August 23, 2022
Dear Friends and Family,
Last Wednesday, August 17, 2022, Dr. Rochelle Walensky, Head of the Centers for Disease and Prevention (CDC) issued this statement to the media:
Dear Friends and Family,
Last Wednesday, August 17, 2022, Dr. Rochelle Walensky, Head of the Centers for Disease and Prevention (CDC) issued this statement to the media:
For 75 years, CDC and public health have been preparing for Covid-19 and in our big moment, our performance did not reliably meet expectations. My goal is a new public health action-oriented culture at CDC that emphasizes accountability, collaboration, and timeliness.
This segment will provide some insight into some of the CDC failures leading to this conclusion. They include: (1) a failed diagnostic test at the start of the pandemic and resistance to utilizing such a test developed by other countries; (2) as a result, the country treated the pandemic as an influenza (the flu) – all people will be affected equally, quarantines to prevent the spread, extensive cleaning assuming transmission could occur by touching a contaminated surface, prevention measures assuming the spread was from virus droplets versus aerosol transmission, and lockdowns; (3) inadequate communication – not communicating analysis errors, not making timely changes in guidance with an explanation as to why; (4) basing decisions on faulty data – hospitalization admissions, collection of clinical data, not distributing data to others by assuming the CDC was the final word and everyone else had to follow; (5) not seeking assistance nor information – from front-line providers, from private labs, from other countries; (6) no evaluation of the efficacy of prevention measures – masks, natural immunity following infection, at home prevention and treatment measures (segment 5 of the series).
To Dr. Walensky’s credit she recognizes there is a problem – a cultural problem – and she is going to address it, throughout an organization with 10,600 employees with annual compensation totaling $1.1 billion as reported by Forbes. An organization with an overall budget of $11.9 billion/year, 85% of which is grants. I can only speculate on the cultural problem, but some aspects stand out based on the excerpts from the books of two former public health officials.
Next: Segment 3 provides an in-depth perspective on the pandemic as lived by White House Task Force coordinator Deborah Birx. She was in essence the leader of the Federal Government’s response, fashioning policy and guidance and then communicating that to state governors. Ninety percent of the excerpts come from Dr. Birx’s book Silent Invasion.
Happy Learning,
Harley
To Dr. Walensky’s credit she recognizes there is a problem – a cultural problem – and she is going to address it, throughout an organization with 10,600 employees with annual compensation totaling $1.1 billion as reported by Forbes. An organization with an overall budget of $11.9 billion/year, 85% of which is grants. I can only speculate on the cultural problem, but some aspects stand out based on the excerpts from the books of two former public health officials.
- CDC’s Covid objective was limited to providing guidance versus aggressively fighting the Covid-19 virus and doing everything possible to minimize Covid deaths.
- A lack of either operating standards or adherence to them, particularly in the communication area.
- Culturally the organization displays extreme arrogance; lack of urgency; and long- standing attitudes of just getting by, disregarding authority, and defying leadership.
Next: Segment 3 provides an in-depth perspective on the pandemic as lived by White House Task Force coordinator Deborah Birx. She was in essence the leader of the Federal Government’s response, fashioning policy and guidance and then communicating that to state governors. Ninety percent of the excerpts come from Dr. Birx’s book Silent Invasion.
Happy Learning,
Harley
COVID PANDEMIC CRITIQUE – SEGMENT 2
U.S. PUBLIC HEALTH AGENCIES
From: Uncontrolled Spread by Scott Gottlieb Former FDA Director (2021).
WE WEREN’T READY: When the pandemic we long feared finally arrived, we weren’t ready. When COVID struck, all eyes turned to the CDC, which, it was assumed, would quarterback our response. However, the agency doesn’t have an operational capability to manage a crisis of this scale. A lot of corrosive failures occurred though out the agency level, inside an ill-prepared bureaucracy. Years of inattention to these risks and underfunding of the key institutions, turf wars between federal agency heads, a lack of strong leadership that should have brought health agencies together in a coordinated way to solve problems and bureaucratic hubris, all created a system failure. The pandemic was not inherently uncontrollable. I spoke to federal health officials and the White House staff often about the nation’s efforts as these events were unfolding, which gave me a close-up view of the response, and I’m convinced that if we had adopted a more coordinated national response and stronger surveillance at the outset, we would have had a better outcome. By March (2020), when the evidence that it would spark a global pandemic could no longer be discounted, it was too late. It was driven largely by a failure to field a test that would let us screen for it. No part of this surveillance plan for sentinel cases ever got started. The CDC was never able to field the diagnostic test they promised.
