Aug 22, 2022

The changes at the CDC.

The changes at the CDC.

The agency changed its Covid guidelines and announced an overhaul.

I’m Isaac Saul, and this is Tangle: an independent, ad-free, subscriber-supported politics newsletter that summarizes the best arguments from across the political spectrum on the news of the day — then “my take.”

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Today's read: 12 minutes.

We break down the new CDC guidelines and the organizational overhaul. Plus, a question about what politicians should prioritize.

CDC director Rochelle Walensky (center) on a trip in Uganda. Photo: U.S. Mission Uganda
CDC director Rochelle Walensky (center) on a trip in Uganda. Photo: U.S. Mission Uganda

ICYMI.

On Friday, we published a subscribers-only edition prompted by Steven Crowder's tweet in which he challenged his followers to "Name me an institution that hasn’t been overtaken by the left." This edition explored the question of whether liberals or conservatives have more power and influence, and it drove a huge number of responses and debate among Tangle subscribers. If you're a paying subscriber and missed it, or want to read a brief preview and subscribe to read it, you can click here.


Quick hits.

  1. The daughter of a close ally to Vladimir Putin was killed in a car explosion in Moscow. Ukraine denied any involvement, but Russia's counterintelligence agency accused Ukrainian spies of the assassination. (The bombing)
  2. Early polling data shows the Mar-a-Lago search bolstered support for former President Donald Trump among Republican voters. (The bump)
  3. The Islamic militant group al-Shabaab stormed a popular hotel in Somalia's capital, killing 21 people. (The attack)
  4. Senate Minority Leader Mitch McConnell predicted Republicans would have a hard time flipping the Senate due to candidate quality. (The comments)
  5. A United States judge sentenced the member of an Islamic State militant cell known as "The Beatle" to life in prison. (The sentence)
  6. BREAKING: Anthony Fauci says he is stepping down from his position in December. (The announcement)

Our 'Quick Hits' section is created in partnership with Ground News, a website and app that rates the bias of news coverage and news outlets.


Today's topic.

The Centers for Disease Control and Prevention (CDC). In the last two weeks, the CDC has been at the center of two major stories.

First, the agency announced the relaxation of existing Covid-19 guidelines, dropping the recommendation that Americans quarantine if they come into close contact with someone who is infected with the virus. If a person is unvaccinated, they should wear a high quality mask for 10 days and get tested after five days. The agency also said people no longer need to stay at least six feet away from each other and don't have to test after exposure if they are not experiencing symptoms.

While many states have long abandoned social distancing precautions, the changes are a major stepping stone for schools across the country who will also no longer need to do routine daily testing. The update ended the so-called "test to stay" policies, which required kids who had been exposed to Covid-19 to obtain a negative test to return to school. Indoor masking continues to be recommended in communities where transmission is high, which is still about 34% of the country.

The changes come after over two and a half years of the pandemic, and the CDC says they are driven by the fact that an estimated 95% of Americans have acquired some immunity to the virus via infection or vaccine.

Meanwhile, daily Covid-19 rates this summer have remained steady at almost 100,000 new cases per day, with 300 to 400 deaths every day.

Then, last week, CDC Director Rochelle Walensky announced that the organization would undergo a shake-up, saying it fell short in responding to Covid-19 and needs to become more nimble and communicate better. CDC leaders are calling it a "reset," and said they plan to make internal staffing changes and speed up data releases. The agency has faced immense criticism for a slow response to Covid-19 and an inability to act quickly enough against rising health threats like monkeypox.

Among other changes, according to the Associated Press, the agency plans to release more preprint scientific reports before peer review, restructure the communications office, and alter the agency's organization chart to undo changes made during the Trump administration and help reduce future turnover. In an effort to reduce turnover, the agency also created a six month time period that leaders are dedicated to specific outbreak responses.

“It’s not lost on me that we fell short in many ways," Walensky said about Covid-19, “We had some pretty public mistakes, and so much of this effort was to hold up the mirror ... to understand where and how we could do better."

Below, we're going to take a look at some commentary from the right and left on the latest guidance and the calls for CDC overhaul.


What the right is saying.

