“A new CEO was hired to take over a struggling company. The CEO who was stepping down met with him privately and presented him with three numbered envelopes. “Open these if you run into serious trouble,” he said.”…. (see the rest of this classic at the end of this POST!)
for links to POSTS 1-267 in chronological order, highlight and click on
There is also an appendix of links to previous POSTS in this project specifically tracking actions of the CDC since the pandemic began.
In POST 166 on August 11th the following was reported:
“U.S. health officials said Wednesday they are not changing the qualifications for being “fully vaccinated” against COVID-19, but they are urging Americans to stay “up to date” on their protection against the virus by getting booster shots when eligible.
The move to keep the existing definition of fully vaccinated — either two doses of the mRNA vaccines from Pfizer and Moderna or a single dose of the Johnson & Johnson vaccine — comes as health officials warned of waning protections from the initial doses. They are encouraging Americans to get additional doses to stave off serious illness and death from the delta and omicron variants.
The decision to keep the initial definition, established more than a year ago when the vaccines first rolled out, means that federal vaccination mandates for travel or employment won’t require a booster dose.
Maintaining the existing definition of “fully vaccinated” could make it more difficult to encourage some Americans who only begrudgingly got their primary doses of the vaccine to get boosted, since they would not face onerous restrictions often imposed on the unvaccinated — including testing requirements or, in some jurisdictions, being barred from indoor dining and other facilities. ”Individuals are considered fully vaccinated against COVID-19 if they’ve received their primary series,” said Centers for Disease Control and Prevention Director Dr. Rochelle Walensky. “That definition is not changing.”
The CDC instead posted information for Americans to more easily determine their eligibility for booster doses so as to remain up to date with their COVID-19 shots.
We are now recommending that individuals stay up to date with additional doses that they are eligible for,” Walensky added…
Asked about the change, a CDC spokeswoman said the definition of “fully vaccinated” has not changed. But she also said: “CDC will now use the phrase ‘up to date’ when talking about COVID-19 vaccination. CDC recommends that individuals stay ‘up to date’ by receiving any additional doses they are eligible for, according to CDC’s recommendations, to ensure they have optimal protection against COVID-19.”” (A)
And then I went out on vacation during which time CDC Director Walensky “…delivered a sweeping rebuke of her agency’s handling of the coronavirus pandemic, saying it had failed to respond quickly enough and needed to be overhauled.
“To be frank, we are responsible for some pretty dramatic, pretty public mistakes, from testing to data to communications,” she said in a video distributed to the agency’s roughly 11,000 employees.
Dr. Walensky said the C.D.C.’s future depended on whether it could absorb the lessons of the last few years, during which much of the public lost trust in the agency’s ability to handle a pandemic that has killed more than 1 million Americans. “This is our watershed moment. We must pivot,” she said.
Her admission of the agency’s failings came after she received the findings of an examination she ordered in April amid scathing criticism of the C.D.C.’s performance. The report itself was not released; an agency official said it was not yet finished but would be made public soon.
Dr. Walensky laid out her basic conclusion from the review in candid terms: The C.D.C. must refocus itself on public health needs, respond much faster to emergencies and outbreaks of disease, and provide information in a way that ordinary people and state and local health authorities can understand and put to use.
In an interview on Monday, Dr. Walensky stressed that hundreds of Americans were still dying each day from the coronavirus and that while the country has not yet seen deaths from the outbreak of a new disease — monkeypox — it has presented some of the same challenges for the agency.
The C.D.C. has been criticized for years as being too academic and insular. The coronavirus pandemic brought those failings into public view, with even some of the agency’s staunchest defenders criticizing its response as inept.
It remains unclear whether Dr. Walensky, an infectious disease expert whom President Biden picked to lead the agency in December 2020, can bring about the changes many see as necessary.
The agency has been under fire since the outset of the coronavirus pandemic two and a half years ago. It bent to political pressure from the Trump White House to alter key public health guidance or withhold it from the public — decisions that cost it a measure of public trust that experts say it still has not recaptured. It also made its own serious errors, including deploying a faulty Covid-19 test that set back the nation’s efforts to curtail spread of the virus.
While it has steadied itself since Dr. Walensky assumed control about 18 months ago, the C.D.C. has continued to fall short.