LOOKING FOR THE SPREAD IN THE WRONG PLACES: Without a diagnostic test to screen patients, health officials were relying instead on a specific tool that the CDC used for syndromic surveillance called the Influenza Like Illness (ILI) surveillance system. For the CDC, flu was the model for how they would detect COVID. They expected SARS-CoV-2 to behave essentially like influenza, and they expected their flu surveillance tools to be effective in identifying its spread. But COVID wasn’t acting like the flu. The CDC relied heavily on claims data from the Medicare program, but that data took about three months to be collected and reported because of the delay between the delivery of healthcare and payment for those services.
These shortcomings were aggravated by the way the coronavirus spread, through asymptomatic transmission. As many as 40% of infected patients didn’t develop noticeable symptoms, and thus never show up on the symptom monitoring. The CDC clung to its use of the ILI syndromic surveillance for months, even after there was ample evidence of asymptomatic spread. It was not until the late winter 2020 that the CDC finally acknowledged the possibility of using widespread testing of asymptomatic individuals as a way to contain transmission.
Without adequate testing and with no emphasis on diagnosing asymptomatic cases, the CDC was attributing a lot of the transmission it was seeing, and that it couldn’t explain, not to asymptomatic infections but to “fomites” – a circumstance where someone touches a surface that had become contaminated with the respiratory secretions of an infected patient and then touches his or her own nose, eyes, or mouth. We put far too much emphasis on cleaning surfaces, when we should have been taking more steps to improve the airflow and filtration in confined indoor spaces and to get N95 respirators to individuals at high risk of bad outcome. Compounding the error, the CDC wouldn’t share its methodology, so those who might have been able to uncover the shortcomings and correct for the CDC’s faulty assumptions had no way to fully understand how the agency made it projections.
At a press conference on February 25, Robert Redfield, the CDC Director and member of the White House Coronavirus Task Force, affirmed the message that the threat to the nation remained low. The federal health officials were working with faulty tools, and from faulty data sets. The inability to field a reliable diagnostic, to deploy it in scale, and the overreliance on syndromic surveillance that was inherently flawed, were historic failures that left us badly at risk. It wasn’t even a hard test to design and manufacture. And still, we badly bungled it.
A PLAN GONE AWRY: It became increasingly clear that a lot of spread wasn’t merely through droplets but also through aerosol transmission. Droplets are larger particles we secrete when we talk, cough, or sneeze. They are heavier and can’t travel long distances. Aerosols are smaller particles that emerge after droplets start to evaporate. They can spread through the air over longer distances and stay suspended for prolonged periods of time. This becomes especially true when the aerosols get into sealed, indoor spaces.
Updating prior recommendations isn’t a priority for the CDC and they sometimes lose track of the stuff that needs to be revisited. Moreover, the CDC isn’t always clear on when the science behind its recommendations is unsettled, making it harder for people to identify which advisories are more fungible. The CDC also doesn’t always identify the underlying science of its recommendations. That’s how we ended up not knowing the actual basis for the six feet of distancing. Among other steps, the CDC ought to have a public vetting process that involves outside experts. That way, they also are less likely to end up with some of the problems they had during the pandemic by putting out bad advice because it was being edited by political appointees. If the CDC expects Americans to follow its guidance, it will have to be more transparent and get the public invested in how these decisions are made.
CDC GUIDANCE ERRORS:
THE INFORMATION DESERT: The CDC’s analysis was never timely or complete. For instance, hospitalization data was not accurate. The CDC wasn’t actually providing data that was being reported to the agency on real hospitalizations but was instead posting an estimate derived from a predictive model. In other words, the number of hospitalizations that the CDC was reporting each day weren’t people who were actually being admitted to the hospital but were hypothetical patients being modeled of a small sample that the CDC was collecting. The CDC reported on the number of hospitalizations each day as if it were tabulating these totals, but it wasn’t. Making matters more uncertain, the data that underpinned that modeling exercise was being lifted from a system that had been built years earlier as a way to monitor the prevalence of hospital-acquired infections like urinary tract infections and hospital-acquired pneumonias, not for tracking hospital admissions.