  • Many on the right criticize the CDC changes for being so late.
  • They call out the mistakes the CDC made, and the failure to consistently align their policies with science.
  • Some say the same mistakes are still playing out right now during the monkeypox outbreak.

In The New York Post, Karol Markowicz said it was "too little, too late."

"The agency now believes we should be taking an individual approach to mitigating our COVID risk. In layman’s terms, we are all Florida 2020 now," Markowicz said. "The new guidance suggests ending 'test to stay' so kids exposed to someone with COVID-19 can remain in school. Of course, this was only related to known exposure. People are exposed to COVID all the time, but only children who were aware of that exposure were punished. Kids lost so much throughout the pandemic because of terrible, irrational CDC guidance like this. The fresh guidance also says people without symptoms no longer need to be routinely tested...But most important, the agency has finally faced some truths about the vaccine that it should have long ago. 'CDC’s COVID-19 prevention recommendations no longer differentiate based on a person’s vaccination status because breakthrough infections occur.'

"And it’s admitted that 'persons who have had COVID-19 but are not vaccinated have some degree of protection against severe illness from their previous infection.' Cities across the country fired teachers, firefighters, health care staffers, police officers, sanitation workers and so many others because they refused to get vaccinated," she wrote. "Many of these people had worked through the early days of the pandemic — and contracted COVID many times over — while we baked banana bread and patted ourselves on the back for ordering from Uber Eats. Now the CDC acknowledges this was the wrong thing to do. Whoopsie! The new guidance is all fine and good, sane even, but it’s August 2022 and fully absurd that the CDC is only now recognizing that people aren’t staying six feet apart and that a previous COVID-19 infection offers a layer of protection similar to the vaccine."

In The Wall Street Journal, John Tierney said Walensky and Anthony Fauci are doubling down on a failed response.

"Lockdowns and mask mandates were the most radical experiment in the history of public health, but Dr. Walensky isn’t alone in thinking they failed because they didn’t go far enough. Anthony Fauci, chief medical adviser to the president, recently said there should have been 'much, much more stringent restrictions' early in the pandemic," Tierney wrote. "The World Health Organization is revising its official guidance to call for stricter lockdown measures in the next pandemic, and it is even seeking a new treaty that would compel nations to adopt them. The World Economic Forum hails the Covid lockdowns as the model for a 'Great Reset' empowering technocrats to dictate policies world-wide.

"Yet these oppressive measures were taken against the longstanding advice of public-health experts, who warned that they would lead to catastrophe and were proved right," Tierney wrote. "U.S. states with more-restrictive policies fared no better, on average, than states with less-restrictive policies. There’s still no convincing evidence that masks provided any significant benefits. When case rates throughout the pandemic are plotted on a graph, the trajectory in states with mask mandates is virtually identical to the trajectory in states without mandates. (The states without mandates actually had slightly fewer Covid deaths per capita.) International comparisons yield similar results. A Johns Hopkins University meta-analysis of studies around the world concluded that lockdown and mask restrictions have had 'little to no effect on COVID-19 mortality.'”

In The New York Times, Ross Douthat said the CDC continues to "lead from behind."

"In an ideal view of how expertise informs society, C.D.C. guidelines would track the evolving nature of the pandemic closely and provide a road map back to normalcy. In reality, the C.D.C. has been consistently behind — behind evolving scientific knowledge, behind the curve of Covid’s evolution, behind how most Americans have already adapted," Douthat wrote. "As my colleague Emily Anthes put it, gently, the new guidelines 'effectively acknowledge the way many Americans have been navigating the pandemic for some time.' Except, of course, in those institutions that still dutifully try to respect public health authority — like, say, the public schools that have been stuck trying to implement early-pandemic recommendations like the 'six-feet rule,' or the 'three feet in masks in classrooms and six feet everywhere else' alternative, which the new guidelines finally jettisoned.

