CDC Director Rochelle Walensky Faces a Surging Virus—And a Crisis of Trust

If viruses know no borders, they
 have an equal disdain for human holidays. On Thanksgiving 2021, Dr. Rochelle Walensky shut off her phone for about 45 minutes and placed the turkey on the dining table to enjoy the holiday meal with her husband and three sons. When she turned the phone back on, she found, among the messages that had piled up, warnings that SARS-CoV-2 had morphed into a potentially dangerous new variant, identified in South Africa. Health officials there predicted that what would become known as the Omicron variant was much better at spreading than previous variants, and Walensky knew it was only a matter of time before Omicron cases would appear in the U.S.

As director of the U.S. Centers for Disease Control and Prevention (CDC), Walensky’s job is to protect the nation, and by extension the world, from threats like this one. To buy time as she and the country’s public-health experts learned as much as they could about the new variant, she joined them in advising that flights from South Africa and nearby nations reporting cases be temporarily halted. She also beefed up genetic-sequencing efforts to monitor for the new variant so health officials would know as soon as the first cases hit the country.

By Christmas, Omicron had overtaken Delta as the dominant variant, accounting for almost 60% of new infections in the nation, and over that holiday weekend, Walensky and the country’s top COVID-19 experts wrestled with a difficult decision. With thousands of flights canceled as airline staff tested positive for COVID-19 and were unable to work, and with hospitals, schools and food industries similarly tottering under the pressure of maintaining an adequate labor force as Omicron pulled employee after employee into the COVID-19-positive ranks, Walensky and the CDC made the critical, and controversial, decision to cut the isolation times for people who were infected by half, from 10 days to five. Business groups supported the change, which provided a release valve on their increasing labor problems, but health care workers and certain labor unions pushed back, arguing that employees would be compelled to work while potentially still contagious, which could lead to an increase in COVID-19 cases.

Walensky defended the move, telling TIME, “There are a lot of studies [from other variants] that show the maximum transmissibility is in those first five days. And [with Omicron] we are about to face hundreds of thousands more cases a day, and it was becoming very, very clear from the health care system that we would have people who were [positive but] asymptomatic and not able to work, and that was a harbinger of what was going to come in all other essential functions of society.” The decision reflects the balancing act that Walensky has been performing since becoming director of the CDC last January: integrating the scientific reality that an infectious and quickly adapting virus ideally requires intensive lockdown with the economic and social realities that make it impossible to do so for lengthy periods of time. In addition, Walensky confronts another equally monumental task: restoring the public’s trust in science, and educating people about the iterative nature of science so they don’t see changing recommendations as so confusing and conflicting that they stop listening.

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Before taking the CDC job, Walensky had never held a government position, and had only visited the CDC as a guest speaker. As with other specialists in her field, for her the agency represented the best and final word on public health; every time she typed in C, her Google search tab auto-filled CDC. On the one hand, coming to the agency from outside of the government gives her a clearer sense of how the CDC can and should convey its advice to the health community and to the public. On the other hand, she lacks an extensive network and experience navigating conflicting political and bureaucratic demands—which may have led to some mixed messages from the CDC that, in some people’s eyes, only deepened the confusion and mistrust the public feels toward the agency and its recommendations.

Especially after 2020, when the Trump White House consistently failed to support and bolster scientific advice from the CDC and other science agencies, the public response to changing CDC guidance—even when it comes with well-researched and corroborated evidence—has often been skeptical at best. “It’s hard being under the microscope of the media, especially social media,” says Captain Amanda Cohn, who was serving as the COVID-19 vaccine lead at the CDC. “It’s hard when every time you change a word on the website, everyone responds immediately.”

Walensky knows better than anyone else that the CDC has an image problem. Because of changing, often conflicting advice about everything from masks to booster shots, and slow release of guidance on how to safely reopen schools and businesses, the CDC has become a scapegoat for missteps throughout the pandemic response. Walensky is keenly aware that such credibility issues can be as contagious as the virus the agency is confronting, eroding the already weakened trust and integrity that are crucial to everything the agency does. Those public perceptions have created a deeply rooted morale problem within the agency itself, at its headquarters in Atlanta, and among its 13,000 scientists, epidemiologists and public-health experts deployed in more than 60 countries around the world.

So, at a digital all-hands meeting that Walensky called in November, more than 8,300 staff members logged in for another chance to hear from their new director, whom the vast majority had yet to meet in person. During the Q&A session, Walensky fielded a question about the hometown Atlanta Braves, who had just won the World Series. Would Walensky, despite being a longtime Boston resident and Red Sox fan, don a Braves cap or T-shirt at the next all-hands meeting to show support for her adopted city?

Walensky did the questioner one better. “I’ll be honest, I’ve spent too much time in Boston to change allegiance from the Red Sox to the Braves entirely,” she said. “But … at the risk of having my family and my boys disown me, here I go. I’m happy to wear a Braves hat for the rest of the meeting.” And she did.

