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Walensky faces CDC burnout as pandemic enters third year

1 week ago 7

“It was a pep talk,” one CDC staff member on the call said. “The message was, ‘We know this is tough, but we have to keep going.'”

To many of those listening, the call was a stark reminder that despite their best efforts to contain the virus, the pandemic was not over and that the crushing workload would continue. Although reports of fatigue among members of the CDC’s pandemic response team are similar to those expressed by millions of health care workers across the country, the agency is in charge of safeguarding the entire country and the burnout scientists feel impacts their ability to help curb the pandemic.

Just months earlier, Walensky and other top officials had a plan to dissolve large parts of the pandemic response team, which has more than 1,500 staffers, and reassign members to their original posts. The Covid-19 work would have continued, but the pace would have allowed officials to return to a more normal work schedule. Walensky and her team shelved the plan with the emergence of Omicron as cases began to tick up across the U.S.

Now, some officials said, morale is low at the CDC, as a feeling of helplessness pervades the staff. That raises questions about Walensky’s ability to usher the agency — and Americans — through the Omicron wave into a year that could bring new rounds of vaccinations and more infectious variants.

“There’s no end in sight,” a second CDC official told POLITICO. “We’re all tired.”

This story is based on interviews with nine current and former CDC officials, all of whom served on the pandemic response team and worked on critical Covid-19 investigations, and four other federal health officials who coordinate with the agency’s leadership. Six were granted anonymity to speak freely about the working conditions in the agency.

Current and former officials of the CDC said employees on the response team — officials and scientists from several CDC offices — have for months told their superiors that they are exhausted and need time off the team. Some staff members have worked on the team since the pandemic began. While others have rotated on and off the response team in three- and six-month intervals, they work as many as 200 fourteen-hour days a year, including weekends.

Officials describe the response team as generally supportive and say that managers of the team’s task forces try to allow employees time off for holidays and family gatherings.

In a press briefing last week, Walensky acknowledged that officials on the CDC response team are burned out, and said she hopes to rotate members onto the team to lighten the load on those who have served for more than a year.

“This has been a hard several years for the people of this agency. They are tired,” Walensky said. “I have been working hard to ensure that people have adequate time away, that we are rotating people through the response and that we are providing data in real time, but only the data that are needed in real time so that people can actually take the time that they need.”

Henry Walke, the former leader of the pandemic response who recently left the team to become the agency’s director of the Center for Preparedness and Response and to focus on testing, was also on the call with reporters last week and said now is the time for CDC employees to “lean in.” In an interview with POLITICO, Walke said the pandemic response team has a specific group that is dedicated to checking in with members of the team to help mitigate burnout.

“It's the science around this and trying to understand how to mitigate the transmission. I think we've been challenged in trying to keep ahead of the science and keep ahead of the virus. And that does cause a lot of late nights and long days and missed holidays,” Walke said. “But it is not like this is the first response we've ever been involved in. I think we know what we signed up for.”

Growing frustration in the pandemic response

In the early days of Covid-19’s spread in the U.S, the CDC pulled thousands of officials and scientists from agency offices to form a team to help the Trump White House respond. Led by then-Director Robert Redfield and Walke, the agency focused on gathering global data as well as information from state health departments to track the spread of the virus and help contain it. The team also facilitated nationwide investigations into large-scale outbreaks to understand the risks the virus posed to both the masked and unmasked, and it expanded its mortality analysis, determining which populations were most at risk from Covid-19.

The first signs of burnout and frustration on the pandemic response team bubbled up in the spring of 2020 — just months after the virus first emerged in the U.S.

“In 2020, my average day was somewhere between 12 and 14 hours. And that's including on the weekends. There were a lot of long days,” said Erin Sauber-Schatz, who served as lead for community interventions and critical populations task force on the response team. “One of the biggest pushes was before school started up again in 2020 and getting the school guidance ready. We were thinking through every sort of scenario that would help keep our kids as safe as possible.”

With a White House then focused on a federal response that relied largely on the advice of individuals with no experience working on infectious diseases, it became increasingly difficult for the response team to make an impact, according to two CDC officials.

Officials described months of long days working on Covid-19 investigations, analyzing incoming data and compiling reports to present to the White House coronavirus task force, only to have the White House promote policies that did not align with the science. In one instance in July 2020, the CDC issued reopening guidelines for schools, advocating that districts implement strict mask wearing and social distancing. Then-President Donald Trump blasted the CDC.

"I disagree with the @CDCgov on their very tough & expensive guidelines for opening schools. While they want them open, they are asking schools to do very impractical things,” Trump wrote on Twitter, pushing back against the agency’s recommendations.

“There are times where we have conversations and it's very clear that people just simply did not read the guidance or did not read the science briefs that support the guidance,” Sauber-Schatz said. “We have a web page that we started basically doing literature reviews … a summation of pulling all those pieces of information, not only from the U.S., but globally, to provide a summary that is understandable, relatively brief, but that also shows the support for the guidance that's out there.”

As Trump continued to criticize the CDC and sideline top officials in the agency, staff on the pandemic response team worked to try and mitigate the spread of the virus by working with state public health departments to improve their data-collection methods.

LaTreace Harris worked on the response for 20 months and led a group that created a method for collecting and reporting vaccination data. Her team had to build a process through which states could collect patient and immunization data. Some state health departments did not have the legal authority to collect and share that information with the federal government.

“That was an extremely arduous task because of the fact that all of the immunization jurisdictions in this country … they actually operate as separate entities,” Harris said. “They’re all really focused on collecting data for their state, but not necessarily representing that information or sending that information to any type of national reservoir. It took a lot of work with the jurisdictions. A lot of work and trust building.”

