At the beginning of the pandemic, the CDC operated at its usual speed. However, due to the rapid spread of a new virus, the country suffered as testing and monitoring fell behind while the agency struggled with outdated methods and infrastructure. Recommendations for masks were delayed because federal scientists took too long to realize the virus was airborne. Now, the highly contagious omicron variant is forcing the CDC to make decisions quickly, leading to recommendations based on limited evidence and concerns about their impact on the economy and education. Dr. Rochelle Walensky, the director of the agency, has occasionally bypassed much of the typical scientific review process, most recently by reducing the isolation period for infected Americans. Following the Trump administration's history of interference, President Joe Biden took office pledging to restore the CDC's reputation for independence and thorough science. Walensky now faces the challenge of effectively communicating to the public that the science is not yet complete, but the current advice is the best available. This shift has been difficult for a bureaucracy primarily made up of medical professionals. In recent interviews, some CDC officials have expressed privately that the decisions have been disheartening, and they are concerned about Walensky relying heavily on a small group of advisors and the perceived political influence from the White House on her decisions. Others from outside the agency praised Walensky for bypassing a slow process and taking a practical approach to handling a national emergency, even when data was uncertain and agency researchers were unsure. Dr. Richard Besser, who was the interim chief of the agency during the H1N1 influenza outbreak in 2009, mentioned that there are policy considerations in a pandemic that go beyond the CDC's jurisdiction. However, he emphasized the need for more clarity when policy and economics influence agency recommendations. According to data from The New York Times, over 800,000 Americans are being infected daily as of Sunday, causing many schools and businesses to struggle to stay open and hospitals in nearly two dozen states to reach full capacity. At the end of December, Walensky announced that Americans who were infected would only need to isolate for five days instead of 10 if they were no longer showing symptoms, and a negative test result would not be necessary to end the isolation period. Critics raised concerns about the potential spread of the virus as contagious individuals were allowed to return to work and school. Despite limited research supporting the shortened isolation period for omicron infections, the recommendation was seen as beneficial for hospitals, businesses, and schools during the surge. Dr. Thomas Frieden, who previously led the agency under President Barack Obama, stated that the recommendations for isolation were essentially correct. The issue is that they were not given a clear explanation. Walensky and the CDC have not commented on recent tensions in decision-making at the agency. However, Walensky has often mentioned rapidly changing science as a reason for recommendations that have been confusing or unpopular. When speaking before the Senate, Walensky stated that the CDC's new guidelines for shortened isolation periods were based on quick actions grounded in science to address the potential problem of staffing shortages. This has been a common theme for Walensky. In March, the CDC stated that students could safely sit 3 feet apart in classrooms instead of 6 feet, even though there was little research to support this recommendation. However, this change did make it easier for school administrators to consider reopening schools. In May, Walensky referenced scientific data when she advised vaccinated individuals to remove their masks and socialize freely, despite criticism from experts who believed this decision overlooked the risk of breakthrough infections, particularly those caused by the delta variant. In August, Walensky, along with Biden, endorsed booster shots for all Americans, preempting the review of the necessity for these shots by scientists at the FDA and her own agency. The recent guidance on isolation caused internal turmoil within the agency due to the process by which it was established and announced. Following this, Walensky held an emergency meeting with the COVID response leaders at the agency on the Sunday night after Christmas. She informed them that the agency would reduce the recommended isolation period and eliminate the need for a negative test result before ending isolation. This information was shared during a video call by an anonymous official. The new guidance would be released the following day by Walensky, and no one was supposed to discuss it until then. Scientists were surprised by this news and quickly worked to gather data to support the changes and update the information on the agency's website related to quarantine and isolation. Normally, federal researchers carefully review data, draft a recommendation, and refine it based on feedback before publication. However, in this case, there was limited evidence supporting the shortened isolation period, particularly for the delta variant, resulting in the accompanying "science brief" being downgraded to a "rationale" document. Some researchers were upset about not being involved in the decision-making process and were angered by the agency's claim that the change was based on science. While some thought the new five-day cutoff was arbitrary, they were aware of data suggesting rapid tests might miss omicron infections and mostly supported Walensky's decision not to require a negative test before ending isolation. However, when Walensky announced the new recommendations on December 26, staff were unprepared. CDC scientists then struggled to update guidance documents on the website over the next week. Approximately 2,000 health officials and researchers joined a weekly call with CDC officials, where on December 27, they questioned the agency about isolation guidance for the general public just hours before the CDC released its statement. CDC staff members were instructed not to discuss the new recommendations, leading to silence among them. Scott Becker, the CEO of the Association of Public Health Laboratories, expressed a desire for more input and advance notice. Supporters of Walensky, the CDC director, believed the agency's change in direction was necessary and commended her decisions. The CDC is a large organization with researchers who are used to working methodically, but the urgent nature of the pandemic required quicker action. Frieden noted that there are individuals at the CDC who do not fully understand the situation. He stated that during his time in office, he often encountered CDC staff who were unaware of the potential consequences of their recommendations and statements. Several experts believe that Walensky has been unfairly blamed for the challenges posed by the ongoing pandemic. Taking on the role of leading the CDC is difficult under normal circumstances, but Walensky assumed the position during a pandemic, in a politically charged environment, and at a time when the agency's credibility and staff morale were low. Additionally, agency researchers are still working remotely, which is seen as a significant obstacle to overcome. "I am worried about the CDC," Besser stated. Besser expressed his concerns about the public's trust in public health and defended Dr. Walensky from unfair blame. Walensky has been explaining her decisions at White House briefings, but in response to criticism, she and other CDC scientists held their own briefing to address questions about isolation guidance, rising hospitalizations among children, and plans for a fourth vaccine shot. This move was seen as a positive step in rebuilding trust in the CDC and providing clarity on its decisions, according to some experts. Besser emphasized the importance of separating public health considerations from political considerations. "She will be able to support CDC scientists and experts by attending briefings from the CDC. The current conflict at the CDC existed before the pandemic and before Walensky's leadership. Some health officials have noted tension between the CDC and the National Institutes of Health, particularly with Dr. Anthony Fauci. In a recent incident, Fauci and Surgeon General Dr. Vivek Murthy made assurances on television about the CDC revisiting recommendations for isolation, even though the agency had no plans to do so, which upset senior CDC scientists. Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine, suggested that Health and Human Services Secretary Xavier Becerra should help resolve the conflict. In a rare interview, Becerra defended Walensky, stating that she has a medical license and a degree in public health." "She is not qualified in marketing as she does not possess a degree." © 2022 The New York Times Company.