Yes, it was a calculated and staged effort to show solidarity with a staff that’s been beleaguered, belittled and bewildered since the pandemic began as they saw the work to which they’d dedicated their lives dismissed and sidelined at a time when the world needed it most. And yes, it was a relatively small gesture in the grand scheme. But President Joe Biden chose Walensky as much for her scientific credentials—she’s a well-respected physician in infectious disease—as for her people skills, which he hoped could halt and maybe even reverse the public’s crisis in confidence about public-health science. Directing the CDC is as much a social and political job as it is scientific, and Walensky, with her easy smile and warm demeanor, has the capacity to be a cheerleader for science and scientists, in addition to the voice of the latest data-based evidence.

“I ran the emergency-preparedness response at CDC for four years before becoming acting director, and we used to run exercises for responding during a crisis,” says Dr. Richard Besser, now president and CEO of the Robert Wood Johnson Foundation, of the political noise that drowned out scientific voices in 2020. “We never exercised a scenario in which the political leadership rejected public-health science as an underlying principle of the response.”

When Walensky took command of the CDC in January 2021, she responded to that credibility issue with the strongest weapon in her arsenal: data-based evidence. “I am committed to the science, and I will deliver recommendations that are based on science,” she tells me during my recent visit in Atlanta, and “Follow the science” is a mantra that she repeats again and again in her briefings and interviews. Soon after joining the CDC, Walensky launched the COVID-19 Data Tracker, a comprehensive dashboard for all things related to pandemic, that she pressured her team to keep updated in near-real time with cases, hospitalizations, deaths and genetic-sequencing information. Trust in science, she believes, starts with good data. “Modeling infectious disease is what I did for 20 years, so I dive in,” she says.

It’s a battle-tested strategy. Walensky’s former mentor Dr. Kenneth Freedberg, professor in health policy and management at Massachusetts General Hospital (MGH), recalls that in 2018 she helped reverse the World Health Organization’s decision to halt the rollout of a three-drug anti-HIV combination for pregnant women over concerns that the medications could cause birth defects. Within hours after the decision was announced, Walensky assembled a team of researchers and crunched the numbers to show that the benefits of the medications far outweighed the risks; the analysis ultimately persuaded the WHO to reverse its position.

But even the best models can’t entirely forecast what an unpredictable virus will do. Assessing the risks and benefits of specific advice about COVID-19 will never be a one-and-done endeavor but rather a constantly evolving effort that must take into account ongoing changes in scientific understanding.

Read more: In 2022, We Need to Shift Our COVID-19 Focus to Testing

For every modification and revision of its guidelines, the CDC, and Walensky, have taken heat. In May 2021, when vaccination rates were increasing, Walensky recommended that immunized people could stop wearing masks indoors. The decision balanced the science at the time—cases were falling but still far from zero—against the growing backlash from the public about the lack of benefits of vaccination; if getting the shots changed nothing about what they could do safely, then why get vaccinated? Two and a half months later, the CDC went back to urging even vaccinated people to wear masks indoors as a new variant pushed case numbers up again.

The media, politicians and the public demolished the CDC for flip-flopping. “I have spent a lot of time thinking about” the shifting advice, says Walensky. “All of the science in that moment said it was safe to take off your masks if you were vaccinated. We perhaps should have said ‘for now.’ I think that if we had said, ‘Despite the science, you have to keep your masks on,’ we would have lost the trust of people with regard to actually following the science.”

Finding that balance is a task unique to the CDC: keeping up with constantly changing science and turning that data into practical public-health advice. “We have to provide what the science says not in a vacuum but with the understanding of the uncertainty and the moment,” says Walensky. And that means adapting recommendations to the influx of new data. “Translating science into practiceable guidance is what has really distinguished the value of CDC over the arc of time,” says Dr. Julie Gerberding, chief patient officer at Merck, who ran the CDC from 2002 to 2009. “We have all had scenarios where we weren’t able to provide perfect communication [and] perfect guidance. That’s part of the challenge.”

Walensky grew up in the suburbs of Washington, D.C., and was inspired by her pediatrician—the only female physician she knew as a child—to pursue medicine. After college, she enrolled at Johns Hopkins School of Medicine, where she trained in internal medicine, in a residency program so notoriously rigorous that its members are called “Osler Marines,” after one of the co-founders of the hospital. After graduating, she and her husband moved to Boston, and in 2017, Walensky became the first female chief of infectious diseases at MGH.

It was in that role that Walensky became indispensable in advising the Harvard University health system about COVID-19 protocols, setting up testing and mitigation measures to ensure safe ways for people who absolutely had to come to the hospital to continue working—and, eventually, serving as COVID-19 consultant for both the mayor of Boston and the governor of Massachusetts. That caught the attention of the Biden transition team, who saw her impeccable scientific credentials and natural ability to translate complicated science as a prescription for solving the CDC’s credibility problem at the time. Walensky was among the Biden Administration’s first political appointees, and started Jan. 20.

It wasn’t until Walensky came to the CDC that the good intentions that had guided her throughout her medical career were scrutinized for the first time. “When you’re a physician or a scientist, no one is questioning your motive, that you want to save someone’s life,” says her husband Loren, a pediatric-cancer specialist at Dana-Farber Cancer Institute. “What’s new in a job like this, which in the end is a political appointment, is that now all of a sudden … that person’s motives are now questioned.”

