Dean's COVID-19 Commentary

During the prior administration, the role of the Centers for Disease Control and Prevention (CDC) in guiding the COVID-19 pandemic response was greatly diminished from what it should have been. Recall that Nancy Messonnier, former director of the CDC’s National Center for Immunization and Respiratory Diseases, was silenced after her straightforward and accurate warning about community spread of SARS-CoV-2 on February 25, 2020. The CDC director during the Trump administration, Robert Redfield, became invisible. He and others are now telling alarming stories about what happened during the administration, further affirming the toxic influence of political considerations on public health. Change is needed.

Last week, the New York Times profiled the current CDC Director, Rochelle Walensky, in an article entitled “The C.D.C.’s New Leader Follows the Science. Is That Enough?” The article emphasizes the need to restore trust in the CDC. In my opinion, the CDC needs to re-establish credibility with research and academic communities, state and local public health agencies, and the public. The agency’s performance around the pandemic was mixed and the CDC’s reputation was tarnished by some of its key clients—the executive branch and some in Congress. Dr. Walensky has a tough job ahead and, per the article, potential critics waiting to pounce. 

The president appoints the CDC director, who heads a vast administrative structure that includes the centers and other entities. The leadership positions are filled with a mix of career public health professionals, some beginning their careers in the Epidemic Intelligence Service (EIS), and recruits from outside the CDC. For example, my Johns Hopkins colleague, Pat Breysse, heads the National Center for Environmental Health/Agency for Toxic Substances and Disease Registry (ATSDR). As with other federal agencies, career professionals maintain the core functions. Political appointees come and go. 

Anne Schuchat, the CDC’s principal deputy director, has announced her resignation from the CDC. Anne exemplifies the CDC staff's dedication to public health. Read her New York Times editorial, “What I learned in 33 years at the C.D.C.” Here are some of her pithy messages:

While I was chair of the Department of Preventive Medicine at the University of Southern California, Anne’s message as our graduation speaker echoed these comments. I urge the Colorado School of Public Health community to read her commentary.
 

Kamala Harris’s trip to Guatemala and Mexico City without a stop at the border proved controversial last week. The vice president said repeatedly that she went to Guatemala to explore the “root causes” of the continued migration from Central America—that is, what factors are driving the exodus and can they be addressed? Her approach is a reminder of the parable about the physician and the epidemiologist confronted by a river full of drowning people. The physician rushes in to save them while the epidemiologist heads upstream to find out why they are in the river. I support the vice president’s root cause approach to the ever-challenging problem of people seeking refuge from the impossibilities of life in Guatemala, El Salvador, and Honduras by coming to the United States. This is a problem with public health consequences, needing downstream and upstream solutions. 

I forecasted that Colorado’s epidemic curve would eventually decline as vaccination continues. Last week’s numbers signal that Colorado’s epidemic may finally do so. Yesterday’s count of Coloradans hospitalized with COVID-19 was 334, a drop of 120 since June 1. For context, last summer’s low was around 130—a level that might be reached in another month. And, turning to another forecast, warm weather is here.