New CDC update on masks 0:58
(CNN) --
If scientists at the US Centers for Disease Control and Prevention (CDC) could have their way, to slow the spread of Covid-19 in this By now, nearly every school in America would be canceling soccer, wrestling, band, and a host of other major school activities.
In another guidance document, the CDC tells people who have recovered from Covid-19 that they can leave their homes after five days, and that while they are away from home for the next five days, they should avoid being around more 80% of the American public.
Dr. William Schaffner, a CDC adviser for four decades, said it's "unlikely, unreasonable and unrealistic" to think Americans will follow any of the agency's suggestions.
"Making public health recommendations ... is not a platonic ideal," Schaffner added.
"They have to work in the real world."
This kind of misplaced advice has been a hallmark of many CDC recommendations long before the pandemic began, and the agency has to do better, said current and former health officials and doctors who have worked with the CDC on health guidance.
"As we say in Tennessee, that dog will not hunt," said Schaffner, an infectious disease expert at Vanderbilt University Medical Center.
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In recent weeks, the agency has faced criticism for issuing guidelines that were confusing or seemed counterintuitive. In this case, the criticism is different; the concern is that CDC staff, hard-working, smart and well-intentioned as they may be, don't always consider whether Americans will -- or even can -- follow their advice.
CNN asked Dr. Rochelle Walensky, director of the CDC, about the two guidelines.
In a statement, Walensky said the agency "prioritized studies over athletics because of the increased risks involved in some extracurricular sports. When followed, our school orientations have been incredibly effective. In the fall, 99% of the schools were able to stay open during the intense wave of the delta variant of the coronavirus.
Part of the problem, Schaffner and others say, is that CDC scientists are sometimes trapped in a bubble.
“You have nerds, literally science nerds, who are writing this stuff,” said Dr. Otis Brawley, who worked with the CDC on cancer guidance while he was chief medical officer at the American Cancer Society from 2007 to 2018.
Brawley added, however, that the CDC often finds itself in a difficult situation.
For example, it is clear that there have been documented outbreaks of covid-19 among choirs, so on the one hand it makes sense to advise schools not to sing.
But on the other hand, it is unrealistic to think that schools are going to cancel band, choir and school musicals now or in any other period of high transmission.
"I feel sorry for the people at the CDC," he said.
"They have no way to win."
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CDC Guidance for Schools
As part of its guidance, last updated on January 6, the CDC advised schools to "cancel or conduct high-risk sports and extracurricular activities virtually" when a community has a "high" transmission rate of covid-19.
The guide links to a CDC map indicating that more than 99% of US counties currently experience high transmission.
The CDC lists soccer and wrestling as examples of high-risk sports, saying "high-risk extracurricular activities are those in which increased exhalation occurs, such as activities that involve singing, yelling, band or exercise, especially when done indoors.
Paul Imhoff, president of the Association of School Superintendents, told CNN that while schools have done everything they can to slow the spread of COVID-19, he is not aware of any school that has canceled activities such as football, band or soccer. chorus.
Such activities, he said, are "important for the mental health of students."
"As schools make the decision about having choir and band classes and wrestling, it's about making sure our children are healthy in every way. I think everyone is doing everything they can to take care of the children in its entirety," said Imhoff, a school superintendent in Ohio.
In his statement to CNN, Walensky said that the CDC "developed our school guidance knowing that school administrators, teachers, and parents were turning to CDC to get their children into the nurturing environment of the classroom and that it was a priority for our children to return to school safely," adding that "vaccines are available for school-age children, adding another layer of protection and improving school orientation.
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At a media briefing on Jan. 7, Greta Massetti, chief of the CDC's Field Epidemiology and Prevention Branch, said the guidance was "meant to really protect that critical in-person learning time."
He added that the guide "is really one piece of a layered prevention strategy that schools can use."
The CDC continues to recommend layered prevention, including universal mask use, including screening, testing, and a variety of other strategies."
However, Schaffner questioned why the CDC is advising schools to cancel after-school activities that involve yelling when kids yell on a regular basis.
"I could take you by the hand and say, 'We're going to walk through three elementary schools.' What we would see is kids screaming in the hallways. That's what kids do," said Schaffner, a liaison representative with the Advisory Committee on Practices. CDC Immunization.
