By Lambert Strether of Corrente.
On February 25, CDC dropped an enormous number of documents. One was new guidance on Covid-19 that rejiggered the metrics for determining one’s personal risk of Covid, leading to leads like this from AP:
Most Americans live in places where healthy people, including students in schools, can safely take a break from wearing masks under new U.S. guidelines released Friday.
But which document? Just for grins, here’s the complete dump:
Nowhere does CDC say that “COViD-19 Community Levels” is the hub document for many others, so it’s unsurprising that most news coverage of the drop never linked to it, and AP got it wrong. (They linked to “COVID-19 by County,” which CDC calls a “tool,” and is in any case not the hub). Science communcation at its finest from CDC, as we have come to expect.
Since I’d probably stroke out if I did a deep dive and in any case I need to move fast, I’m going to keep my commentary at a high — even simplistic — level, but don’t worry; the high level is sufficiently bad to be very bad, and even the most simple-minded will be able to grasp what’s wrong. If you want to grab a shovel and look for a pony, these are the documents from the drop I will be using:
1) COVID-19 Community Levels (“Community Levels”)
2) People with Certain Medical Conditions (“Medical Conditions”)
3) Transcript for CDC Media Telebriefing: Update on COVID-19 (“Transcript”)
4) “Indicators for Monitoring COVID-19 Community Levels and COVID-19 and Implementing COVID-19 Prevention Strategies” (PDF) “Indicators”)
And in addition:
5) Summary of Guidance Review, from 2021 (“Guidance Review”)
Now let’s consider the morality of the CDC’s new guidance, whether it’s based on science, whether it’s dangerous to the public, and its effect on masking as a public health tool.
CDC Guidance Adopts the Morality of the Great Barrington Declaration
Quoting the Great Barrington Declaration (GBD, or, in the vulgate, “Let ‘er rip!”):
The most compassionate approach that balances the risks and benefits of reaching herd immunity, is to allow those who are at minimal risk of death to live their lives normally to build up immunity to the virus through natural infection, while better protecting those who are at highest risk. We call this .
Adopting measures to protect the vulnerable should be the central aim of public health responses to COVID-19… A comprehensive and detailed list of measures, including approaches to multi-generational households, can be implemented, and is well within the scope and capability of public health professionals.
Those who are not vulnerable should immediately be allowed to resume life as normal. Simple hygiene measures, such as hand washing and staying home when sick should be practiced by everyone to reduce the herd immunity threshold.
(Nothing on ventilation, naturally, since GBD is an ideological document, not a medical or scientific one.)
Now, here’s Walensky in “Transcript“:
[WALENSKY:] Now, as the virus continues to circulate in our communities, we must focus our metrics beyond just cases in the community and and preventing COVID 19 from overwhelming our hospitals and our healthcare systems. This new framework moves beyond just looking at cases and test positivity to evaluate factors that reflect the severity of disease, including hospitalizations and hospital capacity, and helps to determine whether the level of COVID 19 and severe disease are low, medium, or high in a community.
I don’t see a difference. Walensky is recommending “Focused Protection.” And from “Community Levels“:
At the same time, we know that some people and communities, such as our oldest citizens, people who are immunocompromised, and people with disabilities, are at higher risk for serious illness and face challenging decisions navigating a world with COVID-19.
In addition to , focusing on reducing medically significant illness and minimizing strain on the healthcare system reflects our current understanding of SARS-CoV-2 infection, immunity from vaccination and infection, and the tools we have available.
It looks to me like CDC has now gone ahead with “focused protection” by implementing GBD’s handwaving “comprehensive and detailed list of measures.” (This is ironic because the exceptionally nimble and flexible Walensky signed the “John Snow Declaration” opposing GBD in 2021.)
It is perhaps needless to say that GBD caused controversy when released (leaving aside its support for herd immunity, which CDC is certainly treating as if it existed for respiratory viruses and can be achieved). Here two of its several weaknesses from The Conversation. First:
3. . The declaration advocates that, “individual people, based upon their own perception of their risk of dying from COVID-19 and other personal circumstances, personally choose the risks, activities and restrictions they prefer.”
“Community Levels” agrees:
More tools than ever before are available to prevent COVID-19 from placing strain on communities and healthcare systems.
Note lack of agency in “available to prevent.” Further:
COVID-19 Community Levels can help communities and make decisions based on their local context and their unique needs. Community vaccination coverage and other local information, like early alerts from surveillance, such as through wastewater or the number of emergency department visits for COVID-19, when available, can also inform decision making for health officials and .
And from “Transcript,” from Greta Massetti of CDC’s COVID 19 Incident Management Team:
[MASSETTI”] And these categories help assess what impacts COVID 19 is having on their community so that they can decide if they need to take extra precautions, including masking based on their location, their health status, and their risk tolerance.
No question that the “individual” is the only decision maker in Massetti’s mind; the community is not mentioned except as a provider of information. On the bright side, there will be plenty of incidents to manage! The Conversation remarks:
If these views were applied to traffic safety, chaos would ensue as we each chose our own speed limit and which side of the road to drive on. Public health matters, and the approach of the declaration to place ideology over facts helps fuel the pandemic.
