How the CDC failed public health officials fighting the coronavirus – USA TODAY

The week America lost the fight against the new coronavirus, the nations premier health agency promised local officials it had the virus under control.

It was the third week in February. Senior leaders at the Centers for Disease Control and Prevention repeatedly brushed off calls to take COVID-19 more seriously.

They dismissed concerns from Minnesota to Hawaii that their plan to contain the outbreak by screening overseas travelers was riddled with inconsistencies.

They punted questions from state officials worried that returning travelers could spread the coronavirus when they showed no symptoms.

For days, they refused to test a California woman because she had not traveled overseas. When she tested positive, the CDC downplayed the fact that the patient who became known as Patient Zero proved the virus was spreading within the USA.

At the beginning of the coronavirus outbreak, CDC Director Robert Redfield insisted the national threat was low.Pool, Getty Images

Instead, CDC Director Robert Redfield went on national television and repeated seven times that the threat to the nation remained low.

The American public needs to go on with their normal lives, he said.

As the virus raced across America, state and local authorities sought help from the CDC, the $7billion federal agency established to lead the nation through pandemics.

Instead of answers, many received slow, confusing and conflicting information or no response at all a USA TODAY investigationfound. Reporters reviewed 42,000 pages of emails and memos obtained from health departments and interviewed more than 100 community leaders and public health experts, including current and former CDC officials.

Theagency has received widespread scrutiny for yielding topolitical pressure from the White House. These interviews and records provide the most extensive look yet at how the CDC, paralyzed by bureaucracy, failed to consistently perform its most basic job: giving public health authorities the guidance needed to save American lives during a pandemic.

Communities were left to make life-or-death decisions about testing, personal protection and reopening.

Health officials flooded the CDC with hundreds of phone calls and emails. Many questions went unanswered. In other cases, the agency response amounted to you decide.

In Nevada, the states top infectious disease scientist called the CDC begging for a list of travelers coming from China. A flustered agency representative hung up on her.

In Kentucky, a CDC official recommended that visitors continue to be allowed into nursing homes because they might not get another chance to visit family members. In an email,he wrote, Let people choose.

Authorities in at least 13 states questioned CDC guidance that contradicted either scientific evidenceor information put out by the CDC itself, records show. At times, rank-and-file CDC representatives, aware of their own leaderships lagging response,told state health departments to consider adopting guidance from academic studies or other states.

In more than two dozen news briefings, congressional hearings and other public statements from January to April, the CDC downplayed the potential harm from the virus.

In the most extreme cases, the CDC undermined health officials advocatinga more aggressive approach to controlthe spread.

The agency went so far as to edit a government science journal in late March to remove a Washington state epidemiologists call fortesting throughout senior assisted-living facilities. I would be careful promoting widespread testing, the CDC editor noted, according to drafts obtained by USA TODAY.

The CDC declined to make senior leaders available forinterviews and did not answer detailed questions about USA TODAYs findings.In a statement emailed by CDC spokesman Tom Skinner,the agency said it has executed its mission to protect Americans and worked to support state and local health departments with accurate information.

CDC has based decisions on known science and data available and has been clear that, as more became known about the virus, guidance and recommendations would evolve and change, the statement said.

The pandemic has presented unprecedented challenges, and many health officials told USA TODAY they were grateful for the CDCs help. CDC has been an incredible partner to us,said Dr. Kathy Lofy, the health officer in Washington state.

The White Househandicapped the agency from the start. Last week, journalist Bob Woodward disclosed that President Donald Trump told him in early February that his administration knew the virus was spreading through the air and killing people at a higher rate than the flu, but Trump publicly minimized the risks.

Former CDC officers who held senior leadership roles under Republican and Democratic presidents told USA TODAY the agency that once commanded global respect collapsed when communities needed it most.

They are incapable of responding to the emergency, said Dr. Pierre Rollin, former deputy chief of a CDC branch on viral pathogens and one of the worlds most renowned infectious disease experts.

