This article by Alexis C. Madrigal and Robinson Meyer at The Atlantic convinces me that the Centers for Disease Control needs attention:
The Centers for Disease Control and Prevention is conflating the results of two different types of coronavirus tests, distorting several important metrics and providing the country with an inaccurate picture of the state of the pandemic. We’ve learned that the CDC is making, at best, a debilitating mistake: combining test results that diagnose current coronavirus infections with test results that measure whether someone has ever had the virus. The upshot is that the government’s disease-fighting agency is overstating the country’s ability to test people who are sick with COVID-19. The agency confirmed to The Atlantic on Wednesday that it is mixing the results of viral and antibody tests, even though the two tests reveal different information and are used for different reasons.
This is not merely a technical error. States have set quantitative guidelines for reopening their economies based on these flawed data points.
The CDC has made enough serious errors over the last few months that it’s obvious that it needs some serious attention. The organization’s problems didn’t start with its mishandling of finding a good, reliable test for SARS-CoV-2 but that was indicative of the problems.
I am not much given to finding fault but I’ll engage in a little finger-pointing here. Whose fault is this mess? First of all, it’s President Trump’s fault in a “buck stops here” sense. Ultimately, the CDC reports to him. The voters who voted for him are at fault. Robert Redfield, the current director of the CDC, appointed by President Trump, is at fault. And most of all the professional staff at the CDC is at fault. I don’t believe that Dr. Redfield is a poor director of the CDC because he’s not an epidemiologist (he’s a virologist). I think he’s a poor director because he’s a lousy manager.
It is not merely a misconception but a lie that to be an effective manager of professional staff you’ve got to be a professional (lawyer, doctor, violinist, etc.) yourself. I don’t believe that in the history of the world any MD has gone to medical school to become a manager. In general I don’t think docs have the temperament, attitude, training, or skills to be good managers.
My experience has been that professional staff commonly chafe at being managed at all but particularly by non-professionals. The path of least resistance for a manager whose job it is to manage professionals is to give the job to a professional but that may not be the right decision. Most of all you need a good manager.
I am more interested in solving problems than admiring them. At this point I’m not convinced that the CDC should continue to exist.
The article is lot of hype, scare mongering, and blaming.
It does not quantify how bad they think it is — my understanding is it is not bad. The reality is multiple governors including New York say they have excess number of tests, they cannot find enough people to test; and cities like Seattle are dropping any requirements to get a PCR test.
The authors complain about the purity of the data; but that ship sailed long ago when the States lumped deaths that were tested positive and caused by COVID; tested positive and not caused by COVID; not tested but were probable caused by COVID together.
The authors then fail to qualify how it impacts the data. The inclusion of antibody tests does not change deaths; and makes the number of positive cases increase. And those are the top two indicators everyone is watching. They argue antibody tests will increase negative results, total tests, and decrease the positivity rate. Those 3 are secondary indicators followed mostly by experts.
The CDC has many faults (and I said so); but this is a small one; and they are not even responsible for the majority of it — the authors should complain to the individual states.
I think journalists who don’t know the subject matter they write about is as bad as the CDC’s screwups when it comes to the causes of failures in the American response.
Why would you need to be an epidemiologist to run the CDC? Have any of them had that background? What you need is training and/or experience in public health. Anyway, I have been painting this out for a while. It is not just testing, though that is part of it. There have been multiple areas they have failed, been wrong or not helpful. AS I keep pointing out, this is new. We dont need to replace the CDC we just need it to return to how it used to function.
Whose fault? Since most of the CDC staff is the same, unless there was some purge I missed, this is clearly a leadership issue. I suspect Redfield and his choices as aides bear some blame. However, I also suspect that they were under pressure to give the executive branch the answers it wanted. (Reminiscent of the National Defense Assessment giving Bush the answers he wanted isnt it?)
“In general I don’t think docs have the temperament, attitude, training, or skills to be good managers.”
Completely agree, but there isn’t any group I can think of that has the intrinsic skills to be good managers, especially MBAs just to single out a group that some would think would be good. Docs are mostly geeks who want to specialize in their own area. That said, individual docs can be excellent, just as individuals from almost any other profession can be good managers or leaders (not always the same thing).
I think that you need a combination of some intrinsic personality assets, but that with training and working at it you can become a really good manager if you want.
“My experience has been that professional staff commonly chafe at being managed at all but particularly by non-professionals.”
Certainly true in medicine. Heck, our sub specialists are sometimes unhappy with being managed by a specialist in their own area. (Our chief of surgery is a thoracic surgeon and the cardiothoracic surgeons cause him some grief.) But if the manager is good it still works out. You need to have senior non physician leadership and physician leadership willing to work together and then it can filter down to lower levels.
Steve
A bit OT, but this New York Intelligencer piece is just about the best thing I’ve read on Covid for quite a while. It’s nice to see people acknowledge uncertainty instead of treating whatever the latest study or anecdote indicates as fact.
https://nymag.com/intelligencer/2020/05/facts-about-coronavirus-kawasaki-and-when-schools-will-open.html
As far as management and expertise go, I always like to use Leslie Groves as an example of effectiveness.
That article, Andy, pretty much sums up at the highest level what I’ve been saying for two months now. The data was and is suspect. The predictions were crap. The models were crap. We don’t know so much. And yet, with certitude, we implemented policies that had predictable and now demonstrably severe consequences. Nary a thought given to let’s wait and see, or at least a toned down response targeted at the most vulnerable.
I realize I have lived in a world of big time risk taking, and therefore have a developed tolerance, unlike most people. However, we came right to the edge of a maniacal “no risk” mentality. The costs of alternative and unchampioned risks, be they monetary, civil liberties or crass political power grabs be damned. We have become soft and prone to heeding the words of the loudest mouths offering the illusion of security.
The article is a good one, Andy, but it has a major omission. The primary barrier to reopening the schools isn’t susceptibility of children to COVID-19 or the lack of confidence among parents, it’s that the teachers are afraid of contracting COVID-19 from the students or each other. Consider that on average 30% of teachers are over 50 and it’s understandable.
“That article, Andy, pretty much sums up at the highest level what I’ve been saying for two months now.”
It kind of says the opposite of what you have been saying. You claim, with absolute certainty, that we should have targeted isolation. This article, many others, and common sense tell us we dont know how to do that at least partially because we dont understand the virus well enough. So nearly every country tin the world had some form of lockdown. Those who started late, like Italy and NYC didnt do very well. Everyone else in the world was wrong. Only US conservatives knew the way.
All you risk is money. You might end up a bit less rich. If it goes really bad you might end up bankrupt. Doesnt Florida still have the Homesteading rule? If so, you can keep your castle and car too IIRC. Other people risk their lives, the lives of those who work for them or the lives they protect. They risk their jobs, and dont have a castle to keep if they do go bankrupt. You Masters of the Universe will never understand that, just money.
Steve
I think Dave has the correct point about why schools are not open. Also, we have different tolerances for risks to children vs the elderly.
About targeted isolation, read the interview with Governor DeSantis from the National Review.
Florida has as many elderly residents as New York. Yet they have had significantly fewer nursing home deaths (also deaths overall) AND their lockdown was later and more relaxed then New York. DeSantis credits much of it to targeted isolation and a targeted focus on nursing homes.
As a follow-on; I personally believe losing an elderly person to COVID is as tragic as losing a child.
In different ways. When a child dies, you’re losing the future. When an old person dies, you’re losing the past. As has been said, when an old person dies, it’s like burning a library.