#Why is the CDC terrifying Americans with asthma about COVID?

Rochelle Walensky, the new director of the Centers for Disease Control and Prevention, has vowed that her agency’s information and guidelines will be “based on science” — essential to public trust in health authorities. Yet there is reason to believe the CDC has failed to deliver on Walensky’s promise in at least one instance.

On March 29, the CDC updated its guidelines on underlying medical conditions that could increase patients’ risk of severe COVID-19 illness. In it, the agency classified moderate to severe asthma as a “high-risk” factor for severe illness or death from COVID.

As an epidemiologist investigating the pandemic, I was curious to learn how the agency reached this revised conclusion.

Last May, I wrote in a public-health journal that asthma appeared not to elevate risk for severe outcomes — indeed, it seems to provide a partially protective effect. The next month, the CDC revised its guidelines that had definitively included asthma as a high-risk factor, suggesting that it “might” be one. Now comes another about-face on the question.

The episode recalls earlier flip-flopping, misinterpretation and miscommunication of scientific evidence. Thirteen months ago, for example, masks didn’t “do very much,” as far as the CDC was concerned. Yet the following month, masks suddenly became the “best way to prevent COVID-19.”

The agency likewise took far too long to acknowledge the extremely low risk of infection from touching surfaces and being outdoors — early misperceptions that caused great anxiety among the American people and continue to prompt irrational behaviors like outdoor masking and obsessive disinfection rituals.

Then there was the mass confusion caused by the CDC “pausing” the Johnson & Johnson vaccine rollout after promising that COVID-19 vaccines are “100 percent safe,” whereas no medications are entirely safe. That decision inevitably will further amplify distrust both in vaccines and public-health messages and institutions.

The asthma question is especially instructive. The agency’s “rigorous review” prompting the latest turnaround cites 13 studies, of which 12 found either no significant difference in COVID-19 outcomes for people with asthma or, in many cases, that they actually have lower risk of death or hospitalization. (In one preliminary review in July 2020, severe asthma was associated with a slightly — and borderline statistically significant — increased risk of death.)

Plus, the CDC’s “Underlying Evidence Table” indicates that the agency relied heavily on “meta-analyses”: studies of other studies, in other words. Yet the conclusions of the four meta-studies cited are that “asthma as a comorbidity may not increase the mortality of COVID-19”; that “patients with asthma are found to have a lower risk of death”; that “people with asthma have a lower risk than those without asthma for acquiring COVID-19”; and that “as in previous [SARS-type] outbreaks, patients with asthma, especially children, appear to be less susceptible to the coronavirus.”

Inexplicably, the CDC didn’t even include in its review the most extensive meta-analysis on asthma and COVID-19, in the journal Allergy, Asthma and Clinical Immunology, which found three times lower COVID mortality in people with asthma.

The CDC’s chief medical officer for its COVID-19 response, Dr. John Brooks, told me that the evidence is “mixed,” representing “an absence of conclusive evidence.” He explained the move by arguing that prioritizing people with asthma and telegraphing “prevention messaging” to this group “poses little harm to them but may provide benefit.”

But truth matters. The evidence isn’t, in fact, “mixed.” And proclamations that counter the evidence aren’t harmless. 

Over the past year, the estimated 25 million Americans with asthma have been living in terror of COVID-19. I personally know of many people who have essentially locked themselves indoors and of children not attending school or even allowed outdoors by concerned parents.

Given widespread vaccine availability in most states, prioritizing asthma is now a more minor concern, but what about those people with asthma who decline vaccination: Must they continue living in terror thanks to scientifically unfounded decrees? And what about asthmatics under age 16: Should they also continue to put their lives on pause until they reach vaccination age?

Is this any way to regain trust in public institutions like the CDC or in the official evaluation of scientific evidence?

Daniel Halperin is an adjunct full professor of public health at the University of North Carolina, Chapel Hill, and author of “Facing COVID Without Panic: 12 Common Myths and 12 Lesser Known Facts about the Pandemic: Clearly Explained by an Epidemiologist.”