Covid has proven the CDC to be broken. Can it be corrected?


MacCannell says he did whatever he could to get agreement on the disaster: he and his staff devised protocols to help public health labs start new sequencing packages; developed partnership plans with industrial laboratories, which have a much larger total capacity; and organize a consortium of scientists across the country to collaborate and pool resources. But these efforts had been only a stopgap, he admits, and anyway, the approval and funding to get them off the ground were delayed for many months. “There was a big gap between what we expected to happen and what we actually saw happen,” says MacCannell. “Not just at the federal level, but every step of the way from there. “

Genomic surveillance is certainly one of the many shortcomings in the disease surveillance system chaired by the CDC. These shortcomings have been invisible to anyone who does not work in the field, because at first glance the system is smart. Public health emergencies that can be recognized at the local level are reported along with state health services, then, when mandatory, forwarded to CDC, local officers analyze information, situation indicators and coordinate responses. federal response efforts. There is a specific system for the 120 or so “reportable diseases” – such as Lyme disease and hepatitis – which everyone agrees are serious enough to warrant an instant move, and another for “syndromic surveillance,” in which epidemiologists can search for emergencies in real time. information on signs of worry. But under this vast structure, chaos usually reigns.

As the coronavirus grew into a full-blown pandemic, scientists at the CDC struggled to answer even major questions about how the disease looked, where, or how it was spreading.

The system itself is deeply disjointed, and the expertise behind it is far less refined than that discovered in many American homes. State health services are generally not linked to each other in a meaningful way, nor are hospitals, clinics, laboratories, and local health companies. The CDC maintains over 100 separate disease-specific computer techniques (a byproduct of corporate funding silos), and many of them cannot interface with each other. Crucial information typically travels from health care services to health care services via a tortured route that can contain handwritten notes, spreadsheets, faxes, and postal mail. It is not uncommon for primary information such as race, ethnicity, age, or grip to lack scientific background. It is also not uncommon for these experiences to languish at the state or national level without ever making their technique to federal agents. Even the most serious conditions, which are supposed to be recorded within 24 hours of detection and reported to the CDC in a timely manner, usually don’t essentially get sent down this chain by a systematic method. “It depends on the jurisdiction,” Janet Hamilton, government director of the Council for State and Territorial Epidemiologists, informed me not too long ago. “Some regions have strong public health services and good reporting, and others do not. “

Disease surveillance can be hampered by the uneven patchwork of surveillance programs across the country and the desire to barter information sharing and different agreements individually with each state. Resistance to antibiotics, respiratory infections and different pathogens are monitored robustly in some areas and very poorly or not at all in others (respiratory infections, for example, are more closely monitored in the Four Corners area than ‘elsewhere), in part because the company does not have the skills or authority to get all the information it wants from each neighborhood. Hanage compares all of the equipment to a Rube Goldberg machine. “There is nothing central,” he says. “Random patchwork collaborations have been initiated and transformed and are now having a disproportionate impact on our understanding of public health. It is not to criticize the people who did these things, because the alternative could have been nothing. But the result is something with no rational plan behind it.

The gaps make it difficult to find even the most well-known diseases and virtually impossible to treat new ones. During a current outbreak of E. coli involving romaine lettuce, officers had been forced to base billion-dollar life-and-death choices on which goods to pull from which cabinets in which regions of the country on information captured on-screen and text-message to epidemiologists and health workers. During the vaping (or Evali) epidemic of 2019, doctors faxed many pages of medical information, in some cases, to local health departments. Epidemiologists can barely analyze information in this format, let alone analyze it for clues. “There isn’t a ready-made process for when something like a vaping injury or Zika or SARS-CoV-2 comes up,” Hamilton says. “There are 64 separate public health jurisdictions in this country, and each will have their own ideas of what information to collect and how to share it. “

In 2020, as the coronavirus progressed from a few remote outbreaks to a full-blown pandemic, scientists at the CDC struggled to answer even major questions about what the disease itself looked like or where or where it was. way it spread. “We were asked who is hospitalized, who are the severe cases, what are the characteristics, and it was so frustrating,” Anne Schuchat, deputy director of the company, told a panel of colleagues last fall. “People would go out to manually review the charts. I was under the impression that, well, the health care industry has that data. It’s in their system. Can we work with them? The company was unable to maintain reliable observation of tests or application fees across the country. It has also struggled to replace information on hospitals, which includes issues such as the availability of mattresses and the provision of ventilators; the Trump administration hired a personal contractor to gather this information, amid accusations of political patronage. And when a number of vaccines were finally rolled out, the company was unable to monitor supplies or accurately keep tabs on waste.

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