CDC guidance on isolation
New CDC update on masks 0:58
In its guidance on isolation and quarantine, last updated on January 9, the agency tells people that if they have covid-19, they should isolate for five days after symptoms appear or a positive test.
After that, they can end isolation if they are fever-free without the use of medication and other symptoms have improved.
This tip links to a CDC page that lists conditions that make people more likely to get seriously ill from COVID-19.
Many of the conditions are very common, such as being overweight or depressed, certain heart conditions, or cancer.
The Computational Epidemiology Laboratory at Boston Children's Hospital estimates that more than 80% of Americans have at least one of the conditions on the CDC's list, according to an analysis the group conducted for CNN.
Schaffner questioned the feasibility of avoiding 80% of the people around you.
"How do you know if people have heart problems or diabetes? How are you supposed to find out? Can you recognize all the people who are pregnant or have sickle cell disease or are former smokers?" he said, naming some of the conditions on the CDC list to avoid.
When asked about the advice at the briefing, Walensky said the agency was asking people to "avoid family members or other people who may be immunocompromised, avoid visiting grandma or a nursing home."
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round and red tomatoes
Considering the CDC's guidance on school and isolation, Glen Nowak recalls an outbreak of foodborne illness that occurred in 2008, when he was the CDC's chief of media relations.
It wasn't clear what had made people sick, but one possible culprit was tomatoes, so Nowak says the agency's scientists wanted to tell Americans to stop eating tomatoes.
Nowak recounts that he told scientists this was too broad, considering that tomatoes are such a common food.
Nowak says he asked his colleagues to be more specific: Was there a particular type or source of tomatoes that Americans should avoid?
"I got a response: they said 'red round tomatoes'. I told them that wasn't feasible," Nowak explains.
The warning about tomatoes was dropped entirely, and the round red vegetable ended up not being the cause of the outbreak, but the jalapeno and serrano peppers.
Nowak said that when he worked at the CDC from 1999 to 2012, scientists repeatedly produced guidance without thinking about the next step: Is it possible to follow the advice we've written?
If so, what exactly would someone have to do?
"It was a constant challenge. It came up in many circumstances," said Nowak, co-director of the Center for Health & Risk Communication at the University of Georgia.
"Scientists and experts have a hard time seeing the world through the lens of ordinary people," he added.
change optics
One of the ways to change the point of view is to seek the opinion of outside groups, but that has been more difficult during the pandemic, when the agency has had to act more quickly.
Spokespeople for the superintendents' association and the National Association of Secondary School Principals said they were not contacted by the CDC for guidance on school sports and extracurricular activities.
A federal health official familiar with how the CDC develops its guidelines said the agency should also make better use of its own communication specialists.
"There simply isn't a seat at the table for communicators when it comes to really developing guidance," the official said, adding that CDC communications specialists "would consider whether the guidance being developed is really practices".
The official asked to speak anonymously because he was not authorized to speak on the matter.
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Brawley noted that the pandemic has posed unusual challenges in issuing guidance.
Brawley said that under normal circumstances, experts first gather all the relevant studies on a particular topic and then debate, sometimes for months, what would be the best advice for the public, also consulting outsiders for their opinion.
"When I was working at the American Cancer Society, we sat down to write the lung cancer guidelines and it took almost a year for a group of 14 people to write them. And then we tested the writing in focus groups, working with doctors and nurses and non-specialized people to try to find out if we were communicating effectively," he said.
"The CDC doesn't have time to do that."
Brawley, now a professor at Johns Hopkins University, said there is an alternative to the way the CDC issued its guidance.
For example, if schools are not prepared to cancel soccer or choir, the CDC could simply explain that these are high-risk activities, without directly advising against them.
Brawley says it would be important to explain the research that shows these are high-risk activities, something the CDC doesn't do right now on its website.
"I would put the studies, because I have a feeling that a large part of the American population does not appreciate how these standards are made. This is not a couple of people in Atlanta making them up in their CDC offices. The standards are based on real observations in real populations," he said.
But he added that the CDC is likely to be criticized for its guidelines anyway, at least by some people.
"There is no way the CDC is going to win," he said.
-- CNN's Danielle Herman and Jamie Gumbrecht contributed to this report.
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