First they came for the CDC staffers, but I was not a CDC staffer so I did nothing...
Then they came for me. And there was no one left to speak for me.
- with apologies to Martin Niemoller (look here)
The US is continuing to suffer during the coronavirus pandemic. Meanwhile, the lead US government public health agency, the Centers for Disease Control and Prevention (CDC) has suffered two attempts by the Trump administration to transform it into a propaganda outlet.
Mysterious Revisions of Pandemic Management Guidelines to Hinder Testing of Exposed Persons
This story broke in late August, 2020. As reported by the New York Times on August 25, 2020:
The Centers for Disease Control and Prevention quietly modified its coronavirus testing guidelines this week to exclude people who do not have symptoms of Covid-19 — even if they have been recently exposed to the virus.
The new guidelines went against public health practice for managing epidemics. People who have been exposed are at increased risk of infection. Infected people may not have symptoms but may still transmit the virus to others. Identifying infected people allows them to be quarantined, and any further contacts to be traced. In particular, as the NYT article pointed out:
Although researchers remain unsure how often asymptomatic people
unwittingly transmit the coronavirus, studies have shown that the
silently infected can carry the virus in high amounts.
The evidence is more clear-cut for pre-symptomatic people, in whom
virus levels tend to peak just before illness sets in — a period when
these individuals might be mingling with their peers,
seeding superspreader events. Notably, experts can’t distinguish
asymptomatic people from those who are pre-symptomatic until symptoms do
or don’t appear.
No Obvious Justification and No One Accountable for the Change
The CDC did not initially provide a clear justification of the change:
The reasons behind the surprise shift in testing recommendations are
unclear. In response to an inquiry from The New York Times, a
representative for the C.D.C. directed the questions to the U.S.
Department of Health and Human Services.
A report from ABC News on August 26 quoted Admiral Brett Giroir of the White House coronavirus task force:
This is evidence-based decisions that are driven by the scientists and
physicians, both within the CDC, within my office in the lab task force,
and certainly amongst the task force members
However, he did not provide any of the evidence on which it was supposedly based, or any logic underlying the change based on this evidence. Nor did he make clear who was accountable for the change
I worked on them. Dr. Fauci worked on them. Dr. Birx worked on them. Dr.
Hahn worked on them. Dr. Atlas provided input. So, it's kind of hard to
know how much was written by one person at this time
On the other hand, a CNN report from the next day suggested that the change came due to political pressure:
A sudden change in federal guidelines
on coronavirus testing came this week as a result of pressure from the
upper ranks of the Trump administration, a federal health official close
to the process tells CNN, and a key White House coronavirus task force
member was not part of the meeting when the new guidelines were
discussed.
'
It's coming from the top down,' the official said of the
new directive from the Centers for Disease Control and Prevention.
An
AP article from August 26 included speculation about the real reasons for the change:
Dr. Carlos del Rio,
an infectious diseases specialist at Emory University, suggested in a
tweet that there are two possible explanations. One
is that it may be driven by testing supply issues that in many parts of
the country have caused widely reported delays in results of a week or
more, he suggested.
Admitting problems providing testing might be a reason to consciously temporarily limit testing, of course, but not to pretend the testing would not be useful. Then
Another possible explanation for the change is that President Donald
Trump simply wants to see case counts drop, and discouraging more people
from getting tested is one way to do it, del Rio said in his tweet.
A Washington Post article on August 27, 2020 explained this further:
The
revised guidelines come as President Trump has feuded with the CDC and
the Food and Drug Administration, both parts of the Department of Health
and Human Services, and marginalized officials who would ordinarily play leading roles in a pandemic response. He has repeatedly said that he did not like that more testing had revealed more cases.
'I
said to my people, ‘Slow the testing down, please!’ ' Trump said at a
rally two months ago. Aides said he had been speaking tongue-in-cheek.
But asked later whether he had been kidding, Trump replied, 'I don’t kid.'
Reducing testing, of course, would reduce the number of apparent, not real cases, allowing Trump to exaggerate his ability to manage the pandemic
On September 17, 2020, the source of the controversial change in the CDC guideline was somewhat clarified again according to the New York Times:
A heavily criticized recommendation from the Centers for Disease Control and Prevention last month about who should be tested for the coronavirus was not written by C.D.C. scientists and was posted to the agency’s website despite their serious objections
The source of the change was
the
Department of Health and Human Services [which] did the rewriting and then 'dropped' it into the C.D.C.’s public website, flouting the agency’s
strict scientific review process.
