The review identified three documents that had already been removed from the agency’s website: One, released in July, delivered a strong argument for school reopenings and downplayed health risks. A second set of guidelines about the country’s reopening, was released last April by the White House, and was far less detailed than what had been drafted by CDC and the Federal Emergency Management Agency. A third guidance issued in August discouraged the testing of people without covid-19 symptoms even when they had contact with infected individuals. That was replaced last September after experts inside and outside the agency raised alarms.
CDC Director Rochelle Walensky ordered the review as part of her pledge to restore public trust in the beleaguered agency, which had seen its recommendations watered down or ignored during the Trump administration to align with the former president’s efforts to downplay the severity of the pandemic.
The review was done “to ensure that all of CDC’s existing covid-19 guidance is evidence-based and free of politics,” according to a memo from the agency’s principal deputy director, Anne Schuchat, who conducted the review, which was posted on the agency’s website Monday. Officials said they are revamping all pandemic-related guidance to ensure that science and transparency are paramount.
The July school reopening guidance was controversial because it was released weeks after Trump criticized the agency’s earlier recommendations as being “very tough and expensive.” The opening preamble extolling the importance of in-school classes, was presented as a CDC document, but the agency was not part of the discussion or drafting, Walensky said. That guidance was removed last October.
“This is something that I will not allow as CDC director,” Walensky said. “The processes we have in place moving forward will ensure this cannot and will not occur.”
Walensky said in an interview that her purpose in asking for the review was to wipe the slate clean “and make sure that with my coming in, that I felt confident in the science and the guidance moving forward, and the team felt comfortable in the science going forward.”
Schuchat does not identify the outside authors who authored the three guidances not developed by CDC staff. Nor does her memo mention political interference by the Trump administration. The word “politics” appears only once, and Walensky and Schuchat appeared to go out of their way in interviews to avoid discussing it.
But the review provides official confirmation of what has been widely reported in press accounts at the time — that political appointees ordered revisions to critical CDC guidance. In addition to the three documents not written by CDC staff, the review also cited recommendations that should have used stronger language and that should have cited supporting scientific briefs.
In addition, the memo said that too often, it was difficult to “decipher the core recommendations” in long guidance documents, and “the crux of what was new or changed was difficult to find.” But the document, a copy of which was shared with The Washington Post, does not provide specifics.
Walensky said she plans to adopt Schuchat’s recommendations to ensure that scientific rationale for major guidance is clearly communicated — with executive summaries that identify what’s new. She said that key guidance will be reviewed quarterly, and briefings held for media and other public health groups when they are issued.
The review also found instances where guidance used weaker language, such as “considerations” and “if feasible,” even though evidence supported a stronger recommendation.
“I can’t speak to how the decisions were made or why the language was less directive than we wanted it to be,” Walensky said. “We need to have language that needs to be clear when the evidence base is sufficiently strong.”
The Biden administration is focusing on the need to “offer the public a unifying message about what we’re doing and help rebuild their faith in government,” said one health official who spoke on the condition of anonymity to talk about internal policy discussions. The official added that it’s harder to rebuild faith in government when people are “constantly reminded of how [the CDC] has been overridden.”
Schuchat and about 15 to 20 CDC staff assessed the major guidance to “identify primary documents that needed updating or removal,” the memo said. Agency officials had already begun assessing key recommendations related to testing and schools in October, because of concerns from clinicians and others about the need for updates as coronavirus cases surged in the fall, Schuchat said in an interview.
On testing recommendations alone, the CDC has “36 different testing guidances that descend from one,” Schuchat said. The agency is working on a major update, including recommendations for prisons, homeless shelters and other workplaces, the memo said. CDC is trying to streamline the process so one major document can cover many circumstances.
Not all guidances have been updated to restore information removed for political reasons. Last May, political appointees delayed the release of and then removed warnings contained in guidance for reopening churches that said that singing in choirs can spread the coronavirus. That warning has not been restored.
Schuchat said the dangers of singing are now covered in general guidance about events and gatherings. “We were trying not to have to update too many different things,” she said. Since May, the CDC has released much more information about the importance of consistent mask use, and the agency will continue to reassess its recommendations.
Officials have released or updated more than a dozen major guidances, eight of them since Jan. 20, when Walensky became director. They include recommendations for wearing properly fitted masks, including double masks; a road map for safely opening schools; and guidelines for fully vaccinated people.