The Trump administration ordered hospitals to bypass the Centers for Disease Control and Prevention and send all COVID-19 patient information to a central database in Washington, starting Wednesday, according to a Health and Human Services document updated July 10.
The handoff had an immediate effect. Wednesday afternoon one of the important CDC pages that tracked changes over time in how many hospital beds in the nation are occupied by COVID-19 patients ceased working. The CDC confirmed the page’s disappearance was a consequence of the switch.
It was first noted by Charles Ornstein from the news non-profit ProPublica.
The data came from the National Healthcare Safety Network, the most widely used hospital infection tracking system in the United States. It is run by the CDC.
In a call with reporters Wednesday, CDC director Dr. Robert Redfield said the agency has agreed to remove the NHSN from the collection process in order to streamline reporting.
The disappearance of the site takes away a useful metric of the pandemic for health care workers.
Changes in time of the number of hospital beds being occupied by COVID-19 patients tells public health officials how close to being unable to accept new patients a hospital or a region is, or if things are getting better.
Michael Caputo, HHS assistant secretary for public affairs, said in a statement earlier Wednesday the new coronavirus data collection system would be “faster,” and the CDC has a one-week lag in reporting hospital data.
“The President’s Coronavirus Task Force has urged improvements for months, but they cannot keep up with this pandemic,” he said. “Today, the CDC still provides data from only 85 percent of hospitals; the President’s COVID response requires 100 percent to report.”
The disappearance of the site takes away a useful metric of the pandemic for health care workers.
Changes in time of the number of hospital beds being occupied by COVID-19 patients tells public health officials how close to being unable to accept new patients a hospital or a region is, or if things are getting better.
Michael Caputo, HHS assistant secretary for public affairs, said in a statement earlier Wednesday the new coronavirus data collection system would be “faster,” and the CDC has a one-week lag in reporting hospital data.
“The President’s Coronavirus Task Force has urged improvements for months, but they cannot keep up with this pandemic,” he said. “Today, the CDC still provides data from only 85 percent of hospitals; the President’s COVID response requires 100 percent to report.”
Caputo added: “The CDC, an operating division of HHS, will certainly participate in this streamlined all-of-government response. They will simply no longer control it.”
Wednesday afternoon, Redfield described the data collection system as a way to streamline the process and make it easier for the nation’s hospitals to get information to state and federal authorities.
“We at CDC know that the life blood of public health is data,” he said. “Collecting, disseminating data as rapidly as possible is our priority and the reason for the policy change we’re discussing today.”
The CDC, along with many federal agencies, has long struggled to provide state-of-the-art data systems with lagging funding and sought to upgrade its systems.
Redfield indicated the change would not be detrimental, saying the new system would streamline the process, reduce duplication and the reporting burden on medical providers and “enable us to distribute the scarce resources, using the best possible approach,” he said.
“We’ve merely streamlined data collection for hospitals on the front lines,” he stressed. “No one is taking access or data away from CDC.”
Public health experts and infectious disease scientists sounded an alarm on the protocols, noting that further politicization of the pandemic will hurt health workers and patients.
“Placing medical data collection outside of the leadership of public health experts could severely weaken the quality and availability of data, add an additional burden to already overwhelmed hospitals and add a new challenge to the U.S. pandemic response,” Dr. Thomas File, president of the Infectious Diseases Society of America, said in a statement.
He said collecting and reporting public health data is a “core function of the CDC,” and bypassing the agency would “undermine our nation’s public health experts.”
“As infectious diseases physicians, front-line providers and scientists, we urge the administration to follow public health expertise in addressing this public health crisis,” File said.
President Donald Trump on Friday criticized the Centers for Disease Control and Prevention for being ill-prepared to test for the coronavirus and he blamed former President Barack Obama for the situation.
“For decades the @CDCgov looked at, and studied, its testing system, but did nothing about it. It would always be inadequate and slow for a large scale pandemic, but a pandemic would never happen, they hoped. President Obama made changes that only complicated things further,” he wrote.
For decades the @CDCgov looked at, and studied, its testing system, but did nothing about it. It would always be inadequate and slow for a large scale pandemic, but a pandemic would never happen, they hoped. President Obama made changes that only complicated things further…..
In a follow-up tweet, Trump continued his broadside: “Their response to H1N1 Swine flu was a full scale disaster, with thousands dying, and nothing meaningful done to fix the testing problem, until now. The changes have been made and testing will soon happen on a very large scale basis. All Red Tape has been cut, ready to go!”
…. Their response to H1N1 Swine Flu was a full scale disaster, with thousands dying, and nothing meaningful done to fix the testing problem, until now. The changes have been made and testing will soon happen on a very large scale basis. All Red Tape has been cut, ready to go!
“The system is not really geared to what we need right now,” he said. “That is a failing. Let’s admit it.”
Two issues have led to the slow process in testing for COVID-19, the disease caused by the coronavirus. One was that the CDC had initially put out narrow guidelines for who could be considered for testing. Those criteria were eventually expanded and so far about 11,000 specimens have been tested, according to the agency. South Korea, on the other hand, has been testing nearly 20,000 people each day for the disease, according to reports.