'That
was a doc that came from the top down, from the H.H.S. and the task
force,' said a federal official with knowledge of the matter, referring
to the White House task force on the coronavirus.
Yet neither that nor earlier reports explained who at "the top" directed the change.
And soon the change it self disappeared as mysteriously as it appeared. On September 18, 2020 per the AP:
U.S. health
officials on Friday dropped a controversial piece of coronavirus
guidance and said anyone who has been in close contact with an infected
person should get tested.The Centers for Disease Control and Prevention essentially returned to its previous testing guidance
Criticism of the Change
Public health and health care professionals criticized the changes, e.g., per the AP article of August 26, 2020:
Dr. Tom Frieden, who
was head of the CDC during the Obama administration, said the move
follows another recent change: to no longer recommend quarantine for
travelers coming from areas where infections are more common.
'Both
changes are highly problematic' and need to be better explained, said
Frieden, who now is president of Resolve to Save Lives, a nonprofit
program that works to prevent epidemics.
Also, Dr Leana Wen wrote an op-ed for the Washington Post on August 26, 2020:
you don’t have to be a public health expert to know the CDC’s guidance is nonsensical.
In MedPage Today of August 28, 2020:
pulmonologist William Janssen, MD, section head of Critical Care
Medicine at National Jewish Health, said the new guidance recommending
testing for fewer people 'flies in the face of everything we have been
told and understand about this disease.'
Also,
Another pulmonologist at National Jewish Health, Kenneth Lyn-Kew, MD, called the CDC move 'a step backwards.'
'The CDC was flat out wrong and the epidemiologists there know this,'
he said, adding that testing and tracing are cornerstones of
epidemiology.
Major health care organizations also criticized the change. The AMA issued a statement:
Suggesting that people without symptoms, who have known exposure to
COVID-positive individuals, do not need testing is a recipe for
community spread and more spikes in coronavirus. When the Centers for
Disease Control and Prevention (CDC) updates a guidance the agency
should provide a rationale for the change. We urge CDC and the
Department of Health and Human Services to release the scientific
justification for this change in testing guidelines
The American Association of Medical Colleges asserted:
These CDC guidelines go against the best
interests of the American people and are a step backward in fighting the
pandemic. The AAMC urges the CDC to return to its earlier testing
recommendations
The Chair of the Board of Regents of the American College of Physicians wrote that the organization:
supports the use of science, based on the best available evidence,
in the fight against COVID-19. Public health agencies should not be
subjected to pressure or be influenced to issue policies that are not
based on evidence and expert recommendations of their own scientists.
Also
The recent revision of the CDC’s COVID-19 testing guidelines of
asymptomatic individuals lacks transparency and clarity, sending a
confusing message to both physicians and the public on appropriate and
necessary testing that will ultimately help to mitigate the spread of
COVID-19.
Summary
So far we only know that someone at "the top" of the government directed the change in the CDC guidelines. No person or group has stepped forward as accountable. No one at any US government agency has explained the rationale for the change, much less provided clear evidence and logical reasoning underlying it. The best explanation for the change seems to be that it fit President Trump's message. It would have made his administration's problems organizing adequate testing for coronavirus less apparent. By reducing testing, it would make the rate of the spread of disease temporarily appear lower, allowing Trump to exaggerate his ability to manage the pandemic.
Yet I could find no health care or public health professional, or any leader of a health care organization willing to criticize "the top" of the US government for directing the change, to criticize the opaque, apparently evidence-free process that produced the change, or to question whether the change was meant to fit with Trump's propaganda, that is, his claims of brilliant management of the pandemic.
Trump Political Appointees Attempt to Intimidate CDC Staff to Manipulate Publications in the Morbidity and Mortality Weekly
White House Installed Pro-Trump Propagandist with No Health Care or Public Health Background as Head of Public Relations for DHHS
The second case began in April, 2020. Then Politico reported:
The White House is installing Trump campaign veteran Michael Caputo in the health department’s top communications position
Caputo was given the title of Assistant Secretary for Public Affairs. He has an unlikely background to have been named head of public relations for the Department of Health and Human Services (DHHS). He has no apparent background in health care or public health. Also, Politico noted:
Caputo is an intense Trump loyalist whose recent book 'The Ukraine Hoax,' alleged a conspiracy behind Trump’s impeachment.
