HHS announced in July that it was shipping hundreds of thousands of rapid antigen tests to nursing homes, she said, but had not consulted states about how they would be distributed or where test results should be recorded.
"We have a perspective from each state that is valuable and should be considered as decisions are made," Levine said. "We all need to work together."
Since the public health association's Sept. 2 statement, Levine said the cabinet-level agency has been more responsive.
Dr. Umair Shah, an emergency room physician and executive director of the Harris County, Texas, public health authority, agreed that the CDC and other federal health agencies have been far less communicative with local authorities than he was used to.
"The CDC in the past made more effort to keep local and state health officials informed and coordinated," he said. "It has not happened during this pandemic."
Shah said messaging from Washington, including the president's antipathy toward masks, continued shutdowns and extensive testing, has seriously undercut local efforts.
When people see different levels of government disagreeing over public health measures, he said, "Generally they choose to go down the less restrictive avenue, putting their health at risk. The disagreements engender confusion and complacency, and that's where people get in trouble. It makes it harder for those of us at the local public health level to get people to follow our guidelines."
In Birmingham, it wasn't just the school reopening issue that prompted harsh criticism of Wilson. People also were angry about his early call to close businesses and stop large gatherings.
"Some of the worst pushback I got," he said, "was from a silly face mask order, a minor inconvenience to help us care for each other here in the Bible Belt where people have always cared for each other. You would have thought I had committed treason by ordering that."
Local politicians have publicly criticized him, he said, while privately telling him he was doing the right thing.
Public health officers say they are used to opposition to their recommendations. During the early years of the HIV/AIDS epidemic, public health authorities frequently faced backlash against programs to provide clean needles and free condoms. Anti-smoking measures and seat belts at first drew resistance, as more recently have restrictions on vaping.
"Political interference in public health is not new. It's just more open and more brash and less thoughtful than it's ever been," said Dr. Georges Benjamin, executive director of the American Public Health Association.
Many local public health officials agree they have never seen the intensity of anger against them from the general public that they have experienced during COVID-19.
"The political challenges are not like anything else we've ever seen," said Baltimore's health commissioner Dr. Letitia Dzirasa, a pediatrician.
But local health officials say the CDC can regain public trust.
"I really believe in the CDC," said Hayes of King County, Washington. "There are just tremendous resources there. I have seen a couple attempts that were so egregious to undermine the CDC, I just hope we can come out of this and reset the dial so the CDC is seen again as a resource for not only us in the United States but in the rest of the world as well."
Many public health officials say the CDC has the potential to earn back its former level of trust if it renews its earlier practice of providing clear, consistent and transparent science-based recommendations.
Dr. Jeff Engel, senior advisor at the Council of State and Territorial Epidemiologists, said the next opportunity to do that will be during the development and distribution of new COVID-19 vaccines.
"If all levels of government are transparent, communicate well and disclose all safety concerns of the vaccines, trust can be re-earned in the coming year," he said.
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