At the beginning of the pandemic, the CDC was slow to respond due to its usual pace, resulting in a delay in testing and surveillance. The agency struggled with outdated methods and infrastructure, leading to a delay in recommending mask-wearing as they were slow to acknowledge the airborne nature of the virus. The emergence of the omicron variant has forced the CDC to make quick decisions with limited evidence, sparking concerns about the impact of their guidelines on the economy and education. Dr Rochelle Walensky, the agency's director, has at times bypassed the usual scientific review process, most recently by shortening the isolation period for infected Americans. President Joe Biden took office vowing to restore the CDC's reputation for independence and rigorous science after the Trump administration's interference. Walensky now faces the challenge of effectively communicating to the public that the science is still developing and their recommendations are based on the best available information. This shift has been difficult for the primarily medical staff of the CDC, with some officials privately expressing demoralization in recent interviews. Concerns have also been raised about Walensky's increasing reliance on a select group of advisers and the perceived political influence from the White House on her decisions. Others from outside the agency praised Walensky for bypassing a lengthy process and taking a practical approach to managing a national emergency, even when the data was uncertain and agency researchers were unsure. Dr. Richard Besser, who led the agency during the H1N1 outbreak in 2009, noted that there are policy considerations during a pandemic that go beyond the CDC's jurisdiction. However, he emphasized the need for more clarity when policy and economics influence agency recommendations. The New York Times reported that over 800,000 Americans are being infected daily, leading to struggles for schools, businesses, and hospitals in nearly two dozen states. At the end of December, Walensky announced that Americans infected with COVID-19 would only need to isolate for five days instead of 10 if they were no longer symptomatic, and a negative test was not necessary to end isolation. Critics were concerned that allowing contagious individuals back into workplaces and schools could lead to the spread of the virus. Despite limited research supporting a shorter isolation period for omicron infections, the recommendation was seen as beneficial for hospitals, businesses, and schools during the omicron surge. Dr. Thomas Frieden, who previously led the agency under President Barack Obama, believed the isolation recommendations were mostly accurate. Walensky and the CDC have not provided explanations for new tensions in the agency's decision-making. Walensky has frequently justified recommendations that were confusing or unpopular by citing rapidly evolving science. She recently testified before the Senate that the agency's new recommendations for shortened isolation periods were based on swift science to address potential staffing shortages. This approach has been a consistent theme for Walensky, as seen in the CDC's recommendation in March that schoolchildren could safely sit 3 feet apart in classrooms instead of 6 feet, despite limited research supporting the change. However, this decision did make it easier for school administrators to consider reopening schools. In May, Walensky used scientific data to inform vaccinated individuals that they could remove their masks and interact freely, which caused concern among experts who believed this decision overlooked the risk of breakthrough infections, particularly from the delta variant. In August, Walensky supported booster shots for all Americans alongside Biden, even before the FDA or her own agency had reviewed the necessary data. The latest incident, providing guidance on isolation, created internal turmoil within the agency due to the way it was decided and communicated. Following an emergency meeting on a Sunday night after Christmas, Walensky gathered the agency's COVID response leaders. She informed them that the agency would reduce the recommended isolation period and eliminate the need for a negative test result to leave isolation. The information was shared during a video call by an official who preferred to remain anonymous. The new guidelines would be announced the next day by Walensky, and it was advised not to discuss it until then. The scientists were caught off guard and rushed to gather supporting data and revise the website content about quarantine and isolation. Normally, federal researchers thoroughly analyze data, draft recommendations, and seek feedback before publishing new guidelines. However, due to the lack of evidence for shortened isolation, particularly related to the delta variant, the accompanying "science brief" was downgraded to a "rationale" document. Some researchers were upset about not being included 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 indicating that rapid tests might not always detect omicron infections, so they mostly supported Walensky's choice not to mandate a negative test before ending isolation. However, when Walensky announced the new recommendations to staff in a meeting on December 26, they were unprepared. CDC scientists then spent the next week updating numerous guidance documents on the website. Approximately 2,000 health officials, public health lab directors, and researchers from state and city levels participate in a weekly call with CDC officials. During the call on December 27, just before the CDC's statement was released, state and local officials questioned agency scientists about the isolation guidance for the general public. CDC staff members were quiet due to orders not to discuss the new recommendations. Scott Becker of the Association of Public Health Laboratories expressed a desire for more input and advance notice. Supporters of Walensky believed the CDC's change in direction was necessary and that she had made the correct decisions. The CDC is a large organization with researchers used to working slowly, but the pandemic required faster action. According to Frieden, there are individuals within the CDC who do not fully understand the urgency of the situation. He mentioned that during his time in office, he often encountered CDC staff who were sometimes charming but also clueless about the potential impact of their recommendations and statements. Many experts believe that Walensky has unfairly taken the blame for the ongoing challenges of the pandemic. Leading the CDC is always difficult, but even more so during a pandemic, in a politically tense environment, and at a time when the agency's credibility and staff morale are low. Additionally, the fact that agency researchers are still working remotely is seen as a significant obstacle to overcome. "I am worried about the CDC," Besser said. Besser expressed his concern about the public's trust in public health and believes it is unfair to blame Dr. Walensky for this. Despite explaining her decisions at White House briefings, Walensky and other agency scientists recently held their own briefing to address criticism and clarify the CDC's decisions, which some experts view as a positive step towards rebuilding trust in the agency. Besser emphasized the importance of separating public health considerations from political considerations. "And through conducting briefings from CDC, she will have the opportunity to elevate CDC scientists and experts." Some of the current tension at the CDC existed before the pandemic and Walensky's leadership. Conflict between the agency and the National Institutes of Health, represented by Dr. Anthony Fauci, has been ongoing even during previous public health crises, according to some health officials. In a recent incident, Fauci and Surgeon General Dr. Vivek Murthy made statements on television assuring that the CDC would reconsider its recommendations for isolation, despite the agency having no plans to do so, which frustrated 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 appearance, Becerra recently defended Walensky in a CNN interview, stating that she possesses "a medical license and a degree in public health." She lacks a marketing degree according to © 2022 The New York Times Company.