Nearly 200,000 have died of COVID-19in the USA, and more than 6.6 million have been infected. The CDC suspects 10 times more Americans have caught the virus, but official counts remain skewed by its inability to fix chronic testing issues.

Without a national plan to guide them,authorities lost months debating whether to require face masks and when best to reopen businesses and schools.

Last month, the CDC reversed critical testing guidance for people exposed, saying those without symptoms did not need to be tested. Health officials and even the staunchest CDC champions lambasted the move. Some states are choosing to ignore it.

The CDCs own scientific advisersfear the agencys multiplefailures since February have destroyed the publics confidence, which will be crucial to successfully roll out a vaccine.

The leadership role of the CDC didnt hold firm,Dr. Brent Pawlecki, the chief healthofficer at Goodyear, told agency leaders in July as a panel of independent scientists reviewed the agencys early response. It has created a lot of confusion and unfortunately a lot of distrust.

Cynthiana, Kentucky, a community of 6,400 residents without a four-lane road, took the CDCs advice to continue life as normal.

No one paid much attention when the tenor with the best voice in thechurch choir called in sick after Sunday practice. Then, alto Julia Donohues migraine turned into a fever. The 28-year-old Walmart cake decorator, who liked to bake brownies for her church family, was airlifted to intensive care as her oxygen levels plunged.

Donohues positive test for COVID-19 was the first confirmed case in the state. Kentucky joined more than 20 states reporting their earliest brushes with coronavirus during the first week of March.

Show captionHide captionJulia Donohue, 28, a cake decorator from Cynthiana, Ky., was the first in her state to test positive for COVID-19. The rural town, which has...Julia Donohue, 28, a cake decorator from Cynthiana, Ky., was the first in her state to test positive for COVID-19. The rural town, which has a population of about 6,000, saw an early outbreak of the virus.Jack Gruber, USA TODAY

As Kentuckys case count ballooned, so did the fallout from the CDCs missteps.

The areas highest elected official, Harrison County Judge Alex Barnett, spent the next two weeks on a lunch tour to support businesses, visiting restaurants with his family. He snapped pictures posing with meals and posted them to Facebook to show people it was safe.

From the CDCs news briefings, the new coronavirus related to the viral family that causes the common cold sounded like a concern mostly for Americas distant big cities.

In public statements, leaders from Connersville, Indiana;Hudson, New York; andWinston-Salem, North Carolina, all repeated the CDCs low risk talking points.

The Kentucky hospital where Donohue first went to the ER had received no urgent warnings about community spread. More than 50 hospital workers did not wear masks or other protective gear, already in short supply, when they came into close contact with her.

I dont think people understood, Crystal Miller, health director for four counties in the area, told USA TODAY. We didnt know.

For the two weeks from when Donohue fell ill until the governor shut down the state, Barnett said he did not realize how much the small city of Cynthiana was at risk.

I am no expert in health when it comes down to it. I am a farmer, Barnett told USA TODAY. I am an expert on growing cattle and tobacco. I rely on the CDC for guidance.

Harrison County Judge Alex Barnett, center, recites the Pledge of Allegiance before a virtual meeting of court magistrates in Cynthiana, Ky. Joining him are Treasurer Melody McClure and 7th District Magistrate Dwayne Florence.Jack Gruber, USA TODAY

Within weeks, the confirmed case count in the county, pop. 19,000, climbed to 11. An outbreak engulfed a nursing home.

Miller sent constant updates around the state about her areas cases, tracking new information first on sticky notes, then a spreadsheet. She worked 15-hour days, responding to text messages from colleagues until 2 a.m.

In email exchanges, Kentucky officials questioned nonsensical directives from the CDC, such as to tell doctoroffices when testing for coronavirus to make sure the air does not mix with other air.

This is next to impossible for provider practices to accomplish, Andrea Flinchum in Kentuckys Health Department told the CDC in an email March 10.

Later that month, Flinchum asked CDC headquarters for advice on when and how to reuse respirators.A local representative shared several studies, but more than a week went by without official word from the agency. Waiting patiently to see this, Flinchum wrote.