And The Conversation‘s second point:
5. The declaration offers no details on how it would protect the vulnerable.
Focused Prevention assumes that the vulnerable can be detected, and then focused upon. But for Long Covid, that’s not true. From the New York Times, “Many ‘Long Covid’ Patients Had No Symptoms From Their Initial Infection“:
An analysis of electronic medical records in California found that 32 percent started with asymptomatic infections but reported troubling aftereffects weeks and months later.
CDC Guidance Is Not Based In Science
Here is the CDC’s rejiggered formula from “Community Levels“:
CDC looks at the combination of three metrics — new COVID-19 admissions per 100,000 population in the past 7 days, the percent of staffed inpatient beds occupied by COVID-19 patients, and total new COVID-19 cases per 100,000 population in the past 7 days — to determine the COVID-19 community level. New COVID-19 admissions and the percent of staffed inpatient beds occupied represent the current potential for strain on the health system. Data on new cases acts as an early warning indicator of potential increases in health system strain in the event of a COVID-19 surge.
There are two issues. First, no science was evidently performed to arrive at the formula. Second, the formula is, well, stupid.
No science was performed. When the CDC performs science, it produces a document like those in the Morbidity and Mortality Weekly Report. Science articles follow a structured format similar to that of professional journals, with an Abstract, Methods, Results, and so forth. There are tables and notes supporting the thesis of the paper. Critically, there are named authors with their institutions. A glance at the CDC’s drop for February 25 (and before and after) shows no such document. We do have “Indicators“, whose file name, hilariously, is Scientific-Rationale-summary-COVID-19-Community-Levels.pdf, but it’s a PowerPoint deck (!!). There are no named authors, meaning that no scientist can be held responsible for scientific error, there are no notes, there is no data, there is — despite the wishful title “Overview and Scientific Rationale” on the first page — no science being done.
Interestingly, Walensky commissioned “Guidance Review, “a study on CDC’s scientific communications:
[C]onsumers and the public [huh?] could be more assured of the science-base for guidance if CDC routinely provides scientific briefs, provided a landing spot that listed all recently updated changes or at a minimum, links to appropriate evidentiary support for major new guidance and guidance changes. .
No such transparency here!
The formula is stupid. The message conveyed by the “Low” (Green) level is low risk. To move the community level from Low to Medium (“Yellow”) risk, the load on hospitals must increase. But hospitalization is a lagging indicator. So there will be a window for Covid to spread while infection is increasing, but hospitaliation is not, while the level remains Green. In that window, people will not be encouraged to mask up, no community measures will be taken, and so on. Note again that people can catch Covid, avoid hospitalization, and still come down with Long Covid later. As one primary care doctor remarks:
… both justifying the relaxation of public health protections now and about justifying too little, too late policy responses in the future when surges re-emerge.
— Andrew Goldstein #EndVaccineApartheid (@AndrewMakeTweet) February 25, 2022
Personally, I’d stick with case numbers, underestimated though they are, rather than CDC’s new formula. It’s almost as if…. It’s almost as if…. CDC wants you to get sick.
CDC Guidance Produced Headline Numbers that are Wrong and Dangerous
Here is a comparison between CDC’s case data (on the left, which I use in Water Cooler) and CDC’s new rejiggered “Community Levels” (on the right):
Today's CDC masking➡️uses B👇
A) Transmission Tracker (based on case data)https://t.co/W1tbqEnPEp
B) Covid19 Level (based on hospital&case data)https://t.co/iytveDvJn3
A (left) Cases🦠
B (right) Hosp🏥&🦠
23% Lo pic.twitter.com/qx4UoWDMCB
— LeggoMyFuego🔥 ʕ •́؈•̀) 🐻🍯 It bears🧸repeating (@Leggomyfuego1) February 26, 2022
Which do you prefer? The one on the right with all that low-risk green? Who wouldn’t? Similar thinking led to headlines like More than 70% of Americans can take off their masks indoors under new CDC guidelines on COVID-19 risk (USA Today), CDC eases masking recommendations for 70% of country, including inside schools (ABC), BREAKING NEWS: CDC to lift mask recommendations for 70% of Americans under revised guidelines that now focus on hospitalization rates rather than cases (Daily Mail), and CDC eases mask guidelines for more than 70% of Americans; NY weighs decision on schools (NBC). As the Times explains:
The new guidelines suggest that 70 percent of Americans can now stop wearing masks, and no longer need to social distance or avoid crowded indoor spaces.
The recommendations no longer rely only on the number of cases in a community to determine the need for restrictions such as mask wearing. Instead, they direct counties to consider three measures to assess risk of the virus: new Covid-related hospital admissions over the previous week and the percentage of hospital beds occupied by Covid patients, as well as new coronavirus cases per 100,000 people over the previous week..
Based on these three factors, counties can calculate whether the risk to their residents is low, medium or high, according to the agency, and only areas of high risk should require everyone to wear a mask.
The difficulty here is that the guidance and the maps will be be used not only by communities but by inviduals to assess their own risk. As “Community Levels” says:
COVID-19 Community Levels can help communities and individuals make decisions based on their local context and their unique needs.
