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CDC needs to adapt Covid guidance more quickly when new science arises

The Centers for Disease Control and Prevention needs to adapt its Covid recommendations more nimbly when new science arises

Dr. Scott Gottlieb, director of the Centers for Disease Control and Prevention, told CNBC on Monday that the agency needs to adapt its Covid recommendations more quickly as new science emerges, and that it also needs to do so more transparently.

“These guidelines have a greater economic effect than regulation,” Gottlieb said on “Squawk Box,” but they are subjected to far less public scrutiny.

The former FDA commissioner made his remarks after the CDC revised its guidelines on social distancing at schools, rather than society as a whole, on Friday. According to the public-health agency, most students will sit 3 feet apart instead of the previous protocol of 6 feet with universal masking. In addition, the CDC continues to recommend a minimum of 6 feet between adults in schools and between adults and students.

Gottlieb urged the CDC to be more transparent about the science behind its guidelines in an opinion piece published in The Wall Street Journal on Sunday, writing that the “exact basis for its initial view to keep 6 feet apart” remains uncertain. Initial recommendations and precautions, he said in the Journal and on CNBC, were based on the novel coronavirus spreading like seasonal influenza early last year.

“It was reasonable to do that because we didn’t know a lot about the coronavirus so we assumed it was going to behave like flu. It has not behaved like flu,” Gottlieb said on “Squawk Box,” contending it led health officials to “both overestimate and underestimate this virus” in crucial ways.

“It isn’t so much an important question of, ‘Were we wrong about that.’ We were wrong in certain respects,” added Gottlieb, who led the FDA from 2017 to 2019 in the Trump administration. “But, ‘Did we learn quickly enough and did we adapt our recommendations and guidelines quickly enough?’ The answer is no.”

A CDC spokesman told CNBC that “there were questions about some of CDC’s advice during the first year of the pandemic.” Dr. Rochelle Walensky, the agency’s new director under President Joe Biden, has “promised to restore scientific credibility and the public’s confidence in the agency,” according to the spokeswoman, adding that this has included a review of the agency’s Covid guidelines to ensure they represent the most recent science.

We underestimated the role of air quality and high-quality masks because we underappreciated that this was spreading through aerosol transmission.

Dr. Scott Gottlieb

Former FDA Commissioner

Gottlieb said on CNBC that health officials “overestimated the utility of physical distancing because flu spreads predominantly through droplet transmission, and we know droplets don’t spread more than about six feet.” On the other hand, he added, “We underestimated the role of air quality and high-quality masks because we underappreciated that this was spreading through aerosol transmission.”

Doctors were initially sceptical about whether advising Americans to cover their faces with a face covering — particularly something homemade like a scarf or bandana — would be effective. The CDC began recommending that people wear them in public in early April of last year, particularly in places like grocery stores where social distancing was more difficult to maintain.

Face masks are now widely accepted in the public health community, and some experts, such as White House Chief Medical Advisor Dr. Anthony Fauci, have even suggested that wearing two masks is likely more effective.

The Centers for Disease Control and Prevention (CDC) admitted in October that coronavirus can spread through airborne particles that can “linger in the air for minutes to hours” and infect people who are more than six feet apart.

The CDC states on its website titled “How COVID-19 Spreads” that it “most frequently” spreads through close contact between people within 6 feet.

“There is evidence that under certain conditions, people with COVID-19 seem to have infected others who were more than 6 feet away,” the CDC adds. “These transmissions occurred within enclosed spaces that had inadequate ventilation. Sometimes the infected person was breathing heavily, for example while singing or exercising.”

Contaminated surfaces were another area where Covid risks were originally overstated, according to Gottlieb. According to NBC News, the CDC updated its website in May 2020, about two months after the World Health Organization declared the coronavirus a pandemic, to emphasise that the virus did not spread easily by a person touching a contaminated surface.

Gottlieb admitted that there can be a lack of quality information to use as a foundation for advice in the early stages of a health crisis like the Covid pandemic.

“When CDC issues recommendations there’s different levels of evidence behind those recommendations and different levels of certainty,” he said. “When the agency is uncertain, or is predicating a recommendation on less-certain science, they really should be transparent around that so we can make an interpretation seriously we want to take it, but they don’t usually do that.”

The CDC spokesperson told CNBC that following the agency’s recent review, “key learnings” have already been implemented, including “reviewing major guidance for potential updates at least every three months,” as well as “improving clarity and usability.”

Dr. Scott Gottlieb is a CNBC contributor and a member of the boards of Pfizer, genetic testing start-up Tempus, health-care tech company Aetion and biotech company Illumina. He also serves as co-chair of Norwegian Cruise Line Holdings′ and Royal Caribbean‘s “Healthy Sail Panel.

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