The C.D.C. Waited ‘Its Entire Existence for This Moment.’ What Went Wrong?

Eric Lipton, Abby Goodnough, Michael D. Shear, Megan Twohey, Apoorva Mandavilli, Sheri Fink and Mark Walker write in today’s New York Times.

WASHINGTON — Americans returning from China landed at U.S. airports by the thousands in early February, potential carriers of a deadly virus who had been diverted to a handful of cities for screening by the Centers for Disease Control and Prevention.

Their arrival prompted a frantic scramble by local and state officials to press the travelers to self-quarantine, and to monitor whether anyone fell ill. It was one of the earliest tests of whether the public health system in the United States could contain the contagion.

But the effort was frustrated as the C.D.C.’s decades-old notification system delivered information collected at the airports that was riddled with duplicative records, bad phone numbers and incomplete addresses. For weeks, officials tried to track passengers using lists sent by the C.D.C., scouring information about each flight in separate spreadsheets.

“It was insane,” said Dr. Sharon Balter, a director at the Los Angeles County Department of Public Health. When the system went offline in mid-February, briefly halting the flow of passenger data, local officials listened in disbelief on a conference call as the C.D.C. responded to the possibility that infected travelers might slip away.

The flawed effort was an early revelation for some health departments, whose confidence in the C.D.C. was shaken as it confronted the most urgent public health emergency in its 74-year history — a pathogen that has penetrated much of the nation, killing more than 100,000 people.

The C.D.C., long considered the world’s premier health agency, made early testing mistakes that contributed to a cascade of problems that persist today as the country tries to reopen. It failed to provide timely counts of infections and deaths, hindered by aging technology and a fractured public health reporting system. And it hesitated in absorbing the lessons of other countries, including the perils of silent carriers spreading the infection.

The agency struggled to calibrate its own imperative to be cautious and the need to move fast as the coronavirus ravaged the country, according to a review of thousands of emails and interviews with more than 100 state and federal officials, public health experts, C.D.C. employees and medical workers. In communicating to the public, its leadership was barely visible, its stream of guidance was often slow and its messages were sometimes confusing, sowing mistrust.

“They let us down,” said Dr. Stephane Otmezguine, an anesthesiologist who treated coronavirus patients in Fort Lauderdale, Fla. Richard Whitley, the top health official in Nevada, wrote to the C.D.C. director about a communication “breakdown” between the states and the agency. Gov. J.B. Pritzker of Illinois lashed out at the agency over testing, saying that the government’s response would “go down in history as a profound failure.”

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A letter sent by Nevada’s top health official to the C.D.C. director, expressing concern about communication.

“The C.D.C. is no longer the reliable go-to place,” said Dr. Ashish Jha, the director of the Harvard Global Health Institute.

Even as the virus tested the C.D.C.’s capacity to respond, the agency and its director, Dr. Robert R. Redfield, faced unprecedented challenges from President Trump, who repeatedly wished away the pandemic. His efforts to seize the spotlight from the public health agency reflected the broader patterns of his erratic presidency: public condemnations on Twitter, a tendency to dismiss findings from scientists, inconsistent policy or decision-making and a suspicion that the “deep state” inside the government is working to force him out of office.

Mr. Trump and his top aides have grown increasingly bitter about perceived leaks from the C.D.C. they say were designed to embarrass the president and to build support for decisions that ignore broader concerns about the country’s vast social and economic dislocation. At the same time, some at the C.D.C. have bristled at what they see as pressure to bend evidence-based recommendations to help Mr. Trump’s political standing.

Located in Atlanta, the C.D.C. is encharged with protecting the nation against public health threats — from anthrax to obesity — and serving as the unassailable source of information about fighting them. Given its record and resources, the agency might have become the undisputed leader in the global fight against the virus.

Instead, the C.D.C. made missteps that undermined America’s response.

“Here is an agency that has been waiting its entire existence for this moment,” said Dr. Peter Lurie, a former associate commissioner at the Food and Drug Administration who for years worked closely with the C.D.C. “And then they flub it. It is very sad. That is what they were set up to do.”

The agency’s allies say it is just one part of a vast network of state and local health departments, hospitals, government agencies and suppliers that were collectively unprepared for the speed, scope and ferocity of the pandemic. They also point out that lawmakers have long failed to adequately prioritize funding for the kind of crisis the country now faces.

