Yes, the CDC Can Change Its Mind
Prof. Joel Eissenberg, Biochemistry & Molecular Biology, Geneticist
The Nobel Laureate economist Paul Samuelson famously acknowledged in a Meet the Press interview:
“Well when events change, I change my mind. What do you do?”
This observation applies to the advice from medical authorities such as the CDC and WHO during the COVID pandemic. Some members of the public are fond of pillorying these agencies for having published different guidelines at different times, as though health officials are in the business of issuing ex cathedra dogma rather than responding to incomplete and ambiguous information. Science doesn’t deal in proof, it deals with the weight of evidence. A scientific hypothesis is one that is capable of being tested and falsified by experiment.
I get it. I used to teach problem-based learning to first year medical students, and they often struggled with what to do with incomplete and ambiguous information, which is what physicians in clinics do every day. Sometimes, one cannot wait for all the tests to be completed and all the data analyzed before taking some action. With new evidence, a change in action is sometimes warranted.
Thanks to COVID, the curtain on research and discovery has been pulled away and the omniscient Oz is revealed to be a mere mortal doing their best with the resources at hand. So when new and better data appear, it is right and responsible to examine previous advice in light of those data. This happens all the time, even if most people don’t see it. As the virus and our understanding of its epidemiology changes, the guidance changes.
So rather than prating at the CDC for evolving standards in light of new data as though discovering that papal bull was found to be papal bull****, celebrate the fact that science is self-correcting and, overall, moves towards better understanding.
To paraphrase MLK:
“the arc of the scientific universe is long, but it bends toward truth.”
Is this anything
What do we know about ‘flurona?’
… flurona is a coinfection of the flu and coronavirus. Similar cases have been reported since early 2020, when the pandemic first took hold. …
… Cases have been reported in several states throughout the United States, including in California, Texas, and Kansas. Other countries, among them Brazil, Hungary, and Spain have also confirmed instances of the coinfection. …
… The CDC expects both the flu virus and the coronavirus to spread throughout this winter. Flu activity in the United States is already increasing, following a period where it did not circulate as much as usual. Massachusetts recently recorded the highest activity of the flu since April 2020.
Coronavirus safety measures that were previously put in place to stem its spread, including stay-at-home orders and school closures, have also been relaxed nationwide, which may additionally “result in an increase in flu activity,” according to the CDC.
“These prevention measures likely contributed to reduced numbers of hospitalizations for both” flu and coronavirus, according to the CDC. “Without these prevention measures in place, annual rates of COVID-19-associated hospitalizations would likely have been much higher than those for flu during typical flu seasons.”
Fewer people are also receiving their flu shot compared to previous years, and a sizable portion of the country is not yet fully vaccinated against the coronavirus, according to the CDC. This comes at a time when COVID cases are spiking nationwide, which has largely been attributed to the emergence of Omicron. …
… “The reason we haven’t talked about it much is that it’s not been clinically a challenge yet,” Dr. Jonathan D. Grein, an infectious disease physician and the director of hospital epidemiology at Cedars Sinai Medical Center, told the New York Times. “We anticipate that as flu becomes more prevalent, we will see more coinfections.” …
@Dobbs,
I saw that recently. Doesn’t surprise me. Both flu and coronavirus are highly contagious and peak during winter months where people spend more times indoors.
Joel,
What do AZ winters have in common with Wisconsin winters? My money is on low humidity, of course even more damaging to bronchial passages when the air is cold. The relative humidity is generally lowest when cold air is heated in winter. I live in the South and we have a dehumidifier, not rare but not very common either as they are pricey. So, how many homes are equipped with humidifiers. Go outside and take in a deep breath of cold air into dry lungs.
This is to say that injured tissue is more susceptible to any infection than healthy tissue.
@Ron,
Sounds reasonable. Not familiar with any peer reviewed research on that hypothesis, although it may well exist.
[Old coke for me, but Google had it.]
https://pubmed.ncbi.nlm.nih.gov/17705968/
Exposure to cold and respiratory tract infections
Abstract
There is a constant increase in hospitalizations and mortality during winter months; cardiovascular diseases as well as respiratory infections are responsible for a large proportion of this added morbidity and mortality. Exposure to cold has often been associated with increased incidence and severity of respiratory tract infections. The data available suggest that exposure to cold, either through exposure to low environmental temperatures or during induced hypothermia, increases the risk of developing upper and lower respiratory tract infections and dying from them; in addition, the longer the duration of exposure the higher the risk of infection. Although not all studies agree, most of the available evidence from laboratory and clinical studies suggests that inhaled cold air, cooling of the body surface and cold stress induced by lowering the core body temperature cause pathophysiological responses such as vasoconstriction in the respiratory tract mucosa and suppression of immune responses, which are responsible for increased susceptibility to infections. The general public and public health authorities should therefore keep this in mind and take appropriate measures to prevent increases in morbidity and mortality during winter due to respiratory infections…
Also Coccidioidomycosis may be a preexisting condition that rarely gets mentioned. However, that is a SWAG for me and a leap. Next time I talk with my friend in Tucson then I will ask him.