In another email exchange,Dr. Kevin Spicer, a federal CDC medical officer stationed in Kentucky, acknowledged that he had been waiting two weeks for the agency to update its guidance on when and how to release people with COVID-19 from hospitals and isolation.

Lacking anything official, Spicer shared a link to a Washington state document outlining more up-to-date practices. It was not consistent with current CDC guidance, he noted.

Long-term care facilities, especially vulnerable, became another point of confusion during the first wave of Kentuckys outbreak in March. Matthew Penn, director of the CDCs public health law program, told a lawyer in the states Health Department not to ban nursing home visitors outright.

Persuasion by education strategy may work best, he wrote in an email. Let people choose.

Two days later, Gov.Andy Beshear banned nonessential visits at nursing homes. That week, the Centers for Medicare and Medicaid Services, which regulates the facilities, advised nursing homes nationwide to do the same.

More than 2,600 nursing home residents have tested positive in Kentucky since March. At least 530 have died, according to CMS data. Across the country, more than 53,000 residents have died.

Dr. Muhammad Babar, a geriatrician at the University of Louisville advising the state on coronavirus care at long-term care facilities, told USA TODAY that following the CDC lawyers advice would have resulted in a disaster.

In its statement to USA TODAY, the CDC noted that the agencysent approximately 1,300 public health experts to conduct more than 2,000 investigations in states to combat the pandemic. The agency said its guidance was tailored around keeping communities informed of the evolving science and changes to guidance through routine, direct and transparent engagements.

Kentuckys first recognized victim, Donohue, recovered but still suffers from migraines and shortness of breath.

Another singer in her choir died after being infected with COVID-19. For that, Donohue carries guilt that she might have unwittingly spread disease.

I thought I didnt have to worry about a killer virus, she told USA TODAY.

The CDC was created 75 years ago to fight malaria. Americans pay billionsfor its protection against outbreaks of disease and chronic conditions.

Headquartered in Atlanta, removed from the direct line of politics, the federal agency employs thousands of public health experts, many embedded in local health departments. Though it's not primarily a regulatory agency, its science guides national medical practice.

When the novel coronavirus surfaced last winter, the CDC spent weeks repeating assurances that the risk to Americans was low. Many local authorities, however, realized a crisis was coming and they were unprepared.

I just cant see how this outbreak will be contained, theNebraska state epidemiologist wrote Jan. 23.I think this is going to be a big pandemic.

In Kansas, the health director wrote to his staff Feb. 19:Are we behind the power curve on planning?

The CDC missed the early spread of the new coronavirus, blinded by its own decision to limit screening for the virus after its initial testing kit failed. That was one of the agencys most consequential scientific errors.

In California, Solano County public health officer Dr. Bela Matyas, working alongside CDC experts, had seen how people without symptomscould spread the disease in February, at an early quarantine site at Travis Air Force Base.

Bela Matyas is health officer for Solano County, Calif., which treated the first confirmed case of community spread of the coronavirus.Martin E. Klimek for USA TODAY

He said it was clear the agencys travel screenings focused on obvious symptoms such as fever were not going to work.

By definition, it was going to be a failure, Matyas told USA TODAY.

The agencys own director of global migration and quarantine knew it, too. Dr. Martin Cetron called the airport temperature screening a poorly designed control and detection strategy in internal emails later in the spring, resisting White House pressure to revive the program.

Health authorities trying to protect their communities pushed the CDC to loosen itsrestrictions on early testing.

The CDC controlled the nations first tests for COVID-19. Supplies were limited, and the agency designed restrictive testing guidelines. Fever and respiratoryillness werenot enough. The person had to have traveled to China or had contact with someone with a confirmed case.

Public health experts, including former CDC officials,accused the agency of creating guidelines on crucial measures such as testing based on supply shortages, not science.

We were told you dont need to be tested unless you have symptoms. Thats stupid and its always been stupid, Jim Curran, an epidemiologist at Emory University who led the CDCs research into HIV for 15 years, told USA TODAY. Policy shouldnt be based on scarcity.