There were also technical issues with the test kits in which they tested for more than just the coronavirus, and the glitch affected the integrity of the kit.
Trump tweeted Thursday that “Sleepy Joe Biden was in charge of the H1N1 epidemic which killed thousands of people,” and said that “the response was one of the worst on record.”
Biden campaign spokesman Andrew Bates responded that Trump should focus on fighting the current outbreak instead of “desperately tweeting lies about the Obama-Biden Administration.”
His newfound disdain for the CDC’s actions and his criticisms of Obama and Biden are based on a faulty description of what happened in the 2009 H1N1 pandemic, initially called “swine flu.”
Then, the CDC’s flu surveillance network actually sounded the alarm, spotting two children in California who were the first diagnosed cases of the new flu strain. About two weeks later, the U.S. declared a public health emergency and CDC began releasing anti-flu drugs from the national stockpile to help hospitals get ready. Trump declared a state of emergency Friday, seven weeks after the first U.S. case of COVID-19 was announced.
Testing wasn’t the primary concern then. The huge challenge was finding a vaccine.
The new flu popped up in April, too late to insert into vaccine already being brewed for that fall. Switching strains was scientifically doable but it took months to grow the new flu virus in eggs and extract it to make a second, separate vaccine that didn’t become available until November, when the new flu was waning.
That vaccine delay prompted the CDC and National Institutes of Health to spur research into new ways to make flu vaccine faster, by skipping having to grow the virus in eggs. Today egg-based shots still are most common but there are some faster-to-produce competitors. And NIH is pursuing a universal flu vaccine that one day might cover all strains in one dose, but is still years away.
On the testing front, 2009 does offer a bit of caution. While CDC’s lab test didn’t have the types of problems it has had with COVID-19, the agency did warn that some “rapid” tests that doctors used varied in accuracy. So far there are no rapid tests for COVID-19.
As for thousands dying, it actually turned out that the new H1N1 strain was less deadly than average seasonal flu. But even that comparison is problematic, because regular flu years are deadliest for the elderly while H1N1 was riskiest for younger people.
Trump’s accusation that Obama introduced further complications appears to refer to a false point he has made before.
Food and Drug Administration guidance drafted during the Obama administration called for tighter regulation of so-called laboratory-developed tests, a market traditionally not overseen by the agency. Trump says that step made it more difficult to come out with a coronavirus test. But that guidance never took effect. And if it had, it would not have applied to public health emergencies like the current one.
President Donald Trump visited the headquarters of the Centers for Disease Control and Prevention (CDC) Friday amid his administration’s push to control the spread of Covid-19, the disease caused by the novel coronavirus first observed in China. But in a press conference during that visit, Trump did little to help Americans understand the government’s response to the virus, instead spreading misinformation while using the public health crisis for self-aggrandizement.
The president spent much of the press conference working to convince the public his administration has the coronavirus under control, something that does not appear to be the case.
For instance, while it is unclear how many people have been infected by the virus due to a delay in testing, it has become increasingly clear in recent days that there are Americans infected with the virus across the country. The number of confirmed Covid-19 cases in the United States has more than doubled in the past week, and as CNN’s Ryan Struyk reported, at least seven states — Minnesota, Oklahoma, Connecticut, Kentucky, Nebraska, Hawaii, and Utah — reported their first Covid-19 cases following Trump’s CDC visit.
Yet during the press conference, Trump dismissed any criticism against the government’s handling of the virus, stressing in particular the availability of Covid-19 tests.
“As of right now and yesterday, anybody that needs a test [can have one], that’s the important thing, and the tests are all perfect, like the letter was perfect, the transcription was perfect,” Trump said, seemingly referring to the White House transcript of his call with Ukrainian president Volodymyr Zelensky in which he requests an investigation into his political rivals.
"The [coronavirus] tests are all perfect. Like the letter was perfect. The transcription was perfect. This was not a perfect as that, but pretty good." — is Trump referring to the transcript of his phone call with the Ukrainian president here? pic.twitter.com/FU5XxPTu7Z
That call was, of course, not perfect, and helped lead to the president’s impeachment — and the tests have not been perfect either.
There have been three main problems with the US government’s coronavirus tests: the first batch, distributed in February, is believed to have had a faulty reagent leading to inconclusive results; once that issue was corrected, there was not enough CDC capacity to test the kits that had been sent out (leading the center to open up testing to state-level facilities), and there aren’t currently enough tests to go around.
Several states have been pushing the CDC for more Covid-19 test kits, and have criticized the government for its slow response in making more tests available. New York, where there are more than 70 confirmed cases, cannot meet the demand for testing because it doesn’t have enough tests, according to Raul Perea-Henze, the New York City deputy mayor for health and human services.
“With multiple positive cases, NYC needs maximum testing capacity to enable successful implementation of the public health strategies that best protect New Yorkers,” Perea-Henze wrote in a letter Friday, requesting more testing kits. “The slow federal action on this matter has impeded our ability to beat back this epidemic.”
