The nation’s top federal disease agency had just started activating teams in nine states still relatively untouched by coronavirus when new orders came in last week from the White House coronavirus task force: shift resources to Tennessee and Nebraska, and double down in New Mexico and North Dakota.
Then, three days later, the Centers for Disease Control and Prevention rolled out yet another plan to expand the more targeted approach to all 50 states, on an uncertain timeline.
The strategy whiplash, documented in meeting notes and internal slides obtained by USA TODAY, comes after weeks of states and public health experts sounding alarms about the need for federal guidance on testing issues and how to ramp up public health staffing to trace coronavirus exposures.
The recent course corrections are a sign of the chaos around federal plans to help states return to some semblance of normalcy, as a national shutdown required to slow the spread of a virus stretches into its second month.
The federal government’s state-by-state reopening plan relies on the strength of local public health networks, for which the CDC has long provided national guidance.
How the federal government aims to realize its goals has been a moving target.
In some cases, records and interviews show, it was the White House task force that directed the CDC to change course, blindsiding veteran public health officials at the agency while leaving some states in the dark about what sort of help to expect from Washington.
For instance, local officials in New Mexico say they still have not begun working with the CDC teams on the ground on any new initiative or received clarity on the federal plan for the state.
“We are working to get more information from the White House about how many CDC folks will be deployed where and when, and what exactly they'll be doing for us,” Tripp Stelnicki, a spokesman for Gov. Michelle Lujan Grisham, said in an email on Thursday.
At the CDC, Dr. Henry Walke — who is running point on coordinating with the states — said since the start of the pandemic the agency has directed hundreds of its scientists and public health experts to work with state officials on their response efforts.
They have offered guidance and technical expertise on everything from laboratory testing to tracing the contacts of the infected.
“Everything is changing quickly in this pandemic,” Walke told USA TODAY, describing the shifting focus as simply an evolution of the agency’s efforts. “We’re deploying as fast as we can to meet the needs. Period.”
Critics say the government’s reopening plans often lack key details, extending the series of federal failures hobbling the nation since the start of the outbreak.
“This is a signal of a bigger problem: the absence of informed strategic thinking,” said Dr. Tara O’Toole, who helped develop pandemic response plans in the Department of Homeland Security under former President Barack Obama. “There is no clear direction and CDC is in a subsidiary position.”
'This is a continuous timeline'
The CDC’s original “community protection” teams fanned out to nine low-risk states, including Wyoming, Kentucky and Minnesota, to help prevent future hotspots and gauge if they had reliable testing.
Then, the White House’s subsequent April 16 pilot program targeted four low-risk states — including two already on the community protection list — plus three cities hit hard: New York, Detroit and Boston.
Officials hoped to track the virus among vulnerable populations, test healthcare workers, and figure out the percentage of people with antibodies to the virus who could get back to work, according to internal CDC documents obtained by USA TODAY.
One senior CDC official paraphrased the mission explained by White House response coordinator Dr. Deborah Birx as an effort to “prove we were not asleep at the switch,” according to meeting notes.
White House spokesman Judd Deere declined to comment for this article.
The program was meant to last two weeks and offer federal officials insight into how to expand to all 50 states, internal records show. Instead, it lasted only a few days before the order came to scale it up. It is unclear who made that decision.
An exasperated Dr. Anne Schuchat, principal deputy director of CDC, broke the news to the staff earlier this week in a conference call, according to an official listening in who asked to remain anonymous.
The official said FEMA would be spearheading the latest effort. FEMA declined to comment and directed questions back to the CDC. Walke reiterated that the agency has been rolling out strategies in response to national needs since the start of the outbreak.
The White House’s broad plan to reopen America calls for states to rely on surveillance metrics to help track COVID-19 illnesses alongside robust local testing for the virus.
Public health experts recommend extensive tracing of the contacts of infected people, so they can be isolated to prevent further infections.
Over just a few days working with the emergency operations center in Tennessee during the last weekend’s four-state beta program, Walke said the agency was able to understand the scope of the state’s needs for contract tracers over the next month. It is helping the state supplement its workforce.
In North Dakota, the CDC already had teams developing a testing strategy for nursing homes that are especially vulnerable to deadly flare-ups, and the agency was able to bolster its work in the state.
Walke did not provide specific dates when the agency will have teams focused on similar efforts in all 50 states or elaborate on why the task force chose those four states at the outset.
“This is a continuous timeline,” he said. “We are not going to do four states and stop and then write a paper.”
'It's a wish list'
Federal guidelines for the states, which will make their own decisions on reopening, have been widely criticized as too loose. The White House plan establishes general criteria for when states can shift between phases of outbreak response, with expansive reopening conditional on adequate hospital and testing capacity.
The result is a continuation of the patchwork of approaches seen since the start of the outbreak, when states closed schools and issued stay-at-home orders at different times.
In Georgia, for example, Gov. Brian Kemp’s announcement this week that he would rapidly reopen businesses such as bowling alleys, gyms and hair salons drew criticism from many, including the mayor of Atlanta, the state’s largest city. Ultimately, the soundness of his plan was questioned by President Trump.
Public health experts find it troubling that the federal government has not communicated clear guidance to resource-strapped or overwhelmed communities looking to prepare for the next stage of response.
Jeremy Konyndyk, who led the Obama administration’s response to the Ebola outbreak, said the Trump administration’s plan for reopening America is not only too vague but wrongly shifts federal responsibilities onto the states.
It sets high expectations for states around goals such as testing expansion without addressing how they are supposed to get there, said Konyndyk, now a senior fellow at the Center for Global Development.
“The hard part is: How are you going to make that happen?” he said. “In that sense, it is not really a plan. It is a wish list.”
Brett Murphy and Letitia Stein are reporters on the USA TODAY investigations desk. Contact Brett at firstname.lastname@example.org or @brettMmurphy and Letitia at email@example.com, @LetitiaStein, by phone or Signal at 813-524-0673.
Data journalist Matt Wynn contributed to this story.