Rather than try to cajole the CDC into fixing its reporting system, Birx and Secretary Azar decided to re-create that structure outside the agency. The had concluded that getting the CDC to change its own scheme, and abandon its historical approach to modeling these data, would have been too hard. Under the new system, 95% of US hospitals soon provided 100% of their daily hospital admission data. Unfortunately, the CDC declined to work with the new data, worrying that since it wasn’t their data, they couldn’t assure its provenance and couldn’t fully trust its reliability.
On December 19, 2006, the Pandemic and All-Hazards Preparedness Act was signed into law by George W. Bush. The law required the CDC to “establish a near real-time electronic nationwide public health situational awareness capability through an interoperable network of systems to share date and information to enhance early detection of rapid response to, and management of, potentially catastrophic infectious disease outbreaks and other public health emergencies that originate domestically or abroad.” As Dr. Yuval Levin, a senior White House official in the Bush administration overseeing the public health portfolio for the Domestic Policy Council observed, “the simplest way to describe the CDC’s response to this binding legal mandate was that it just ignored it. It did nothing.”
Source: Uncontrolled Spread by Scott Gottlieb, MD (2021)
From: Silent Invasion by Dr. Deborah Birx Coordinator of the White House Task Force (2022)
TESTING: Where was the testing? Where was the warning that this virus could be spread by those without symptoms, so Americans could be on guard? At least the Japanese had a reliable diagnostic test. The same could not be said of us.
On February 8 we learned that contaminated testing materials caused the tests the federal agencies had created to result in false positives. Now, rather than ensuring that those test kits were deployed at the first sign of outbreak, the CDC had to validate a new test. This general disregard for and mismanagement of testing would continue to haunt us throughout the spring and summer. We were no longer days behind; we were weeks behind. By the time the federal agencies had caught up to where they were before the testing debacle, they were actually 16 to 24 weeks behind the progress of the viral spread. We were flying almost totally blind.
While the failure of the tests was deeply disturbing, I was also concerned about some of the decision making at the CDC. When the tests were designed back in January, they were built mainly for use and analysis by our country’s Public Health Laboratories and their often-unique equipment. The Public Health Labs were quite unsuited for testing on a scale needed for this current crisis, in comparison to higher-through-put commercial labs. So, designing a test that relied on Public Health Labs meant that the bulk of U.S. processing was sitting idle, about 0.1% utilized and 99.9% sidelined when they were needed the most. I asked one of the manufacturers critical to the production of high-throughput and point-of-care tests if anyone from the CDC has called them in early 2020. Their reply was that, in fact, it had been the other way around: the manufacturers were the ones calling the CDC to understand what it was doing and how they could help. Why there had been no prior conversations with the private sector on testing was answered by saying it was another agencies job.
Further the FDA approved CDC test was only approved for use with symptomatic people. The test was not approved to do the most important thing we needed it to do; diagnose and isolate the asymptomatic, pre-symptomatic, and very mildly symptomatic people who were spreading the virus unknowingly.
Most of the evidence supporting the need for widespread, strategic testing to find asymptomatic spread in the community had come for other, mostly Asian countries. Now we had increasing amounts of evidence from within our country supporting the strategy. For weeks within the doctors’ group of the task force, we worked on a blueprint for strategic testing involving the antigen test, especially since the federal government had purchased 150 million of them. I struggled to get everyone to shift gears into a proactive mindset. The FDA would not approve antigen tests for asymptomatic diagnosis until July 2021.
Throughout November and December 2021, I worked to expand PCR testing and shorten turnaround times, to make the testing better able to stop community spread. We had monies that would have brought us to well over 2,500,000 PCR tests per day, but it took a backseat once President Biden was in office. Once again, we entered the next surge, in summer 2021, blind to the early silent invasion.
