CDC Director Rochelle Walensky Faces a Surging Virus—And a Crisis of Trust
If viruses know no borders, they
have an equal disdain for human holidays. For Thanksgiving 2021 Dr. Rochelle Wilensky turned off her cellphone for approximately 45 minutes. She then placed the turkey on her dining room table with her husband, and their three sons. After deleting all the messages, Dr. Rochelle Walensky discovered that SARS CoV-2 was now a dangerous variant. This new variant had been found in South Africa. Omicron was to be known by health officials in South Africa. Walensky was certain that Omicron would soon appear in the United States.
As director of the U.S. Centers for Disease Control and Prevention (CDC), Walensky’s job is to protect the nation, and by extension the world, from threats like this one. To buy time as she and the country’s public-health experts learned as much as they could about the new variant, she joined them in advising that flights from South Africa and nearby nations reporting cases be temporarily halted. To ensure that health officials knew as soon as possible about the new variant, she also intensified genetic-sequencing efforts.
By Christmas, Omicron had overtaken Delta as the dominant variant, accounting for almost 60% of new infections in the nation, and over that holiday weekend, Walensky and the country’s top COVID-19 experts wrestled with a difficult decision. After thousands of flight cancellations due to airline employees being diagnosed with COVID-19, hospitals, schools, and other institutions were struggling to maintain a sufficient labor force, Walensky, the CDC, made the controversial decision to reduce the time it took to isolate people infected from the public by half. This was from 10 to 5. The change was supported by business groups, and provided relief for their labor issues. However, health workers, as well as certain labor unions, opposed it, saying that employees could be forced to work even though they are still potentially contagious. This would increase the number of COVID-19 cases.
Walensky defended the move, telling TIME, “There are a lot of studies [from other variants]That is when maximum transmission occurs. Und [with Omicron]We are facing hundreds of thousands more cases every day. It was clear to the health system that there would be people who were [positive but] asymptomatic and not able to work, and that was a harbinger of what was going to come in all other essential functions of society.” The decision reflects the balancing act that Walensky has been performing since becoming director of the CDC last January: integrating the scientific reality that an infectious and quickly adapting virus ideally requires intensive lockdown with the economic and social realities that make it impossible to do so for lengthy periods of time. In addition, Walensky confronts another equally monumental task: restoring the public’s trust in science, and educating people about the iterative nature of science so they don’t see changing recommendations as so confusing and conflicting that they stop listening.
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Walensky was a guest speaker at the CDC before she took the CDC job. Walensky, like other experts in her area, considered the agency the ultimate authority on public and community health. Every time she entered a word into the computer the agency was there. C,Her Google search tab is automatically filled CDC.One, she is able to see the agency’s potential and limitations from a different perspective. On the other hand, she lacks an extensive network and experience navigating conflicting political and bureaucratic demands—which may have led to some mixed messages from the CDC that, in some people’s eyes, only deepened the confusion and mistrust the public feels toward the agency and its recommendations.
Especially after 2020, when the Trump White House consistently failed to support and bolster scientific advice from the CDC and other science agencies, the public response to changing CDC guidance—even when it comes with well-researched and corroborated evidence—has often been skeptical at best. “It’s hard being under the microscope of the media, especially social media,” says Captain Amanda Cohn, who was serving as the COVID-19 vaccine lead at the CDC. “It’s hard when every time you change a word on the website, everyone responds immediately.”
Walensky is the best person to tell you that there are problems with the image of CDC. The CDC is often seen as a scapegoat for mistakes made during the pandemic response. They have changed, inconsistently advised on everything, including booster shots and masks. Walensky is acutely aware of the fact that these credibility issues could be just as infectious as the disease Walensky faces, and can lead to the loss or corruption of the trust and integrity essential for all that the agency does. The agency’s public perceptions are causing a morale crisis at headquarters in Atlanta and its 13,000 public-health scientists and epidemiologists who have been deployed to more than 60 countries.
At a November all-hands call Walensky made, over 8,300 staff members log in to the website to have another opportunity to talk to their new director. Most had not yet met face to face. During the Q&A session, Walensky fielded a question about the hometown Atlanta Braves, who had just won the World Series. Walensky was a Boston native and Red Sox fan for many years. Would she wear a Braves T-shirt or cap at her next all-hands event to support her adopted hometown?
Walensky answered the questioner better. “I’ll be honest, I’ve spent too much time in Boston to change allegiance from the Red Sox to the Braves entirely,” she said. “But … at the risk of having my family and my boys disown me, here I go. I’m happy to wear a Braves hat for the rest of the meeting.” And she did.