Still, the CDC was criticized for moving too slowly on its Covid-19 investigations and scientific analysis. Behind the scenes, Trump officials in the White House and at the Department of Health and Human Services claimed the agency was too bureaucratic and academically minded for a pandemic that required health agencies to respond quickly to evolving science.

“The temptation if you're politically minded is to blame Bob Redfield, who was, I think, by all means a disastrous CDC director,” said Ashish Jha, dean of Brown University’s School of Public Health. “But the CDC’s problems go well beyond Bob Redfield. The previous leadership had not done enough to get the organization in good shape. So Dr. Walensky inherited a really messy organization with some real strengths but also a lot of problems.”

A new era for the CDC?

Four current and former CDC officials who worked alongside the pandemic response team said they hoped the election of President Joe Biden would clear the way for a more integrated federal response to Covid-19, one that would put the CDC — and its response team — back at the forefront of the conversation. When Walensky became director, she vowed to rebuild the CDC by promoting its work and streamlining inefficient practices.

But over the last year, the CDC has struggled to move above the political fray as its Covid-19 guidelines led to confusion and frustration.

The criticism lobbed at the agency over its handling of the booster debate and its communication on its isolation and quarantine rules has deepened low morale at the CDC. Multiple officials who have worked with the response team said they’ve become increasingly frustrated with the CDC’s communications strategy on Covid-19, particularly its messaging on masks, boosters and transmission of the virus.

This fall, following weeks of debate, the CDC’s advisory committee voted not to endorse a broad booster campaign, instead advocating that boosters be given to people 65 and older and people 18 to 64 with chronic health conditions. The panel said there was not enough data to recommend boosters for everyone. Walensky went against her own advisers, recommending that frontline and health care workers also be eligible for the boost. The decision sparked confusion as to what science Walensky was using to support her decision. Weeks later, the agency published several vaccine efficacy studies that showed the extent to which boosters could help protect Americans.

“The organization is still too bureaucratic, its tools still too slow. And, and the problem is, in a pandemic, when policy changes need to be made quickly, an organization that's too slow, feels irrelevant,” Jha said. “And to the extent it feels irrelevant, it undermines people's confidence in the organization.”

In another confusing messaging episode, the CDC last month shortened the recommended time period that Americans who contracted Covid-19 or who are exposed to the virus from 10 days to five as long as they wear a mask. The move led to an uproar among public health officials and physicians who questioned why the CDC did not recommend Americans receive a negative test before leaving isolation and quarantine. It wasn’t until days later that the agency added a scientific rationale to its guidelines webpage — a long memo that detailed how the CDC came to its recommendation.

“I feel like one of the most important tools of public health is communication with the public and explaining the why,” said Celine Gounder, an infectious disease specialist who advised the Biden transition’s Covid-19 response. “This isn’t just the CDC … our government is stuck in this very outmoded sort of antiquated approach, which is more about public relations than it is about real communication and education.”

‘Treading water’

Interagency fatigue escalated this summer when the Delta variant began advancing across the country, according to interviews with two of the CDC officials who said the response team came under intense pressure to produce work quickly, sometimes before it was ready, to align it with White House priorities. Scientists moved to complete two massive projects at once: tracking breakthrough infections and investigating vaccine effectiveness.

Data from Israel and the United Kingdom suggested that the vaccine’s effectiveness was beginning to wane and that fully vaccinated elderly individuals who contracted Covid-19 were increasingly seeking medical attention at hospitals.

The international data prompted conversations in the Biden administration about the possibility that Americans would soon need booster shots, a top Biden health official said. The White House Covid-19 task force turned to the CDC, requesting the agency quickly complete its analysis so the administration could decide whether to recommend boosters and to whom. Top Biden health officials, including Anthony Fauci, the president’s chief medical officer, advocated that the administration should conduct a broad booster campaign, and the White House set a deadline for late September for the rollout.

Walensky defended the CDC, telling White House officials that the late September booster target was likely too ambitious, and that the agency had not yet completed studies that would help provide the rationale for the shots.

As the booster campaign began to roll out, scientists on the response team hoped they would be able to find some reprieve — that cases would begin to come down.

Then came Omicron.

The CDC’s burnout dilemma comes as the country is facing an onslaught of new Covid-19 cases and hospitalizations. Although more than 60 percent of the country is fully vaccinated, the U.S. continues to report record numbers of breakthrough infections in part because the booster campaign has moved slowly, top Biden health officials have said.

The Omicron wave seems to have pushed the pandemic response team to the brink. One CDC official on the response team said they have worked as intensely now as they did when the pandemic first began, saying team members are still required to fulfill work for their roles outside of the response team.

Meanwhile, Walensky and her top lieutenants do not require officials with experience working with infectious diseases, data analysis or field work, for example, to put in time on the response team. Instead, they have relied on employees volunteering.

“A lot of people don’t want to come and work on the team because they know how much work it is,” the CDC official said.

Sauber-Schatz said some of the individuals who have not worked on the response team picked up extra work that those serving on the response can’t get to. “That's part of the way that we've made this sustainable,” she said.

Walke told POLITICO some employees working on the response have been moved off the team back to their normal offices because their work is either not crucial to this stage of the pandemic or because it overlaps with what others in the group are already doing.

In the press briefing last week, Walensky said she has tried to reduce the workload of the response team by, for instance, pushing employees to provide real-time data only when absolutely necessary. But the agency has no current plans to formally reorganize its response team.

“[The CDC] is just treading water. They're just trying to control the next crisis, not even being able to anticipate what that is,” Gounder said. “Whether it's the CDC or the White House Covid response team, they're just completely maxed out in just trying to keep up with what they're trying to do right now.”

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