Former CDC directors say coming into the agency as an outsider can be daunting. “I had more than a decade of experience running public-health programs in both the U.S. and globally, and worked for five years running the largest tuberculosis program in the country [in New York City],” says Dr. Tom Frieden, who ran the CDC from 2009 to 2017 and is currently president of the nonprofit Resolve to Save Lives. “And it was overwhelming. No matter how hard I worked, how many hours I worked and how efficiently I worked, I just couldn’t keep up with the combination of demands from the White House and the Department of Health and Human Services and the media, and the constantly changing information and the diversity of health care systems in the U.S. And that was in a much less, enormously less challenging situation.”

Besser, who was an acting director of the CDC in 2009, adds, “I can’t think of a more formidable challenge than stepping into the helm of the CDC in the midst of a pandemic in a setting where you are working totally remotely. That is absolutely an unbelievable challenge.”

Walensky works mostly from home but seems to have overcome the challenges of connecting with a staff and country mostly through Zoom, and flies into CDC’s Atlanta headquarters for several days a month. “Rochelle has a very high emotional intelligence and is able to convey to staff how much she values them and listens to them,” says Frieden. Walensky is impressively on time for her back-to-back meetings, efficiently getting her points across and making sure to end with action plans for next steps.

Every evening, her bedtime reading consists of a carefully compiled report of the latest scientific studies on COVID-19—not exactly light fare, considering the urgency of the pandemic means that studies are now published not only in peer-reviewed journals but also on preprint servers that churn out the latest data as quickly as possible and avoid the lengthy review and editing process.

Aware of the long hours and often thankless sacrifices CDC staffers have made, Walensky has been making what she refers to as “heroes calls” to thank them personally. “People are shocked,” she says. “People have asked me, ‘Am I fired?’ But I love doing it.” The calls are a natural extension of her inclusive leadership style, which includes a human touch that isn’t lost on people she works with. “Sometimes people in high places may not be willing to show vulnerability or talk about times they failed,” says Dr. Ingrid Bassett, co-director of the Medical Practice Evaluation Center at MGH, whom Walensky mentored. She recalls her mentor sharing her own experiences of having her grant applications rejected, which Bassett says was reassuring and motivating.

In March 2021, as cases in the U.S. began surging upward, and public-health officials were urging people to get vaccinated to spare the health care system that was, once again, drained of hope and motivation, Walensky veered from the script at the regular White House COVID-19 briefing and spoke from the heart. She empathized with the health care workers who were often the last ones to hold a dying patient’s hand because their family was not allowed to visit because of COVID-19 protocols, and said, her voice wavering, “I’m speaking today not necessarily as your CDC director—not only as your CDC director—but as a wife, as a mother, as a daughter. And I ask you to just please hold on a little while longer. I so badly want to be done. I know you all so badly want to be done. Get vaccinated when you can so that all of those people that we all love will still be here when this pandemic ends.”

Read more: We Need to Start Thinking Differently About Breakthrough Infections

In that same briefing, Walensky admitted to feeling a sense of “impending doom,” and some in the media and public—health community criticized her for being overly dramatic. But that sort of empathy may be exactly what the CDC needs the most right now. “Morale was a challenge,” she says of the state of the staff when she arrived in January. “The voices of the people who were delivering the science were not being heard and were not being heeded. And there was exhaustion; people had been working a lot and for a long time.” When she spoke publicly, Walensky wasn’t just talking to the American population at large; she was talking to the CDC personnel tasked with protecting them. “I needed to let people know that even in the moment when morale was down, and people were tired, the country was relying on them to make decisions,” she says. “And the only way for that to happen is for them to know you have their back.”

Walensky recognizes that was never going to happen overnight, and that it’s moving more slowly than is ideal—the fact that the majority of the staff are still working remotely doesn’t help. Cohn, who last year served as the COVID-19 vaccine lead at the CDC, admits, “I do not share where I work with people I do not know. I don’t want to have to get into a conversation with people not believing in vaccines; I don’t have the energy to talk about it one more time. Even though Dr. Walensky is out there trying to right the ship, I don’t know if we would say we all feel like it’s been righted yet. I still think there’s a morale problem at the CDC, and it’s starting to shift, but it’s going to take some time.”

Walensky and her team also still need to persuade the public not to give up. As the Omicron variant has exploded across the U.S., Walensky remains convinced that a multi-layered approach—getting vaccinated, getting boosted, wearing masks in indoor public settings and self-testing before small gatherings—will better position us to fight the virus this year than last year.

“We’re certainly not where we want to be, and we have more work to do—this virus is a formidable foe—but we know what we need to do to keep Americans safe,” she says. “The hard work now is just coming together as a country and recognizing what we need to do in order to keep one another safe … I would love to see us as a country be in a place where we’re focused a little more on the health and protection of each other, as well as our own health. I think that would be an incredible gift in 2022.”

—With reporting by Leslie Dickstein