CDC head talks screwups, 4th doses, omicron’s wave in long-awaited briefing

The Centers for Disease Control and Prevention (CDC) headquarters stands in Atlanta, Georgia, on Saturday, March 14, 2020.
Enlarge / The Centers for Disease Control and Prevention (CDC) headquarters stands in Atlanta, Georgia, on Saturday, March 14, 2020.

The US Centers for Disease Control and Prevention on Friday held its first COVID-19 press briefing in over a year. The briefing covered a wide range of pandemic-related topics, from the rise in pediatric COVID-19 cases to the trajectory of the omicron wave and the agency’s own missteps in communicating with the public.

CDC Director Rochelle Walensky fielded most of the questions herself during the roughly 35-minute phone conference, as reporter after reporter expressed the need for more briefings and thanked her for being available today. Walensky noted that she had been in over 80 COVID-19 briefings held by the White House. However, the CDC had not given its own briefing on its pandemic-related work since January 6, 2021.

In the intervening year, the CDC has experienced periodic missteps and has taken heavy criticism for muddled messaging around ever-evolving pandemic guidance. The latest such episode unfolded last week after the agency said that certain individuals infected with COVID-19 could leave isolation periods early without having to test negative. The agency has stood by the decision, despite science-based criticisms and concerns that the CDC’s decision was influenced by political interests, namely avoiding the problem of test shortages.

In today’s briefing, Walensky didn’t directly reference the latest dust-up but said the abrupt resumption of press briefings was spurred by a recognition that reporters want to hear from the CDC independently. When pressed, she assured reporters, saying, “I anticipate that this will be the first of many briefings.”

Walensky opened the briefing with a focus on recent updates aimed at keeping children safe during the current phase of the pandemic—the worst wave so far amid the stunning rise of the ultra-transmissible omicron coronavirus variant. But the roughly 30-minute question-and-answer portion of the briefing spanned a wide range of topics, providing useful insight into the agency’s thinking on the omicron phase. Here’s the rundown of what was covered.

Kids and COVID in schools

The CDC on Thursday updated quarantine and isolation protocols to prevent the spread of COVID-19 in K-12 schools, Walensky highlighted. The updates align the CDC’s school-specific guidance with the agency’s controversial update to quarantine and isolation protocols for the public, shortening both to only five days.

That is, students, teachers, and staff who test positive for COVID-19 should isolate from others for at least five days. If at five days, they remain asymptomatic or if symptoms are resolving (if they’re fever-free for at least 24 hours), they can end isolation, though they need to wear a mask in indoor settings for an additional five days. As with the general guidance for the public, the K-12 guidance does not require that people receive a negative test to end isolation early.

Likewise, students, teachers, and staff who are not up to date on their vaccinations need to quarantine for at least five days if they have had close contact with someone known to be infected. People are considered “up to date” on vaccination if they have received all the vaccinations for which they are eligible, including boosters. People who are up to date on their vaccinations do not need to quarantine after close contact with a case but should mask for 10 days.

In announcing the update, Walensky acknowledged that many schools have had to move back to remote learning amid the towering omicron wave. This update, along with other CDC guidance on test-to-stay systems, mask-wearing, and increased ventilation, “provide the tools necessary to get these schools reopened for in-person learning and to keep them open for the rest of the school year,” she said.

Kids in hospitals

Still, Walensky acknowledged the heavy toll that the current surge is having on children, particularly unvaccinated children. “Pediatric hospitalizations are at the highest rate compared to any prior point in the pandemic,” she said. “Sadly, we are seeing the rates of hospitalization increasing for children [ages] 0 to 4—children who are not yet currently eligible for COVID-19 vaccination.”

It’s still unclear how severe omicron is in children. It’s also unclear if the increasing hospitalizations simply reflect the colossal case numbers being seen now in the omicron wave or if the record-high hospitalization numbers reflect the relatively low vaccination rates in children.

