicron started battering the country, it hasn’t learned from past errors.
To be fair, there’s no playbook for a situation of this nature. Even the Biden administration has struggled to toe the line in messaging about Omicron – “take it seriously, but don’t panic” isn’t an easy directive to get across.
But the release of new CDC guidelines at the height of the holiday surge did little but further muddy the waters. The guidelines shortened the isolation period for people who have tested positive from 10 days to five days, with asymptomatic individuals given the thumbs-up to return to their regular routines so long as they mask up for an additional five days.
The release of the guidelines resulted in backlash from the public, physicians and public health experts alike, with many criticizing the agency’s move.
“The change gave the impression it wasn’t being driven by science,” said Amesh Adalja, a senior scholar at the Johns Hopkins University Center for Health Security.
The American Medical Association (AMA) added that the CDC guidance was “confusing” and could inadvertently contribute to further spread of the virus.
“A negative test should be required for ending isolation after one tests positive for COVID-19,” the AMA said, according to a Reuters report. “Re-emerging without knowing one’s status unnecessarily risks further transmission of the virus.”
Given how many times I’ve had to say ‘No, that’s NOT at all what the new CDC guidelines say!’ in the last few hours, I’m guessing this ain’t gonna go well.— Craig Spencer MD MPH (@Craig_A_Spencer) December 28, 2021
I am baffled at CDC’s decision to shorten isolation. Here are tests from the same person: day 0 (3 days after exposure) and day 8. The person still has a huge amount of virus in their nose 8 days after testing positive. n=59. Quickest clearance 6 days, longest (vacc) 8.5 days. pic.twitter.com/yKuXG4NwUO— Erin Bromage Ph.D. (@ErinBromage) December 27, 2021
The CDC’s decision was, in fact, supported by case contact data showing that most COVID-19 transmission happens in the first five days after a positive test. The issue, Adalja pointed out, was that the science wasn’t communicated effectively.
“At the same time the guidance change was happening, you had a shortage of home tests, where people wanted to know their status and gauge their contagiousness,” he explained. “Then the wishy-washy guidelines about testing made people even more suspicious, and gave the impression to not test.”
The end result, Adalja added, was “a perfect storm for public health miscommunication to occur. In many ways, the CDC should have done this earlier to avoid any of that.”
There’s no easy or fast fix for the CDC’s COVID-19 messaging, which came under especially heavy fire when the agency flip-flopped on mask guidance in May 2021. Unlike the Food and Drug Administration, which leans heavily on science to make its drug and device approval decisions, the CDC’s advisory role is shaded more grey than black or white, said Dr. Norman Edelman, a professor in Stonybrook University’s Department of Medicine.
“The role of the FDA is to approve new drugs and devices, so their philosophy is a conservative one,” Edelman noted. “The CDC is our public health agency – technically speaking, they’re advisors to the state. They can say everyone should wear face masks, but they have no jurisdiction. They’re making recommendations to the states, and the states can do whatever they want.”
The CDC’s conundrum is, not surprisingly, reflected in the polarized politics around COVID-19. The changed isolation guidelines were motivated in part due to the agency’s current lean toward recommendations that allow businesses to stay open and people to go about their daily lives.
The 5 day isolation period shows a frequent CDC conundrum. When it considers behavioral or economic factors (compliance or the effect on the workforce) it is faulted for not sticking to science. When it doesn’t it is criticized for making policy with blinders on. It can’t win.— Drew Altman (@DrewAltman) December 29, 2021
“COVID-19 is a moving target; it’s like building an airplane as you’re flying it,” Edelman said. “Initially, the goal was to eradicate COVID-19. Now we’ve come to understand that may not be possible. You can’t criticize the government for not having a clear position when the circumstances keep changing.”
Given that unpredictability, Adalja believes the CDC’s harm-reduction approach makes sense. But if the messaging is botched, it doesn’t matter how sound the decision-making behind it may be.
“We know most transmission occurs in five days and we have science to show it’ll block the bulk of transmission,” Adalja said. “When rapid tests become available, we can right-size isolation periods based on contagiousness, and do it based on rapid testing. But because the CDC hasn’t communicated that, it’s more confusing and makes people even more distrustful.”
Adalja pointed to CDC’s HIV communication strategy around harm reduction and PrEP as a fine example to follow.
“I would say the strategy should include more transparency,” he continued. “They’re so afraid of being wrong and don’t articulate the nuance of their thinking. It becomes harder for people to understand and leaves everything open for misinterpretation.”
Trey Watkins, EVP of global health and corporate responsibility at GCI Health, agreed.
“The science is moving so quickly, to the point where we can’t even keep up with it,” he explained. “While scientists around the world are trying to get ahead of that, healthcare communicators and especially authorities really need to ensure that they are developing plans that are grounded in evidence but also underpinned by a solid communications plan. A core piece of that has to be transparency.”
This story first appeared on mmm-online.com.