California simultaneously does not have enough kits to test all those at risk of having been infected, and does not have the lab capacity to process all of the tests it has already run. Lab technicians have been working 18-hour shifts in order to try to work through a testing backlog, but have been unable to do so. In Los Angeles County, commercial laboratories will begin processing tests on Monday, which is expected to help alleviate this issue.
But not all states have the resources California and New York do — while they were able to send tests to state-run labs after the CDC began allowing them to do so, some states, including Maine, Ohio, West Virginia, Oklahoma, and Wyoming, do not currently have the capacity for in-state testing.
The government has tried to respond to mounting criticism about the shortage of testing kits. On Wednesday, Vice President Mike Pence promised to increase supply, saying 1.5 million tests would be made available. So far, however, the actual number of tests being administered fails to live up to that promise — as of Friday, US Secretary of Health and Human Services Alex Azar said the CDC had distributed enough tests for 75,000 people, and partnered with a private firm to distribute material for 700,000 additional tests.
Trump’s CDC presser confirms everything people were worried about if Covid-19 hit the US
Even before the recent uptick in US-based Covid-19 cases, critics of the Trump administration’s coronavirus response argued the administration was disorganized and ill-equipped to combat Covid-19. As Vox’s Matt Yglesias has written, the president was slow to put someone in charge of the coronavirus response efforts — and when he finally did, he selected Vice President Mike Pence, someone who failed in his responses to public health crises while serving as governor of Indiana, according to experts. And there were also concerns Trump’s efforts to cut CDC funding — and the size of the administration’s initial coronavirus budget — might have limited the government’s ability to fight the virus effectively.
But experts have argued the biggest issue with the administration’s coronavirus response so far is, as former director of the USAID’s Office of US Foreign Disaster Assistance Jeremy Konyndyk told Vox’s Alex Ward, Trump has “made it primarily about himself.”
And this concern was on display at the CDC press conference when Trump took time to talk at length about his own intelligence, in part by referencing a “great, super genius” uncle who taught at MIT.
“I like this stuff. I really get it,” Trump said. “People are surprised that I understand it. Every one of these doctors say, ‘How do you know so much about this?’ Maybe I have a natural ability. Maybe I should’ve done that instead of running for president.”
Here's Trump rambling at length about how smart he is and how well he understands public health pic.twitter.com/1Co6MaRkzl
Trump’s public response, however, is a reminder of how he has recently put his public health knowledge into question. During a White House meeting on Monday with pharmaceutical executives and public health officials, Trump displayed his ignorance by pushing for a vaccine to be developed in a few months (something he has promised the public will happen) — even though that’s just not how it works.
And he went on to express confusion as to why pharmaceutical companies can’t release the drugs they are currently working on immediately, as Vox’s Aaron Rupar reported:
Trump pressed the pharmaceutical leaders on why they can’t just release the coronavirus drugs their companies are working on tomorrow — in the process revealing that he doesn’t understand the concept of clinical trials.
“So you have a medicine that’s already involved with the coronaviruses, and now you have to see if it’s specifically for this. You can know that tomorrow, can’t you?” he said.
“Now the critical thing is to do clinical trials,” explained Daniel O’Day, CEO of Gilead Sciences, which has two phase-three clinical trials going for remdesivir, a potential treatment for the coronavirus. “We have two clinical trials going on in China that were started several weeks ago … we expect to get that information in April.”
Hours after learning about how vaccines work and the timeline for a potential coronavirus vaccine, Trump told supporters at a rally: “We had a great meeting today with a lot of the great companies, and they’re going to have vaccines I think relatively soon. And they’re going to have something that makes you better, and that’s going to actually take place we think even sooner.”
It isn’t clear why Trump said this, particularly after seemingly having been disabused of his misconceptions in his White House meeting, but such a statement does not support his claim at the CDC that “I understand that whole [scientific] world.”
Nor did the president’s CDC visit allay concerns about a lack of coordination between officials. If anything, it added confusion to an already tumultuous — and potentially dangerous — situation.
For example, the Trump administration has been offering a variety of answers to the question of whether the country is experiencing a shortage of test kits (it is). On Thursday, Pence said, “We don’t have enough tests today to meet what we anticipate will be the demand going forward,” according to The Hill.
Trump, however, had a completely different message as he boasted of the US’s testing capabilities in Atlanta on Friday, saying, “Anybody who needs a test gets a test. … They have the tests and the tests are beautiful.”
This left Pence with the difficult task Friday of attempting to bring his factually correct messaging in line with the president’s incorrect statements.
“I think for any American that’s symptomatic, speaking to your doctor, if you have reason to believe that you have been exposed to the coronavirus, I have every confidence that your physician would contact state health officials and have access to the state lab,” Pence said at a White House briefing. And this, unlike Trump’s statement, is closer to the truth — the CDC revised its testing guidelines on Wednesday, allowing primary physicians to conduct testing in concert with local authorities. Whether local labs have the ability to process those tests, or if those tests are even available, however, remains a matter of concern.