Its public guidance has often been confusing, even to public health experts. Leaders of its Covid team rotate so frequently that other senior federal health officials have at times been unsure about who is in charge. And important data was sometimes released too late to inform federal decisions, including studies on breakthrough infections that could have influenced a federal recommendation on authorizing a round of booster shots…
She outlined in broad terms how she hopes to transform operations by emphasizing public health needs, especially with a quicker response to emergencies like infectious disease outbreaks. One of her top priorities is to deliver clear, concise messages about public health threats, in plain language that can be grasped without sifting through voluminous pages on a website…
The pandemic itself is another impediment. The agency’s massive complex outside Atlanta sits mostly empty, while employees, including Dr. Walensky, work remotely.” (B)
“The US Centers for Disease Control and Prevention says the nation should move away from restrictive measures such as quarantines and social distancing and focus on reducing severe disease from Covid-19.
In new guidelines released Thursday, the agency no longer recommends staying at least 6 feet away from other people to reduce the risk of exposure — a shift from guidance that had been in place since the early days of the pandemic.
The shift is a sign of how much has changed since the beginning of the pandemic more than two years ago. Nearly the entire US population has at least some immunity through vaccination, previous infection or, in some cases, both.
“The current conditions of this pandemic are very different from those of the last two years,” Greta Massetti, who leads the Field Epidemiology and Prevention Branch at the CDC, said Thursday.
“High levels of population immunity due to vaccination and previous infection and the many available tools to protect the general population, and protect people at higher risk, allow us to focus on protecting people from serious illness from Covid-19.”
The new CDC guidelines say contact tracing, another hallmark during the pandemic, should be limited to hospitals and certain high-risk group-living situations such as nursing homes, and the guidelines de-emphasize the use of regular testing to screen for Covid-19, except in certain high-risk settings like nursing homes and prisons.
The new guidance also does not advise quarantining people who’ve been exposed to Covid-19 but are not infected.
But the guidance does keep some measures the same. It encourages testing for people with symptoms and their close contacts. It also says people who test positive should stay home for at least five days and wear a mask around others for 10 days. It also continues to recommend that people wear masks indoors in about half the country.
The new guidelines also tailor advice on isolation for people who became very sick from Covid-19. People with moderate symptoms — such as shortness of breath — and those who were hospitalized should stay home for at least 10 days. People with compromised immune systems should now talk to their doctor about ending their isolation after an infection.
There’s new advice on what to do if your Covid-19 symptoms rebound, too. If you end isolation and your Covid-19 symptoms get worse, you should start isolation over again and see your doctor.
Trying to meet people where they are
The changes are an acknowledgment that SARS-CoV-2 may be with us for the long haul. They aim to help people live their lives around Covid-19 with minimal disruptions to work and school. They are also more risk-based, advising people who are at higher risk for severe illness to take more personal precautions than others.
“I think they just overall come into alignment with what people are doing anyway,” says Dr. Peter Chin-Hong, an infectious disease specialist at the University of California at San Francisco.
Chin-Hong thinks some states, like California, will continue to go beyond the CDC’s guidance in their own recommendations, but by and large, he thinks these reflect the prevailing attitudes toward the pandemic. He sees it as a move by the CDC to try to regain the public’s trust.
Other experts, however, feel that the new guidelines don’t go far enough to correct scientific missteps in previous guidance.
“This revision does not go anywhere near enough to correct the problems of flawed recommendations and lack of evidence,” said Dr. Eric Topol, a cardiologist at Scripps Research Institute in La Jolla, California, said in an email to CNN. Topol has been critical of the CDC for months, saying it wasn’t strict enough with its isolation policies for people with Covid.” (C)
“Americans have been given the all clear to dispense with most of the pandemic-centric behaviors that have defined the past two-plus years—part and parcel of the narrative the Biden administration is building around the “triumphant return to normalcy,” says Joshua Salomon, a health-policy researcher at Stanford. Where mitigation measures once moved in near lockstep with case numbers, hospitalizations, and deaths, they’re now on separate tracks; the focus with COVID is, more explicitly than ever before, on avoiding only severe illness and death. The country seems close to declaring the national public-health emergency done—and short of that proclamation, officials are already “effectively acting as though it’s over,” says Lakshmi Ganapathi, a pediatric-infectious-disease specialist at Boston Children’s Hospital. If there’s such a thing as a “soft closing” of the COVID crisis, this latest juncture might be it.” (D)
“There is consensus within the CDC that it “needs to make some changes for how it communicates and how it operates — to be faster, to be nimbler, to use more plain spoken language,” said a CDC official, who was granted anonymity to discuss the changes before they were announced.