Furthermore
Caputo is a longtime friend of Trump ally Roger Stone and former Trump campaign chairman Paul Manafort, both of whom were convicted of crimes in the last two years.
Then CNN reported:
The new spokesman for the Department of Health and Human Services in a series of now-deleted tweets
made racist and derogatory comments about Chinese people, said
Democrats wanted the coronavirus to kill millions of people and accused
the media of intentionally creating panic around the pandemic to hurt
President Donald Trump.
In particular,
In a series of tweets on March 12,
Caputo responded to a baseless conspiracy theory that the United States
brought the coronavirus to Wuhan, China, by tweeting that 'millions of
Chinese suck the blood out of rabid bats as an appetizer and eat the ass
out of anteaters.'
CNN had many more graphic examples.
Also,
Mother Jones reported more about Caputo's involvement in Russia and Ukraine:
A longtime Republican operative who was ousted
from a job on Trump’s 2016 campaign, Caputo recently worked to boost
discredited claims alleging that Ukraine, not Russia, meddled in the
2016 election.
In particular, Caputo was alleged to have been involved in political dirty tricks on behalf of Trump in 2016:
In June 2018, the Washington Post reported
that ... [Caputo] and Stone had met in 2016 with Henry Oknyansky, a Russian expat
living in Florida, who wanted to sell damaging information about
Hillary Clinton. Caputo, in text messages with Stone the Post
obtained, referred to Oknyansky as 'the Russian.' Though no deal was
reached, news of the meeting seemed to contradict claims both Stone and
Caputo had made in testimony to the House Intelligence Committee. Both
men denied any contact with Russians during the 2016 campaign.
Also, Caputo was alleged to have been involved in creating propaganda or disinformation about Ukraine's supposed intervention in the 2016 campaign, and Hunter Biden's actions there:
Last year, Caputo, along with other figures in Trump’s orbit, turned his
focus to Ukraine. He says he travelled there last August to try to
bolster the theory that Ukrainians interfered in 2016 election to help
Clinton. He subsequently wrote a book, titled The Ukraine Hoax: How Decades of Corruption in the Former Soviet Republic Led to Trump’s Phony Impeachment,
which pushes discredited allegations, including claims that former Vice
President Joe Biden intervened in Ukrainian affairs to help his son,
Hunter. Caputo produced a documentary offering similar allegations that aired in January on the rabidly pro-Trump One America News. Giuliani starred in a separate OAN series which pushed similar claims based his own trip to Ukraine.
Yet despite Caputo's record as an unscrupulous political operator, and allegations that he was involved in peddling propaganda and disinformation, his appointment drew no outcry.
Assistant Secretary for Public Relations of DHHS Orchestrated Intimidation to Distort the Morbidity and Mortality Weekly Report
Somehow Caputo and the associates he brought to the DHHS managed to avoid much public notoriety for a few months. Then on September 11, 2020 Politico reported that Caputo and his associates had been quietly busy. Their apparent mission was to turn the respected CDC public health publication, the Morbidity and Mortality Weekly Report, into a vehicle for pro-Trump propaganda. Politico noted that:
The CDC's Morbidity and Mortality Weekly Reports
are authored by career scientists and serve as the main vehicle for the
agency to inform doctors, researchers and the general public about how
Covid-19 is spreading and who is at risk. Such reports have historically
been published with little fanfare and no political interference, said
several longtime health department officials, and have been viewed as a
cornerstone of the nation's public health work for decades.
But since Michael Caputo, a former Trump campaign official with no medical or scientific background, was installed in April
as the Health and Human Services department's new spokesperson, there
have been substantial efforts to align the reports with Trump's
statements, including the president's claims that fears about the
outbreak are overstated, or stop the reports altogether.
