A Candid Conversation with CDC Director Rochelle Walensky on Politics of the Office, Masking Guidelines, COVID Testing and Pandemic Frustration

Dr. Rochelle Walensky

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Marianne O’Hare: Welcome to Conversations on Health Care . This week we welcome
CDC Director Dr. Rochelle Walensky on the Biden A dministration's plan
to provide a billion fr ee ra p id test and more high quality mas k s to the
American people. Now, here' s Mark Masselli , Margaret Flinter and Dr.
Rochelle Walensky

Mark Masselli: Our guest says she has the great honor of leading the Centers for
Disease Control and Prevention. During the pandemic, it's been an
especially challenging position to be in. Right n ow you're going to
hear from her in her own words direct answers to the most pressing
COVID questions as the Om icron variant takes its hold in America.

Margaret Flinter: Dr. Rochelle Walensky is an influential scholar, her pioneering
research has helped ad vance the national and global response to
HIV / AIDS. Dr. Walensky is also a well respected expert on the value of
both testing and treatment of deadly viruses , a nd she's been leading
the Center for Disease Control for about a year now.

Mark Masselli: Well , welcome Dr. Walensky . In a political story, former CDC Director
Tom Frieden said about your job. It is incredibly difficult at any time
and inconceivably difficult at this time. I wonder, though, if you could
comment about the story b ecause it also reports tensions between
you and the Biden team f or many months . I t said y ou've been too
insular and haven't been sharing information with the administration.
What do you want our audience to know about this situation?

Dr. Walensky: You know what I would like to convey is, first of all, how proud I am of
the work of this agency 12,000 people strong whose job it is to quietly
but diligently review science and work 24/7 to make sure that we
protect America's health and we provide guidance . I n real time now
during a pandemic, with all of the scientific backing that we have . And
also recognizing that there's some uncertainty right now, not all of the
science is black and white, that there's some gray zones in the science
as we learn more and more and as this pandemic g ives us more and
more curveballs.

Margaret Flinter: Well, Dr. Walensky , I think I echo those comments that probably
never been a more challenging time, though , I'm sure some of your
predecessors would say that it was equally challenging for them to o,
not a n easy job under any circumstances. But I ’ m so glad to have a
chance to ask you about this. It seemed like a lot of the noise or
criticisms picked up steam when CDC issued the new isolation and
quarantine guidelines, and people just seem to find them confu sing.
E ven in health care, when people looked at, okay, there's a
conventional isolation and quarantine, then there's contingency a nd
then there's if it's a crisis . T he translation, I think, at least for people in
health care, seems to be more like we just need to get back in and do

Dr. Rochelle Walensky

th e job or the health care system is going to implode. I wonder if you
could share with people really what was the science and the data, the
epidemiology that led you to make that decision and feel that you
could safely have tho se different categories for people?

Dr. Walensky: Yeah, thank you for that question. M aybe if I may, just to rewind the
clock to the week before Christmas, essentially. W hat we were seeing
was increasing science . W e have been standing on the shoulders of
t wo years worth of science on the transmissibility of SARS - CoV - 2 , and
also an anticipation of a tidal wave of new Coronavirus cases that we
saw based on what was happening in other countries. We're about to
really threaten our health care infrastructure in terms of the number
of people who are going to be out sick.

W hat we wanted to provide for our health care workers, given the
science and the epidemiology and what was feasible in talking with
our public health and health care worker partners was to provide
evidence based science on what you should do in certain situations, if
you're in sort of peacetime if things are okay, if you really have a
stressful situation where you're about to close beds, because people
are out , and r eally if you're in maximal stres s, what are the things that
you should do? How should you follow those ? O f course, every
healthcare institution is going to have to understand where they are
in that spectrum. But this was intended to provide the spectrum .

F ast forward a nd what we were sta rting to hear was not only was this
going to be a problem in health care itself, but that we were going to
hear about dialysis centers who didn't have their supplies that they
needed , dialysis that they needed. We were starting to hear about
pharmacists wh o wer e out and therefore people couldn't get insulin.
T his was really starting to affect a lot of different areas of health , a nd
so that was really the motivation during that time to make sure we
had guidance for the general public as well.

