Letter From The Editor: CDC answers its many critics

Opinion

“The credit belongs to the man who is actually in the arena.” –TR

The voice of the CDC is The Morbidity and Mortality Weekly Report, which is published by the federal Centers for Disease Control and Prevention, located in Atlanta.

This week, MMWP has found the CDC’s voice by mounting if not a defense of the agency’s time-eating mistake in making a diagnosis test available for COVID-19, then an explanation of why this event is much less significant in the great scheme of things.

Ultimately, this one will be settled in the history books.   The June issue of the popular magazine, Rolling Stone, attempts to make the case that thousands of lives would have been saved if the United States had merely adopted a German test during that period that was used by the World Health Organization (WHO).

The Washington Post’s health and science reporters Lena H. Sun and Joel Achenbach were able to speak to CDC Director Robert R. Redford after the current MMWR came out.  

The WP reporters quoted Redfield as saying CDC was “never really blind when it came to surveillance” for COVID-19.  We’ve always understood that CDC’s diagnostic testing exists to confirm whether someone is infected or sickened with a specific illness, but doctor’s diagnosis is usually accurate without a confirming test,

We of course wanted a test asap to throw some nets out to ID and track any community spread.   Redford told the WP that at that point would have been “looking for a needle in a haystack” if widespread diagnostic testing was in place.

Here are the  money quotes from the MMWR report:

First, syndromic surveillance based on emergency department records from counties affected early by the pandemic did not show an increase in visits for COVID-19–like illness before February 28. Second, retrospective SARS-CoV-2 testing of approximately 11,000 respiratory specimens from several U.S. locations beginning January 1 identified no positive results before February 20. Third, analysis of viral RNA sequences from early cases suggested that a single lineage of virus imported directly or indirectly from China began circulating in the United States between January 18 and February 9, followed by several SARS-CoV-2 importations from Europe. Finally, the occurrence of three cases, one in a California resident who died on February 6, a second in another resident of the same county who died February 17, and a third in an unidentified passenger or crew member aboard a Pacific cruise ship that left San Francisco on February 11, confirms cryptic circulation of the virus by early February. These data indicate that sustained, community transmission had begun before the detection of the first two non-travel–related U.S. cases, likely resulting from the importation of a single lineage of the virus from China in late January or early February, 

The WP reporters noted that the  CDC “results are consistent with other scientific studies that have described a two-stage viral attack that began in January on the West Coast with the coronavirus introduced by travelers from China and continued in February as travelers from Europe brought the virus to the East Coast. Most of the virus spreading in the United States can be traced to the introductions from Europe.”

Redfield told the WP that the findings debunk speculation the virus was circulating months earlier.

“There was one opinion that was circulating that in November, December and January, there was, if you will, significant seeding of the nation,” Redfield told the WP reporters. “And what this data clearly shows is by four independent lines of evidence, that the early introduction of this virus in the Northwest and Northern California was sometime between the second week of January and the second week of February.”

According to Jay Butler, CDC’s deputy director for infectious diseases,  the findings reported in MMWR also show that transmission was limited and not as widespread as some experts have suggested for that time.

Rather than allowing “the virus to take hold and speed” as CDC’s critics claim, the delay in diagnostic testing likely made little difference at that point in time, according to Redfield.

The Rolling Stone puts the blame for CDC tripping up in the lab on Pence or Trump, which seems about as fair as blaming Henry Wallace or  FDR for the hedgerows our Sherman tanks discovered behind the beaches of Normandy.  Both were big problems that got worked out in fairly short order.

It was not that long ago that there was informed speculation that spread in California might have occurred much earlier.  It’s important that the  CDC is ruling that out.   Think of what it would mean for China or the WHO if this dreadful event had actually started last Fall or Summer.

The virus did get into this country and began to spread before we had a good diagnostic test, not before we had a clue.  The U.S, travel bans, from China on Feb. 2 and Europe on March 31, were heavily criticized but should have come sooner. 

CDC’s evidence points community transmission, at levels too low to be picked up by emergency rooms or the public health system, beginning in mid-January.  But not earlier.   The Feb. 6th death of a California resident is one such marker.

But it’s not like there were numerous cases with COVID-19 symptoms calling Atlanta for test kits at that point in February.