WASHINGTON — Dr. Rochelle Walensky forcefully defended her bumpy CDC tenure in a Globe interview this week, describing her critics as “naysayers” who have helped sow the public confusion she is widely seen as fueling and pointing out that many Americans are still not following her agency’s most basic guidance.
Walensky, director of the Centers for Disease Control and Prevention, said she was committed to doing better but acknowledged few specific mistakes in her or her agency’s handling of the pandemic, even though she has faced criticism in recent weeks from public health experts and scientists for decisions on issues like testing and masks, and the way she has communicated them.
“We’re making decisions in imperfect times, sometimes without all the data that we would like to make them,” Walensky, an infectious disease expert from Massachusetts General Hospital, said Tuesday. “It’s easy to criticize what’s there — it’s not obvious to provide the alternative.”
The comments were something of a departure for Walensky, who acknowledged in another recent interview that she had not been clear enough in her guidance as she attempts to change course after a rocky first year in her job.
Acknowledging a record-breaking surge in COVID cases that has strained some hospitals, Walensky said her agency had faced “curveballs” from a fast-mutating virus. She also suggested that people who are ignoring the agency’s “crystal clear” guidance to get vaccinated and wear masks, as well as the ailing state of the nation’s public health infrastructure, have contributed to the mess.
“When there’s a public health crisis, the public health agency is partly responsible,” she said.
But, she added, “The CDC alone can’t fix this public health crisis.”
Walensky, a physician and scientist who last ran the 70-person infectious disease department at Mass. General, took the helm of the CDC after it had been sidelined and undermined by the Trump administration during the first year of the pandemic. But her critics, some of whom spoke to the Globe in interviews last week, say she has confused the public on issues like quarantine guidance, school reopening, and mask-wearing. Some administration officials, including Dr. Anthony Fauci, have disagreed with aspects of her agency’s guidelines in public.
“There’s no question that the CDC has lost some public confidence,” said Dr. Thomas Frieden, a former director of the agency under President Barack Obama.
Some of her critics say the problem is not messaging alone.
“What we’re seeing is policy failures, accompanied by poor messaging,” said Anne N. Sosin, a public health researcher at Dartmouth College, who added that the rest of the administration is also to blame.
In the interview, Walensky acknowledged that her agency’s May 2021 guidance that vaccinated people no longer needed to wear masks — which some critics say exacerbated the pandemic — was missing something important.
“All of the science pointed to what we did,” she said. ”What I didn’t say at the time, which you know, maybe I should have, is, ‘This may change and we may need to put them back on.’”
During his press conference on Wednesday, President Biden said he did not plan to make changes at the CDC and defended Walensky and the agency, chalking up confusion in the agency’s messaging to the changing science.
“She came along and said look . . . ’I’m a scientist, I’m learning,’” he said.
Walensky, who is now working with a communications coach to improve her messaging, said she is happy to listen to her critics. But she sounded skeptical at times that better communication about the pandemic is always possible or even would make a difference in the fight against the disease.
“Some of this is not based on the messaging, because ‘wear a mask’ is about as crystal clear as you could be. And still we have much of America not doing it,” Walensky said. “So some of the really easy stuff is not being followed, and some of the harder stuff is actually complicated science.”
She cited that science to defend her agency’s Dec. 27 guidance to shorten the COVID isolation period from 10 to 5 days and to not require people who contracted COVID to have a negative test in order to leave isolation — a move that drew a rare rebuke from the American Medical Association. The guidance stoked accusations that the CDC was prioritizing the economy, which was suffering due to COVID-related staffing shortages, over public health.
Walensky said the science behind parts of the decision was so convoluted it was difficult to communicate it to the public.
“Why is it that we didn’t recommend a test at the end of the five-day quarantine?” Walensky asked. “Well, let me tell you about what FDA authorization of all of these rapid tests is, and it is best used in the first seven days, it is best used as a qualitative test, not a quantitative test. It is best used serially when negative. That’s hard to convey in a two-minute soundbite.”
But prominent public health experts are urging Walensky to try harder to convey the reasoning behind her decisions to build trust with the public.
“What CDC could have done better is to outline, ‘Okay, these are the scientific data that we have. These are the sort of bigger-picture public health priorities that we’re weighing,’” said Dr. Celine Gounder, an infectious disease specialist at NYU and a former adviser to President Biden’s transition team.
Walensky told the Globe she moved to shorten the quarantine window because the country’s medical and public health infrastructure was straining under the weight of the 10-day quarantine guidance. First, she said, the agency shortened isolation and quarantine guidelines for health care workers, but soon realized that would not be enough.
“We were starting to hear pharmacies were closed. People couldn’t get their meds in pharmacies. Dialysis centers couldn’t get dialysate,” Walensky said. “It wasn’t about, really, [the] economy. It was about . . . all of the other health things that are necessary in a public health infrastructure.”
The rollout was rocky, with key administration officials like Fauci publicly undercutting her decision not to require negative tests to end isolation and privately griping they had been blindsided.
Walensky typically holds meetings to inform the White House COVID team of her thinking, she said, and pointed out that the new isolation guidance was released over the holidays.
“Kudos to the whole CDC team that literally worked Christmas Day and New Year’s Day to provide this to the American people so that pharmacists could work,” Walensky said.
Walensky has been willing to move quickly to combat a fast-changing virus, and contrasted that speed to the agency’s sometimes sclerotic response in the past. “If we waited for all the data we wanted on Omicron, the surge would have passed before we had the data,” she said. She accused her critics of being the ones to cloud the waters by hashing out their disagreements with her in public, which caused confusion.
“I am confident we can always do more and always do better,” Walensky said. “I will also say that where there’s gray, the people who disagree will always be on the other side and happy to speak about it and that’s confusing to the public.”
“It’s not typical that scientific dialogue happens on primetime — it usually happens in scientific meetings,” she said.
Walensky, who is splitting her time between Washington, her home in Newton. and CDC headquarters in Atlanta, also faces questions about how her agency will approach the pandemic going forward. Some former advisers to Biden’s transition team have called on the administration to treat the virus as an endemic disease, like a cold or seasonal flu, rather than trying to vanquish it.
Walensky said, essentially, that it is too early to make that shift.
“We’ve been thinking about it,” she said. “But we also have to recognize that at a million cases a day, 1,800 deaths a day, hospitals that can’t perform their elective surgeries — we have to get through now and make sure our guidance is relevant now.”
“We will be ready to talk about endemicity,” she added, “after we get through the surge.”
Felice J. Freyer of the Globe staff contributed to this story.