Mark Masselli: Well, I think that underscores the complexity of making decisions.
There are so many different factors . B ut I think generally Americans
want to know, when do we expect the Om icron virus to peak here in
the United States . W e know we've heard some good news out of New
York City, it seems like it's dropping. But what's the bigger trend a s
you look out for the entire country? What's the timing, given the best
information you have now?

Dr. Walensky: Yeah, from what we've seen from other countries, South Africa,
specifically, we saw things in South Africa go up really precipitously,
and then come down actually quite quickly as well. Now, we're, of
course, a very bigger a much bigger country than South Africa a nd a
more heterogeneous country, perhaps, than South Af rica. But what
we can expect based on the trends there is that we might see that this
wave is actually narrower. W hile things are coming down in New York,

Dr. Rochelle Walensky

they may actually not yet have peaked in other areas of the United
States. But what we have generally --- what we generally think is that
it'll come down faster than prior waves.

Margaret Flinter: Great. Well, the President had a big announcement that next week
there'll be a website for ordering, free masks and a way to order free
test at home, which I th ink will be extremely welcome d across
America. Any additional details you can tell us about this, when it's
going to roll out . I just have to ask you remembering back to the last
national website, I can remember in health care was when we're
rolling out th e Affordable Care Act, and everybody was emailing in
and kind of crashed the system for a while. Any concerns that you
have , or you think this is going to be p retty smooth across the
country?

Dr. Walensky: Certainly, this was a terrific announcement today . T he administration
has been working hard to make sure that America has the protection
that they need. Throughout this pandemic, they've recognized
through testing that they've needed to do more in this confluence of
massive amounts of Om icron cases just a round the holidays . There ’s
not only been a shortage of test here in the United States, but truly
globally with Omicron in the number of cases. W orking really hard to
roll out that website, make sure it runs smoothly. T hen also to help
provide Americans th e protection they need , the maximum
protection that they need in terms of masking.

Mark Masselli: Well, let me pull the thread on masking , and we really pick up on
Margaret's earlier question, just giving you the opportunity to talk
about the science in ep idemiology. It's been done about cloth mask.
You said that any mask is good. Other experts are saying cloth mask
really don't prevent the spread of Om icron . I'm just wondering if you
give our listeners some clarity about what should they be doing ,
what's t he best strategy to stay safe using a mask?

Dr. Walensky: Yeah, this is really important. L et me clarify a nd let me just make sure
people understand. W e are working to update the information on our
masking webpage. First of all, it's really important to ma sk , so any
mask that you are wearing is better than no mask. W e really want to
make sure that people have a two ply comfortable mask with a wire
bridge nose that fits snugly around the face . T hat is certainly better
than nothing. We also recognize that the science demonstrates that
there are gradations in the protection of different masks. T here's the
cloth mask , the KN 95, the N 95 a nd certainly the higher level masks
offer more filtration and therefore a higher level of protection.

They also are pretty well recognized to be harder to tolerate for long
periods of time. T he best mask that you can get that you can wear
comfortably is the one that you should wear. But we also recognize if
you can't wear those higher level masks comfortably, that you should

Dr. Rochelle Walensky

wear a cloth mask.

Margaret Flinter: Perfect, very clear advice for people . Dr. Walensky in our audience we
have a lot of folks that are engaged in community health center work,
a lot of folks engaged in education in schools across the country.
These are very i mportant areas for addressing the pandemic. I know
there's an effort underway to make sure that these organizations
have the testing supplies that they need. What's happening on this
front end, what should health centers or schools across the country
do if they're not getting access to these tests? Do they have a voice in
the administration a way to get help?

Dr. Walensky: Yeah, first of all, let me just say a general thank you for all of the
incredible work that you and your partners have been doing in our
health care centers, our health centers across the country, because it
has been instrumental in our ability to access populations . W e're just
very grateful for that partnership.

We have an increased community access to t esting i nitiative, we call it
the I C AT (PH) initiative that is doing more testing in our community
health centers, and also through our schools. W e had $10 billion from
the American Rescue Plan that went to roll out of testing in schools.
We at CDC have peer to peer consultation if you're a school and you
want to learn how to do a testing program, if you need referral for
testing programs, how to conduct one, some technical assistance, all
of that is available from us here at CDC websites into how to engage
and get more test. A ll of that is available . P lease do reach out because
we --- what we do know is that it's critically important for our children
to be in school.