"The arbitrariness of those distances was widely understood even before the contagiousness of the Delta variant made the rules still more absurd. Yet it’s taken a year, at least, for official science to finally catch up with the real thing," he wrote. "That lag is, at this point, more familiar than maddening. But it’s genuinely infuriating to see Covidian patterns replaying with a completely different disease — the broadly non-fatal but still-pretty-terrible monkeypox epidemic, which the Biden administration just officially declared a public health emergency. If Covid-19 probably would have overwhelmed even the most effective public-health bureaucracy, monkeypox — which as of now is mostly spread through close human contact, especially sexual contact, and for which we already have a vaccine — offered a chance to replay the Covid outbreak at a milder degree of difficulty. Yet the same kinds of bureaucratic failure were repeated — too little testing early on, too little interagency coordination, too little preparation for what should have been predictable challenges."


What the left is saying.

  • The left is divided, with some critical of the new guidelines because Covid-19 is still spreading rapidly, while others say it's time for bigger changes.
  • Some say the CDC changes need to be thought of as the beginning of preparing for the next pandemic.
  • Others say the updated guidance for schools is mostly right.

In NBC News, Brian Castrucci said "Covid isn't done with us, whatever the CDC says."

"It’s been two and a half years. More than 92 million people in the United States have gotten sick and 1 million have died. While it’s true that we are no longer running out of ventilators and far fewer Americans are dying, there are still more than 34,000 hospitalizations and about 400 deaths every day from Covid, and those two trend lines are flat — not getting much worse or better; a steady toll of sickness and death," Castrucci said. "This new guidance may be signaling a strategic shift in the nation’s prevention strategy, but is everyone equally ready for that shift? If you are under 60, healthy, vaxxed and boosted, the data suggest you are very unlikely to become severely ill or die from Covid. But what about all the people who don’t fit those criteria? What if you are among the more than half of all Americans with a chronic disease, or one of the 7 million-plus who are immunocompromised?

"In a world where special shopping hours and accommodations for those at greater risk of hospitalization and death are long gone, these relaxed criteria further leave behind people who are chronically ill, disabled or immunocompromised," he wrote. "How is it that we’ve become numb to losing 400 people each day? Just think what you would do to save one person from drowning. Would you dive in to save them, or at least throw them a rope? How hard would you fight to save another human from imminent death? And why doesn’t that concern for one life translate to saving 400 people — day after day after day?... While the guidelines are not binding laws, they will make it increasingly difficult for states and cities to maintain or propose more stringent preventive policies. And they will leave responsible and vulnerable people who are trying to protect themselves by wearing a mask open to increased ridicule, isolation and even discrimination."

The Washington Post editorial board criticized the agency and said changes are needed.

"The agency dropped the ball on developing an early diagnostic test for the coronavirus. Once a trusted source of public information nationally and globally, in the first year of chaos and confusion it went quiet under pressure from the Trump White House. Under the Biden administration — which promised competence and science-based policies — guidance and decision-making from the CDC on masking, isolation and booster doses have been repeatedly faulted as slow, opaque and confusing," the board said. "A swift internal review ordered by Dr. Walensky concluded the agency needs to share its scientific findings and data more quickly; translate science into practical, easy-to-grasp policy; prioritize its public health communications practices; and respond with greater alacrity to public health emergencies.

"Some fixes seem logical, such as rewiring the agency to expedite its scientific findings, creating incentives for experts to report promptly rather than hold back their papers for publication. Also, the agency must overcome its long-standing troubles with data-sharing and modernize its laboratories," the board wrote. "Finding a way to deliver crystal-clear, action-oriented communications to the American people to protect their health should not be rocket science. Along with the CDC’s own troubles, the pandemic response was hampered from the outset by White House meddling under President Donald Trump... President Biden has vowed to rely on the science. But the pandemic response remains under a White House coordinator; shortly before monkeypox became an emergency, it, too, was put under a White House overseer. The goal should be for experts at retooled public health agencies to fight health crises, not politicians in the White House."

In The Washington Post, Dr. Leana Wen said the CDC is ushering in a new normal.

"The newly released CDC guidance that eases covid-19 precautions in schools has it mostly right: At this point in the pandemic, the emphasis must shift from universal mandates to individual decisions to minimize the disruption of in-person learning," she wrote. "Previous guidance from the Centers for Disease Control and Prevention was appropriate for the last school year, but it is out of step with the situation today. It referenced social distancing and separating kids into cohorts, which posed practical difficulties for many schools. It urged masking at schools in communities with high levels of covid transmission, which is the case for more than 40 percent of the United States.

