Thread by @michaelzlin

HCWs are the last people who would criticize CDC; they must maintain an united front with CDC to limit the epidemic and make their jobs doable (+ less deadly). So this finding that trust in CDC has dropped in 77% of doctors and 77% of nurses is striking.
webmd.com/lung/news/2021…

The survey doesn't reveal how complaints are distributed within the 77%, e.g. if HCWs think the CDC is being too cautious or too lenient, or just too confusing. But there's been plenty to criticize from both scientific and behavioral points of view, so it's probably all the above

The list of failures is well known, and I'm not just speaking from hindsight. These failures were identified in real-time by many on twitter (even if established media orgs obediently parroted the CDC), and it was the CDC that was slow to learn and reverse.

There was the refusal to admit masks were useful, the incorrect belief that the main route of spread was through surfaces, and the incorrect rejection of aerosol spread. All were antiscientific and pointed out as such by scientists on twitter.

CDC resisted the evidence, clearly provided by studies of the similar SARS 17 years ago and by clear early examples of COVID19 superspreader events such as the choir practice, while maintaining false assurances in handwashing and 6ft distance.

There's the recent decision to trust people to wear masks if not vaccinated, which might seem to be an overcompensation for previously slow decisionmaking, but could also be a continued lack of appreciation for behavioral science or for the non-linear benefits of mask wearing.

These problems cannot only be attributed to poor CDC leadership only or political interference by the previous administration, although those exist. Rather they evince an inability of CDC internal procedures to integrate physical, biological, and behavioral sciences.

Again it's not all in retrospect and it's not actually that hard to come up with a consistent public health philosophy (identify the worst-case scenario using the most up-to-date science and recommend easy things that can mitigate that, basically go for bang for buck)

Nor should it be hard to overcome CDCs insularity to get real expert consultation, e.g. have advisory panels to get feedback from academics who actually are working on aerosols or viral pathogenesis, an approach that has benefited the FDA until recently.

Other possibilities for improving scientific dynamism are to have CDC staff attend and present at virology conferences and academic researchers go to CDC to collaborate on high-profile projects. These things, in addition to better pay, could make CDC jobs more attractive.

In any case, this article has some more pointed criticism of the CDCs with some good zingers:
businessinsider.com/doctors-lost-t…

Finally CDC communication is outdated and not appropriate for hte Google/Facebook/Twitter era. CDC still acts as if their recommendations are taken as commandments from above. But everyone has access now to the same information, so CDC can no longer issue guidelines unchallenged.

If it's unpopular or unscientific, guidelines will get challenged. CDC should then issue decisions with a link to the scientific rationale. It should be like in law – you wouldn't want the Supreme Court to issue decisions without their long documents with citations.

The non-interested don't have to read the rationale. But if a decision is counterintuitive, then the rationale will either prove it's correct or will reveal gaps that can be communicated back to CDC. By not hiding behind silence, better decisions will be made and trust restored.

Since the Business Insider article is paywalled (although you can still read it with some standard browser tricks) here's an excerpt with examples of capricious and unscientific messaging

The @nytimes weighs in

"Many scientists I spoke with insisted that the biggest barrier to modernizing the C.D.C. was the agency’s own lack of imagination."

nytimes.com/2021/06/16/mag…

In a followup thread, I suggest that the philosophy of identifying the worst-case scenario using the most up-to-date science and taking easy measures to mitigate actually leads to an obvious recommendation for J&J vaccine recipients.

https://twitter.com/michaelzlin/status/1407060001395458051