We also know that during the Delta wave, we successfully had 99% of
our kids in school. T hen importantly, to keep our kids saf e in school,
we know it's important to vaccinate them . W e have just about 17% of
our children between the ages of 5 to 11 who are currently finished
their primary series, and we really want to increase those numbers s o
we look to you for some help there as well.

Mark Masselli: Well, let me just pull the thread that because those numbers have
been disappointing, the 5 to 11 year old . I think all of us who were
doing mass vaccination sites and / or at o ur regular primary care sites
knew th at the 12 a nd over, we had much better success. I'm
wondering if there was anybody in your family or extended family or
among your friends that might have a child in that group that might
be resistant to the vaccine . I'm wondering what would you say to
them to try to convince t hem to take this vaccine .

Dr. Walensky: Yeah, really great questions. First of all, all of our research
demonstrates that you all are the trusted messengers in this. A gain,
we're looking for your help , a nd I know you're out there doing so

Dr. Rochelle Walensky

much to try and g et our children vaccinated. What I generally do in
these situations is not to talk but to listen, what are your concerns , b
b ecause I could convey a whole bunch of data , b ut in fact those data
don't reflect the concerns of a given parent. H ow I generally a pproach
it is say, you know, what are you thinking about? Why have you not ?
Why have you been resistant or reluctant? Do you need to talk to
other parents who've had their kids vaccinated? Do you want to see
the data on safety , b ecause it's now publicly av ailable ? Do you want
to see the data on hospitalizations among those who haven't been
vaccinated , o r the data on long COVID? What are the things that are
making that parent reluctant , b ecause that's really where you have to
address those concerns.

Margaret Flinter: Well, Dr. Walensky , you're doing a great job of informing and
updating the knowledge of our audience. I'd like you to maybe just
comment on other area , a nd that is how we're keeping an eye on
what might be coming down the pike in terms of varianc e . W e know
that you're using genomic surveillance . M aybe explain that a little bit
to our listeners to track emerging variants, how that works , a nd can
you shed any insight into what you are seeing beyond Omicron r ight
now, if anything?

Dr. Walensky: Yeah, it's really important. W e work collaboratively in an interagency
group, with CDC and other agencies, including NIH. W hat we do is we
work with the WHO and examine what is happening internationally ,
a ll the sequences that are coming in internationally to a nticipate what
we might be seeing here in the United States . Domestically , what we
do is, we have a genomic sequencing surveillance mechanism . W e
generally sequence in partnership with 19 academic centers,
commercial labs, every public health , state lab, s o that we can get a
really good line of sight as to the sequences that are out there.

How many sequences do we do a week? Well, that generally depends
on how much disease is out there, but we do tens of thousands a
week. G enerally, what we do is we figure out how many we need by
assessing . W e want to know if there's a new sequence here in this
country down to the 0.1% level. I f there's a sequence at about that
level, we want to make sure that we can find it at variant at that level,
we want to make sure th at we can find it. W hen we have lots of
disease that may mean 80,000 , a 100,000 sequences that we do a
week. B y doing this surveillance, we were able to start detecting
th
Omicron as early as December 5 .

Mark Masselli: Well, let me have you just tell us a l ittle more about what you see at
that perch. It's kind of interesting, you have both the national picture,
but you have this global communication that goes on with your peers
who are running similar CDCs around the globe. I'm wondering , one,
what they migh t be seeing in terms of variants that are keeping you

Dr. Rochelle Walensky

up at night . A lso, what are you learning about what they're getting
right . Is there somebody that some other country that we're looking
at and there's probably they're looking to us for certain things t hat
we've been getting right, but what have they been getting right and
how do we learn from them?

Dr. Walensky: Yeah, it's such an important question a nd it's such a privilege to be
able to work with these other countries to convey s cience in real time .
W e meet with many countries many times a week. I t's really just a gift
and a privilege to be able to do that .

I do think that part of what we need to do is help to vaccinate and
protect the rest of the world. We frequently said, no one is safe until
everyon e is safe . W e do know that variants will continue to emerge,
they may emerge here, they may emerge from other countries . W e
do know a large proportion of populations in other countries are
immunocompromised, and that many of these variants may emerge
by ha rboring an immunocompromised patients who can ’t clear the
virus quickly, and so we really do have a lot of work to do. T hat I think
is something that we're all watching out for.

