曾经威武的美国疾控中心，这次疫情期间为什么靠边站了？

The U.S. Centers for Disease Control and Prevention has become a focal point for criticism of the American government’s coronavirus response, blamed for botching tests that would have helped track the illness in its early days, and then receding from the Trump administration’s public messaging.

In a nearly hour-long interview with Bloomberg News, CDC Director Robert Redfield predicted that the CDC would emerge with its reputation and capabilities intact, even improved, from an outbreak that has infected at least 465,000 Americans, caused more than 16,000 deaths, and is projected to kill thousands more.

“We continue to be the premier public-health institution in the world,” Redfield told Bloomberg, addressing questions about the agency’s response to the virus, its public role, and its future.

The CDC was founded in 1946 as the Communicable Disease Center, charged with making sure that malaria didn’t spread across the nation. With a $7.28 billion annual budget and 10,000 employees in the U.S. and abroad, it’s one of the world’s foremost public-health agencies, charged with defending the nation against disease and protecting the health and well-being of Americans.

But the coronavirus pandemic has tested the agency like never before, including a high-profile misstep during an important window when the virus might have been contained.

“We didn’t get ahead of the outbreak. And the CDC in its history would have always gotten ahead of the outbreak,” said Eric Topol, founder and director of the Scripps Research Translational Institute in La Jolla, California, citing the agency’s work on Ebola, Zika and other diseases that have threatened the world. “Lives have been lost. It’s not just the CDC. It’s the entire government.”

Test troubles

In January, as the outbreak expanded in China, the CDC’s scientists developed a test for the virus at the agency’s labs. On Feb. 4, the CDC was cleared to send out hundreds of test kits to state and local public-health labs, part of a stepped-up program to identify infections and track their contacts. The test kits were crucial to the U.S. effort to contain the disease while there were still less than 20 known cases in the country.

“I think history will lay the facts down correct,” Redfield said. “The real truth is, CDC did its job really in a record time and developed the test within seven to 10 days” from when the virus’s genetic sequence became available.

Unfortunately, the version of the test the CDC sent to labs failed to work for most. It took eight days for the CDC to announce the problem, and more time to get new kits out and modify existing ones.

“We then said, don’t use it, let us take it back,” he said. “And in a couple weeks we figured it out, we corrected it and got it out.”

Those weeks, however, were crucial. By the time the CDC shipped new versions of its test out, the virus had already started to spread inside the U.S., eventually setting off clusters of infections in New York, Seattle, and California.

The CDC encouraged other authorities, including the Food and Drug Administration, to allow hospitals and commercial labs to get tests on the market faster. But ensuring that America had widespread testing capacity for the novel pathogen ultimately was not the CDC’s job, Redfield said.

“It was really the responsibility of the private sector and the clinical medicine apparatus to develop these tests for clinical medicine,” he said. “That’s the part that’s still frustrating some people.”

Other parts of government share responsibility. It took weeks for the FDA to begin issuing emergency authorizations for other tests, after problems with the CDC kits emerged, for example. But the errors cost crucial time, said Topol.

“The singular egregious failure was the lack of having a test ready, at scale, with all that was happening in China,” said Topol. “It was their job to be ready for the worst-case scenario. Ready to do millions of tests throughout the country. Because that didn’t occur, everything that has happened since then is attributable to that failure.’’

Redfield maintains that that’s a misunderstanding of the agency’s responsibilities, and predicted the CDC would come out of the pandemic stronger. “Our public-health capacity for decades to come is going to be strengthened, the core capabilities are going to be finally brought to where they need to be,” he said. “We’re going to have laboratory capacity that has enormous redundancy.”

Where’s the CDC?

Redfield, 68, is a devout Catholic and a noted virologist who has done extensive research and clinical work on HIV and AIDs. He served for 20 years in the U.S. Army Medical Corps, and after his retirement founded the Institute of Human Virology at the University of Maryland with two other renowned HIV researchers. He’s led the CDC for two years, taking over from President Donald Trump’s first director, Brenda Fitzgerald, who resigned from the agency after buying stock in a tobacco company shortly after taking the job.

While Redfield has never had a reputation for seeking the spotlight, the CDC’s public presence looks far different than when the outbreak began. Through early March, its experts held regular briefings to educate the public on the virus and the government’s attempts to contain it. In recent weeks, Trump has taken on responsibility for briefing the public himself, with a rotating cast of officials that rarely includes the CDC, but often includes a mix of conflicting scientific claims and medical advice put forth by the president that are then gently walked back by other members of government.

Redfield was a regular presence at the government’s briefings early on. But as the White House and Trump have taken over, he’s receded. Since March 14, according to an analysis of transcripts, he’s appeared only four times at the Trump-led White House briefings that are broadcast across the U.S. and serve as the administration’s most visible and best-covered message to the public about the virus. Most days, no one from the CDC appears at the briefings at all.

