The Centers for Disease Control and Prevention has been praised for its methodical approach. Agencies in other nations adopted the name of the world's most highly regarded public health authority.
The C.D.C. moved at its usual pace. With a novel virus moving so quickly, the country paid a price as the agency tried to implement dated approaches with creaky infrastructure. Federal scientists took too long to recognize that the virus was airborne, so officials were late to recommend masking.
The Omicron variant is pushing the C.D.C. into new territory. Because decisions must be made at a rapid pace, the agency has issued recommendations based on what used to be considered insufficient evidence, which has caused public concern about how these guidelines affect the economy and education.
Rochelle P. Walensky, the agency's director, has sometimes skipped the traditional scientific review process, most recently shortening the isolation period for Americans who have been exposed to the disease.
President Biden promised to restore the C.D.C.'s reputation for independence and rigorous science after the Trump administration interfered. The science is incomplete, and this is our best advice for now, as the challenge for Dr. Walensky is figuring out how to convey this message to the public.
The change has not been easy for a bureaucracy that is mostly staffed by medical professionals.
Some officials at the C.D.C. privately described the decisions as demoralizing and worried about the White House influence on Dr. Walensky's actions.
Others outside the agency praised Dr. Walensky for taking a pragmatic approach to managing a national emergency even though the data was not clear.
During the H1N1 flu outbreak of 2009, Dr. Besser said that policy considerations were not the sole purview of C.D.C. He thinks we need more clarity when policy and economics drive agency recommendations.
According to data gathered by The New York Times, more than one million Americans are affected by the disease every day. Hospitals in nearly two dozen states are nearing capacity, and many schools and businesses are struggling to remain open.
At the end of December, Dr. Walensky said that if Americans were no longer experiencing symptoms, they would not need to be isolated for 10 days.
Critics said that the virus could spread if people were allowed to return to offices and schools. The research supporting a shortened isolation period for Omicron infections was not very extensive.
The recommendation could help keep hospitals, businesses and schools afloat during the worst of the Omicron surge.
The recommendations for isolation are correct, according to Dr. Thomas R. Frieden, who led the agency under President Barack Obama. They were not explained.
The C.D.C. and Dr. Walensky declined to comment on the new tensions in the decision-making. The director often cites rapidly evolving science as a reason for recommendations that are confusing or unpopular.
Dr. Walensky told the Senate that the agency's new recommendations for shortened isolation periods were swift science-based action to address the very real possibility of staffing shortages.
It has been a constant for the director.
The C.D.C. recommended last March that children be seated three feet apart in classrooms, but there was no research to back up the recommendation. The move made it easier for administrators to open schools.
In May, Dr. Walensky cited scientific data when she told people that they could take off their masks and mingle freely, despite the fact that experts said that the move ignored the possibility of breakthrough infections. Those arrived with the Delta variant.
In August, Dr. Walensky joined President Biden in supporting booster shots for all Americans, before scientists at the Food and Drug Administration or at her own agency had a chance to review the data on whether they were needed.
The most recent example, the isolation advice, left turmoil within the agency over the way in which it was established and announced.
An emergency meeting of the agency's Covid response leaders was called on the Sunday night after Christmas. An official familiar with the video call who was not authorized to speak on the matter said that she told them the agency would shrink the recommended isolation period and that a negative test result would be required for leaving isolation.
The new guidance would be made public the next day.
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The National Guard helped staff a virus testing site in Columbus, Ohio.
The scientists had to gather the limited data to support the recommendations and to rewrite the hundreds of pages on the website that touch on isolation and quasar.
Before publishing a new recommendation, federal researchers usually por over data, write a draft and fine- tune it based on comments from others. The science brief that accompanies guidance was usually upgraded to a "rationale" document due to the lack of evidence for shortened isolation.
Some researchers were angry that they were left out of the decision-making process and were enraged by the agency's public statement that the change was "motivated by science."
Some people believed that the new cutoff was arbitrary, but they also knew of data suggesting that rapid tests might miss some Omicron infections.
The staff was far from ready when Dr. Walensky told them of the new recommendations. C.D.C. scientists had trouble adjusting hundreds of guidance documents on the website.
About 2,000 health officials, public health lab directors and epidemiologists at the state and city levels join a weekly call with C.D.C. officials.
State and local officials questioned agency scientists about the plans for isolation guidance for the general public just hours before the C.D.C. released its statement.
Staff members were told not to talk about the new recommendations.
Scott Becker is the chief executive of the Association of Public Health Laboratories.
The pivot by the C.D.C. was inevitable, according to Dr. Walensky's supporters. The agency is filled with researchers who are accustomed to taking their time, and they needed more urgent solutions to the Pandemic.
There are people at C.D.C. who don't understand.
He said that he was confronted with "in some ways charming, but in some ways problematic, cluelessness on the part of C.D.C. staff that their recommendations, their guidance, their statements could have big implications."
Several outside experts said that Dr. Walensky had become a scapegoat for people who were weary and frustrated by the virus that seemed to have retreated only to return in a new form.
They said that leading the C.D.C. is challenging even at the best of times. In the middle of a Pandemic, Dr. Walensky took the reins at a low point in the agency's credibility and staff's feelings.
Agency researchers are still working remotely, which is almost an unthinkable hurdle to overcome.
Dr. Besser is concerned about the nation's trust in public health. I don't think it's fair to put that on the shoulders of Dr. Walensky.
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Some agency scientists worry about what they see as the White House's undue influence.
Dr. Walensky explained the rationale for her decisions at the news briefings. She and other agency scientists held a briefing of their own last week, answering questions from reporters about the isolation guidance, the rising rate of hospitalizations among young children and the agency's plans for a fourth shot of the coronaviruses vaccine.
Some experts said that the briefing was a good step towards rebuilding trust.
Dr. Besser said that separating out public health considerations from political considerations is very important. She will be able to lift up C.D.C. scientists and experts by doing briefings.
The current conflict at the C.D.C.predates the Pandemic. Some health officials noted that the tension between the agency and the National Institutes of Health was not new.
Dr. Fauci and Dr. Murthy gave assurances on television that the C.D.C. would revisit its recommendations for isolation, when the agency had no plans to do so.
Dr. Peter Hotez, dean of the National School of Tropical Medicine, said that the secretary of health and human services should smooth things over.
Mr. Becerra defended Dr. Walensky in a CNN interview, saying that she had a medical license and a degree in public health. She does not have a degree in marketing.
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