In particular, Caputo et al tried to
retroactively change agency reports that they said wrongly inflated the
risks of Covid-19 and should have made clear that Americans sickened by
the virus may have been infected because of their own behavior
and
halt the release of some CDC reports, including delaying a report
that addressed how doctors were prescribing hydroxychloroquine, the
malaria drug favored by Trump as a coronavirus treatment despite scant
evidence
To underscore that the effort was to promote Trump's political self-interest
an aide
to Caputo berated CDC scientists for attempting to use the reports to 'hurt the President' in an Aug. 8 email sent to CDC Director Robert
Redfield and other officials that was widely circulated inside the
department and obtained by POLITICO. 'CDC
to me appears to be writing hit pieces on the administration,'
appointee Paul Alexander wrote, calling on Redfield to modify two
already published reports
Alexander tried to gain control of the contents of the MMWR, calling
on Redfield to halt all future MMWR reports until the agency modified
its years-old publication process so he could personally review the
entire report prior to publication, rather than a brief synopsis.
Alexander, an assistant professor of health research at McMaster
University near Toronto whom Caputo recruited this spring to be his
scientific adviser, added that CDC needed to allow him to make line
edits — and demanded an 'immediate stop' to the reports in the meantime.
Apparently CDC staffers resisted Caputo, Alexander et al, so that eventually contents untouched by their manipulations did become public.
One day after the Politico article, the New York Times confirmed its essential findings
Current and former senior health officials with direct knowledge of
phone calls, emails and other communication between the agencies said on
Saturday that meddling from Washington was turning widely followed and
otherwise apolitical guidance on infectious disease, the Morbidity and
Mortality Weekly Reports, into a political loyalty test, with career
scientists framed as adversaries of the administration.
The Times called Caputo's work a "bullying operation."
The Washington Post also confirmed the Politico report after gaining access to emails sent by Alexander.
The Assistant Secretary's Actions Became Bizarre, and He Resigns Citing Mental Health Issues
As soon as the story of his attempts to "bully" the MMWR became public, Caputo's actions became more bizarre. On September 14, 2020, the New York Times reported:
The top communications official at the
powerful cabinet department in charge of combating the coronavirus made
outlandish and false accusations on Sunday that career government
scientists were engaging in 'sedition' in their handling of the pandemic
and that left-wing hit squads were preparing for armed insurrection
after the election.
Michael R. Caputo,
the assistant secretary of public affairs at the Department of Health
and Human Services, accused the Centers for Disease Control and
Prevention of harboring a 'resistance unit' determined to undermine
President Trump, even if that opposition bolsters the Covid-19 death
toll.
Then he announced:
he personally could be in danger from opponents of the
administration. 'If you carry guns, buy ammunition, ladies and
gentlemen, because it’s going to be hard to get,' he urged his
followers.
He went further, saying his physical health was in question, and his 'mental health has definitely failed.'
'I
don’t like being alone in Washington,' Mr. Caputo said, describing 'shadows on the ceiling in my apartment, there alone, shadows are so
long.'
One day later Politico reported an announcement:
Today, the Department of Health and Human Services is announcing that
HHS Assistant Secretary for Public Affairs Michael Caputo has decided to
take a leave of absence to focus on his health and the well-being of
his family
Alexander also left the agency
Since Caputo's departure, Politico published an article detailing how he placed "his own loyalists and Trump veterans" into public relations positions at the DHHS.
Also, the New York Times published an article detailing some of his efforts to bully CDC staff,
Mr. Caputo moved to punish the C.D.C.’s communications team for granting
interviews to NPR and trying to help a CNN reporter reach him about a
public relations campaign. Current and former C.D.C. officials called it
a five-month campaign of bullying and intimidation.
For instance, after Mr. Caputo forwarded
the critique of Dr. Schuchat to Dr. Redfield, C.D.C. officials became
concerned when a member of the health department’s White House liaison
office — Catherine Granito — called the agency to ask questions about
Dr. Schuchat’s biography, leaving the impression that some in Washington
could have been searching for ways to fire her.
In
another instance, Mr. Caputo wrote to C.D.C. communications officials
on July 15 to demand they turn over the name of the press officer who
approved a series of interviews
between NPR and a longtime C.D.C. epidemiologist, after the department
in Washington had moved to take ownership of the agency’s pandemic data
collection.
'I
need to know who did it,' Mr. Caputo wrote. A day later, still without a
reply, Mr. Caputo wrote back. 'I have not received a response to my
email for 20 hours. This is unacceptable,' he said.
