WASHINGTON — Shortly after the Centers for Disease Control and Prevention on Dec. 27 posted new recommendations cutting isolation time for people infected with COVID-19 from 10 to five days, and not requiring a negative test, agency officials convened a standard call with public health professionals.
They, like many regular Americans, had lots of questions.
“People just wanted to be clear what they were talking about,” said Dr. Georges Benjamin, executive director of the American Public Health Association, adding that participants asked about the lack of a testing requirement, and when people should test, if they could. On that, he said, “they were still a bit fuzzy.”
The communication behind the new protocol, which triggered widespread confusion among the public, is now seen as another misstep for the nation’s public health agency and its director, Dr. Rochelle Walensky, who is trying to correct course after a rocky first year.
A star physician and scientist from Massachusetts General Hospital, Walensky was chosen by President Biden to take the helm of an agency that had been sidelined in the pandemic fight by the previous administration, with promises to restore its credibility. With an ever-evolving virus still raging, and the country still deeply polarized over the best tools for fighting it, it would not be easy.
But Walensky has made a series of stumbles that exacerbated an already difficult task, according to multiple experts, making statements that had to be walked back and issuing guidance that vexed some outside scientists.
They underscore just how rough the transition has been for Walensky from running a 70-person infectious disease department at Mass General to a sprawling, public-facing government agency whose word on health matters has often served as definitive guidance for the country.
“She’s an esteemed scientist, but leading a federal agency and making policy decisions is very different,” said Anne N. Sosin, a public health researcher at Dartmouth College. “This is an unprecedented crisis and she doesn’t bring the experience of someone who’s led a federal agency and engaged in formulating policy at the federal level.”
Her defenders say Walensky has made the best decisions possible based on the available science about an evolving virus.
“When you as a person are doing your best, to be attacked is really difficult,” said Kelly Gebo, a professor of medicine at Johns Hopkins who has worked closely with Walensky. “I think she feels a huge amount of personal responsibility to try to make things better.”
The CDC did not make Walensky available for an interview this past week. But her allies say she is addressing the problems, pointing to a rare solo media briefing she held this month and her as-yet-unfulfilled promise to hold more, as she navigates what they describe as one of the trickiest jobs in America.
“We’re in an unprecedented time with the speed of Omicron cases rising, and we are working really hard to get information to the American public,” Walensky said at that briefing on Jan. 7, describing health care staffing shortages as a harbinger of things to come. “This is hard and I am committed and to continue to improve as we learn more about the science and to communicate that with all of you.”
Born in Peabody, Walensky grew up in Maryland and earned an MD at the Johns Hopkins School of Medicine and a master’s in public health degree from Harvard. As an HIV researcher, it was her study of clinical effectiveness, or how to tell which treatments have the most value to individuals and society, that won her medical renown.
“What she did over 20 years was really shepherd guidelines in the United States, national, including CDC guidelines, to improve care and testing and outcomes,” said Dr. Kenneth A. Freedberg, the director of the Medical Practice Evaluation Center at Mass General, which Walensky joined in 2000.
She became chief of the infectious diseases division in 2017, which put her at the center of the hospital’s response to the pandemic, and she drew wide praise when she was chosen to lead the embattled agency, whose previous director, Robert Redfield, had been all but written out of President Donald Trump’s pandemic response.
But even her allies acknowledge her lack of experience communicating with the public — and working in the federal government — gave her lots to learn in a job that is easy to criticize from the outside.
“She doesn’t know all the people, perhaps all the stakeholders, at least not on a personal level,” said Celine Gounder, an infectious disease specialist at New York University who advised Biden’s transition team and described Walensky as a mentor. “When you’re talking about people you’ve worked with for decades, like somebody like Tony Fauci, it’s going to be much smoother in that sense than if you’re having to develop these relationships in the middle of a crisis.”
“That’s not a reflection of her,” Gounder added. “It’s just a learning curve.”
It has all left some experts worried the CDC is still siphoning credibility at a critical moment for public health.
“My expectation is it would be much closer to restoration of the CDC, to a time when it was highly regarded, and we have not seen that happen,” said Eric Topol, a professor of molecular medicine at Scripps Research. “If her job had been done well, some of these miscues wouldn’t have occurred.”
In February, Walensky said vaccines for teachers weren’t a prerequisite for safely reopening schools — a statement the White House quickly downplayed. In March, she suggested vaccinated people do not carry the virus, something that turned out not to be true and was subsequently walked back by agency staff (inaccurate headlines generated by her comments, however, are still on the Internet).
In May, as virus cases waned, Walensky told a Senate panel that masks were still key to curbing the spread; then, just days later, she said fully vaccinated Americans could stop wearing them.
“When they lifted mask requirements without proof of vaccinations, arguably, that contributed to the surge of Delta that we saw over the summer,” said Dr. Leana Wen, the former Baltimore City Health Commissioner and a professor of public health at George Washington University.
In early fall, disagreement among the White House, the CDC, and the Food and Drug Administration over who should get booster shots slowed their rollout with Omicron just around the corner. And just after Christmas, the CDC released its shortened isolation recommendations without requiring testing — and without, experts said, laying out clear enough scientific justification. There was no initial explanation of the science behind the move, leaving experts and the public alike to wonder about its basis.
“In my view, they’re sensible guidelines in a very difficult situation, but they weren’t presented that way,” said Dr. Thomas Frieden, a former CDC director in the Obama administration. “I felt like CDC kind of snatched defeat from the jaws of victory.”
The guidance spurred a rare rebuke from the American Medical Association, whose director, Gerald E. Harmon called it “cloudy” and said infected people should have a negative test before leaving isolation.
“It kind of leaves us all, as citizens and recipients of the CDC’s information, a little bit in the dark,” Harmon said.
On Jan. 4, the CDC updated the guidance to include more information about testing, and then on Friday, also updated its guidance on which masks best protect against COVID, something many experts said was long overdue.
Some of Walensky’s allies point out that the CDC is frequently scapegoated for larger problems with the government’s approach to public health; the booster issue, for example, involved multiple agencies. Many decisions, Sosin said, are being made by White House officials, who “lurch from one haphazard decision to another in the absence of a policy framework.”
Health and Human Services Secretary Xavier Becerra has been conspicuously absent from the government’s public-facing COVID response and largely escaped media scrutiny; Fauci, Biden’s chief medical adviser who is often quick to step into the spotlight, has at times publicly contradicted Walensky.
“That does make her job harder,” said Monica Gandhi, a professor of medicine at the University of California in San Francisco, who has worked closely with Walensky.
“My disappointment is primarily with how the broader administration has decided to handle things,” said Glen Nowak, a former head of media relations at the CDC, pointing to the way the administration’s COVID briefings are typically joint events involving Walensky, Fauci, and Jeff Zients, the White House coronavirus response coordinator. “It’s probably more similar to what we had seen in the Trump administration … similar in the sense that the messaging and what’s coming out is centralized at the White House.”
He and other advocates of the CDC have called for Walensky, who CNN recently reported has been getting media training, to do more briefings on her own.
“I think that should be a regular occurrence,” Frieden said. “It gives CDC the chance to explain not just what they’re recommending, but on what basis.”
Some experts, however, insist that Walensky’s problem is not simply bad messaging.
“Rochelle’s problem is not that she’s a poor communicator,” said Julia R. Raifman, assistant professor of health law, policy and management at the Boston University School of Public Health. “The problem is the policies are in direct contradiction to public health principles.”