In the early days of Covid, staffers at the Centers for Disease Control and Prevention sought to give Americans guidance about maintaining some semblance of normalcy during a once-in-a-century pandemic that had upended daily life.
One recommendation? Play basketball with your friends — online.
There was one big problem: The nation’s top public health professionals failed to consult their very colleagues who’d be responsible for communicating this advice to the public.
“We have to have a seat at the table sooner, so we can raise our hand and say, ‘Hey guys, I’m sorry, but playing basketball virtually with your friends is probably not a great recommendation,’” a CDC staffer told NBC News before adding: “That’s pretty stupid.”
Another staffer echoed the frustration. “There were a number of people inside the agency that were sometimes perplexed at whether what we were recommending was really practical.”
Communication failures like that, along with much more consequential errors, would continue throughout the pandemic, deeply tarnishing the agency — long considered the gold standard of public health institutions. The blunders have left career scientists and other longtime employees worried that the wounds can’t be healed.
All culminated in what would become a series of unsettlingly defining moments for CDC employees who say the agency was unable to move fast enough for the public with science solid enough to meet their own expectations.
This account is based on interviews with seven CDC employees who spoke to NBC News about their experiences during the pandemic on the condition of anonymity to discuss matters freely. All but one have been with the agency for at least 14 years, and three are nearing or have exceeded their third decade of service.
While some employees say they are optimistic that the agency can improve its public health responses, blunders during the Covid response still haunt those who have dedicated their lives to public health.
“When people ask, ‘where do you work?’ I used to say that ‘I work at CDC’ with pride,” a staffer said. “Now I just tell people that I work in public health and not exactly where I work, because it’s just going to become a discussion of our failures.”
“People’s lives were changing based on our decisions,” said a senior scientist within the agency. “The fear, the anxiety, the stress …” the person said, trailing off. “If only we could have stopped time.”
“There are going to be headlines that praise you and headlines that slam you,” the CDC’s director, Dr. Rochelle Walensky told NBC News. “It was going to be hard for the agency however it shook out. I can tell you numerous times where I’ve had these big decisions... many nights I’ve lost sleep.”
Six of the CDC employees who spoke to NBC News were either interviewed for or were otherwise heavily involved in a highly publicized review of the agency this year. The review was requested by Walensky and led by Jim Macrae, a longtime official within the Department of Health and Human Services.
“In our big moment, our performance did not reliably meet expectations,” Walensky said in a statement in August, when the review was completed. Macrae’s report on the agency’s pandemic response, published Sept. 1, echoed the need for the CDC to move more quickly and reliably.
Not all employees were happy with the proposed changes. “I certainly have talked to staff who are very distressed by it and feel very concerned,” a senior staffer said.
Another was more blunt: “It’s gonna piss off a lot of people, and people are going to leave.”
But others said they were relieved to see their frustrations outlined in Macrae’s final report, and ultimately, all agreed that the agency must make drastic changes before the next public health emergency.
‘Do what you think is best’
It was clear to CDC staffers early on in the pandemic that things were going awry. The first Covid tests to roll out in January 2020, made in a CDC lab, proved to be faulty.
By February, staffers said, CDC scientists were unable to give clear, commonsense advice to other public health officials.
In one case, the agency sent teams from its headquarters in Atlanta to areas of the country where the earliest cases had been reported. One team was sent to Chicago, the city that reported the first documented human-to-human transmission of the coronavirus in the U.S.
There, CDC officials met with local and state health officials to help facilitate early guidance, even though little was known about the new virus at the time. The team got on a conference call with CDC scientists in Atlanta to ask how they might best stop further spread of the virus.
“If someone sneezes on a table, how long will the virus live on the table?” they asked, according to a staffer familiar with the conversation. “What kind of precautions should they take? What kind of cleaning should be done?”
“Rather than saying, ‘We don’t know; we’re going to have to look into this,’” the person said, the CDC scientists said they didn’t see a need for any special decontamination, because there was no science at the time to back it up.
When local health officials on the call questioned the advice, the response from the CDC was “do what you think is best.”
There was a lot of weird looking around the room, like, ‘What do I do with that?’
“There was a lot of weird looking around the room, like, ‘What do I do with that?’” the person said.
Problems communicating guidance continued. The agency later flip-flopped on critical advice for the public, such as when people should wear masks, who should be tested after a Covid exposure and how the virus spreads.
All are examples, CDC employees said, of the agency’s inability to pivot from its reliance on a deliberate, tried-and-true way of gathering scientific data to an uneasy space where decisions must be made quickly, even when there’s insufficient evidence.
