House Committee Puts CDC Director in the Spotlight

 Members of a House committee seemed to go a bit easy on CDC Director Mandy Cohen, MD, MPH, when they questioned her Thursday about her agency's failures during the COVID-19 pandemic, although some Republicans still took the opportunity to criticize the agency.

"If the CDC wants its credibility back, you've got to have a mea culpa moment," Rep. Dan Crenshaw (R-Texas), a member of the House Energy & Commerce Oversight and Investigations Subcommittee, told Cohen during a hearing on the CDC's challenges in rebuilding trustopens in a new tab or window during the respiratory virus season. "You're in the perfect position to do it because you had nothing to do with their decisions at the time."

"You can blame it on hindsight, you can blame it on 'we didn't know as much as we know now' -- you can do all sorts of things, but you can tell the truth," he added. "And then the public will start trusting the CDC again."

But Cohen seemed more focused on the actions her agency was taking now and would take in the future. "There have been many ways in which we've been thinking about lessons learned, particularly whether we think about the communication space or the lab safety space and the quality space," she said. Cohen appeared to be referring to what many people consider the mixed messages that the CDC gave at the beginning of the pandemic regarding the effectiveness of masks, as well as the agency's decision to roll out COVID-19 tests that it knew were flawedopens in a new tab or window.

"Those are all lessons learned that we're already baking in to our work, and I hope you're already seeing us communicate differently, both more timely, telling folks what we know when we know it -- and also what we don't know," she said. "I think we have many new procedures related to lab quality to make sure we don't ever see the mistakes on the lab side that we saw before. And we are making sure our workforce is ready to respond."

Rep. Jeff Duncan (R-S.C.) criticized the mask mandates and school closures that Cohen oversaw earlier in the pandemic when she was the health secretary for North Carolina.

"I'm very proud of the work that we did in North Carolina," Cohen responded. "I feel like we did that in a way that was very inclusive. We listened. I had great partners on both sides of the aisle in North Carolina who did that work."

She added that, at the time -- 3 years ago -- "we had very little information, we barely had any tests. We had very little PPE [personal protective equipment]. We certainly didn't have vaccines or treatment. There were very few tools at our disposal to protect folks."

Duncan asked if she would impose similar restrictions today. "The good news is, we're in a new place," Cohen said. "But I want to make sure that we are in a place where we don't have to get into that [situation] again."

Duncan expressed concern that the agency's authority was too broad. "We in Congress have never told the CDC definitively what it's supposed to do and what it isn't supposed to do," he said. "This has led to mission creep at CDC; I see the CDC as an agency of all trades but master of none ... We in Congress need to revisit the CDC's authority to impose mask mandates and vaccine mandates."

Situation in China

Subcommittee Chair Rep. Morgan Griffith (R-Va.) said the level of CDC cooperation since Cohen became director was "a little bit disappointing."

"CDC specifically has not responded to certain letters -- instead, we've received letters signed by the HHS Assistant Secretary for Legislation," he said. "Even these responses did not respond to all of our questions or provide a single document; instead, the responses recounted publicly available information ... Will you commit to working with us?"

Cohen said she would do so.

Griffith also expressed concern about the recently reported increase in respiratory viruses among children in Chinaopens in a new tab or window. "This subcommittee sent a letter to you just yesterday regarding this mysterious uptick in cases," he said. "We are hoping that you can put some pressure in an attempt to try to get China to not mislead the world as they did with COVID-19."

"What we know as of right now [is that] in China they are having an increase in some of their respiratory illnesses," Cohen responded. "In the northern part of their country, they're seeing an uptick in their pediatric population. We do not believe this is a new or novel pathogen. We believe this is all [already] existing -- meaning COVID, flu, RSV, mycoplasma [pneumoniae], but they are seeing an upsurge."

"CDC does have an office in China, and our officials have been in touch with our counterparts to make sure they were understanding the situation there," and they were saying there isn't a novel pathogen, she added.

Response on Mask Types Criticized

Rep. Debbie Lesko (R-Ariz.), the subcommittee's vice-chair, asked Cohen which was better for COVID-19 prevention: surgical masks or cloth masks. Cohen did not respond directly, saying only that "masks work" and that surgical masks work to protect the person wearing them from circulating viruses. When Lesko pressed her for a more definitive answer, Cohen said, "Surgical masks are certainly better -- N95s are better than that. But cloth masks still provide some barrier ... When CDC makes its recommendations about what kind of mask to wear, we say, 'wear a well-fitting, appropriate mask.'"

That answer left Rep. Scott Peters (D-Calif.) very dissatisfied. "I wanted a clear answer to the question, 'do cloth masks work?'" he said. "And you gave me an answer as a lawyer, but I had a hard time understanding it, and I think it's a fair question. And I guess I wish that you just said, 'Don't use a cloth mask; use a surgical mask.' Don't we have enough information to answer the question like that?"

Cohen continued to demur. "I want to make sure that we are saying that cloth masks are a barrier, meaning that they do work," she said. "But do surgical masks work better? Absolutely. Would I wear a cloth mask? No, I wouldn't. I would wear a surgical mask."

Peters was still not happy. "That's still pretty complicated ... [If] my neighbor would say, 'Should I still wear a cloth mask?' I don't know from your answer of what I should tell them."

Malaria Response

Subcommittee Chair Rep. Kathy Castor (D-Fla.) praised Cohen for the CDC's work on a malaria outbreak in Florida, saying she was "heartened" by the agency's quick response.

Cohen called that incident a "good news" story. "When we identified those first few cases of domestically acquired malaria -- which we hadn't seen in 20 years -- the local leaders were very much on top of it, but were able to reach back to state and then to us at CDC to ask for assistance," she said. "We were able to provide technical assistance related to how to control the mosquitoes and how to think about treatment for the individuals. We gave out guidance to the local communities, as well as the healthcare providers in that agency to make sure that they were looking for additional cases. We provided some backup laboratory capability for the area, and we also made sure to look at all of the mosquitoes in the area to make sure we weren't seeing further malaria in those mosquitoes."

https://www.medpagetoday.com/publichealthpolicy/publichealth/107624