Even for children who are eligible to get their shots, vaccination rates are low. For instance, only 16 percent of children ages 5 to 11 are fully vaccinated. Walensky urged parents of eligible children to get them vaccinated and boosted as soon as possible, noting that unvaccinated 11-to-12-year-olds were 11 times more likely to be hospitalized for COVID-19 than vaccinated children that age.

Vaccine updates

This week, the CDC made three new vaccination recommendations, which may have been drowned out in the overflowing news cycle, Walensky noted.

  • First, the CDC signed off on the Food and Drug Administration’s authorization of giving Pfizer-BioNTech booster doses at five months, rather than six, after the initial dose.
  • The CDC’s advisory group on Wednesday voted in favor of expanding eligibility of booster doses to children ages 12 to 15, and the CDC endorsed the decision. Now, everyone ages 12 and above should receive a booster dose five months after their second dose of the Pfizer-BioNTech vaccine.
  • Lastly, the CDC recommended that immunocompromised children ages 5 to 11 should receive a third dose 28 days after their second shot. This age group is not yet eligible for boosters.

Fourth doses

The expanded use of boosters in the US and elsewhere has raised questions about future doses. This week, officials in Israel began offering a fourth dose to people ages 60 and above in an effort to maintain high levels of protection against infection.

When asked if a fourth shot was in the future for Americans, Walensky said it was too early to consider it given the slow uptake of boosters and the difficulty in getting nearly 40 percent of the country to get even their first two shots.

Walensky noted that only about 35 percent of the over 207 million people who are fully vaccinated have gotten a booster dose. “Right now, I think our strategy has to be to maximize the protection of the tens of millions of people who continue to be eligible for a third shot before we starting thinking about what a fourth shot would look like.”

The shape of omicron’s wave

The low level of booster uptake is particularly tragic amid the rise of omicron. Laboratory and clinical data has consistently suggested that two doses of vaccines are generally not enough to prevent omicron infections, but booster doses can significantly increase protection.

As such, cases in the US are on a vertical rise, with a current seven-day average of daily new cases at nearly 611,000. A reporter asked Walensky if she expects the omicron wave to peak and then quickly plummet, much like it has in South Africa, where there are low vaccination rates.

“The wave in South Africa has been coined an ‘ice pick shape’ rather than even a wave—a precipitous increase and then a precipitous decline,” Walensky said. There are many differences between South Africa’s population and ours, Walensky noted. A larger proportion of the population in South Africa had been previously infected with the pandemic coronavirus, while a larger proportion of the US has been vaccinated.

Walensky said that places in the US that are seeing a sharp spike in cases may well see an equally sharp decline. “But we’re also a much bigger country than South Africa,” Walensky said, “so it may very well be that we see this ice-pick shape but that it travels across the country,” suggesting that on a national level, there could be a long tail of declining cases.

Omicron immunity and reinfections

A key element to the questions of future boosters and omicron’s wave may be what kind of immunity people will have after they recover from an omicron infection. So far, it’s clear that people who were previously infected with the delta variant are still susceptible to infection with omicron. However, preliminary data from South Africa has suggested that people who recover from an omicron infection may be protected from getting infected with the delta variant in the future.

Whether an omicron infection provides protection from a second omicron infection is still unknown, Walensky said. “We are setting up studies to evaluate that, but we don’t have that information quite yet,” she said.

CDC’s messaging mishaps

With all the pandemic unknowns, curveballs, and shifting guidance, the CDC has periodically come under fire for muddled messaging and questionable guidance. Many Americans have been left wary or even distrustful of the CDC, which had previously been viewed as the premier public health agency in the world.

Walensky responded to questions about the criticism and confusion, seeming to acknowledge that the agency had done a bad job at messaging at times. “This is hard, and I am committed to continue to improve as we learn more about the science and to communicate that with all of you,” she told reporters.

“We’re in an unprecedented time with the speed of omicron cases rising,” she added. “And we are working really hard to get information to the American public and balancing that with the realities that we’re all living with.”



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