“People work incredibly, incredibly hard and care deeply about trying to make sure that the American people have the right information,” the official said. “Maybe the way that a lot of the [Covid-19] response was structured, and some of the incentives that people have here, are just not aligned properly to really put the focus toward getting information to people quickly and how that information can benefit Americans’ health.”
The CDC has come under intense pressure from Americans of all political stripes since the earliest days of the pandemic.
It has fended off a battery of allegations over the course of the crisis, from putting politics over its vow to “follow the science” to bungling messaging to putting Americans’ lives at risk as pandemic restrictions have eased.
As public health officials came under attack across the country, so has the agency’s authority to implement Covid-19 mitigation measures, with critics on one side accusing the agency of federal overreach and critics on the other accusing the agency of not doing enough.
The CDC’s authority has been challenged in multiple court cases. Last year, the Supreme Court struck down its moratorium on evictions during the pandemic. The government has appealed a Florida federal district court judge’s April decision to strike the CDC’s directive that people wear masks on airplanes, trains and other public conveyances.
This year, the agency has struggled to strike a balance between the competing interests of a virus that continues to find ways to evade vaccines and natural immunity, and a public that is weary of taking the sort of precautions that federal and state governments have mandated.
As the Omicron variant swept the nation, the agency came under fire for shortening its recommended quarantine guidelines. This spring, its shift to assessing community-level risk by weighing hospitalizations and the burden on the health care system over the level of transmission was both confusing and put Americans at unnecessary risk, many public health experts say.
The agency’s more recent handling of the monkeypox outbreak, which many epidemiologists worry is now past the point of containment in the country, has again sparked widespread criticism that the CDC is unable to rise to the demands of a complicated public health crisis as it unfolds in real time…
The agency did not offer a specific timeline for when the council would be established, but noted broadly in a statement that “the work ahead will take time and engagement at all levels of the organization.”
The overhaul of the CDC’s approach to communicating with the public has already begun, and will include revamping and streamlining the agency’s web site and creating simplified public health guidance. The agency will also create a new equity office, working across all functions of the organization from hiring to policy to improve the agency’s diversity.
The overhaul seeks to change “the CDC’s culture” by moving away from a “misaligned” approach of incentivizing staff to publish their research in scientific publications and instead encouraging personnel to produce research and data aimed at public health policy and action, the CDC official said.” (E)
“Some changes still are being formulated, but steps announced Wednesday include:
—Increasing use of preprint scientific reports to get out actionable data, instead of waiting for research to go through peer review and publication by the CDC journal Morbidity and Mortality Weekly Report.
—Restructuring the agency’s communications office and further revamping CDC websites to make the agency’s guidance for the public more clear and easier to find.
—Altering the length of time agency leaders are devoted to outbreak responses to a minimum of six months — an effort to address a turnover problem that at times caused knowledge gaps and affected the agency’s communications.
—Creation of a new executive council to help Walensky set strategy and priorities.
—Appointing Mary Wakefield as senior counselor to implement the changes. Wakefield headed the Health Resources and Services Administration during the Obama administration and also served as the No. 2 administrator at HHS. Wakefield, 68, started Monday.
—Altering the agency’s organization chart to undo some changes made during the Trump administration.
—Establishing an office of intergovernmental affairs to smooth partnerships with other agencies, as well as a higher-level office on health equity.
Walensky also said she intends to “get rid of some of the reporting layers that exist, and I’d like to work to break down some of the silos.” She did not say exactly what that may entail, but emphasized that the overall changes are less about redrawing the organization chart than rethinking how the CDC does business and motivates staff.
“This will not be simply moving boxes” on the organization chart, she said.” (F)
THE THREE ENVELOPES
“A new CEO was hired to take over a struggling company. The CEO who was stepping down met with him privately and presented him with three numbered envelopes. “Open these if you run into serious trouble,” he said.
Well, three months later sales and profits were still way down and the new CEO was catching a lot of heat. He began to panic but then he remembered the envelopes. He went to his drawer and took out the first envelope. The message read, “Blame your predecessor.” The new CEO called a press conference and explained that the previous CEO had left him with a real mess and it was taking a bit longer to clean it up than expected, but everything was on the right track. Satisfied with his comments, the press – and Wall Street – responded positively.