Although we’ve grown used to the Trump administration’s frequent inconsistency in messaging, it becomes dangerous in times like this, when transparent communication is key in helping contain a disease and keep trust in the government strong. And Trump’s tendency to self-aggrandize is not helpful in a moment that calls for collaboration and creating an apolitical environment.
Trump continues to politicize the Covid-19 outbreak
In fact, perhaps the most concerning aspect of the CDC conference was how it gave us a glimpse into Trump’s view of the coronavirus as a political rather than health-based issue.
During his remarks, Trump said he would rather have the passengers of the Grand Princess, a cruise ship docked in San Francisco with 21 confirmed cases onboard, stay on the ship than move to land — all because doing so would raise the number of total Covid-19 cases in the US.
“I would rather because I like the numbers being where they are,” Trump said. “I don’t need to have the numbers double because of one ship that wasn’t our fault. And it wasn’t the fault of the people on the ship either, okay? It wasn’t their fault either and they’re mostly Americans. So, I can live either way with it. I’d rather have them stay on, personally.”
"I like the numbers being where they are. I don't need to have the numbers double because of one ship" — Trump explains that he doesn't want to let people off the Grand Princess cruise ship because he doesn't want the number of coronavirus cases in the country to go up pic.twitter.com/ELhZDjiZW9
Trump’s comment suggests a grim reality: that keeping the number of Covid-19 cases low is more important to him than the actual people who have the disease — all because he wants to avoid the political fallout of a growing case count.
And that wasn’t the only political moment during the conference — he also took time out to praise Fox News for its ratings, attack CNN as “fake news,” and smear Washington’s Democratic Gov. Jay Inslee — who was praised by Pence for his work in fighting the spread of Covid-19 — as a “snake” who wants to “take advantage” of the administration’s kindness.
Trump smears Jay Inslee, governor of the state at the heart of the coronavirus outbreak: "I told Mike [Pence] not to be complimentary of the governor, because that governor is a snake." pic.twitter.com/zfraPiqmGI
These sort of attacks undercut the seriousness of the situation — and they also draw attention toward Trump and away from the coronavirus itself. And they come at a time when the virus needs more attention than ever.
Topping a week of conflicting statements from the administration about how many tests the U.S. is now able to administer for the coronavirus, President Donald Trump on Friday told reporters at the Centers for Disease Control and Prevention in Atlanta that “anybody who wants a test gets a test.”
U.S. health officials started the week by defending themselves to members of Congress for a shortage of tests across the country. That shortage, along with tight restrictions from the CDC on who could be tested, allowed infected people to go undetected and further spread it, say health experts.
After being rebuked for the delays, Food and Drug Administration chief Stephen Hahn on Tuesday told the Senate Committee on Health, Education, Labor and Pensions that, with the aid of private sector partnerships, the government would be able to test roughly a million individuals by the end of the week.
But by Thursday, U.S. Health and Human Services Secretary Alex Azar told reporters he expects public laboratories this week to test 400,000 people. Later that day, Vice President Mike Pence said “we don’t have enough tests today to meet what we anticipate will be the demand going forward.” Pence is leading the government’s response to the COVID-19 outbreak.
A spokesperson for the CDC did not respond to requests to confirm the number of people who have been tested for the coronavirus.
Part of the administration’s hope in expediting its testing capability was partnering with the private sector to help make up for limitations created by what experts say is an underfunded public health system.
The CDC is partnering with Integrated DNA Technologies to manufacture the tests under a CDC contract. IDT is partnering with commercial labs, including LabCorp and Quest for the testing, both companies have confirmed.
“What was different was this response,” said John Auerbach, CEO of the Trust for America’s Health and former head of the CDC’s policy office. “The administration said it wasn’t just going to use public health labs as its core — it was going to say to the commercial sector, you develop these, get them out the door. … [But] that assumed they had the capacity to get these kits out the door.”
“But there are no real mechanisms for monitoring how much their capacity is — it’s kind of a wild west.”
LabCorp said Thursday its coronavirus test would be available at 6 p.m. that day. Quest said its test would be available Monday.
Meantime the number of infected people continues to grow. There are at least 245 confirmed cases of COVID-19 in the U.S., according to data compiled by Johns Hopkins University. Pence said Friday that 21 people on the Grand Princess cruise ship off California have tested positive.
The growing count has led to mounting frustration by many in Congress over what they say are the president’s conflicting statements and a lack of transparency amid a public health crisis.
“They won’t disclose how many test kits are now available or when they will be fully deployed, but we know that they haven’t come close to the one million mark,” said Rep. Jan Schakowsky, D-Ill., in a statement to CNBC.
“Congress has done its job in providing emergency funding for the Administration to acquire, stockpile, and distribute an adequate supply of diagnostics,” Schakowsky wrote. “The question remains, is this Administration capable of doing so?”