DATA: Data is everything in a pandemic. Data shows you gaps; it shows where communities have an effective response. Without data, you don’t know what is working and what isn’t. You can’t see who need help and who doesn’t. And you can’t manage what you don’t measure. Bob Redfield, the Director of the CDC, said. “So, do you really think I can push my people on Covid-19 data and get anything close to real-time analyses and recommendations? We’re not built for that, as much as I would like us to be.” In the end, the flu bias in the CDC’s data system and the agency’s jurisdictional limitations exposed, once again, the rigidity in its thinking. Perhaps the most crucial part of my approach was to try, once again, to get more of the medical establishment to acknowledge the greater degree of silent spread. I had to find a way to change minds on this – starting with the rank and file at the CDC. Unfortunately, Bob could only do so much to influence the CDC rank and file. The CDC is populated with many talented and gifted professionals, many of whom also happen to hold liberal points of view. As a political appointee, Bob was stained by his association with a Republican/conservative administration.
MASKS: Recommending that masks be reserved for health care workers did not solve the supply shortages that had health care facilities rationing masks and other protective gear. We could have climbed out of that hole if the CDC and other researchers had immediately started to test the effectiveness of other types of masks – cloth ones or less robust surgical masks. But because the CDC had not studied other types of masks other than the N95 and KN95’s, it wouldn’t formally recognize them as an effective mitigation tool.
The CDC prides itself on being a preeminent medical and scientific authority. Historically, its adherence to scientific rigor has suited it well, but if a level of rigor isn’t adaptable to the moment, it can become an Achilles’ heel. In the midst of an enormous health crisis, you can’t wait until a definitive, tightly controlled, randomized, replicable, peer-reviewed study has been done to make a recommendation that will likely save lives while costing none.
Source: Silent Invasion by Deborah Birx (Late April 2022).
From: Covidslayers by Rajesh Mohan, MD (2020):
A FRONTLINE PHYSICIANS VIEW OF THE CDC: As medical professionals, we did not see “guidelines” change so frequently and so drastically, some almost daily. Many “guidelines” did not even make any sense, some being incoherent and some contradictory. Some were indefensible! Guidelines were becoming an impediment to critical thinking as well as creative thinking, which is what is required when one is dealing with the unknown, that too at such an overwhelming scale. The CDC had started making a precipitous decline in its standards, recommendations, guidance and ultimately what would be, its credibility.
However, it was heartening to notice that many of these updates from the CDC were ignored or interpreted differently by some local hospital clinical leaders and many clinicians.
There is no reason that more than 9 months later, medications and therapeutics are still rationed, and physicians are being restricted in many instances the freedom to use the full gamut of arsenal that should be readily available in their armamentarium for the benefit of their patients. All this is despite the fact that the technology is available, and resources can be acquired.
We now know why we are in a worse situation than we should have been. We know that we have done a worse job than many developed countries. We also know that a combination of arrogance and ignorance at multiple levels of the government – state and national, and in the bureaucracies of hospitals and healthcare institutions have impeded the ability and efforts of physicians and nurses to combat the virus and the pandemic more effectively. We are now acutely aware, more than ever, that there are inefficiencies and incompetence which are systemic in the administration of the U.S. healthcare system. The problems which have been so blatantly exposed by the pandemic are a testament to an unhealthy U.S. healthcare system.
Source: Covidslayers by Rajesh Mohan, MD, MBA, FACC, FSCAI (2020)
The unabbreviated version of the above can be found in the pdf document below.
U.S. PUBLIC HEALTH AGENCIES
From: Uncontrolled Spread by Scott Gottlieb Former FDA Director (2021).
WE WEREN’T READY: When the pandemic we long feared finally arrived, we weren’t ready. When COVID struck, all eyes turned to the CDC, which, it was assumed, would quarterback our response. However, the agency doesn’t have an operational capability to manage a crisis of this scale. A lot of corrosive failures occurred though out the agency level, inside an ill-prepared bureaucracy. Years of inattention to these risks and underfunding of the key institutions, turf wars between federal agency heads, a lack of strong leadership that should have brought health agencies together in a coordinated way to solve problems and bureaucratic hubris, all created a system failure. The pandemic was not inherently uncontrollable. I spoke to federal health officials and the White House staff often about the nation’s efforts as these events were unfolding, which gave me a close-up view of the response, and I’m convinced that if we had adopted a more coordinated national response and stronger surveillance at the outset, we would have had a better outcome. By March (2020), when the evidence that it would spark a global pandemic could no longer be discounted, it was too late. It was driven largely by a failure to field a test that would let us screen for it. No part of this surveillance plan for sentinel cases ever got started. The CDC was never able to field the diagnostic test they promised.
