“CDC director orders agency overhaul, admitting flawed Covid-19 response”, says today’s Politico. “Walensky, Citing Botched Pandemic Response, Calls for C.D.C. Reorganization”, says today’s New York Times. “Inside America’s monkeypox crisis — and the mistakes that made it worse”, says today’s Washington Post.
Yeah, you can’t make this stuff up—and, most unfortunately, you don’t have to, because the Post’s story makes clear that our federal health bureaucracies haven’t learned a goddamn thing:
Interviews with more than 40 officials working on the monkeypox response, outside advisers, public health experts and patients show that despite efforts to learn from the nation’s coronavirus failures, officials struggled to meet growing demand for testing, vaccines and treatments. Early mistakes, including the failure to recognize the virus was spreading differently and far more aggressively than it had previously, and a plodding bureaucracy left hundreds of thousands of gay men facing the threat of an agonizing illness that has not led to U.S. fatalities but can cause painful lesions some have likened to being pierced by shards of glass while going to the bathroom. And experts fear broader circulation of a virus that can infect anyone by close contact.
Anyone who knows anything about monkeypox knows that about 99% of the cases currently in the U.S. occur in gay men, and the disease is being spread almost entirely as the result of close physical contact—that is to say, sex—and most specifically the sort of anonymous, “bath house” sex practiced almost exclusively by young gay men. Yet to say so would hurt gay men’s feelings, so no one outside of right wing big mouths are saying so. So it’s good to know that the CDC is promising to “create a new equity office, working across all functions of the organization from hiring to policy to improve the agency’s diversity.” Because that’s why the U.S. is suffering from one massive epidemic after another: not enough “diversity”.
Yeah, as I say, you can’t make this stuff up. Unfortunately, there’s more; a lot more. Dr. Deborah Birx, who served as White House Coronavirus Response Coordinator under Donald Trump, in her book, Silent Invasion, is “scathing” with regard to Trump, but also in regard to the Centers for Disease Control and Prevention, for, among other things, designing a test that could only be analyzed in a handful of high end scientific laboratories, and also insisting on using only the most accurate testing methods, which, though intellectually satisfying, could not provide information that was fresh enough and extensive enough to actually be acted upon in real time—but at least we were absolutely sure of what happened, even though we couldn’t do anything about it. As Dr. Birx tells it, the CDC simply couldn’t imagine that it was facing an actual epidemic, costing hundreds of thousands of lives, despite the experiences with AIDS, SARS, and Ebola. They were in a bureaucratic rut so deep they couldn’t see over the sides.
But what really stunned Dr. Birx was her discovery that the U.S., unlike most other countries in the world, had no national data system for providing meaningful information about the spread of a disease like Covid:
we were dangerously behind the eight-ball on this one. The CDC had precious little systematic data, and what it did have had not been curated efficiently or effectively. It existed on outdated hardware, using software not meant for this kind of pandemic. Things were so bad in fact that, in 2020, the exchange of information within some states was often transmitted by fax. Hand-entered data was then passed along to the CDC electronically or by fax. Clearly, data collection at the CDC was inadequate. [“Inadequate” as in “an obscene joke! AV]
One of the gaping holes in the U.S. pandemic preparedness plan was not having a capable data collection system. Data is everything in a pandemic. Data shows your gaps; it shows where communities have an effective response; it lays bare the truth, where things are deteriorating and where they are better. It allows you to stay laser-focused and develop evidence-based policies. Without comprehensive data, you won’t have a comprehensive response. Without data, you don’t know what is working and what isn’t. You can’t see who needs help and who doesn’t. And you can’t manage what you don’t measure.
The CDC should have this information. The federal government doles out billions of dollars to hospitals all over the country, and the data existed, but there was no duty to report it, and thus no effective way to report it in the first place. This, really, “typical” of the way the federal government operates, thanks to state and local political pressure: billions are doled out, but there are no reciprocal duties imposed at the state and local level—none, at least, that cannot be safely ignored. Says Dr. Birx
This lack of will was the root issue. The CDC has never required anyone, neither the states nor hospitals, to report data outside a specific list of required reportable diseases, and that reporting is often done weeks to months after the cases are diagnosed. Every year, the CDC disburses an enormous amount of taxpayer money in the form of block grants and cooperative agreements to all fifty states, local governments, nonprofits, educational institutions, and for-profit groups, but it has been historically unwilling to attach strings to those federal dollars in the form of mandated data reporting and accountability for the dollars spent. Work plans are often submitted and reviewed, but there was no required reporting of outcomes or impact. Had the rates of diabetes, hypertension, and obesity declined? Were the dollars linked to the reporting of respiratory diseases (including viral ones like Covid-19) and to improving their laboratory diagnosis in real time? Without mandatory reporting, we lacked the data to answer these questions.
The CDC now says it will ask Congress to mandate state reporting. But why wasn’t that done, you know, two years ago? Says Birx, “Ultimately, the CDC’s greatest sin was not recognizing and acknowledging that it had sinned. Instead of fixing the issues, it hardened its belief that its approach was the best because they were the best.” Reading the Post’s article, it doesn’t sound like a lot has changed.
Afterwords
Here’s an earlier take by me on the CDC’s sins, including a few unkind words regarding an outbreak of swell-headedness by “Mr. Science” himself, Anthony Fauci. As Dr. Birx says, Trump was so clearly that “bad guy” during the outbreak that everyone—everyone on the left, at least—assumed that the CDC and Fauci had to be the good guys. But that wasn’t the case either.
Afterwords II Special Ron Bailey Edition
Reason’s Ron Bailey casts a similarly skeptical eye on CDC’s promises to reform, and links to stories discussing many of the agency’s failures, including this one in the New York Times, describing how the CDC routinely withholds information from the public, because we couldn’t handle the truth!