In a briefing to the media on Tuesday, officials from the centres for disease control and other health experts, said communities in the US should start planning for “social distancing measures”.
“It’s not so much of a question of if this will happen anymore but rather more of a question of exactly when this will happen,” said Nancy Messonnier, director of the national centre for immunisation and respiratory diseases.
But in his own press conference on Wednesday, Mr Trump appeared to play down such certainty, while insisting his government was ready for whatever came.
“I don’t think it’s inevitable. I don’t think think it’s inevitable because we’re doing a really job at the borders and checking people coming in,” he said.
“I think there is a chance there could a substantial increase. But nothing is inevitable.”
“Wash your hands, stay clean, you don’t have to necessarily grab every handrail unless you have to.
Mr Trump went on to dismiss concerns over the risk the virus poses to the public.
“View this the same as the flu,” he said: “When somebody sneezes, I mean, I try and bail out as much as possible when they’re sneezing.”
Turning to one of the health experts stood behind him, Mr Trump added: “I really think, doc, you want to treat this like you treat the flu, and, you know, it’s going to be fine.”
Flanked by vice president Mike Pence, who he has appointed to head the government’s response to the disease, and other officials, Mr Trump said: “The risk to the American people remains very low.”
He added: “We’re ready to adapt and we’re ready to do whatever we have to as the disease spreads, if it spreads. It probably will, it possibly will. It could be at a very small level, or it could be at a larger level. Whatever happens we’re totally prepared.”
There are currently 15 cases of coronavirus detected among individuals inside the United States. In addition, 40 American passengers brought back from a cruise ship in Japan also tested positive for the virus.
The administration has proposed $2.5bn in additional funding to address the coronavirus, a sum politicians from both parties have said may be insufficient.
On Wednesday, public health officials warned Americans to prepare for more coronavirus cases and New York City announced plans to provide up to 1,200 hospital beds if needed stock markets fell for the fifth consecutive day.
Dr Anthony Fauci, the head of the national institute of allergy and infections diseases, said that while the virus was contained in the United States, Americans must prepare for a potential outbreak as transmissions spread outside of China.
“If we have a pandemic, then almost certainly we are going to get impacted,” he told CNN.
In the wee hours of a rainy Monday, more than a dozen buses sat on the tarmac at Tokyo’s Haneda Airport. Inside, 328 weary Americans wearing surgical masks and gloves waited anxiously to fly home after weeks in quarantine aboard the Diamond Princess, the luxury liner where the novel coronavirus had exploded into a shipwide epidemic.
But as the buses idled, U.S. officials wrestled with troubling news. New test results showed that 14 passengers were infected with the virus. The U.S. State Department had promised that no one with the infection would be allowed to board the planes.
A decision had to be made. Let them all fly? Or leave them behind in Japanese hospitals?
In Washington, where it was still Sunday afternoon, a fierce debate broke out: The State Department and a top Trump administration health official wanted to forge ahead. The infected passengers had no symptoms and could be segregated on the plane in a plastic-lined enclosure. But officials at the Centers for Disease Control and Prevention disagreed, contending they could still spread the virus. The CDC believed the 14 should not be flown back with uninfected passengers.
“It was like the worst nightmare,” said a senior U.S. official involved in the decision, speaking on the condition of anonymity to describe private conversations. “Quite frankly, the alternative could have been pulling grandma out in the pouring rain, and that would have been bad, too.”
The State Department won the argument. But unhappy CDC officials demanded to be left out of the news release that explained that infected people were being flown back to the United States — a move that would nearly double the number of known coronavirus cases in this country.
The tarmac decision was a pivotal moment for U.S. officials improvising their response to a crisis with few precedents and extraordinarily high stakes. Efforts to prevent the new pathogen from spreading have revealed the limits of the world’s readiness for an unprecedented public health emergency. In the worst-case scenario, covid-19, a flulike respiratory infection, could become a full-blown global pandemic.
Navigating the crisis has required delicate medical and political judgments. The decision to evacuate the Americans from the Diamond Princess came only after infections on the cruise ship spiked and passengers revealed their grim living conditions.
One lesson from that debacle is that cruise ships are like petri dishes.Thousands live in close quarters on a vessel never designed for quarantines. The crew continued to deliver food, and health workers moved throughout the ship. More than 600 of the 3,700 passengers and crew members have now tested positive for the virus and two older Japanese passengers have died.
With Japanese authorities isolating the passengers for weeks off the coast, the ship, operated by Princess Cruises, quickly developed the second-largest number of coronavirus cases on the planet outside of China — more than in Japan, Singapore, Thailand, the United States or all of Europe. Avoiding “another China” has been the goal of the World Health Organization for weeks, and then it happened anyway, in Yokohama harbor.
The treatment of the Diamond Princess passengers stands in stark contrast to what happened to those on another cruise ship, the Westerdam, who were greeted by the Cambodian prime minister with handshakes and flowers, and who later traveled widely. Only later did news come that one of the Westerdam passengers had tested positive for the virus.