Another quarter went by and the company continued to struggle. Having learned from his previous experience, the CEO quickly opened the second envelope. The message read, “Reorganize.” So he fired key people, consolidated divisions and cut costs everywhere he could. This he did and Wall Street, and the press, applauded his efforts.
Three months passed and the company was still short on sales and profits. The CEO would have to figure out how to get through another tough earnings call. The CEO went to his office, closed the door and opened the third envelope. The message said, “Prepare three envelopes.” (G)
- A.WATCH: CDC urges ‘up to date’ COVID shots but won’t change definition of ‘fully vaccinated’, By Zeke Miller and Mike Stobbe, https://www.pbs.org/newshour/health/cdc-urges-up-to-date-covid-shots-but-wont-change-definition-of-fully-vaccinated
- B.Walensky, Citing Botched Pandemic Response, Calls for C.D.C. Reorganization, By Sharon LaFraniere and Noah Weiland, https://www.nytimes.com/2022/08/17/us/politics/cdc-rochelle-walensky-covid.html?smid=nytcore-ios-share&referringSource=articleShare
- C.CDC ends recommendations for social distancing and quarantine for Covid-19 control, no longer recommends test-to-stay in schools, By Brenda Goodman and Elizabeth Cohen, https://www.cnn.com/2022/08/11/health/cdc-covid-guidance-update/index.html
- D.The Pandemic’s Soft Closing, By Katherine J. Wu, https://www.theatlantic.com/health/archive/2022/08/cdc-weakened-covid-guidelines-pandemic-preparedness/671147/
- E.CDC director orders agency overhaul, admitting flawed Covid-19 response, By KRISTA MAHR, https://www.politico.com/news/2022/08/17/cdc-agency-overhaul-covid-19-response-00052384
- F.After criticism over COVID, the CDC chief plans to make the agency more nimble, https://www.npr.org/2022/08/17/1117904729/cdc-reorganization-walensky-covid
- G.The CEO and the Three Envelopes, https://kevinkruse.com/the-ceo-and-the-three-envelopes/
PART 1. January 21, 2020. CORONAVIRUS. “The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.”
PART 5. February 12, 2020. CORONAVIRUS. “In short, shoe-leather public health and basic medical care—not miracle drugs—are generally what stop outbreaks of emerging infections..”
POST 28. May 23, 2020. CORONAVIRUS. ““You’ve got to be kidding me,”..”How could the CDC make that mistake? This is a mess.” CDC conflates viral and antibody tests numbers.
POST 34. June 26, 2020. CORONAVIRUS. CDC Director Redfield… “the number of coronavirus infections…could be 10 times higher than the confirmed case count — a total of more than 20 million.” As Florida, Texas and Arizona become eipicenters!
POST 36. July 2, 2020. CORONAVIRUS. “There’s just a handful of interventions proven to curb the spread of the coronavirus. One of them is contact tracing, and “it’s not going well,” (Dr. Anthony Fauci)..
POST 40. July 27, 2020. CORONAVIRUS.” One canon of medical practice is that you order a test only if you can act on the result. And with a turnaround time of a week or two, you cannot. What we have now is often not testing — it’s testing theater.”
POST 44. September 1, 2020. CORONAVIRUS. “The CDC…modified its coronavirus testing guidelines…to exclude people who do not have symptoms of Covid-19.” (While Dr. Fauci was undergoing surgery.) A White House official said: “Everybody is going to catch this thing eventually..”
POST 46. September 17, 2020. CORONAVIRUS. “Bill Gates used to think of the US Food and Drug Administration as the world’s premier public-health authority. Not anymore. And he doesn’t trust the Centers for Disease Control and Protection either….”
POST 67. November 13, 2020. CORONAVIRUS. “When all other options are exhausted, the CDC website says, workers who are suspected or confirmed to have COVID-19 (and “who are well enough to work”) can care for patients who are not severely immunocompromised — first for those who are also confirmed to have COVID-19, then those with suspected cases.”
POST 68. November 14, 2020. CORONAVIRUS. The CDC “now is hewing more closely to scientific evidence, often contradicting the positions of the Trump administration.”..” “A passenger aboard the first cruise ship to set sail in the Caribbean since the start of the pandemic has tested positive for coronavirus..”