Certainly other countries have been able to vaccinate higher
proportions of th eir population, and we're talking to them about how
they've been effectively able to do that. S ome of that is political w i ll,
and in different times in different regions of the world. W e spent a lot
of time thinking about that. Also, looking at the data, w e've had this
great partnership with South Africa and sharing data with other
countries as well and with Israel with UK, and just sharing the data
that we have in real time and data they have in real time and really
assessing different policies in how they 've played out.
th
Margaret Flinter: Well, Dr. Walensky you're only the 19 person to lead CDC in its
history. F or most of that time CDC has been the trusted voice
particularly I think in the public health community. I think the public
at large has gotten to know CDC much more over these last couple of
years that we've been living through the pandemic, but the public is a
harsh critic sometimes .

I think Gallup conducted a poll and found Americans gave CDC maybe
the largest drop in approval compared to other a gencies from 2019 to
2021. C ertainly a lot of that was prior to your time. How do you turn
that around, though, knowing that your ability to have the confidence
right to have the approval of the public is kind of core to them being
able to hear the message , the science and the public health?

Dr. Walensky: Yeah, it's a really --- I think about this a lot. The first thing I need to
convey is that all of our decisions are scientifically driven, scientifically
motivated, and transparent. I will be out there con veying the science.
The other thing I need to just acknowledge is we're all tired, nobody

Dr. Rochelle Walensky

wants to be in this pandemic anymore , a nd people are frustrated.
W hen people are frustrated they go to the root, which is the place
that the public health agency . I a ppreciate that frustration, I
acknowledge that frustration.

T hen finally, I think one of the real challenging issues is that the
science is evolving, the science is moving , the variants change . W hen
those variants change the science around them changes and people
want to have a policy and stick with it.

My responsibility to the American public is not to have that mentality,
to have a policy and stick with it until the science changes that it's no
longer valued or important --- i t's no longer appropriate. In which
case, my responsibility is to change. I take that responsibility
seriously , a nd I do my best to convey how that science has changed
and why the reason for the change . B ut change gray zones, especially
two years into a pandemic is really hard right n ow.

Margaret Flinter: Yeah.

Mark Masselli: You know, I want to just pick up on the word frustration . W e're seeing
so many people acting out, and it's getting very, very difficult for
many public health leaders, particularly leaders in health care or
scient ists like yourself and Dr. Fauci . Y ou're facing the public health
sector, front facing . I'm wondering how do we handle , o r how do you
all handle the criticism, and even missteps that might have happened,
but it seems that it's gone past the level of good d ialogue a nd to be ing
off putting for maybe young people w ho were thinking about a public
health career b ecause it is , I won't say --- w ell, I guess it is dangerous
at this point to follow the science, and that's very troublesome.

Dr. Walensky: Yeah, maybe what I would say in that, first of all, is when I went into
infectious diseases as a trainee, never did I imagine that our moment
would be that of a pandemic in 2019 / 2020 . B ut here is where we are
and this was our calling, and this is what we are here and meant to be
doing. It 's hard. There's no question that it's hard, but this is what I
was called upon to do.

I think there's a little bit of misunderstanding , that following the
science implies that the science is always clear. It's always black and
white. Science is emerging. New science comes every day, sometimes
conflicting science emerges. I have this great privilege of working with
this incredible team, scientific team , where it's a multidisciplinary
group . W e have im munologist, and epidemiologists and everything in
between , a nd because of that multidisciplinary group we have robust
dialogue about how we interpret new and emerging science, and for
the most part we’re unified and on the same page, and I think that
that's really terrific. But there is a lo t of robust dialogue out there , a nd
we need to understand that that's playing out in the public view.

Dr. Rochelle Walensky

Usually it's in scientific meetings, but that is we should be having that
scientific dialogue.

Margaret Flinter: Dr. Walensky , we want to thank you for re turning to Conversations on
Health Care for this important talk. For our audience, CDC ’s mission is
to protect America from health, safety and security threats both
foreign and in the United States. And you can go to cdc.gov for
information on this COVID p andemic and a wealth of other topics. Dr.
Walensky , thank you for joining us and to our audience t hank you all
for joining us today for this edition of Conversations on Health Care .