That situation spurred fears that Westerdam passengers would spread the virus around the world. But no additional passengers have tested positive, and so far, no evidence has emerged they have widely seeded the virus.
The coronavirus (officially, SARS-CoV-2) is extremely contagious. Experts estimate that without protective measures, every infected person will spread it to an average of slightly more than two additional people. The disease has been fatal in roughly two out of 100 confirmed cases.
Travelers have already spread it to more than two dozen countries, where it has infected more than 75,000 people and killed more than 2,000.
The Trump administration’s top public health official bought shares in a tobacco company one month into her leadership of the agency charged with reducing tobacco use — the leading cause of preventable disease and death and an issue she had long championed.
The stock was one of about a dozen new investments that Brenda Fitzgerald, director of the Centers for Disease Control and Prevention, made after she took over the agency’s top job, according to documents obtained by POLITICO. Fitzgerald has sincecome under congressional scrutiny for slow walking divestment from older holdings that government officials said posed potential conflicts of interest.
Buying shares of tobacco companies raises even more flags than Fitzgerald’s trading in drug and food companies because it stands in such stark contrast to the CDC’s mission to persuade smokers to quit and keep children from becoming addicted. Critics say her trading behavior broke with ethical norms for public health officials and was, at best, sloppy. At worst, they say, it was legally problematic if she didn’t recuse herself from government activities that could have affected her investments.
“You don’t buy tobacco stocks when you are the head of the CDC. It’s ridiculous; it gives a terrible appearance,” said Richard Painter, who served as George W. Bush’s chief ethics lawyer from 2005 to 2007. He described the move as “tone deaf,” given the CDC’s role in leading anti-smoking efforts.
Even if Fitzgerald, a medical doctor and former Georgia Department of Public Health commissioner, met all of the legal requirements, “it stinks to high heaven,” Painter said.
A Health and Human Services Department spokesman confirmed “the potentially conflicting” stock purchases, saying they were handled by her financial manager and that she subsequently sold them.
“Like all presidential personnel, Dr. Fitzgerald’s financial holdings were reviewed by the HHS Ethics Office, and she was instructed to divest of certain holdings that may pose a conflict of interest. During the divestiture process, her financial account manager purchased some potentially conflicting stock holdings. These additional purchases did not change the scope of Dr. Fitzgerald’s recusal obligations, and Dr. Fitzgerald has since also divested of these newly acquired potentially conflicting publicly traded stock holdings.”
After assuming the CDC leadership on July 7, Fitzgerald bought tens of thousands of dollars in new stock holdings in at least a dozen companies later that month as well as in August and September, according to records obtained under the Stock Act, which requires disclosures of transactions over $1,000. Purchases included between $1,001 and $15,000 of Japan Tobacco, one of the largest such companies in the world, which sells four tobacco brands in the U.S. through a subsidiary.
The purchases also include between $1,001 and $15,000 each in Merck & Co., Bayer and health insurance company Humana, as well as between $15,001 and $50,000 in US Food Holding Co., according to financial disclosure documents.
On Aug. 9, one day after purchasing stock in global giant Japan Tobacco, she toured the CDC’s Tobacco Laboratory, which researches how the chemicals in tobacco harm human health, according to financial forms obtained from HHS’ Office of Government Ethics and calendars obtained through a Freedom of Information Act request.
The records confirm that Fitzgerald sold the shares of tobacco on Oct. 26 and all of her stock holdings above $1,000 by Nov. 21, more than four months after she became CDC director.
Fitzgerald, who declined to be interviewed for this story, has made tobacco efforts a focus of her public health career, despite owning stock in the industry. She listed tobacco cessation as one of her primary priorities while still serving in the Georgia position in February 2017.Prior to accepting the CDC position, she owned stock in five other tobacco companies: Reynolds American, British American Tobacco, Imperial Brands, Philip Morris International, and Altria Group Inc. — all legal under Georgia’s ethics rules. HHS did not respond to questions about why she invested in tobacco companies while working to reduce tobacco consumption.
“It’s stunning,” said Matthew Myers, president of the Campaign for Tobacco-Free Kids. “It sends two messages, both of which are deeply disturbing. First, it undermines the credibility of a public official when they argue that tobacco is the No. 1 preventable cause of disease. Second, and perhaps even worse, it indicates a public official is willing to put their personal profit above the ethics of investing in a company whose products cause so much harm.”
“It gives you a window, I think, into her value system,” said Kathleen Clark, a professor of law focusing on government ethics at Washington University in St. Louis. “It doesn’t make her a criminal, but it does raise the question of what are her commitments? What are her values, and are they consistent with this government agency that is dedicated to the public health? Frankly, she loses some credibility.”
While holding the newly purchased tobacco, drug company and food stock, along with other financial holdings in various health companies, Fitzgerald participated in meetings related to the opioid crisis, hurricane response efforts, cancer and obesity, stroke prevention, polio, Zika and Ebola, according to a copy of her schedule between Aug. 1 and Oct. 27.