Yes, it was a calculated and staged effort to show solidarity with a staff that’s been beleaguered, belittled and bewildered since the pandemic began as they saw the work to which they’d dedicated their lives dismissed and sidelined at a time when the world needed it most. It was an insignificant gesture, but it is part of a larger scheme. But President Joe Biden chose Walensky as much for her scientific credentials—she’s a well-respected physician in infectious disease—as for her people skills, which he hoped could halt and maybe even reverse the public’s crisis in confidence about public-health science. The job of directing the CDC can be as socially and politically demanding as scientific. Walensky’s warm smile and friendly demeanour make her a great cheerleader for scientists and the voices behind the most recent data.
“I ran the emergency-preparedness response at CDC for four years before becoming acting director, and we used to run exercises for responding during a crisis,” says Dr. Richard Besser, now president and CEO of the Robert Wood Johnson Foundation, of the political noise that drowned out scientific voices in 2020. “We never exercised a scenario in which the political leadership rejected public-health science as an underlying principle of the response.”
Walensky, who assumed command of the CDC January 2021 in response to the credibility problem with her strongest weapon: evidence-based data. “I am committed to the science, and I will deliver recommendations that are based on science,” she tells me during my recent visit in Atlanta, and “Follow the science” is a mantra that she repeats again and again in her briefings and interviews. Walensky, soon after her arrival at the CDC launched the COVID-19 data tracker. This dashboard provides a complete overview of all aspects related to pandemics. She pressured her staff to stay up-to-date in real time about cases, deaths, and gene-sequencing information. She believes that good data is the foundation of science. “Modeling infectious disease is what I did for 20 years, so I dive in,” she says.
It’s a battle-tested strategy. Walensky’s former mentor Dr. Kenneth Freedberg, professor in health policy and management at Massachusetts General Hospital (MGH), recalls that in 2018 she helped reverse the World Health Organization’s decision to halt the rollout of a three-drug anti-HIV combination for pregnant women over concerns that the medications could cause birth defects. Walensky organized a group of scientists and crunched numbers within hours of the announcement. The analysis eventually convinced the WHO to change its decision.
But even the best models can’t entirely forecast what an unpredictable virus will do. Not only will it not be easy to assess the risks and benefits associated with COVID-19 specific advice, but this is an ongoing process that needs to take into consideration scientific developments.
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The CDC and Walensky have been hot for every revision and modification to their guidelines. Walensky advised that vaccine-affected people should stop using masks indoors in May 2021 as the vaccination rate was increasing. The decision balanced the science at the time—cases were falling but still far from zero—against the growing backlash from the public about the lack of benefits of vaccination; if getting the shots changed nothing about what they could do safely, then why get vaccinated? The CDC urged everyone to use masks inside two and a quarter months later as a new variation of the disease pushed up case numbers.
Media, politicians, and the public demolished CDC for its flip-flopping. “I have spent a lot of time thinking about” the shifting advice, says Walensky. “All of the science in that moment said it was safe to take off your masks if you were vaccinated. We perhaps should have said ‘for now.’ I think that if we had said, ‘Despite the science, you have to keep your masks on,’ we would have lost the trust of people with regard to actually following the science.”
This balance requires the CDC to keep up with changing science, and turn that data into real-world advice for public health. “We have to provide what the science says not in a vacuum but with the understanding of the uncertainty and the moment,” says Walensky. This means that recommendations must be adapted to new data. “Translating science into practiceable guidance is what has really distinguished the value of CDC over the arc of time,” says Dr. Julie Gerberding, chief patient officer at Merck, who ran the CDC from 2002 to 2009. “We have all had scenarios where we weren’t able to provide perfect communication [and]You can only get the best guidance. That’s part of the challenge.”
Walensky was born in Washington D.C., and was inspired by her pediatrician—the only female physician she knew as a child—to pursue medicine. After college, she enrolled at Johns Hopkins School of Medicine, where she trained in internal medicine, in a residency program so notoriously rigorous that its members are called “Osler Marines,” after one of the co-founders of the hospital. She and her husband then moved to Boston. Walensky was the MGH’s first female chief infectious disease officer in 2017.
It was in that role that Walensky became indispensable in advising the Harvard University health system about COVID-19 protocols, setting up testing and mitigation measures to ensure safe ways for people who absolutely had to come to the hospital to continue working—and, eventually, serving as COVID-19 consultant for both the mayor of Boston and the governor of Massachusetts. That caught the attention of the Biden transition team, who saw her impeccable scientific credentials and natural ability to translate complicated science as a prescription for solving the CDC’s credibility problem at the time. Walensky was among the Biden Administration’s first political appointees, and started Jan. 20.
It wasn’t until Walensky came to the CDC that the good intentions that had guided her throughout her medical career were scrutinized for the first time. “When you’re a physician or a scientist, no one is questioning your motive, that you want to save someone’s life,” says her husband Loren, a pediatric-cancer specialist at Dana-Farber Cancer Institute. “What’s new in a job like this, which in the end is a political appointment, is that now all of a sudden … that person’s motives are now questioned.”
Ex-CDC directors have said that it can be difficult to join the agency from an outsider. “I had more than a decade of experience running public-health programs in both the U.S. and globally, and worked for five years running the largest tuberculosis program in the country [in New York City],” says Dr. Tom Frieden, who ran the CDC from 2009 to 2017 and is currently president of the nonprofit Resolve to Save Lives. “And it was overwhelming. No matter how hard I worked, how many hours I worked and how efficiently I worked, I just couldn’t keep up with the combination of demands from the White House and the Department of Health and Human Services and the media, and the constantly changing information and the diversity of health care systems in the U.S. And that was in a much less, enormously less challenging situation.”
Besser, who was an acting director of the CDC in 2009, adds, “I can’t think of a more formidable challenge than stepping into the helm of the CDC in the midst of a pandemic in a setting where you are working totally remotely. That is absolutely an unbelievable challenge.”
Walensky works mostly from home but seems to have overcome the challenges of connecting with a staff and country mostly through Zoom, and flies into CDC’s Atlanta headquarters for several days a month. “Rochelle has a very high emotional intelligence and is able to convey to staff how much she values them and listens to them,” says Frieden. Walensky manages to be punctual for back-to-back meetings and communicates her ideas clearly. She also makes sure she ends with actions plans.
Every evening, her bedtime reading consists of a carefully compiled report of the latest scientific studies on COVID-19—not exactly light fare, considering the urgency of the pandemic means that studies are now published not only in peer-reviewed journals but also on preprint servers that churn out the latest data as quickly as possible and avoid the lengthy review and editing process.
Aware of the long hours and often thankless sacrifices CDC staffers have made, Walensky has been making what she refers to as “heroes calls” to thank them personally. “People are shocked,” she says. “People have asked me, ‘Am I fired?’ But I love doing it.” The calls are a natural extension of her inclusive leadership style, which includes a human touch that isn’t lost on people she works with. “Sometimes people in high places may not be willing to show vulnerability or talk about times they failed,” says Dr. Ingrid Bassett, co-director of the Medical Practice Evaluation Center at MGH, whom Walensky mentored. Bassett recalls how her mentor told her about her experience with having grant applications denied. Bassett said it was motivating and reassuring.
As the number of cases rose in the U.S., public-health officials were encouraging people to be vaccinated. This was March 2021. Walensky broke from the routine at the White House COVID-19 briefing to speak from her heart. She empathized with the health care workers who were often the last ones to hold a dying patient’s hand because their family was not allowed to visit because of COVID-19 protocols, and said, her voice wavering, “I’m speaking today not necessarily as your CDC director—not only as your CDC director—but as a wife, as a mother, as a daughter. Please, just a moment longer. This is something I long for. You all want it so bad. Get vaccinated when you can so that all of those people that we all love will still be here when this pandemic ends.”
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In that same briefing, Walensky admitted to feeling a sense of “impending doom,” and some in the media and public—health community criticized her for being overly dramatic. That kind of empathy could be just what the CDC desperately needs. “Morale was a challenge,” she says of the state of the staff when she arrived in January. “The voices of the people who were delivering the science were not being heard and were not being heeded. And there was exhaustion; people had been working a lot and for a long time.” When she spoke publicly, Walensky wasn’t just talking to the American population at large; she was talking to the CDC personnel tasked with protecting them. “I needed to let people know that even in the moment when morale was down, and people were tired, the country was relying on them to make decisions,” she says. “And the only way for that to happen is for them to know you have their back.”
Walensky acknowledges this was not going to happen overnight, and that it’s moving more slowly than is ideal—the fact that the majority of the staff are still working remotely doesn’t help. Cohn, who last year served as the COVID-19 vaccine lead at the CDC, admits, “I do not share where I work with people I do not know. I don’t want to have to get into a conversation with people not believing in vaccines; I don’t have the energy to talk about it one more time. Even though Dr. Walensky is out there trying to right the ship, I don’t know if we would say we all feel like it’s been righted yet. I still think there’s a morale problem at the CDC, and it’s starting to shift, but it’s going to take some time.”
Walensky, her team and others must convince the public to not give up. As the Omicron variant has exploded across the U.S., Walensky remains convinced that a multi-layered approach—getting vaccinated, getting boosted, wearing masks in indoor public settings and self-testing before small gatherings—will better position us to fight the virus this year than last year.
“We’re certainly not where we want to be, and we have more work to do—this virus is a formidable foe—but we know what we need to do to keep Americans safe,” she says. “The hard work now is just coming together as a country and recognizing what we need to do in order to keep one another safe … I would love to see us as a country be in a place where we’re focused a little more on the health and protection of each other, as well as our own health. I think that would be an incredible gift in 2022.”
—Reporting by Leslie Dickstein