LOOKING FOR THE SPREAD IN THE WRONG PLACES: Without a diagnostic test to screen patients, health officials were relying instead on a specific tool that the CDC used for syndromic surveillance called the Influenza Like Illness (ILI) surveillance system. For the CDC, flu was the model for how they would detect COVID. They expected SARS-CoV-2 to behave essentially like influenza, and they expected their flu surveillance tools to be effective in identifying its spread. But COVID wasn’t acting like the flu. The CDC relied heavily on claims data from the Medicare program, but that data took about three months to be collected and reported because of the delay between the delivery of healthcare and payment for those services.
These shortcomings were aggravated by the way the coronavirus spread, through asymptomatic transmission. As many as 40% of infected patients didn’t develop noticeable symptoms, and thus never show up on the symptom monitoring. The CDC clung to its use of the ILI syndromic surveillance for months, even after there was ample evidence of asymptomatic spread. It was not until the late winter 2020 that the CDC finally acknowledged the possibility of using widespread testing of asymptomatic individuals as a way to contain transmission.
Without adequate testing and with no emphasis on diagnosing asymptomatic cases, the CDC was attributing a lot of the transmission it was seeing, and that it couldn’t explain, not to asymptomatic infections but to “fomites” – a circumstance where someone touches a surface that had become contaminated with the respiratory secretions of an infected patient and then touches his or her own nose, eyes, or mouth. We put far too much emphasis on cleaning surfaces, when we should have been taking more steps to improve the airflow and filtration in confined indoor spaces and to get N95 respirators to individuals at high risk of bad outcome. Compounding the error, the CDC wouldn’t share its methodology, so those who might have been able to uncover the shortcomings and correct for the CDC’s faulty assumptions had no way to fully understand how the agency made it projections.
At a press conference on February 25, Robert Redfield, the CDC Director and member of the White House Coronavirus Task Force, affirmed the message that the threat to the nation remained low. The federal health officials were working with faulty tools, and from faulty data sets. The inability to field a reliable diagnostic, to deploy it in scale, and the overreliance on syndromic surveillance that was inherently flawed, were historic failures that left us badly at risk. It wasn’t even a hard test to design and manufacture. And still, we badly bungled it.
A PLAN GONE AWRY: It became increasingly clear that a lot of spread wasn’t merely through droplets but also through aerosol transmission. Droplets are larger particles we secrete when we talk, cough, or sneeze. They are heavier and can’t travel long distances. Aerosols are smaller particles that emerge after droplets start to evaporate. They can spread through the air over longer distances and stay suspended for prolonged periods of time. This becomes especially true when the aerosols get into sealed, indoor spaces.
Updating prior recommendations isn’t a priority for the CDC and they sometimes lose track of the stuff that needs to be revisited. Moreover, the CDC isn’t always clear on when the science behind its recommendations is unsettled, making it harder for people to identify which advisories are more fungible. The CDC also doesn’t always identify the underlying science of its recommendations. That’s how we ended up not knowing the actual basis for the six feet of distancing. Among other steps, the CDC ought to have a public vetting process that involves outside experts. That way, they also are less likely to end up with some of the problems they had during the pandemic by putting out bad advice because it was being edited by political appointees. If the CDC expects Americans to follow its guidance, it will have to be more transparent and get the public invested in how these decisions are made.
CDC GUIDANCE ERRORS:
- It would take the CDC almost a year to fully revisit the risk from fomites. In the meantime, businesses and municipalities overinvested in cleaning programs. It was May 7, 2021, eighteen months after the pandemic began that the CDC finally updated its explanations on how SARS-CoV-2 is spread, citing inhalation as the main mode of transmission and emphasizing the role of aerosols, and placing less emphasis on fomites.
- The CDC’s revision of its recommendations for people to remain six feet apart, in March 2021, a full year after the pandemic began. The six-foot distancing requirement was a primary reason many schools cited for why they couldn’t open for full-time classroom instruction. It was probably the single most costly intervention the CDC recommended that was consistently applied throughout the pandemic. It was another reflection of how the CDC’s focus on the flu as a model for COVID spread ended up being a costly misjudgment.