Efforts to Turn the MMWR Into Propaganda Criticized byAcademics in Public Health and Health Care, and the CEO of the Robert Wood Johnson Foundation
Per the Politico article above, Jennifer Kates, leader of the Kaiser Family Foundation's global health work
defended the CDC's process as rigorous and said that there was no reason
for politically appointed officials to review the work of scientists.
Per the New York Times article above, Dr. William Schaffner, an infectious disease specialist at Vanderbilt
University who sits on the external editorial board of the Morbidity and
Mortality Weekly Report, said Caputo's operation
undermines the credibility of not only the M.M.W.R. but of the C.D.C.
And the C.D.C.’s credibility has been tarnished throughout Covid already
Per USA Today on September 13, 2020:
The interference is not just anti-science but disinformation intended to
deceive the American public, said Dr. Eric Topol, a professor of
molecular medicine at the Scripps Research Institute in La Jolla,
California.
'This is outright egregious. It’s despicable,' Topol said, accusing
Redfield and other leaders of allowing the agency to be hijacked by
politics.
Also,
On Twitter, Dr.
Sherri Bucher, a global health researcher, wrote, 'There are no words
to articulate how horrific this is. Trust & credibility, shattered,
overnight. MMWR has been, for a long time, one of the most reliable,
steadfast, scientific resources; unquestioned veracity, impeccable
reputation for quality of data/analysis. No longer.
The Washington Post published an op-ed by Dr Erin Marcus, a professor of clinical medicine at the University of Miami Miller Medical School:
Caputo’s manipulation is appalling. If left unchecked, it could have
disastrous consequences for the reputation and reliability of the CDC,
which has already been battered by the U.S. response to covid-19. It could also prove devastating for medical practice in the United States more broadly.
In Scientific American, Dr Richard Besser, the CEO of the Robert Wood Johnson Foundation, wrote an op-ed entitled "We can't allow the CDC to be tainted by politics," noting:
To meddle with, delay or politicize these [MMWR] reports would be a form of
scientific blasphemy as well as a breach of public trust that could
undermine the nation’s efforts to fight the coronavirus.
Summary
So to summarize, the White House put a pro-Trump political operative who had allegedly been involved in producing propaganda and disinformation in support of Trump to oversee all Department of Health and Human Services communications. He and his hired cronies tried to bully and intimidate DHHS, particularly CDC staff, and to distort the contents of the renowned MMWR to support the Trump message. Had these efforts succeeded they would have seriously impeded efforts to control the coronavirus pandemic by undermining the dissemination of scientific evidence needed for pandemic management and clinical care for affected patients.
I found several academic public health and health care professionals willing to criticize Caputo and cronies' actions. I found one leader of a prominent health care foundation willing to at least implicitly criticize them. I found no one willing to hold accountable anyone at the "top" of the government who hired Caputo or encouraged his actions. On this case, I could find no leader of a health care organization other than Dr Besser willing to say anything at all.
Conclusions
Last month, we noted how disinformation about the coronavirus pandemic is being disseminated by the US president.
Since then, two major efforts to use the CDC, the lead US public health organization, to support President Trump's political messaging, in effect, to function as a political propaganda outlet. Individual US academic and practicing public health and health care professionals have been willing to decry these efforts, though not to directly hold Trump and his top lieutenants in the executive branch accountable. In some cases, leaders of major medical organizations have been willing to state the principles that should have been upheld within the government.
However, no chairpersons, deans, chancellors, vice-presidents for health affairs,
university presidents; or journal editors, hospital executives,
leaders of professional societies, executives of health care
corporations, etc, etc were willing to publicly challenge Trump and his top collaborators. Such leaders so far have also been unwilling to challenge Trump's efforts to spread disinformation.
To be charitable, such leaders may be to used to a kinder, gentler era to be able to fully comprehend that parts of the US government meant to be apolitical advocates for public welfare, such as the CDC, are being pushed to become part of an incipient Ministry of Propaganda.
Fighting a deadly pandemic is hard enough. It is gut wrenching that the
fight is being subverted by political leaders spreading
propaganda and disinformation. It is sad that front line public health and health care professionals are hardly
supported in their work by those who claim to lead them. Where is the courage? Where
is the outrage?
"If not now, when?"