“If she participated in meetings in which she has financial conflicts of interest, that is not fine in my book,” said Craig Holman, a lobbyist at the liberal watchdog group Public Citizen. Because some of the meetings took place before Fitzgerald had an ethics agreement, Holman said she “could have an easy avenue for excusing herself,” by saying she didn’t understand it was a conflict, or arguing she didn’t make decisions in those meetings. “But that is not how the law should be applied,” he added. “Even if you could claim you didn’t speak up at those meetings, your presence poses a conflict of interest.”
But it could have been possible for Fitzgerald to participate in briefings on topics like tobacco or Ebola without violating government ethics policy, depending on her role, said a former government ethics official. For example, if Fitzgerald was just in listening mode and not making any substantive comments or decisions, she would likely be within the rules, the official said.
Fitzgerald has already been criticized by some lawmakers for her inability to offload two financial holdings, which date to before she became CDC director and left her unable to perform some tasks, such as testifying in front of lawmakers.An HHS spokesperson said she is actively working to address her remaining recusal obligations related to the two companies, adding that both have “complex transfer restrictions.”
HHS officials said Fitzgerald’s lengthy divestment process was due to her complicated stock portfolio. They declined to say whether she had any ethics training. She didn’t enter into a formal ethics agreement with HHS until two months after taking office.
“It’s a little concerning it took two months to get her ethics agreement signed and an additional month for her to dump conflicting stock,” said Scott Amey, general counsel at the Project on Government Oversight, a watchdog group.
The Health and Human Services Department declined to respond to detailed questions about Fitzgerald’s investments, including whether she herself approved the transactions and what activities and decisions she recused herself from due to her holdings.
Normally, senior government officials commence the process of outlining their conflicts of interest before they assume a job, so that they can quickly divest within days of taking office, a former HHS senior legal counsel told POLITICO.
HHS lawyers usually advise employees to avoid purchasing new stock during an interim period, particularly in areas where they would likely need to divest. Fitzgerald’s ethics agreement, dated Sept. 7, identified nearly all the companies in which she bought stocks on the job as conflicts of interest.
But officials are liable for their actions, regardless of whether they have an ethics agreement in place or have been warned by ethics officials that a financial holding is a conflict, multiple former government ethics officials told POLITICO.
One reason Fitzgerald’s divestment may have taken so long is that the Office of Government Ethics has little ability to force government officials to speedily address financial conflicts, unless they are undergoing a Senate confirmation process, said Walter Shaub, who directed the U.S. Office of Government Ethics under Barack Obama from 2013 to 2017. The CDC director is not a Senate-confirmable post.
“There is a lot less transparency around the non-Senate confirmed individuals … and the ethics process lags, even though the rules still apply,” said Max Stier, president of the Partnership for Public Service, a government oversight group. “Those folks put themselves at risk by not getting clearance and understanding the rules.”
Four years after the United States pledged to help the world fight infectious-disease epidemics such as Ebola, the Centers for Disease Control and Prevention is dramatically downsizing its epidemic prevention activities in 39 out of 49 countries because money is running out, U.S. government officials said.
The CDC programs, part of a global health security initiative, train front-line workers in outbreak detection and work to strengthen laboratory and emergency response systems in countries where disease risks are greatest. The goal is to stop future outbreaks at their source.
Most of the funding comes from a one-time, five-year emergency package that Congress approved to respond to the 2014 Ebola epidemic in West Africa. About $600 million was awarded to the CDC to help countries prevent infectious-disease threats from becoming epidemics. That money is slated to run out by September 2019. Despite statements from President Trump and senior administration officials affirming the importance of controlling outbreaks, officials and global infectious-disease experts are not anticipating that the administration will budget additional resources.
Two weeks ago, the CDC began notifying staffers and officials abroad about its plan to downsize these activities, because officials assume there will be “no new resources,” said a senior government officialspeaking on the condition of anonymity to discuss budget matters. Notice is being given now to CDC country directors “as the very first phase of a transition,” the official said. There is a need for “forward planning,” the official said, to accommodate longer advance notice for staffers and for leases and property agreements. The downsizing decision was first reported by the Wall Street Journal.
The CDC plans to narrow its focus to 10 “priority countries,” starting in October 2019, the official said. They are India, Thailand and Vietnam in Asia; Jordan in the Middle East; Kenya, Uganda, Liberia, Nigeria and Senegal in Africa; and Guatemala in Central America.
Countries where the CDC is planning to scale back include some of the world’s hot spots for emerging infectious disease, such as China, Pakistan, Haiti, Rwanda and Congo. Last year, when Congo experienced a potentially deadly Ebola outbreak in a remote, forested area, CDC-trained disease detectives and rapid responders helped contain it quickly.
In Congo’s capital of Kinshasa, an emergency operations center established last year with CDC funding is operational but still needs staffers to be trained and protocols and systems to be put in place so data can be collected accurately from across the country, said Carolyn Reynolds, a vice president at PATH, a global health technology nonprofit group that helped the Congolese set up the center.
