We’re now on the sixteenth day of the federal shutdown. As I write, the Senate has announced a deal to avoid a debt default and open the government. It remains to be seen whether that will work, or how fast. Yesterday, on Day 15, I had a long conversation with Dr. Thomas R. Frieden, director of the U.S. Centers for Disease Control and Prevention, about what this shutdown has meant for his agency, its employees, and the health of Americans, and the world. I have lightly edited the conversation for clarity.
Maryn McKenna, WIRED: You’re on Day 15 of sending home 68 percent of your 13,000-person staff, in Atlanta and around the world. How is the CDC coping?
Thomas R. Frieden, CDC: Every day this goes on, it gets harder to manage. We’re used to juggling things at CDC, but this is like juggling chain saws.
We’ve got two-thirds of our staff out. The exempt staff, the ones who are here, are here just because of a happenstance of how they’re paid: They are people who are on multi-year money, or grant money, or people in the Commissioned Corps, the uniformed Public Health Service. Of the people who are furloughable, 95 percent are furloughed.
I walk through the offices and talk to the remaining staff to thank them for being here. A woman who was the only person on her floor said to me, “We have no idea what we’re missing right now.” For years people have asked me, ‘Do you sleep well, knowing all these terrible threats we face?” And I’ve always said, “I sleep great because I know we have fantastic staff on watch.” And now I’m not sleeping.
MM: Can you go into a little more detail about the staff you kept and lost?
TRF: About 2,500 are on what’s informally called good money; they’re paid for by grants or PEPFAR (the President’s Emergency Plan for AIDS Relief) or the President’s Malaria Initiative or mandatory Vaccines for Children Program. So they’re not on an annual appropriation. And then another 900 or so are commissioned officers. They can be redeployed, so we’re using them to manage everything from databases to feeding lab animals. But of the remaining 9,500 people at CDC, we’ve only got 500 here.
We went through every center, every office, every division, every branch, every team, and said: For whom do we have a legally acceptable argument to say, if they’re not here, it would be either “an imminent threat to health,” that’s the phrase, or “a risk to property”? And those we could keep.
I said to folks in Washington on Day 1 of this: What we find to be an imminent threat to health on Day 1 is going to be very different on Day 10 or 15. So we’re having to bring back two or three people here, four or five people there, because problems are getting out of hand. And pretty much everyone is working without pay.
MM: How have your programs been affected? For instance, foodborne outbreaks – lots of people are concerned about the Salmonella outbreak in chicken right now – or flu surveillance?
TRF: The broader question is, what are the outbreaks that we don’t know about? At any one time, we’re investigating 25 or 30 clusters of illness. Initially we had sent home the vast majority of the staff working on foodborne disease. When it became clear that [the shutdown] was going to go on more than a week, we called a bunch of them back. But our monitoring systems throughout the agency are working at really skeletal levels and that means we have more blind spots, we may be slower to respond, and we may be less effective at prevention.
For instance, here’s what we’re responding to right now: An outbreak of Legionella in a residential facility in Alabama. An outbreak of tuberculosis in another state. An investigation of a fatal case of Rocky Mountain Spotted Fever on an American Indian Reservation in Arizona where we’ve been working for two years to control that disease. A serious healthcare-associated infection outbreak in Baltimore. A cluster of infants who have been dying, or getting severely ill, in another part of the country. A cluster of meningitis in a university in the northeast that is going to require a very complicated response. An outbreak of hepatitis B in healthcare.
Every day in this country, there are births and deaths and hospitalizations and surgical procedures and emergency department visits and infections, and HIV and TB, and people who get sick from contaminated foods. For every day that goes by, there’s a less intensive investigation, less effective prevention of situations like this. If I had to use one phrase to describe what’s happening: This is a self-inflicted wound.
MM: In other parts of the government – at the National Institutes of Health, for instance – scientists have spoken about having to shut down their experiments, euthanize their lab animals. Is any research at CDC imperiled?
TRF: Sure – though part of the problem is that with so many people out, we don’t have perfect visibility, so I’m not sure of everything that’s being damaged. We’ve asked to bring people in for a half-day to identify things like that. For instance: We’re studying tickborne diseases. We had to call someone in to feed the ticks, because if the tick colonies die, the research is lost. There are other problems for which we are running clinical trials and had to stop enrollment. That means those trials will have to go on for longer. And that’s going to cost lots of money.
We’ve also got training programs that we’re very concerned about. People come for a one-year training, they lose a month of it, they may lose their certification. We may have to pay them to stay on another month at the end of that. Quite a few of our Epidemic Intelligence Service officers (the CDC’s front-line disease detectives, who serve two years) are not Commissioned Corps and therefore are not here. What will we do when their two years are up and they didn’t receive their full training? That’s a good question.
MM: What will it take to bring the CDC up to full strength when this situation is over? It sounds as though you can’t just flip a switch.
TRF: I did a back-of-the-envelope calculation. For every day of government shutdown, about one million emails at CDC go unread – millions of pieces of information. I just authorized someone to come back to look at reports from the laboratories that deal in select [biowarfare] agents. Our inspectors are all furloughed, but their inspected entities actually report directly to their designated inspector to say whether they’ve got a problem. No one has checked those emails.
There’s stuff like that all over the agency. We were about to scale up our efforts to increase HPV vaccination to prevent cervical cancer. We have healthcare-associated infection work in every state. You almost don’t know where to start.
Plus, there are huge staff issues here. All of us have a mass of emotions about the shutdown: frustration; anxiety, about what are we missing; guilt, about why are we not doing the things we have committed to. And there’s anger, that we aren’t being allowed to serve the people we want to serve.