"Masks and distancing are mitigation measures that were needed before vaccines became widely available for school-age children. That’s no longer the case. Everyone 6 months and older can be vaccinated, and those 5 years old and above can be boosted. Moreover, the vast majority of children have been exposed to covid," she wrote. "The CDC’s new guidance removes blanket distancing and cohorting requirements. Importantly, it also allows children exposed to covid to stay in class. This should prevent entire classrooms from being forced to stay home because one child tested positive and will come as a huge relief to parents who have seen how the unpredictability of covid restrictions negatively affects their work and their children’s education."


My take.

Reminder: "My take" is a section where I give myself space to share my own personal opinion. It is meant to be one perspective amid many others. If you have feedback, criticism, or compliments, you can reply to this email and write in. If you're a paying subscriber, you can also leave a comment.

I'll start with the good.

It's good that the CDC is looking to overhaul itself. It's good that a public health official like Dr. Rochelle Walensky is openly (and directly) taking responsibility for the agency's failures. It's good that she is doing this without any qualifiers or excuses, and it's tremendous that she is saying the CDC needs to be a results-based organization. One could easily imagine a lesser leader taking the stance that the CDC did the best it could with what it had, that the public made some of its own reckless choices, and that the agency would change little. She isn't doing that — she is owning the failures and working to remedy them. Kudos to her.

It also seems good that the agency is changing its guidelines in a nearly wholesale fashion. Frankly, I was surprised to see some of them were still the official line. The recommendation to give a six-foot distance indoors has long been retired by most of the public, and with such high rates of both vaccination and infection in the U.S., it seems that everyone I know has some level of immunity — something that, for good reason, changes their behavior and calculus.

Personally, I'm fully vaccinated, boosted, and have now had Covid twice. The second time I got it, I was taking Paxlovid within hours of testing positive, my symptoms were gone in three days, and I was testing negative on day five — with no bounce back case. Though I know the risk of long-Covid is very real, I'm going to act much differently now than I did in the first few months of the pandemic with so many added layers of protection. And with good reason, since much of the country is in a similar position.

Now, let’s discuss the bad. The CDC's failures are too numerous to really cover here, but most of them fall into buckets of being late to the party or clearly the product of politicization. At this point the hits are probably familiar to you: The initial (mis)guidance on masks, the flip-flopping on closures and lockdowns during the George Floyd protests, the irrational restrictions on outdoor activity, the lack of consideration for the boost in immunity from being infected, the misunderstanding of the tremendous efficacy of children's immune systems against the virus, and so on. The dynamics of these things were often broadly understood well before the agency incorporated that knowledge into its official protocol, which is why it's now being described as slow and derelict.

What still seems largely under-discussed is the degree to which the CDC should be a function of American life rulemaking going forward. On the one hand, a cautious and deliberate organization is exactly what you want from your national health guidance makers. On the other hand, when you consider that caution produces guidance like not eating sushi or medium rare steak, we need to be more discerning about the degree to which we empower such an agency to organize our lives. How and when we translate CDC guidance into law is a complicated question we still need to reckon with.

Of course, there are millions of Americans who are high-risk, immunocompromised or disabled that may be more than wary about these latest guidelines. I'm not uninitiated on those fears. When the pandemic struck, my mom was finishing up chemotherapy, and the first few months of my pandemic life, with no vaccines, no treatment, and the person I love most in every high-risk category known to man, were incredibly stressful. But it's undeniable that the fundamentals of the pandemic have long since changed, and in some ways the data we have should be encouraging.

95% of all Americans have some level of strong immunity. We know that three out of four children have now had Covid, and all kids over the age of six months can be vaccinated. We know instances of children getting very sick are still extremely rare. However rampant breakthrough infections are among the vaccinated, it's clear vaccines dramatically reduce your chance of dying. It also appears new variants, which are far more contagious, are less likely to result in long Covid. Treatments are effective. And while the efficacy of mask mandates has not been proven, the efficacy of masks has. For folks who are immunocompromised or elderly, we now know that one-way masking works (especially if you’re vaccinated and properly wearing a quality mask).