But mere transmission is utterly inadequate to assess personal risk! Why? Co-morbidities. There is a handy list of them in ““Medical Conditions“. As Walensky herself wrote in The Lancet, criticizing GBD:
The Great Barrington Declaration is predicated on the idea that you know who is going to get sick and you can somehow isolate and protect them, but there is absolutely no evidence that we can do this”, she said. She pointed out that the US Centers for Disease Control and Prevention estimates that up to 40% of Americans have some kind of co-morbidity that makes them vulnerable to the ravages of COVID-19. Identifying all these people is not straightforward.
Now, if CDC wanted to really put its billions to work on helping individuals assess their risk, they’d add some overlays for co-morbidities. Ah well, nevertheless,
CDC Guidance Destroys Masking as a Future Public Health Measure
Here are Walensky’s views on masks. Play the audio, it’s worth it:
"the Scarlet Letter of this pandemic is the mask"–@CDCDirector
Are you ashamed to wear a mask? I'm not. It's unclear why Director Walensky thinks we should be ashamed, but it does make it easier to understand why @CDCgov is retreating from this safe, effective, lifesaving tool https://t.co/Zfkh2Ausod pic.twitter.com/v4Zx0s5FUt
— Matthew Cortland, JD (@mattbc) February 25, 2022
For those who missed High School English, the “Scarlet Letter,” from American author Nathaniel Hawthorne’s novel of that name, is a badge of sin and shame. If you are forced to wear the “Scarlett” letter, you are ostracized from the community. So, if you’ve been wearing a mask to protect yourself and others during a pandemic, that is what Walenksy thinks of you. As Yale Epidemiologist Gregg Gonsalves points out:
And it's essentially a recommendation for one-way masking. Immunocompromised/vulnerable will do on their own initiative & own dime & the rest of us have the opt-in * (i.e. "At all levels, people can wear a mask based on personal preference, informed by personal level of risk.").
— Gregg Gonsalves (@gregggonsalves) February 28, 2022
I’ve gotta underline that last sentence. It’s a footnote to a table in “Community Levels,” and it’s one of the weirdest, most twisted footnotes I’ve ever seen (and in a previous life I read a lot of footnotes in treatises on tax, because they were so funny). The footnote is here:
High Wear a well-fitting mask1….
And this is its text:
1 At all levels, based on personal preference, informed by personal level of risk. People with symptoms, a positive test, or exposure to someone with COVID-19 should wear a mask.
“Don’t worry. You can still wear a mask”? Of course you “can” wear a masks, just like I “can” wear a funny hat, or my Goldwater button or (in open carry states), one of my guns. Who on earth wrote this footnote and what were they thinking? (Note of course with “exposure” the reality of asymptomatic transmission has been casually erased.)
If Walensky keeps her job after her “Scarlet Letter” remark, masking is a dead letter in the public health establishment (though mutualist, bottom-up efforts “can” try erase the shame and the ostracism). “Scarlet Letter,” forsooth.
It’s very hard for me to see how this immoral, anti-science, dangerous document managed to get loose and insult millions of Americans. Perhaps because Walensky and her fellow appointees aren’t doing any real science at all. From CNN:
Scientists within the CDC have also grown increasingly frustrated with Walensky’s handling of public health guidance, a CDC scientist told CNN. According to the scientist, Walensky largely crafted the new guidance with the help of a small circle of top advisers, eschewing the traditional process of rigorous scientific vetting by experts at the CDC who would in turn also consult with outside public health partners and experts.
For months, Walensky has met privately with prominent Democratic media consultant Mandy Grunwald to improve her communication skills and continues to do so, according to a person familiar with the previously unreported sessions. On Friday, Walensky will hold the CDC’s first independent media briefing since the summer after deciding abruptly this week that she wanted to take questions “head on,” according to a person familiar with her decision to hold the briefing.
(The “guidance” discussed in this quote is not “Community Levels,” but guidance released two weeks ago.) Certainly the malign presence of a Clintonite goon like Grunwald would go a long way toward explaining the shoddiness and lethality of “Community Levels.”
To be fair, however, “Community Levels” rejiggered metrics are already having a positive effort where it counts. From ABC:
The nation’s capital is now in an area considered low risk under the Centers for Disease Control and Prevention’s new metrics, which place less of a focus on positive test results and more on what’s happening in community hospitals. The new system greatly changes the look of the CDC’s risk map and puts more than 70% of the U.S. population in counties where the coronavirus is posing a low or medium threat to hospitals. Healthy people in those risk areas can stop wearing masks indoors, the agency said.
The Capitol is mask-frei, folks! And Scranton Joe’s gonna look good on TV. Covid is over, baby! The State of the Union is strong!
 “Indicators” is linked to from “Community Levels” but, oddly, is not listed in the drop.
 Some say Walensky has never tweeted about Long Covid:
A short 🧵. What is not said is as important as what is said.@RWalensky has literally never tweeted LongCoVid.
— Lazarus Long (@LazarusLong13) February 25, 2022
I don’t think that’s fair: