CDC updates are straining already-pressed public health departments

Dr. Michael Kilkenny did not expect the Centers for Disease Control and Prevention news release he received on Dec. 27. Four days earlier, the CDC had cut the isolation time for health care workers with Covid to seven days, if they were asymptomatic and had a negative test. The new announcement said that people with Covid could isolate for just five days after symptoms developed, instead of 10. “When we got a press release on the 27th that seemed to contradict guidance we got on the 23rd — that was quite a bombshell for us,” said Kilkenny, chief executive officer and health officer of the Cabell-Huntington Health Department, which serves Huntington, West Virginia, and the surrounding county. Around the country, schools and health organizations scrambled to interpret the news release and adjust their policies — only to change course again when the CDC filled out details and its rationale in full guidance published about a week later.

“That gap left us guessing what we should actually do,” Kilkenny said. “That’s not good management and good communication. It leads to misunderstanding. It leads to distrust.” The CDC decision to cut isolation times in half for many people who have caught Covid-19 took local public health agencies by surprise and left some struggling to explain to their communities exactly what the changes meant and why federal officials had made them. Gaps in communication between federal, state and local officials have left some public health leaders fearing that they’ve lost trust with those they serve amid public confusion. In interviews, three local public health leaders, one state leader and two leaders of medical associations offered a mixture of reactions to the CDC’s recent shifts: frustration over lack of communication but also understanding that every public health officer faces challenges in making timely changes and offering clear guidance. None took issue with the guidance itself. “We were hearing from the hospitals, in particular, great concern for how we were going to be able to keep operations going,” said Dr. Philip Huang, the director of the Dallas County Health and Human Services department in Texas, who said his agency was looking at changes to local quarantine and isolation protocols before the CDC made its recommendations. “Was it ideal? No. I think though, these are extraordinary times with lots of variables and things happening.”