@Ron,
Thanks for the follow-up. I see they mention cold, but I thought your point was humidity, not temperature.
Joel,
Unless one lives in a desert then cold air is dry after it has been warmed for human consumption and hot is wet or humid. Cold air holds less water in absolute terms even at 100% relative humidity. Air with a fixed absolute humidity when warmed continues to lower relative humidity with each degree of temperature rise. When we breathe in then our bodies warm the air making it drier in relative terms. Even the cold air on our exposed body parts is warmed by our skin, which biology attempts to maintain at around 92F (down a few degrees from our internal 98F+.
OTOH, extreme cold can do additional tissue damage, but not temps that I will be outside in . If the air in ones lungs is below freezing they may die if exposed too long, which is worse that catching a virus.
I rarely work outside at temperatures below 32F, but I must apply Gold Bond lotion to my hands daily throughout our winter months, even if I am only working inside. In desert regions then the most frequent contagions of the respiratory system are fungal infections such as Coccidioidomycosis, but Covid-19 became widespread in AZ this past year.
Joel,
My understanding is that social behavior differs vastly between the upper mid-west and the desert southwest although political behavior is somewhat similar. In the upper mid-west then people congregate in bars to pass time in winter or go ice fishing, while in the desert SW one can venture outdoors at midday during the winter. Summers are just the opposite. My friend in Tucson bikes and plays tennis before 9AM during the warmer half of the year. OTOH, he does spend a bit of time in bars socializing during summer evenings when people in the upper mid-west are having their beer by the gas grill outdoors.
Can You Get the Flu and Covid at the Same Time?
NY Times – Jan 7
Forgive me, but the CDC from the beginning of the coronavirus genetic decoding to the resent has continually turned away from the experience of several important other countries. For instance, China decoded the coronavirus genome in about 7 days and immediately developed testing primers for the virus. The testing primers and code were given to WHO. However, the CDC spent more than 2 months before finally developing a test. Testing primers were available from WHO, Germany, Korea and, of course, China.
China made it immediately clear that age was a risk factor, but in the US nursing homes were often used for treating coronavirus patients. The CDC made a point of not learning from the Chinese experience…
https://news.cgtn.com/news/2022-01-08/Chinese-mainland-records-159-confirmed-COVID-19-cases-16EeUaMiONG/index.html
January 8, 2022
Chinese mainland reports 159 new COVID-19 cases
The Chinese mainland recorded 159 confirmed COVID-19 cases on Friday, with 95 linked to local transmissions and 64 from overseas, data from the National Health Commission showed on Saturday.
A total of 52 new asymptomatic cases were also recorded, and 661 asymptomatic patients remain under medical observation.
Confirmed cases on the Chinese mainland now total 103,454, with the death toll remaining unchanged at 4,636 since January last year.
Chinese mainland new locally transmitted cases
https://news.cgtn.com/news/2022-01-08/Chinese-mainland-records-159-confirmed-COVID-19-cases-16EeUaMiONG/img/7a5c4f607a6b4027891de385bb2e7a56/7a5c4f607a6b4027891de385bb2e7a56.jpeg
Chinese mainland new imported cases
https://news.cgtn.com/news/2022-01-08/Chinese-mainland-records-159-confirmed-COVID-19-cases-16EeUaMiONG/img/1ba8d36eb66543fab9e54fe9955c8c1e/1ba8d36eb66543fab9e54fe9955c8c1e.jpeg
Chinese mainland new asymptomatic cases
https://news.cgtn.com/news/2022-01-08/Chinese-mainland-records-159-confirmed-COVID-19-cases-16EeUaMiONG/img/1cfcf56b10bd4b0e9006ab45b126b244/1cfcf56b10bd4b0e9006ab45b126b244.jpeg
January 7, 2022
Coronavirus
United States
Cases ( 60,464,426)
Deaths ( 858,346)
Deaths per million ( 2,570)
China
Cases ( 103,295)
Deaths ( 4,636)
Deaths per million ( 3)
@ltr,
The Trump Administration certainly blinded the CDC, so that the information they acted on (and were allowed to act on) was more limited than the universe of data. That said, do you recall how the sequence information issue you highlighted impacted CDC advice on masking, social distancing, hand washing, surface cleaning and air handling? If so, I’m happy to be educated.
