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“A resurgent CDC is necessary to recapture the vitality of U.S. medical science. A scientific researcher alone cannot do this work. This will also require heavy managerial work and restructuring and charting a different course altogether. CDC will need a double-headed leader approach, one excelling in scientific expertise and another proficient in managerial miracles.
The current messaging algorithms at the CDC are misplaced. The CDC tried to placate diverse constituencies at different times without having a solid baseline policy. In some instances, the CDC came to wrong conclusions because there were no accurate scientific data to depend on. And the U.S. did not produce that data when COVID-19 was ravaging in 2020 and 2021.”
P. Dileep Kumar is a hospitalist.
He shares his story and discusses his KevinMD article, “The CDC’s continuing failures: Is there a way out?”
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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.
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Transcript
Kevin Pho: Hi, welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Dileep Kumar. He is a hospitalist, and he wrote an article on KevinMD about the CDC’s continuing failures. Dileep, welcome to the show.
P. Dileep Kumar: Thank you.
Kevin Pho: We’ll get into your article in a little bit, but first off, can you just share your story and journey to where you are today?
P. Dileep Kumar: So I grew up in India, and I finished my medical school there. I worked in the Middle East for a few years, and then I traveled to the U.K. and Ireland for some studies, courses, and things like that. Then I did a residency in Cleveland, and then I started working as a hospitalist in Michigan. So that’s the story in a nutshell.
Kevin Pho: All right. So we are speaking in the beginning of February. Tell me, what are you seeing now on the hospital floor?
P. Dileep Kumar: Oh, we have lots of, especially in Michigan, we have lots of COVID patients still. Our ICU is full, and one of the major things we are noticing is that the majority of patients are not vaccinated, because that’s the truth. I would say that the numbers are high, and the mortality is the same as the worst part of COVID, which we had in 2020. It’s almost like a second act. So it’s sad, actually, because still people are dying. It’s a struggle for everyone to deal with the situation: all the providers, even the physicians, and even the nurses. The nurses, especially those who work in the ICU, are very stressed out. The burnout rate is very high, and people are leaving. So yeah, it’s really, really surprising that we are still dealing with this after two years.
Kevin Pho: And when you talk to these patients who are unvaccinated and are in the hospital, do you get a sense that some of them have any regret about not receiving the vaccine?
P. Dileep Kumar: Yeah, they do. Some of them, actually a lot of them, have regrets. I’ll ask them, I’m just curious, and I ask them, “Why did you not vaccinate?” And it’s because of the misinformation, because of what other people tell them. And then some are sorry, and some are like, “OK, I’m going to take it soon.” But there are still some people who won’t take it no matter what it is. They’re not going to take questions, and they do not want to hear about anything else. But some are really kind of sorry for that. So as a compassionate physician, my approach is not to judge them, to offer whatever we have, and to support them.
Kevin Pho: All right, we’re going to talk more about public health messaging as it relates to the CDC. Your KevinMD article is titled “The CDC’s continuing failures: Is there a way out?” Now, for those who didn’t get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?
P. Dileep Kumar: Yes. As you know, during the past two years we have seen a lot of recommendations from the CDC which are controversial, or we were even doubting why they were saying things like that, starting from the mask. So you get the mixed messages, and I think that also kind of confused the whole COVID situation and might have led to the current situation.
So my concern was that the CDC came out with the recent regulation about the shortened quarantine time, where they’re saying you only have to quarantine five days after testing positive. But there are no hard and fast studies supporting that. So basically, they’ve come up with that recommendation based on the anticipated Omicron surge of COVID and the shortage of workers, and probably it was pushed by the big industries, like airlines, which are concerned with the lack of workers. It’s confusing for the general lay public to get these kinds of mixed messages.
Now, if you think about it, why is this happening? Of course, the director is coming out with all the proclamations, but I don’t think she’s personally responsible. As you know, the CDC is a big organization, so just like any other big business, after some time, unless you take really good care of the business processes, it can degenerate. You can get a business decay. So I think the CDC is in that phase of entropy, if you call it that. I have nothing against the people working at the CDC. They are very smart people, and they are very committed and dedicated, but somehow there is some disconnect between, just like you said, the messaging and what is happening and the work the CDC is doing.
One of the reasons, of course, apart from the business part of the CDC, is the academics. If you look at the papers, Kevin, for the last two years there are not many COVID papers coming out of this country. Why is this happening? Where is the NIH? Where are the grants going? There are a lot of questions to be answered. In the article I also have a graph showing the percentage of the papers coming out of the U.S. compared to other countries. If you look at that, in the 1990s we had like 30 percent of the whole scientific papers, but right now it stands at 17 percent, and other countries are catching up. So somehow our scientific establishment has to take the responsibility for the CDC’s failures, because the CDC cannot act in a vacuum. They have to depend on the studies, and there are no studies, so we had to depend on Israeli studies to get the COVID booster approval.
These are the things where we have to go back, introspect, and find out what’s happening. It’s not a question of finger-pointing or finding fault; it’s a question of going forward and making it right. So I think before doing that, we have to acknowledge that there was a failure, and then secondly, we have to study the processes. What happened, what is happening in the CDC, what’s happening at the NIH, what is happening with our grant processes, what is happening with the youngsters? Maybe the NIH grant process needs to be completely revamped.