POST 117. January 23, 2021. CORONAVIRUS. 1.Dr. Fauci:“The idea that you can get up here….”and.. let the science speak”… “It is somewhat of a liberating feeling.” 2.updated CDC guidance:”.. providers could give the second dose up to six weeks after the first dose..” 3.Dr. Fauci: people would be “taking a chance” if they follow the CDC’s updated guidance.
POST 128. February 14, 2021. CORONAVIRUS. “The Centers for Disease Control and Prevention released new research on Wednesday that found wearing a cloth mask over a surgical mask offers more protection against the coronavirus, as does tying knots on the ear loops of surgical masks…
POST 129. February 15, 2021, CORONAVIRUS. “ “The CDC released its much-anticipated, updated guidance to help school leaders decide how to safely bring students back into classrooms, or keep them there.”…” For politicians, parents and school leaders looking for a clear green light to reopen schools, this is not it.”
POST 139. March 8, 2021. CORONAVIRUS. CDC Issues First Set of Guidelines on How Fully Vaccinated People Can Visit Safely with Others…” In practice, that means fully vaccinated grandparents may visit unvaccinated healthy adult children and healthy grandchildren of the same household without masks or physical distancing.” (C)
POST 174. July 1, 2021. CORONAVIRUS. “..while the WHO is encouraging people to keep wearing masks even if they’re vaccinated, Dr. Anthony Fauci says it doesn’t look like the CDC currently plans to change its guidelines.” … health officials in Los Angeles recommended that “everyone, regardless of vaccination status, wear masks indoors in public places as a precautionary measure.”..”
POST 184. August 1, 2021. CORONAVIRUS. “The coronavirus could be “just a few mutations potentially away” from evolving into a variant that can evade existing COVID-19 vaccines, CDC director Rochelle Walensky said..” (A) “The Delta variant is more transmissible than the viruses that cause MERS, SARS, Ebola, the common cold, the seasonal flu and smallpox, and it is as contagious as chickenpox..” (I)
POST 200. September 23, 2021. CORONAVIRUS. CDC Director overrides a recommendation of its scientific advisors saying “that people can get a booster if they are ages 18 to 64 years and are health-care workers or have another job that puts them at increased risk of being exposed to the virus.”…“In a pandemic, even with uncertainty, we must take actions that we anticipate will do the greatest good.”
POST 237. February 27, 2020. CORONAVIRUS. “Decision-makers are increasingly embracing the reality that we will have to “learn to live with” the coronavirus. But how will they know when to impose or lift restrictions?” “Now, the CDC’s “Covid-19 community level” metrics are based on three pieces of data in a community: new Covid-19 hospitalizations, hospital capacity and new Covid-19 cases.”
POST 243. March 28, 2022. CORONAVIRUS. “…the US Food and Drug Administration is planning authorize a fourth dose of the Pfizer and Moderna mRNA vaccines for adults over age 50 next week.”…”The decision to make fourth doses available now will bypass independent groups of scientific advisers for both the FDA and CDC, which would normally meet and publicly review the available science and then make recommendations to the agencies.”
POST 247. April 23, 2020. CORONAVIRUS. “The DOJ lawyers tasked with defending the CDC’s mask mandate authority have warned Biden administration officials that continuing to push the legal fight over the mask mandate could backfire, if the conservative-leaning appeals court upholds the order.”….”A Supreme Court ruling upholding the decision to strike down the mask mandate would make the Florida judge’s conclusions about CDC authority binding nationwide.”
POST 259. June, 2022. Monkeypox. ”If HIV and Covid-19 were wake-up calls for the government to prioritize public health, monkeypox shows the consequences of hitting the snooze button too many times. HIV showed the importance of creating an infrastructure of health care workers who can provide approachable, competent care for stigmatized infections. Covid-19 revealed the make-or-break nature of coordinated logistics and communications.”
POST 260. July7, 2022. CORONAVIRUS. “Fauci says he’s taking 2nd course of Paxlovid after experiencing rebound with the antiviral treatment.”…” At this time, CDC states that there is currently no evidence that an additional treatment of Paxlovid, is needed, following a rebound.” So what happened to “following the science”?
POST 264. July 30, 2022. Monkeypox. “The federal response to monkeypox, including the limited testing capacity, has echoes of how public health authorities initially mismanaged Covid-19.”
POST 265. August 4, 2022. Monkeypox. “The shortage of vaccines to combat a fast-growing monkeypox outbreak was caused in part because the Department of Health and Human Services failed early on to ask that bulk stocks of the vaccine it already owned be bottled for distribution…”