Through January 2020, a course of detection and spread prevention and preliminary understanding of the course of illness and treatment approaches were worked out. Work on vaccines had begun by the middle of January. The need for quarantine was established about January 20. The problem with asymptomatic persons was understood by the middle of February. The problem with surface transmission was assumed early in January and found to be correct in following months, though still routinely dismissed. *
* The Chinese made a point of protecting against imports of cold-chain products from February on.
I remember an article in the NYTimes in spring 2020, about the parents of a physician who treated coronavirus patients sadly becoming infected and dying. But, Chinese physicians and nurses in January were living apart from families in special facilities to prevent infection spread. Before Chinese medical personnel returned to families, they were quarantined.
Disruption, Dismay, Dissent: Americans Grapple With Omicron’s Rise
NY Times – Jan 9
NY Times – Jan 9 (Link won’t post)
Disruption, Dismay, Dissent: Americans Grapple With Omicron’s Rise
With infection rates mounting, the Omicron variant has ushered in a new and disorienting phase of the pandemic, leaving Americans frustrated and dismayed that the basic elements they thought they understood about the coronavirus are shifting faster than ever.
There were reasons for heightened concern and reasons for consolation: Omicron is more transmissible than previous variants, yet it appears to cause milder symptoms in many people. Hospitalizations have soared to new highs in some states, but “incidental patients” — people who test positive for Covid-19 after being admitted for another reason — make up close to half of their cases in some hospitals. …
The Trump Administration certainly blinded the CDC, so that the information they acted on (and were allowed to act on) was more limited than the universe of data….
[ I do not understand this sentence, since the CDC is not part of an administration but an independent agency. However, I would like to respond to the entire comment, and tried to but am not sure what expressly is being asked.
The American response to the coronavirus routinely dismissed the Chinese experience which was always available and offered by the Chinese. Dismissing the Chinese experience strikes me as indeed unfortunate. ]
@ltr,
The American response dismissed strategies of various nations (or if you like, they dismissed ours). It wasn’t limited to China. There wasn’t a single world-wide response. Was the US response at the time metaphysically perfect? I don’t think so. I would have preferred much more testing, mandatory indoor masking and closure of indoor service at bars and restaurants much sooner. But Sweden, for example, did even less than the US.
As for my comment about the Trump Administration political pressure on the CDC, I’m sorry you missed it, but you can find evidence all over the internet using Google. Here’s the first hit I found:
https://www.cnbc.com/2021/02/08/trump-administration-influenced-cdc-guidance-to-suppress-covid-testing-house-panel-says.html
The Trump Administration certainly blinded the CDC, so that the information they acted on (and were allowed to act on) was more limited than the universe of data….
[ CDC officials are independent of an administration, though they can be pressured. Still, CDC officials have a public responsibility and should act accordingly.
The Trump administration was awful, but that does not excuse CDC officials in making unfortunate decisions.
No matter, your post was superb and I only sought to respond but evidently I responded poorly. ]
@ltr,
No prob, thanks for the kind words. I would have liked to see more courage from the CDC in standing up to the Trump Administration. I could say the same about Fauci, and did at the time. I suspect they all stifled themselves in the belief that they’d only be replaced by Trump political commissars. Unfortunately, I don’t think the US was well-served by their acquiescence.
I would have liked to see more courage from the CDC in standing up to the Trump Administration. I could say the same about Fauci, and did at the time. I suspect they all stifled themselves in the belief that they’d only be replaced by Trump political commissars. Unfortunately, I don’t think the US was well-served by their acquiescence.
[ Perfect and really important. ]
https://www.worldometers.info/coronavirus/
January 8, 2022
Coronavirus
United States
Cases ( 60,954,028)
Deaths ( 859,046)
Deaths per million ( 2,572)
China
Cases ( 103,454)
Deaths ( 4,636)
Deaths per million ( 3)
The Trump Administration certainly blinded the CDC, so that the information they acted on (and were allowed to act on) was more limited than the universe of data….
[ The Wuhan Health Commission learned of and informed all Wuhan hospitals of cases of an unusual pneumonia on December 30, 1999. The Chinese National Health Commission sent an emergency response team to Wuhan on December 31. The public was informed and cautioned on December 31.
The Chinese were in direct contact with the CDC on the coronavirus from January 3, 2020 on. On January 3, WHO officials were informed of the coronavirus by the Chinese. January 7, the Chinese decoded the coronavirus genome…. ]
COVID may become endemic
Boston Globe – Jan 9