The CDC’s last public briefing of its own took place over a month ago, on March 9. Asked where the decision to end the agency’s briefings had come from, Redfield said he didn’t know. “I just know that our regular briefing was discontinued,” he said.

A Trump administration official said Redfield attends task force meetings by phone when he’s in Atlanta and in person when in Washington. The official said the White House briefings cover much of the same material that CDC briefings did, so it doesn’t make sense to hold both. The official said he did not know who decided to discontinue the CDC’s own briefings.

Redfield said the agency is focused on getting its recommendations on how to stop the spread of the disease out through other channels, not on appearing at high-profile briefings.

“I don’t think that the press briefings, at the end of the day, with all the different things, is really the place to do that,” Redfield said. “It’s more how do we maximize our public-health message to the components of the American public who are involved in public health.”

“You may not see them on the television, or you may not read about them, or hear them on the radio, but we're constantly communicating with the American public to make sure they get the best information that CDC has to give them,” Redfield said. Redfield cited guidance on the agency’s website and more narrowly tailored outreach to medical workers, faith communities, business leaders, and nursing homes, including daily telephone calls that draw up to 40,000 participants.

As questions have arisen about the CDC’s role in recent days, Redfield has become more outwardly visible. He gave an interview to the health news publication Stat published on April 4, defending the agency’s performance, and appeared at a CNN event on April 9. He’s also engaged in appearances on local, often conservative, talk radio, reported Politico, which characterized his role as a trusted voice speaking to Trump’s base.

Before they stopped, the CDC’s briefings were a reliable source of information about the virus and the government’s response. They also proved prescient about the impact on the U.S., at a time when the White House was downplaying the situation and calling the virus nearly contained and unlikely to have a major impact.

Almost three weeks before the White House called for significant social distancing measures to stop the spread of the virus, one of the CDC’s top infectious-disease experts warned that Americans needed to start preparing for dramatic changes, including the possibility of closing schools, sporting events, and other elements of daily life. The official, Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases, warned of a serious outbreak in the U.S.

“It’s not so much a question of if this will happen anymore but rather more a question of exactly when this will happen and how many people in this country will have severe illness,” Messonnier said at the Feb. 25 briefing.

Messonnier, whose comments helped spark a drop in the U.S. stock market, hasn’t spoken publicly in recent weeks. The closing of the channel between the agency and the public leaves the nation less prepared, one of Redfield’s predecessors said.

“Let’s be frank: they are our No. 1 experts in how to address a pandemic of respiratory illness,” Tom Frieden, who led the CDC under then-president Barack Obama, said on call with reporters in early April. “If all of us had been hearing from Doctor Nancy Messonnier every day for the past five to six weeks, we as a country and families and as individuals would be much better prepared.”

Changing role

Redfield said that as the pandemic spread, the public face of the government’s response naturally shifted up the government ranks. What began as a response led by Messionnier’s center within the CDC rapidly escalated to the entire agency, and then to the U.S. Department of Health and Human Services, and eventually to one led by the White House.

“I think it's important to see how this response has gone from a CDC center, to CDC, to the Department of Health and Human Services, to an all-of-government response,” he said.

But as the responsibility for leading the response has shifted, confusion over what information is right and what’s wrong has grown, as well.

The dynamic was on display in mid-March as authorities began to bar public gatherings. On March 16, citing “lack of federal direction,” governors of New York, New Jersey and Connecticut said they would limit gatherings to 50 people. Later the same day, the Trump advised against gatherings of more than 10 nationwide.

“They have lost the role of being the public-facing agency," said Lorien Abroms, an expert on health communications at George Washington University’s Milken Institute School of Public Health. The danger is more chaos as the country grapples with the fast-moving crisis, she said.

“We have different parts of the government saying different things,” Abroms said. “People started by being confused and not knowing who to follow.”

In late March, more than 80% of Americans said they trusted the agency for reliable information on the coronavirus, according to a poll by the Kaiser Family Foundation, a health research group. That is a remarkable number when the country is divided and overall faith in institutions is low. Almost as many people said they trusted state leaders, the World Health Organization, and Anthony Fauci, a National Institutes of Health scientist who has taken on the role of expert-in-chief at the White House sessions. Less than half said they trusted Trump or the news media.

The CDC’s latest health recommendation is that Americans wear a facial covering when out in public, part of an effort to reduce spread of the virus, in particular by people who may not have symptoms.

Redfield said he carries a face covering his wife made him from a bandanna and rubber bands, and he wears it in situations when he cannot maintain the recommended six-foot distance from others.

“It’s only a recommendation,” Trump told reporters on April 3, the day the CDC’s mask recommendations came out. “You don’t have to do it.”