Dr. Amy Ray, an infectious disease specialist in Cleveland, said the C.D.C. did not “get enough credit,” adding, “They are learning at the same time the world is learning, by watching how this disease manifests.”

The agency, which declined repeated requests for interviews with its top officials, said in a statement: “C.D.C. is at the table as part of the larger U.S. government response, providing the best, most current data and scientific understanding we have.”

“It’s important to remember that this is a global emergency — and it’s impacting the entire U.S.,” the agency said. “That means it requires an all-of-government response.”

‘Not Our Culture to Intervene’

In early March, Dr. Redfield led Mr. Trump on a V.I.P. tour of the high-tech labs at the C.D.C.’s Atlanta headquarters, standing off to the side as the president spoke.

Wearing a red “Keep America Great” cap, Mr. Trump falsely asserted that “anybody that wants a test can get a test,” claimed he had a “natural ability” for science and noted that he might hold campaign rallies even as the virus spread.

“Thank you for your decisive leadership in helping us, you know, put public health first,” Dr. Redfield told the president as they posed for the cameras.

The moment underscored the challenge for the director and his agency. To combat the virus, he would have to manage the mercurial demands of the president who appointed him and the expectations of the career scientists he leads.

The sensibilities could not be more different. At one point that month, administration officials asked the agency to provide feedback on possible logos — including “Make America Healthy Again” — for cloth face masks they hoped to distribute to millions of Americans. The plan fell through, but not before C.D.C. leaders agreed to the request, according to one person familiar with the discussions.

White House aides saw Dr. Redfield, 68, as an ally, but as the coronavirus crisis intensified, his meandering manner in television appearances and congressional hearings irritated a president drawn to big personalities and assertive defenders of his administration.

A former military virologist who specialized in H.I.V., Dr. Redfield was Mr. Trump’s second choice after his first C.D.C. director resigned. He had no experience leading a government agency — though he had been considered for jobs in previous Republican administrations — and often told associates that he was happiest treating patients in Africa or Haiti.

Dr. Robert C. Gallo, who founded the Institute of Human Virology at the University of Maryland School of Medicine with Dr. Redfield in 1996, said he had warned him against taking the C.D.C. post, describing it as “massive public health, lots of politics, lots of pressure.”

While praising his friend as “a terrific, dedicated infectious disease doctor,” Dr. Gallo, who also co-founded the Global Virus Network, said in an interview that Dr. Redfield “can’t do anything communication-wise.” He added, “He’s reticent, never wanting the front of anything — maybe it’s extreme humility.”

The C.D.C., established in the 1940s to control malaria in the South, has the feel of an academic institution. There, experts work “at the speed of science — you take time doing it,” said Dr. Georges C. Benjamin, executive director of the American Public Health Association.

The agency, a division of the Department of Health and Human Services with 11,000 employees, cannot make policy, but it guides federal and state public health systems and advises government leaders.

The C.D.C.’s most fabled experts are the disease detectives of its Epidemic Intelligence Service, rapid responders who investigate outbreaks. But more broadly, according to current and former employees and others who worked closely with the agency, the C.D.C. is risk-averse, perfectionist and ill suited to improvising in a quickly evolving crisis — particularly one that shuts down the country and paralyzes the economy.

“It’s not our culture to intervene,” said Dr. George Schmid, who worked at the agency off and on for nearly four decades. He described it as increasingly bureaucratic, weighed down by “indescribable, burdensome hierarchy.”

The exacting culture shaped its scientists’ ambitions; it also locked some into a fixed way of thinking, former officials said. And it helped produce the C.D.C.’s most consequential failure in the crisis: its inability early on to provide state laboratories around the country with an effective diagnostic test.

The C.D.C. quickly developed a successful test in January designed to be highly precise, but it was more complicated to use and turned out to be no better than versions produced overseas. And in manufacturing test kits to send to the states, the C.D.C. contaminated many of them through sloppy lab practices. That, along with the administration’s failure to quickly ramp up commercial and academic labs, delayed the rollout of tests and limited their availability for months.

By Eric Lipton, Abby Goodnough, Michael D. Shear, Megan Twohey, Apoorva Mandavilli, Sheri Fink and Mark Walker write in today’s New York Times.