The “root cause” of that unease, said Dr. Tom Frieden, the president of the global public health initiative Resolve to Save Lives, is that “too few people in Atlanta have worked at the local level and understood the need for communicating in real time.” Frieden was the CDC’s director from 2009 to 2017.
A ‘holy crap’ moment
Scientists at the CDC, the country’s foremost public health institution, have long prided themselves on thorough research to support its guidance and recommendations.
But such research moves slowly, often including data gathered over months and years, followed by careful analysis and review. Completed reports are published in the CDC’s Mortality and Morbidity Weekly Report or in prestigious medical journals, where the work is reviewed by outside experts.
The long-held reliance on published data is what caught so many CDC scientists off-guard when the public demanded information about what was occurring in real time, before data could be collected and assessed.
“We had to change and be more comfortable making decisions on data that was much less baked” than previous research, a staffer said.
It also proved difficult when recommendations changed — even if those changes were based on new evidence.
“There was a lot of dogma that went into the initial round of pronouncements and recommendations without preparing people for the fact that we have a lot to learn about this, and we learn as we go,” said Dr. Julie Gerberding, who was the CDC’s director from 2002 to 2009. Gerberding is now the CEO of the Foundation for the National Institutes of Health.
In May 2021, Walensky announced that vaccinated people no longer needed to wear masks. The shift, she said, was due to several studies that suggested vaccinated people couldn’t transmit the then-dominant alpha variant to others. “We felt like we were on solid ground, scientifically.”
But an outbreak among vaccinated people over the July 4th weekend in Provincetown, Massachusetts, changed everything. It showed that the more contagious delta variant could be spread among vaccinated people.
A senior-level CDC official said it was a “holy crap” moment. “I was like, oh my God, we have to put masks back on,” the person said.
The perceived flip-flop was another blow to the agency’s credibility.
“The traditional way that we have done public health was not meeting the needs of the American public in a pandemic,” a senior staffer said. “There are times when we can take longer and do our due diligence and do studies over multiple years, but when we’re in a pandemic, we have to learn how to share what we know when we know it.”
Communicating quickly versus communicating clearly
Before the pandemic, public health recommendations from the CDC were generated thusly: CDC scientists would write up massive guidance documents for every scenario they could think of to inform clinicians and public health partners. The information was then simplified into digestible bites that the public could understand.
Once Covid hit, agency scientists still wrote up those documents, but instead of breaking them down into easy-to-understand guidance, the agency’s communications specialists simply posted them online — regardless of length.
It was an approach, several employees said, that was completely unworkable.
You can’t put 17 pages of a guidance document on a website designed for the American consumer and say, ‘Consume this,’ right?
“You can’t put 17 pages of a guidance document on a website designed for the American consumer and say, ‘Consume this,’ right?” a person said. “The idea of communicating clearly was quickly abandoned to communicating quickly with whatever you had.”
Adding to the problems, the CDC hadn’t had an official head of communications for four years when Walensky signed on as director in January 2021.
“I suppose that’s manageable when you’re dealing with a food-borne outbreak or when you’re dealing with something relatively small,” Walensky said. “You can imagine trying to navigate a pandemic without a standing director of communications.”
This June, the CDC hired Kevin Griffis for the job. He’d worked in communications at the Department of Health and Human Services during outbreaks of Ebola and Zika.
Separating public health from politics
Making matters more difficult was the role the White House played, opting to involve itself in briefings under both President Donald Trump and President Joe Biden. The Trump administration abruptly put an end to CDC-controlled media briefings in February 2020 after Dr. Nancy Messonnier, then a top CDC official, warned the public that, because of Covid, “disruption to everyday life might be severe.”
“We were in a period where we were driving the message,” said a staffer with close knowledge of the situation. “That’s probably what got us into trouble” early on.
While the Biden administration has allowed the CDC to participate more freely in Covid briefings, it has continued to lead most of them, frustrating some CDC staffers.
“That carries a certain political connotation and tone to it that you can’t get away from,” an employee said. “That had people on both sides of the aisle not trusting the CDC at one time or another.”
Frieden agreed. “There’s an advantage to being in Atlanta,” where the CDC is headquartered, he said. “They need to be briefing from Atlanta. They need to distinguish themselves from the White House.”
Still, the CDC director is a position appointed by the president. Until that changes, “I don’t think we’re ever going to get to where we have the trust of the American people as a whole,” one staffer said.
For all the confusion and misunderstood messaging over the past two years, Walensky says she still supports the decisions the agency has made during her tenure.
They include controversial ones, including the initial decision in May 2021 to tell vaccinated people that they no longer needed to wear masks.
Looking back, Walensky said she stands by that recommendation based on the science available at the time.
Would she do it again?
Yes, with the addition of two small words: “for now.”