This next phase of work may be at risk if CDC cuts back its support, she said. “It would be akin to building the firehouse without providing the trained firemen and information and tools to fight the fire,” Reynolds said in an email.
If more funding becomes available in the fiscal year that starts Oct. 1, the CDC could resume work in China and Congo, as well as Ethiopia, Indonesia and Sierra Leone, another government official said, also speaking on the condition of anonymity to discuss budget matters.
In the meantime, the CDC will continue its work with dozens of countries on other public health issues, such as HIV, tuberculosis, malaria, polio eradication, vaccine-preventable diseases, influenza and emerging infectious diseases.
Global health organizations said critical momentum will be lost if epidemic prevention funding is reduced, leaving the world unprepared for the next outbreak. The risks of deadly and costly pandemic threats are higher than ever, especially in low- and middle-income countries with the weakest public health systems, experts say. A rapid response by a country can mean the difference between an isolated outbreak and a global catastrophe. In less than 36 hours, infectious disease and pathogens can travel from a remote village to major cities on any continent to become a global crisis.
On Monday, a coalition of global health organizations representing more than 200 groups and companies sent a letter to U.S. Health and Human Services Secretary Alex Azar asking the administration to reconsider the planned reductions to programs they described as essential to health and national security.
“Not only will CDC be forced to narrow its countries of operations, but the U.S. also stands to lose vital information about epidemic threats garnered on the ground through trusted relationships, real-time surveillance, and research,” wrote the coalition, which included the Global Health Security Agenda Consortium and the Global Health Council.
The coalition also warned that complacency after outbreaks have been contained leads to funding cuts, followed by ever more costly outbreaks. The Ebola outbreak cost U.S. taxpayers $5.4 billion in emergency supplemental funding, forced several U.S. cities to spend millions in containment, disrupted global business and required the deployment of the U.S. military to address the threat.
“This is the front line against terrible organisms,” said Tom Frieden, the former CDC director who led the agency during the Ebola and Zika outbreaks. He now heads Resolve to Save Lives, a global initiative to prevent epidemics. Referring to dangerous pathogens, he said: “Like terrorism, you can’t fight it just within our borders. You’ve got to fight epidemic diseases where they emerge.”
Without additional help, low-income countries are not going to be able to maintain laboratory networks to detect dangerous pathogens, Frieden said. “Either we help or hope we get lucky it isn’t an epidemic that travelers will catch or spread to our country,” Frieden said.
The U.S. downsizing could also lead other countries to cut back or drop out from “the most serious multinational effort in many years to stop epidemics at their sources overseas,” said Tom Inglesby, director of the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health.
CDC spokeswoman Kathy Harben said the agency and federal partners remain committed to “prevent, detect and respond to infectious disease threats.”
The United States helped launch an initiative known as the Global Health Security Agenda in 2014 to help countries reduce their vulnerabilities to public health threats. More than 60 countries now participate in that effort. At a meeting in Uganda in the fall, administration officials led by Tim Ziemer, the White House senior director for global health security, affirmed U.S. support to extend the initiative to 2024.
“The world remains under-prepared to prevent, detect, and respond to infectious disease outbreaks, whether naturally occurring, accidental, or deliberately released,” Ziemer wrote in a blog post before the meeting. “. . . We recognize that the cost of failing to control outbreaks and losing lives is far greater than the cost of prevention.”
The CDC has about $150 million remaining from the one-time Ebola emergency package for these global health security programs, the senior government official said. That money will be used this year and in fiscal 2019, but without substantial new resources, that leaves only the agency’s core annual budget, which has remained flat at about $50 million to $60 million.
Officials at the CDC, the Department of Health and Human Services and the National Security Council pushed for more funding in the president’s fiscal 2019 budget to be released this month. A senior government official said Thursday that the president’s budget “will include details on global health security funding,” but declined to elaborate.
The Trump administration has reportedly banned the Centers for Disease Control from using the phrases “evidence-based” and “science-based” on official documents.
Senior CDC officials distributed the list of “forbidden” words and phrases to policy analysts at the CDC on Thursday, the Washington Post reported Friday. The list also bans the use of “vulnerable,” “entitlement,” “diversity,” “transgender” and “fetus.”
Analysts are reportedly prohibited from using the phrases on official documents they prepare for the 2019 budget, which is expected to be released in February.
An analyst who attended the meeting at the CDC in Atlanta told the Washington Post that instead of “evidence-based” or “science-based,” policy analysts are instructed to use the phrase, “CDC bases its recommendations on science in consideration with community standards and wishes.”
The analyst told the Post that other branches of President Trump’s health department are likely adhering to the same list of banned words. The source said that others at the meeting reacted with surprise when given the list.
“It was very much, ‘Are you serious? Are you kidding?’” the analyst said, “In my experience, we’ve never had any pushback from an ideological standpoint.”
The Trump administration has been repeatedly scrutinized for declining to acknowledge science-based findings, particularly related to climate change. Trump himself has not said whether he believes in climate science, and numerous members of his administration and his appointees have denied aspects of scientific consensus related to global warming.
