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CDC messaging issue highlights uncertain future of pandemic

At a particularly crucial time in the pandemic, the Centers for Disease Control and Prevention has an email problem.

The CDC and its director, Dr Rochelle Walensky, have come under increasing criticism over statements and guidelines that have been revised or pushed back.

The United States faces an enigma. Millions of Americans get vaccinated every day, and state and local governments are easing restrictions. Meanwhile, as the number of cases increases in parts of the country, public health experts are worried about the possibility of a fourth outbreak.

There are no easy answers.

“One of the most important things we say in public health is that you have to have a very simple message,” said Dr Wafaa El-Sadr, professor of epidemiology and medicine at Columbia University. . “But we are in a situation where the message is very complex.”

The problems started last week with what have been perceived to be mixed messages about the state of the pandemic and what is safe for people who have been fully vaccinated.

Walensky warned on March 29 of “impending disaster” due to the recent increase in the number of cases across the country. In an interview with MSNBC the same day, she raised her eyebrows by suggesting that “vaccinees do not carry the virus.” Many researchers have criticized the comments, saying it is too early to know for sure what effect vaccines might have on transmission. The CDC reversed its statement a few days later.

The agency then relaxed its travel advice for fully vaccinated people, but in light of the steadily rising number of cases and the majority of the U.S. population still unvaccinated, Walensky said: “I would campaign against travel in general.”

The recent back-and-forth has caused confusion and frustration, and has blurred public health messages in the face of what some experts call precarious. The CDC comes under fire at a volatile time as it attempts to rebuild the trust that has eroded over the past year, in large part due to political interference from the Trump administration.

“Whether you are a public health agency or leading a communications campaign of any kind, an erosion of trust is extremely damaging,” said Alison Buttenheim, associate professor of nursing and health policy at the University of Pennsylvania.

She said Walensky’s comments about people vaccinated and transmission were “not super thoughtful,” but added that missteps in public health messages can be saved if handled transparently.

Others were less sympathetic.

“CDC messaging on post-vax restrictions was a messTweeted Dr. Vinay Prasad, associate professor of epidemiology and biostatistics at the University of California, San Francisco.

The missteps highlight the enormous challenges of public health messaging during the pandemic, when science unfolds in real time and developments often occur at a breakneck pace. Developing public health guidelines in such circumstances makes it difficult to take nuances into account, especially as the pandemic evolves and the situation changes.

“People want a black or white answer: is it risky or not risky?” said Sandra Albrecht, assistant professor of epidemiology at Columbia University. “But risk is a spectrum – it depends on the context, the circumstances, the individual, the geography. There are so many factors that contribute to risk that it is really difficult to provide one line of public health messages for everyone.

And conversations about risk become more difficult as “pandemic fatigue” sets in. A recently released Gallup poll found that concerns about the coronavirus contraction have fallen to record highs, with just 35% of Americans saying they are very worried or somewhat worried about catching the coronavirus. virus.

Albrecht and Buttenheim saw the challenges of communicating risk and advice early on in the pandemic. Last year, they teamed up to create Dear Pandemic, an online project aimed at answering questions from the public in an easy-to-digest way and helping people navigate the onslaught of information about Covid-19.

One of the main objectives of the project is to bridge the gap between official guidance and the facts and context.

“A lot of what we’ve done is discuss the reasons and motives behind the public health messages that come from the CDC, because the public is confused,” Albrecht said. “Part of what we do is explain the rationale and evidence to support a certain line of recommendation.”

At the start of the pandemic, for example, Albrecht and Buttenheim attempted to explain why the CDC and the World Health Organization turned the tide on recommendations for people to wear masks in public.

“As scientists and public health professionals, we understood why this change happened and why it was necessary, but the reasons for this change were not sufficiently communicated to the public,” said Albrecht. “It caused a lot of confusion and fed conspiracy theorists.”

Loren Lipworth, an epidemiologist at Vanderbilt University Medical Center, said the events of the past year have revealed how important it is for the CDC and public health professionals to be open about the state of science and manage people’s expectations of how things can change. .

“The CDC needs to be honest and transparent and share everything they can in terms of assessing evidence, but they also need to be careful when we are at a point where we cannot say something yet,” he said. she declared.

The balance is especially important now, when rising infections in some states threaten to wipe out hard-fought gains to stem the spread of the virus.

And as the number of cases increases and variants of the virus spread across the country, the reaction of people and communities in the coming weeks could alter the trajectory of the pandemic in the United States, Lipworth said.

“We are so lucky to have these vaccines, and this is definitely our solution, so there is real reason to be optimistic in front of us,” she said, “but it is definitely not the moment to let your guard down. “

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