Dr Tom Frieden spent eight years as director of the US Centers for Disease Control and Prevention under Barack Obama, where he led the country’s response to swine flu, Ebola and Zika. Now he heads up Resolve to Save Lives, a $225 million five-year initiative to prevent epidemics and cardiovascular disease.
Here he talks to The Telegraph about face masks, ‘armchair epidemiology’ and CDC’s curtailed role during the pandemic.
You’ve been working in the field of disease control for decades – what has surprised you most about the reaction to the coronavirus pandemic?
On the one hand, Covid is unprecedented. We haven’t seen an infectious disease behave in this manner ever before. And it’s been astonishing to see the global economy essentially shut because of a tiny virus.
On the other hand, we know that new infectious disease outbreaks are inevitable. So this is not only unsurprising, it’s expected. We will continue to face dangerous, and potentially devastating infectious disease threats – it’s inevitable.
What’s not inevitable is whether the world will continue to be so woefully underprepared.
Advice has changed considerably around face masks – is the public listening? Was it a mistake not to advocate face masks from the start?
There were elements of this infection that were unexpected if you compare Covid with SARS, its close cousin. With SARS, the amount of virus in the person’s mouth and nose and body increases steadily for the first week or 10 days after infection. With Covid it’s the opposite, viral load is highest just before people are sick, then it decreases steadily. No one expected that.
Then we realised that there’s a large number of people with asymptomatic infection who could spread the disease. This is the point at which we realised that yes, actually face masks are going to be very important.
So I think the reasoning leading to the recommendation of a mask is something that even public health experts had to gradually absorb and get to know. I don’t think that’s a mistake, that’s how the world learns.
But with masks it’s not only a question of wearing them – it’s where, when, how. Indoors, when you’re within six feet of someone, and in a community where Covid is spreading – it’s clear that then it’s really important.
The US and UK are among the countries which have been criticised for a slow response, especially around widespread testing and contact tracing. Why do you think nations appeared to ignore WHO advice?
I can’t really understand all of the reasons for it. I will say that the countries that have done the best have been those that have been led by science, that have had public health guiding the response and have fully supported public health.
In the US, what’s been most striking has been the sidelining of the US Centers for Disease Control and Prevention (CDC), which I led for eight years under President Barack Obama. In the nearly 75 years that CDC has existed, this sidelining has never occurred. In every significant health event of this country, CDC has been front and centre.