One hospital in Seattle, the site of the first major U.S. outbreak, used paper and some spare space at the nurses station to track changes to the CDC testing guidance that often came unannounced and without clarifications, emergency room physician Sachita Shah told USA TODAY.

They taped paper after paper onto a computer monitor. The CDC told the hospital to test patients only if they had symptoms and had traveled to China; then Japan and South Korea; then Iran and Italy.

By the time the agency broadened the criteria to those without travel histories, the hospital had turned away several patients who needed testing.

CDC was too slow, Shah said. They should have been on top of this.

At the center of the first major U.S. outbreak of the coronavirus, Seattle, Dr. Sachita Shah said her hospital struggled to keep up with changing CDC testing guidance.Karen Ducey for USA TODAY

The case in Northern California, known as Patient Zero,exposed how wrong the CDC had been to test so narrowly.

Doctors at UC Davis Medical Centerpleaded for days to test the woman on a ventilator. She suffered from an unexplained respiratory disease yet had not recently traveled. The CDCs testing process did not allow for the possibility that the virus was spreading in the community.

We werent even able to test for it, CEO Dr. David Lubarsky said. It was a failed algorithm.

The CDC said in its statement provided to USA TODAY that the early testing protocol was based on the epidemiology of the disease at the time. CDC senior officer Dr. Nancy Messonnier said in Februarythat the agency greenlighted testing for the patient when it became aware of the case. Clinicians and a health official involved said they lost days pushing for access.

Patient Zero ultimately ledthe agency to rewrite its testing guidance. By then, more than 200 workers at two hospitals that treated her had risked exposure.

So many staff members had to be quarantined that one of the hospitals temporarily shut down its intensive care unit.

The CDCs leadership went on to fail Latino, Black and Native American communities and low-income neighborhoods. Experts said minority populations often were excluded from the policymaking process. They are more than twice as likely to be infected as non-Hispanic whites and nearly five times as likely to be hospitalized.

We were not prepared despite everything we know about public health disparities, K. Vish Viswanath, a health communication professor at Harvard and an independent scientist on the CDCs advisory board, told the agency during a panel review in July. That to me is inexcusable.

Donald Flores, a maintenance worker at the hospital that treated Patient Zero, developed symptoms in quarantine but was never tested. Heworries every workday that he is not protected.

Somebody, Flores said, doesnt give a damn.

The breakdown in the agencys communication with communities contributed to the failure of the Trump administrations signature defense against the pandemic: restrictions on travel from hot spots in China and later around the world.

Authorities expected the CDC to provide basic information names, contact information and arrival time so they could track travelers. Time and again, the CDC failed to do so.

In early February, Nevadastate epidemiologist Melissa Peek-Bullock learned from the local news about an airplane carrying three people who had been traveling in China,which was about to land in Las Vegas. The travelers posed a threat to U.S. cities, based on the CDCs criteria.

When Peek-Bullock called the agency seeking the passengers names and contact information, she was met with hostility, according to interviews and documents from the state Health Department.

At the Los Angeles airport, where the flight had been temporarily redirected, officials with the CDCs quarantine and mitigation division told her they were unaware of the requirements drawn up bytheir own colleagues.

In a call to the CDCs emergency hotline, Peek-Bullock said, she spoke with a representative who refused to identify the passengers, saying they were free to move along their way.

Increasingly desperate, she explained her fear that they could place all of Las Vegas at risk. Then the CDC representative hung up on her, Peek-Bullock said.

Its hard to imagine that would happen, she told USA TODAY. Truly, you just want to get the information that you need to do the right thing.

Afterward, the head of Nevadas Health Department, Richard Whitley, wrote to Redfield,the CDC director, to complain: The lack of communication in this circumstance created frustration and confusion for all those involved.

Senior CDC official Dr. JosMontero responded that the agency was trying to educate all of its divisions on the latest guidelines and requirements to share traveler information. He wrotethat the CDC regrets that Nevada Department of Health and Human Services had difficulty initially obtaining this information.

The shortcomings exposed by a pandemic had been years in the making.

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How the CDC failed public health officials fighting the coronavirus - USA TODAY