Of course, the encouraging numbers we see now follow a million dead and millions of others left with long Covid. Under two different administrations, the agency has failed in most conceivable metrics. So, yes. The CDC needs an overhaul. Its guidelines needed to change. And as it has through the pandemic, the concession of both of those points seemed to have come too late. Better late than never, sure, but hopefully whatever changes are ushered in can make the agency more agile and responsive for our next Covid-like pandemic.


Your questions, answered.

Q: How should our elected officials vote? Aligned with political party platform? Aligned with constituent values/views? Aligned with personal beliefs? Some combination depending on the situation(s)? Do you have examples of how politicians have successfully or unsuccessfully employed those strategies? Thank you for all that you do!

— Eric, Virginia Beach, Virginia

Tangle: This is a great question. I'm not sure there is any one formula I would prescribe, but I do think (if I were a member of Congress) there's a pyramid of priorities that I'd have.

First and foremost is to your constituents. Vote in line with what you ran on. If you campaign, make promises, and get elected, your primary goal should be to fulfill those promises. Presumably those things are aligned with your constituents’ values and views, since they elected you, but when new issues arise I think you should lean into what constituents want.

Second is personal beliefs. I think politicians get elected not just on their platform but on their character. And they are expected to lead. So politicians should also be prepared to make tough votes when they fully believe taking a position is right. I think this should be secondary to fulfilling your promises, but still highly prioritized.

Third, I'd love to see party line voting de-emphasized, for obvious reasons. But it's worth noting that falling in line with the party can also be advantageous to get your constituents what they want (or to vote your conscience) more freely down the road. So to do one and two, sometimes you need to fall in line. This is just political reality.

I think the obvious example here is Joe Manchin. I'm not sure how successful he has been, but he has taken a lot of hard votes where he has had to weigh the opinion of his conservative constituents, his own personal views and priorities, and whether to fall in line with the party he campaigned with. Clearly, it is not an easy calculus to make.

Want to ask a question? You can reply to this email and write in (it goes straight to my inbox) or fill out this form.


A story that matters.

The cost of raising a child through the age of 17 is now over $310,000, according to a Brookings Institute estimate. A married, middle-income couple with two children would spend $310,605 — about $18,271 per year — to raise a younger child born in 2015 through 2017. The multiyear total is up 9% from two years ago, reflecting the rising costs of goods and services driven by inflation. “A lot of people are going to think twice before they have either a first child or a subsequent child because everything is costing more,” Isabel Sawhill, a senior fellow at Brookings, told The Wall Street Journal. “You also may feel like you have to work more.” WSJ has the story here (paywall).


Numbers.

  • 44%. The percentage of Americans who said they trust what the CDC has to say about the pandemic, according to a January 2022 NBC News poll.
  • 58%. The percentage of Americans who say America's best years are behind it, according to a new NBC News poll.
  • 68%. The percentage of Republicans who express a high level of interest in the upcoming midterm elections.
  • 66%. The percentage of Democrats who express a high level of interest in the upcoming midterm elections.
  • 57%. The percentage of voters who say the investigations into former President Trump should continue.
  • 257,110. The number of migrant children released into the U.S. since President Biden took office, according to U.S. Customs and Border Protection data.

Have a nice day.

33 years ago, Brian Dahl put a message in a bottle as a sixth grader. A few months ago, that message was discovered by a salvage diver named Billy Mitchell, who made it his mission to find out who had written the message. When Mitchell finally got a lead, he discovered that Brian had died at the age of 29. Eventually, Mitchell connected with Brian's dad, Eric, who learned that the message had been cast by his late son when he was just a sixth grader. It traveled 200 miles. Eric, his wife and his son decided to go meet Brian's sixth grade teacher and reconnect with her. Now, the group considers themselves family. Brian "was victorious in his life because of the relationships he established, the bonds with other people," Eric told USA Today about his son. "And he continues to inspire connections." USA Today has the tale.


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Isaac Saul
I'm a politics reporter who grew up in Bucks County, PA — one of the most politically divided counties in America. I'm trying to fix the way we consume political news.