So my point was that just appointing a medical expert is not going to help, because the processes have failed. In order to correct that, a business expert needs to be appointed as a leader. So a sort of double-headed leader approach, with one person being a medical expert and the other person being a business expert, might be the way out.
Kevin Pho: So you talk about a few examples of the mixed messaging of the CDC. The first example was about masks in the spring of 2020, and another example was their five-day isolation period after getting sick. So I’m interested in hearing your explanations for the reasons for the mixed messaging. Is it, like you said, the influence of business and politics? Is it the fact that the science is changing so rapidly that it can’t keep up with the science? How much do you think politics and business interests influence the decisions and messaging of the CDC?
P. Dileep Kumar: Yes, very, very true. I think we had very, very confusing politics, as you remember, at the beginning of 2020, when the whole pandemic started. So there were a lot of pressures on the CDC, and then they had to act in a vacuum, because they did not have any solid scientific evidence. So they were making decisions on the run, sort of based on, so to say, hearsay, no hard facts.
So basically, in the beginning, if you remember, in 2020 they said masks are not useful, which is totally ridiculous. But they said that because they were afraid that if the general public used masks, they wouldn’t be available for the health care workers. So the failure was our supply chain failure. The failure was the people who are making masks in our country. Recently I was driving through one of the auto factories, and they proudly announced, “We made 20 million masks this year,” or something like that. They did a good job, I agree, but they were a little bit lagging behind the rapidly evolving epidemic.
So that is politics. The federal government has to be ready for such a pandemic, and we are totally not ready for such an event. Interestingly, about two years ago there was a report, and I think the WHO assessed the pandemic preparedness of all the countries, and the U.S. was number one and the U.K. was number two. But even then, when it comes to the real thing, we are not prepared. We were caught off guard, and we dropped many balls. I think that’s one of the reasons the CDC was forced to make those decisions. The CDC, and also probably the process in the CDC, the messaging: There might be some issues which need to be looked into and corrected, because we should be a very nimble organization.
As you know, when I was working in Oman, there was actually an outbreak of Congo-Crimean hemorrhagic fever, which is a very rare case of hemorrhagic fever, and the case fatality rate is only like five percent. But still, people were concerned, because it comes from cattle, and people will have thrombocytopenia and severe bleeding. And actually, a CDC team came, pinpointed the origin of the epidemic, and helped in controlling it. It happened very quickly. So what happened to our CDC after 20 years? We are not ready to stop the pandemic even after two years. It’s kind of disheartening after spending a lot of resources.
Kevin Pho: Now, in the middle of the pandemic there was a change, of course, in administration. What’s your assessment of Dr. Rochelle Walensky’s messaging? Has there been a significant improvement in the messaging after that change in administration?
P. Dileep Kumar: Yeah, I think Dr. Walensky is very sincere in trying to improve the messaging. But just like I said, the issue is not the messaging but what’s happening: What is it basing things on, and what is happening at the CDC? So I think we are almost back to square one because of these kinds of situations.
But again, the hard reality is that within the last two years we don’t have any substantial studies from the U.S. We are not keeping pace with the science, and many other studies are coming out of other countries which are not done with very scientific rigor, and then they were giving us positive information. So the whole thing became very confused. So I think Dr. Walensky needs some help. She needs some managerial help to figure out what’s going on inside the CDC, and she should probably work with that person to correct the processes happening at the CDC.
And also, there should be a hard look at what’s happening in our country with the scientific publication of articles. If you look at it, I think your blog is actually more current than many of the medical journals, because people are writing. So when you follow KevinMD.com, you can get a current sense of what’s happening with COVID-19 much better than if you read a medical journal, because medical journals have a lag time, so the information comes only after, I don’t know, three or four months. But I think there are so many things to be fixed.
Kevin Pho: We’re talking to Dileep Kumar. He is a hospitalist. He wrote the KevinMD article “The CDC’s continuing failures: Is there a way out?” Dileep, one of the solutions you mentioned was having a managerial or administrative lead in conjunction with the medical lead. So go into more detail about that. How would that look in practical terms?
P. Dileep Kumar: It has to be really two people working together. One person will be taking the medical decisions, because right now we are probably asking Dr. Walensky to be in charge of the whole thing. It is like a big business, with like 15,000 employees and different departments. So somebody has to look at how the inside of the CDC works, how the different departments interact together, and what the business structure is. We need to have somebody who is experienced in business reorganization, so to say, so that person can advise the medical lead, and they need to work together so that the CDC will work like a well-oiled machine. Again, it’s all going to be a work in progress, and I think the main thing is to find two people who are very smart in their own disciplines and able to work together.
Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience in these difficult times?
P. Dileep Kumar: I think burnout is a major issue among physicians. I think people who went through your articles can also find so many clues and so many tips. So my recommendation is to look beyond clinical medicine and find out what’s happening, or try to understand the processes, try to understand the people, and then try to contribute in that way. And always support each other, because that’s one of the best ways to prevent burnout.
Kevin Pho: Dileep, thank you so much for sharing your time and insight, and thanks again for being on the show.
P. Dileep Kumar: Thank you.
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