- Ultimately, the overreliance on the model for responding to flu, and the late and incomplete efforts to readjust that position as new science emerged that showed that COVID wasn’t behaving like flu, caused us to make costly mistakes.
THE INFORMATION DESERT: The CDC’s analysis was never timely or complete. For instance, hospitalization data was not accurate. The CDC wasn’t actually providing data that was being reported to the agency on real hospitalizations but was instead posting an estimate derived from a predictive model. In other words, the number of hospitalizations that the CDC was reporting each day weren’t people who were actually being admitted to the hospital but were hypothetical patients being modeled of a small sample that the CDC was collecting. The CDC reported on the number of hospitalizations each day as if it were tabulating these totals, but it wasn’t. Making matters more uncertain, the data that underpinned that modeling exercise was being lifted from a system that had been built years earlier as a way to monitor the prevalence of hospital-acquired infections like urinary tract infections and hospital-acquired pneumonias, not for tracking hospital admissions.
Rather than try to cajole the CDC into fixing its reporting system, Birx and Secretary Azar decided to re-create that structure outside the agency. The had concluded that getting the CDC to change its own scheme, and abandon its historical approach to modeling these data, would have been too hard. Under the new system, 95% of US hospitals soon provided 100% of their daily hospital admission data. Unfortunately, the CDC declined to work with the new data, worrying that since it wasn’t their data, they couldn’t assure its provenance and couldn’t fully trust its reliability.
On December 19, 2006, the Pandemic and All-Hazards Preparedness Act was signed into law by George W. Bush. The law required the CDC to “establish a near real-time electronic nationwide public health situational awareness capability through an interoperable network of systems to share date and information to enhance early detection of rapid response to, and management of, potentially catastrophic infectious disease outbreaks and other public health emergencies that originate domestically or abroad.” As Dr. Yuval Levin, a senior White House official in the Bush administration overseeing the public health portfolio for the Domestic Policy Council observed, “the simplest way to describe the CDC’s response to this binding legal mandate was that it just ignored it. It did nothing.”
Source: Uncontrolled Spread by Scott Gottlieb, MD (2021)
From: Silent Invasion by Dr. Deborah Birx Coordinator of the White House Task Force (2022)
TESTING: Where was the testing? Where was the warning that this virus could be spread by those without symptoms, so Americans could be on guard? At least the Japanese had a reliable diagnostic test. The same could not be said of us.
On February 8 we learned that contaminated testing materials caused the tests the federal agencies had created to result in false positives. Now, rather than ensuring that those test kits were deployed at the first sign of outbreak, the CDC had to validate a new test. This general disregard for and mismanagement of testing would continue to haunt us throughout the spring and summer. We were no longer days behind; we were weeks behind. By the time the federal agencies had caught up to where they were before the testing debacle, they were actually 16 to 24 weeks behind the progress of the viral spread. We were flying almost totally blind.
While the failure of the tests was deeply disturbing, I was also concerned about some of the decision making at the CDC. When the tests were designed back in January, they were built mainly for use and analysis by our country’s Public Health Laboratories and their often-unique equipment. The Public Health Labs were quite unsuited for testing on a scale needed for this current crisis, in comparison to higher-through-put commercial labs. So, designing a test that relied on Public Health Labs meant that the bulk of U.S. processing was sitting idle, about 0.1% utilized and 99.9% sidelined when they were needed the most. I asked one of the manufacturers critical to the production of high-throughput and point-of-care tests if anyone from the CDC has called them in early 2020. Their reply was that, in fact, it had been the other way around: the manufacturers were the ones calling the CDC to understand what it was doing and how they could help. Why there had been no prior conversations with the private sector on testing was answered by saying it was another agencies job.
Further the FDA approved CDC test was only approved for use with symptomatic people. The test was not approved to do the most important thing we needed it to do; diagnose and isolate the asymptomatic, pre-symptomatic, and very mildly symptomatic people who were spreading the virus unknowingly.
