Why are public health professionals across the country frustrated with the CDC again?
The federal agency should work better with state and local health departments.
Last week the Centers for Disease Control and Prevention Announced yet another revision of quarantine and isolation guidelines for COVID-19 disease.
Following President Joe Biden’s recent bout with COVID-19 and his experience of rebound infection after treatment with Paxlovid, many public health professionals have called on the CDC to rethink the five-day isolation without testing required. I feel safe saying that most public health professionals expected a tightening of the recommendations. That’s not what we got.
What we got instead was a press release outlining an elimination of quarantine for those exposed to a known case of COVID and a relaxation of isolation standards. They added that if someone with COVID experiences a rebound infection from using Paxlovid, they should restart isolation on day 0. Thank you!
I’ll put aside, for a moment, the fact that I don’t know of any new science that supports these new changes, other than the changes due to the Paxlovid rebound. For me, the most frustrating part of these new guidelines is that once again state and local public health agencies are finding out about the changes through the media.
I was about to start a meeting with our new cohort of contact tracers for our campus, preparing for the start of the new academic year, when a colleague forwarded the New York Times article about the changes. I immediately went to the CDC website to find the changes. While the public-facing website had been updated the previous day, the health services site was last updated in October 2021.
I looked to see if there was an announcement through the Health Alert Network. Nothing here. The guidelines for K-12 schools have been updated, but the guidelines for higher education cannot be found on the website. This is not how the public health care system is supposed to work in the United States.
In the United States, the public health system operates within the framework of the Constitution under police powers that are delegated to the states. In many states, these powers are then delegated to local jurisdictions. It is these local health services, which are closest to their populations, that are responsible for protecting and promoting the health of people within their jurisdiction.
The CDC can be seen as FEMA or the US Fire Administration. These are federal agencies that provide advice and sometimes funding to organizations on the ground at the local level that provide day-to-day services.
When your home is on fire, your local fire department responds, not the US Fire Administration. Likewise, when there is a public health emergency, your local public health department responds.
If our public health system is to be able to meet the growing demands of multiple simultaneous public health emergencies, as well as the daily public health needs of our communities, we must be considered partners of the CDC. As partners, the CDC should talk to us directly when they are about to change the guidelines we need to implement. At a minimum, it should update the guidelines for health services at the same time it updates the pages for the general public. Preferably, he should update the health service pages first.
The CDC is not the department of health for the general population of the United States, this work belongs to the more than 3,000 state, territorial, local and tribal health departments.
Please, CDC, do not use the media to communicate with us. We deserve more respect than that.
Kimberly Shoaf, DrPH, is a professor of public health at the University of Utah. She has 30 years of experience teaching, researching, and working with local and state health departments in Utah and across the country on public health emergency planning and response. These comments reflect his own professional opinion and should not be construed to represent the views of the University of Utah.