At the beginning of the pandemic, the CDC was slow to respond due to its usual pace, resulting in a lag in testing and surveillance as the agency struggled with outdated methods and infrastructure. Delayed recommendations on masking were partly due to federal scientists taking too long to acknowledge the airborne nature of the virus. The CDC is now facing new challenges with the omicron variant, making rapid decisions and issuing recommendations based on limited evidence, causing concern about the impact on the economy and education. The director of the agency, Dr. Rochelle Walensky, has at times bypassed the traditional scientific review process, most notably by reducing the isolation period for infected Americans. Following the Trump administration's interference, President Joe Biden took office pledging to restore the CDC's reputation for independence and rigorous science. Walensky's current challenge is how to communicate to the public that the science is still evolving and the current guidelines are the best advice available. The shift has been difficult for a bureaucracy primarily composed of medical professionals. Some CDC officials have privately expressed concerns about the demoralizing decisions and Walensky's increasing reliance on a small group of advisers, as well as the perceived political influence from the White House. Others outside the agency praised Walensky for her efficient handling of a national emergency, even when the data was unclear and agency researchers had doubts. Dr. Richard Besser, who led the agency during the 2009 H1N1 outbreak, emphasized that policy decisions during a pandemic are not solely the CDC's responsibility. He also stressed the need for clarity when policy and economics influence agency recommendations. The New York Times reported that over 800,000 Americans are being infected daily, leading to challenges for schools, businesses, and hospitals in many states. At the end of December, Walensky announced that infected Americans would only need to isolate for five days instead of 10 if they were no longer experiencing symptoms, and a negative test result was not necessary to end the isolation period. Critics raised concerns about the potential spread of the virus as contagious individuals were allowed to return to workplaces and schools. Many noted the limited research supporting the shortened isolation period for omicron infections. However, the recommendation had a key advantage in helping to maintain the functioning of hospitals, businesses, and schools during the omicron surge. Dr. Thomas Frieden, who previously led the agency under President Barack Obama, stated that the recommendations for isolation were "essentially accurate." Walensky and the CDC have not provided explanations for new tensions in the agency's decision-making. The director has often used rapidly changing science as a reason for recommendations that may be confusing or unpopular. Walensky recently stated to the Senate that the CDC's new guidelines for shorter isolation periods are based on quick, science-driven actions to prevent staffing shortages. This approach has been a recurring theme for Walensky. In March, the CDC advised that students could safely be seated 3 feet apart in classrooms instead of 6 feet, even though there was little research to support this suggestion. However, this change did make it easier for schools to consider reopening. In May, Walensky used scientific data to advise vaccinated individuals that they could remove their masks and socialize freely, despite concerns from experts about the risk of breakthrough infections, particularly from the delta variant. In August, she joined Biden in recommending booster shots for all Americans before the data had been thoroughly reviewed by the FDA or her own agency. The recent guidance on isolation caused turmoil within the agency due to the way it was introduced and communicated. Walensky called an emergency meeting of the agency's COVID response leaders 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 official who requested anonymity. The new guidelines would be announced the following day by Walensky, and no discussion was to take place until then. Scientists were taken aback by this news and rushed to gather data to support the revised recommendations and update the agency's website materials on quarantine and isolation. Typically, federal researchers thoroughly review data, draft recommendations, and refine them based on feedback before publication. However, in this case, there was limited evidence supporting the shortened isolation period, mainly related to the delta variant. As a result, the accompanying "science brief" was changed to a "rationale" document. Some researchers were upset about being excluded from the decision-making process and were angered by the agency's claim that the change was based on science. Even though some thought the new five-day cutoff was arbitrary, they were aware of data suggesting rapid tests might not detect all omicron infections, and thus mostly supported Walensky's decision not to require a negative test before ending isolation. However, when Walensky announced the new recommendations at an emergency meeting on Dec 26, staff were not prepared. CDC scientists then spent a week updating hundreds of guidance documents on the website. Around 2,000 health officials, public health lab directors, and researchers participate in a weekly call with CDC officials. During the call on Dec 27, just before the CDC's statement was released, state and local officials asked numerous questions about the isolation guidance for the general public. CDC staff members were ordered not to discuss the new recommendations, leading to silence among the staff. Scott Becker, CEO of the Association of Public Health Laboratories, expressed a desire for more input and advance notice. Supporters of Walensky, the CDC director, believed that the agency's shift in direction was necessary and that she had made the correct decisions. The CDC is a large organization with researchers used to working methodically, but the urgent nature of the pandemic required quicker action. Former CDC director Frieden noted that there were individuals within the agency who did not fully understand the situation. He mentioned that during his time in office, he often encountered CDC staff who were both charming and clueless about the potential impact of their recommendations and statements. Many experts believe that Walensky has unfairly been made the scapegoat for the frustrations caused by the unpredictable nature of the virus. Leading the CDC is always challenging, but Walensky took on this role 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 a significant obstacle. Besser expressed his concerns about the CDC. Besser expressed his concerns about the public's trust in public health, stating that it is unfair to blame Dr. Walensky for it. Walensky has been explaining her decisions at news briefings, but in response to criticism about unclear messaging, she and other CDC scientists held their own briefing. This was seen as a positive step towards rebuilding trust in the CDC and clarifying its decisions. Separating public health considerations from political ones is crucial, according to Besser. By receiving briefings from the CDC, she will be able to highlight the expertise of CDC scientists and experts. The tension between the CDC and the National Institutes of Health (represented by Dr. Anthony Fauci) has been ongoing and existed before the pandemic. During a recent public health crisis, Fauci and Surgeon General Dr. Vivek Murthy made public assurances about the CDC revisiting its recommendations for isolation, even though the agency had no such plans, 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 these conflicts. Becerra recently defended CDC Director Walensky in a CNN interview, pointing out her medical license and degree in public health. She is not in possession of a marketing degree.