Frequently Asked Questions about COVID-19 — September 21, 2022

“Shared expectations lead to predictability.”

587. The CDC is now undergoing a thorough review and reorganization

         QI hear the CDC is not preforming as well as it could.  What’s happening?

         A:  For weeks, news media have been issuing reports that the U.S. Centers for Disease Control and Prevention has been examining ways to streamline its work enabling it to provide clearer, less confusing messages to the public.  In the September 19 issue of Time Magazine, Alice Park of the Time staff published an article based on questions asked and responded to by Rochelle Walensky, MD, MPH, the CDC director.  Walensky stated she had learned for herself that in its 26-year history, the CDC has always been preparing for a pandemic but never had to manage one.  To identify areas where changes can be made, more than 170 people inside and outside the agency were interviewed by senior staff asking critical questions about the recent successes and failures of the agency in managing Covid-19.

It was identified that the CDC has developed an infrastructure of academia.  The agency was driven by research, publication of studies, and generally has communicated with scientists, public health experts and academics.  Walensky has concluded the CDC was no longer an agency for public health officials.  “We have to be an agency for the American people,” she stated.

Discussing the bad headlines about confusing advice over masking and other mitigation measures, she stated, “We all didn’t like the headlines.  We found ourselves having to convey the nuances of the reasons behind the decisions we made with science that was difficult to convey.”  She concluded it was more important to communicate in ways that convinced the American public.  The agency is now moving to establish ways of communicating that is more readable, more accessible, and not tied down by scientific details.

One of the issues raised in their review was the lengthy time it takes to set up case studies of large numbers of people, collect the data, publish the results and have others review and agree the findings are valid and safe.  All of this before deciding to authorize it for general use.  In the traditional peer-review process, agreement can be quite prolonged.  The CDC is talking now about possibly posting early study data on a pre-publication server to let other experts see the results and collaborate earlier.

Dr. Walensky stated that the culture at CDC will be changing, but this will take time and effort.  The emphasis will be shifting away from publishing public health data, studies and publications, and focusing more on publishing public health actions.

588. Native Americans have suffered greatly with Covid-19.

         QHow well have American Indian tribes survived the pandemic?

         A:  Ashley Wu and German Lopez are two reporters for the New York Times, who recently published an article addressing the impact of Covid-19 on Native Americans.

The C.D.C. revealed early in September that from 2019 to 2021, the life expectancy of Native Americans fell from 71.8 years to 65.2. Covid was largely to blame.  The average Native American person is now expected to live as long as the average American did in 1944.  There are many reasons for this.  Native Americans tend to have higher rates of underlying health problems that exacerbate Covid, as well as worse access to health care.  “Even prior to the pandemic, rates of death among Indigenous people were higher in lots of categories,” said Dr. Laura Hammitt, an epidemiologist at Johns Hopkins University. Covid magnified those health disparities, causing a drop in life expectancy with no modern precedent in the U.S.

The link between people who refuse to be vaccinated and become sick fails with Native Americans as a group.   Vaccination rates among Native Americans are higher than they are among Black or Hispanic Americans, according to CDC data.  Yet Native Americans have died from Covid at one of the highest rates of any race or ethnicity since the start of the pandemic.  Other than vaccinations, other factors appear to be the reason for this.  For instance, Native Americans have some of the highest rates of health conditions, such as obesity and diabetes, that make a person much more likely to die from Covid.

Health care is also often inaccessible. The Indian Health Service, a federal program that provides care to more than two million Native Americans, have a fraction of the funding on a per-person basis received by Medicare, Medicaid or the Veterans Health Administration. “How can somebody think this is not a problem? Yet it’s become normal,” said Loretta Christensen, the Indian Health Service chief medical officer.  As a result, Native Americans frequently have to travel long distances to get health care, and its quality can be shoddy. A quarter of Native Americans reported experiencing discrimination when visiting a doctor or a health clinic, one poll found.  Cultural and language barriers can also make it difficult for Indigenous people to get the care they want. Given those obstacles, some try to tough out illness at home, with potentially deadly results.

Poverty also is surely a major factor.  Widespread poverty limits what precautions people can take to avoid Covid. People living paycheck to paycheck can’t afford to take time off work to avoid spreading or catching the virus. Native Americans also often lack access to internet, electricity and running water — making remote work, virtual schooling or telemedicine impossible.  And Native Americans often live in crowded, multigenerational homes. So, if they are sick, they can easily spread the virus to the rest of the family, including older relatives who are much more vulnerable to Covid.

The authors conclude that preventing deadly pandemics isn’t just about containing the pathogens that cause them, but also about improving the health of communities across the board.