Most of the evidence supporting the need for widespread, strategic testing to find asymptomatic spread in the community had come for other, mostly Asian countries. Now we had increasing amounts of evidence from within our country supporting the strategy. For weeks within the doctors’ group of the task force, we worked on a blueprint for strategic testing involving the antigen test, especially since the federal government had purchased 150 million of them. I struggled to get everyone to shift gears into a proactive mindset. The FDA would not approve antigen tests for asymptomatic diagnosis until July 2021.
Throughout November and December 2021, I worked to expand PCR testing and shorten turnaround times, to make the testing better able to stop community spread. We had monies that would have brought us to well over 2,500,000 PCR tests per day, but it took a backseat once President Biden was in office. Once again, we entered the next surge, in summer 2021, blind to the early silent invasion.
DATA: Data is everything in a pandemic. Data shows you gaps; it shows where communities have an effective response. Without data, you don’t know what is working and what isn’t. You can’t see who need help and who doesn’t. And you can’t manage what you don’t measure. Bob Redfield, the Director of the CDC, said. “So, do you really think I can push my people on Covid-19 data and get anything close to real-time analyses and recommendations? We’re not built for that, as much as I would like us to be.” In the end, the flu bias in the CDC’s data system and the agency’s jurisdictional limitations exposed, once again, the rigidity in its thinking. Perhaps the most crucial part of my approach was to try, once again, to get more of the medical establishment to acknowledge the greater degree of silent spread. I had to find a way to change minds on this – starting with the rank and file at the CDC. Unfortunately, Bob could only do so much to influence the CDC rank and file. The CDC is populated with many talented and gifted professionals, many of whom also happen to hold liberal points of view. As a political appointee, Bob was stained by his association with a Republican/conservative administration.
MASKS: Recommending that masks be reserved for health care workers did not solve the supply shortages that had health care facilities rationing masks and other protective gear. We could have climbed out of that hole if the CDC and other researchers had immediately started to test the effectiveness of other types of masks – cloth ones or less robust surgical masks. But because the CDC had not studied other types of masks other than the N95 and KN95’s, it wouldn’t formally recognize them as an effective mitigation tool.
The CDC prides itself on being a preeminent medical and scientific authority. Historically, its adherence to scientific rigor has suited it well, but if a level of rigor isn’t adaptable to the moment, it can become an Achilles’ heel. In the midst of an enormous health crisis, you can’t wait until a definitive, tightly controlled, randomized, replicable, peer-reviewed study has been done to make a recommendation that will likely save lives while costing none.
Source: Silent Invasion by Deborah Birx (Late April 2022).
From: Covidslayers by Rajesh Mohan, MD (2020):
A FRONTLINE PHYSICIANS VIEW OF THE CDC: As medical professionals, we did not see “guidelines” change so frequently and so drastically, some almost daily. Many “guidelines” did not even make any sense, some being incoherent and some contradictory. Some were indefensible! Guidelines were becoming an impediment to critical thinking as well as creative thinking, which is what is required when one is dealing with the unknown, that too at such an overwhelming scale. The CDC had started making a precipitous decline in its standards, recommendations, guidance and ultimately what would be, its credibility.
However, it was heartening to notice that many of these updates from the CDC were ignored or interpreted differently by some local hospital clinical leaders and many clinicians.
There is no reason that more than 9 months later, medications and therapeutics are still rationed, and physicians are being restricted in many instances the freedom to use the full gamut of arsenal that should be readily available in their armamentarium for the benefit of their patients. All this is despite the fact that the technology is available, and resources can be acquired.
We now know why we are in a worse situation than we should have been. We know that we have done a worse job than many developed countries. We also know that a combination of arrogance and ignorance at multiple levels of the government – state and national, and in the bureaucracies of hospitals and healthcare institutions have impeded the ability and efforts of physicians and nurses to combat the virus and the pandemic more effectively. We are now acutely aware, more than ever, that there are inefficiencies and incompetence which are systemic in the administration of the U.S. healthcare system. The problems which have been so blatantly exposed by the pandemic are a testament to an unhealthy U.S. healthcare system.
Source: Covidslayers by Rajesh Mohan, MD, MBA, FACC, FSCAI (2020)
The unabbreviated version of the above can be found in the pdf document below.
| covid_2l_public_health_agencies_--_segment_2.pdf |