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CDC director on coronavirus, masks, and the agency in the midst of the pandemic

This story was republished with permission from STAT News. You can find the original article here.

Robert Redfield, director of the Centers for Disease Control and Prevention, describes the coronavirus pandemic as the greatest public health crisis in a century.

And yet the storied agency that Redfield leads — one that has been used as a model by countries around the world, including the China CDC — has played a largely invisible role in the nation’s response since the White House took over communications about the outbreak last month.

CDC experts, who held regular briefings to update the public about previous health threats such as the H1N1 flu pandemic and the Zika outbreak, have been silenced. It has been nearly a month since the last CDC media briefing, which took place March 9.

STAT asked Redfield about the agency’s role, whether he was satisfied with it, the agency’s evolving thinking about whether people should wear cloth masks in public, and how he sees the pandemic unfolding. The conversation has been lightly edited for length and clarity.

How are you? It’s a very challenging time.

I’m doing fine.

I would like to ask you a bit about the mask issue. [After this interview with Redfield, the CDC issued guidance urging the public to wear cloth masks in public to slow spread of the disease. President Trump announced the new recommendation at a press briefing.]

We strongly continue to recommend that N95 masks and surgical masks really be committed to the health care workers that are on the frontlines. Our nation owes them all a great gratitude as they continue to confront what you and I now know is the greatest public health crisis that’s hit this nation in more than a century.

But we actually have one of the most powerful weapons that we need to defeat the spread of this virus. And I know a lot of people may not see it as a powerful weapon, but it is. And that’s social distancing. This virus cannot jump 6 feet. So this is why the president’s recommendation is to slow the spread of the coronavirus.

I want to constantly thank the American public that have taken these social distancing recommendations and operationalized them into action with vigor and vigilance. And I just want to petition the remainder to have everybody go all in. That big, powerful weapon that we have is just to stay 6 feet apart.

Now that said, there’s probably greater numbers of individuals that are without symptoms, and have this virus and can shed this virus than I think was originally appreciated. So we are discussing in detail whether a face covering, a face barrier, whether that would modify the ability of those of us that may be infected and don’t know it to actually infect others. It’s not a decision to try to protect me from getting coronavirus. It’s to help modify spreading. And there is scientific data to show that when you aerosolized virus through a cloth barrier, you have a reduction in the amount of virus that gets through the other side.

Kind of a homemade, make-it-yourself barrier, whether it’s a bandana or a scarf.

Are you going to give people some advice on what kind of fabric? Because all fabrics are not created equal.

Obviously, there will be guidance on the fabrics, guidance on how to make them.

You mentioned earlier that the biggest tool that we have is social distancing. But it is being applied in a patchwork manner across the country. Some states have been more aggressive. Others are not. Do you think it’s time for a national stay-at-home order?

I think ultimately in these things it’s, how do you get full participation? I think you have to get the hearts and minds of people behind this. And so I think, you know, different jurisdictions will approach it in different ways. I will say what I’ve seen is the American public is embracing these strategies.

Dr. [Deborah] Birx says not enough of them.

I think people can decide independently in these states, the governors, and the mayors, how they think they’re best going to motivate their individuals to adhere to the social distancing. My own personal view is the best way to motivate is to have them shut their eyes and see their parents’ faces, their grandparents’ faces, their neighbors that have chronic illness, children that are suffering from cancer and say, “I need you to do it for them.”

What is the next year, the next 18 months going to look like in your estimation?

I think there’s a reasonable probability that this virus is going to have a seasonality to it. And that means that there’s a potential global catastrophe that may, in fact, be on its way to the Southern Hemisphere, particularly sub-Saharan Africa. And we need to prepare for that.

Related to us, that means that we may, in fact, get through in the weeks ahead, the months ahead into a lull. But I would say [if] we’re lucky enough to have that we need to get very prepared because next late fall and early winter, like most respiratory viruses, coronavirus 19 will be an enemy that we’re going to have to face again. Now we’re going to have time to prepare. We’re going to have, I think, hopefully time to reinforce our public health capacity in many parts of the nation so that we can do early diagnosis, isolation, contact tracing, prevent large community clusters, prevent what we call sustained community transmission. Just one of our challenges next season is going to be two simultaneous outbreaks: coronavirus 19, second wave, and our regular flu season. And they both compete for the same hospital resources.

The CDC hasn’t had a briefing in almost one month. That is extraordinary. Don’t you fear that your agency has been sidelined in this?

No, I wouldn’t say that at all. I think we’re fully engaged in all of the decisions. If you look at CDC’s website and what we’re doing constantly in our communications …

People are not going to dive through the website and read hundreds of words.

CDC is at the table in every decision. We’re at the task force meeting every single day. We’re giving our public health guidance and our recommendations.

We’ve got literally thousands of people working 24/7 gathering data all over this nation, not to mention sending people across this country to help with outbreak responses. So I think we’re fully engaged in the operations of the response. You know, if others seem to communicate some of that, that’s a decision that the administration can make. But I will guarantee you we’re 100% engaged 24/7 in operationalizing the response throughout this nation.

So you’re OK with the fact that the CDC hasn’t briefed for a month?

I’m saying that we’re giving our recommendations at the highest level on a daily basis and on a daily basis we’re working 24/7 to actually operationalize the day-to-day response throughout this nation.

In this incredibly polarized time something that should be pretty basic — a virus is looking for throats to infect and it doesn’t care which way those throats vote — has become utterly polarized. Having the messaging come from the CDC, which is completely agnostic on a political basis, could strip out some of that politicalization that is just really not helpful.

I don’t think there’s any way you can even overstate how aggressively the CDC is involved throughout this nation in operationalizing the response. You know, we do think that we have a calming effect in being viewed as being basically …

But you’re invisible now, sir. Your agency is invisible.

You may see it as invisible on the nightly news, but it’s sure not invisible in terms of operationalizing this response. And all you have to do to find that is go talk to your state and territorial health departments. Go out and look at the outbreaks. Go look in the field. So I guess it depends on how you define visibility.

Who is in charge of the outbreak response at the CDC now?

Anne Schuchat [CDC’s principal deputy director] is running the day-to-day response down at CDC.

So was Nancy Messonnier, director of the CDC’s Center for Immunization and Respiratory Diseases, sidelined?

It was an evolution. Nancy really activated her center for the response in very early January when China probably still had less than 50 cases. But it was clear that this was going to be a broader agency wide response. Nancy is a very important technical person involved in the response.

So this has nothing to do with the fact that it was felt that she was contradicting the messaging from the White House?

I think Nancy Messonnier is a gift to this nation. She’s a great talent. She continues to provide those talents and recommendations to the agency. She continues to run one of our most important centers for respiratory disease and immunization.

I did mean to ask you, have you had Covid-19?

Not to my knowledge.

Have you been tested for it?

No.

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