Back in March, a doctor at the US Centers for Disease Control and Prevention found himself swearing at his television set.
He was watching a news segment about a couple in Arizona who'd heard then-President Donald Trump's enthusiasm for the drug hydroxychloroquine to fight Covid-19. The couple noticed their home aquarium cleaner contained an ingredient with a similar name, and so they ingested it.
The husband died and the wife was hospitalized, critically ill.
Alongside the couple's story, the TV program ran clips of Trump cheerleading for hydroxychloroquine.
"I was screaming at the television, 'Shut up, you f**cking idiot. Jesus Christ, stop it! You don't know what you're talking about!" said the longtime CDC physician. "I was just beside myself. I was livid."
The physician took off on a 10-mile bike ride, circling Peachtree-DeKalb Airport near his Atlanta home, trying to pedal away his rage.
It would be one of many long bike rides for the CDC doctor. Day after day, month after month, he watched as Trump misled the country about Covid-19 -- mocking masks, for example, or cheerleading for hydroxychloroquine, or claiming that the virus would pass when the weather got warmer.
The doctor desperately wanted to speak out, but the CDC briefings, held every few days at the beginning of the year, slowed down to a trickle by April.
"The CDC is the most trusted public health voice in the world, and our voice was silenced," he said.
The doctor wasn't the only one worried about the CDC losing its reputation. In September, six months after the doctor swore at his television, a letter written by an angry and frustrated former CDC director was leaked to the media.
"The failure of the White House to put CDC in charge, has resulted in the violation of every lesson learned in the last 75 years that made CDC the gold standard for public health in the world," Dr. William Foege, who ran the CDC from 1977-1983, wrote to Dr. Robert Redfield, Trump's CDC director. "In 6 months, [the White House has] caused CDC to go from gold to tarnished brass."
Interviews with current and former CDC officials underscore the concern that the CDC's influence inside the United States and worldwide has taken a perhaps irreparable hit, due both the Trump administration and to the agency's own missteps. Now CDC staffers are trying to regain the reputation of their beloved agency -- and recover their own sanity as well.
'Death by a thousand cuts'
The CDC is not a police agency. It rarely orders anyone to do anything.
Health departments and ministries around the world respect the CDC's recommendations not because they have to, but because the CDC has the "gold" reputation Foege described.
Any whiff that the agency's recommendations are based on politics instead of science could hurt the CDC's reputation and diminish its influence.
Last year, there wasn't just a whiff of politicization, but rather an overwhelming stench, as the Trump administration directed CDC officials on what they could and could not say, according to the CDC officials interviewed for this story.
These officials -- who asked not to be identified in this story, given longstanding norms about government employees speaking to the media -- said the onslaught was relentless, starting in the spring.
In May, the CDC published a report about a dozens of people who contracted Covid-19 following choir practice at a church in Skagit County, Washington.
Two weeks later, an updated version of the CDC advisory for houses of worship omitted warnings about singing.
"[The Trump administration] just wanted us to be silent," the CDC doctor said. "Just be silent. Don't say anything."
In July, Trump criticized CDC school reopening guidelines, which encouraged masks, staggered scheduling, modified seat layouts to allow social distancing, physical distancing, closing of communal spaces and staggered schedules.
Trump fired off an angry tweet calling them "very tough," "expensive," and "impractical." When he threatened that he might cut off funding from schools that didn't do things his way, the CDC changed its guidelines.
"You'd read the preamble to [the revised] school guidelines, and you'd say, 'That doesn't sound right. Who put this thing together?'" said Dr. Nancy Cox, the chief of the CDC's influenza team from 1992 to 2014.
Then in August, the CDC changed its guidelines to say that some people without symptoms may not need to be tested, even if they'd been in close contact with someone known to have the virus. Experts were perplexed by the illogical advice.
"It was this constant ongoing process of moving further and further away from a focus on the science," said another CDC physician. "It was death by a thousand cuts."
The CDC officials interviewed for this story say soon Trump administration officials were regularly intervening.
"We would write our reports to be published, and we would fight over the content," the first CDC physician said. "[But] we can't change the facts."
Cox said her old colleagues at the CDC told her that HHS officials had their eyes glued to the CDC's website.
"The website was being monitored for even keystroke changes -- even tiny changes were noticed, and the CDC would be notified to change it back to the way it was," Cox said. "If there was a minor tweak to a document to strengthen the recommendations in any way to make it more scientific -- they would be notified and told to put it back."
The first CDC physician said Redfield, the then-CDC director, was privately telling people "how mad he was" about interference from HHS, and that it was "very frustrating."
Foege, the past CDC director, didn't mince words with Redfield. In his September 23 letter to Redfield, he called the pandemic a "slaughter."
"This will go down as a colossal failure of the public health system of this country. The biggest challenge in a century and we let the country down. The public health texts of the future will use this as a lesson on how not to handle an infectious disease pandemic," Foege wrote . "The cause will be the incompetence and illogic of the White House program."
Foege had an idea for Redfield. He suggested he should get himself fired.
If Redfield wrote a letter to CDC employees acknowledging "the tragedy of responding poorly, apologize for what has happened, and (Redfield's) role in acquiescing," Trump would surely let him go.
Then, Foege said, "you can hold your head high."
Trump administration's response
Redfield did not respond to a request for comment for this story, and USA Today, which reported the Foege letter in September, said the CDC did not respond to their request for comment at the time.
While director, Redfield defended the CDC and denied they were putting politics ahead of science. In an interview with the New York Times last month, Redfield said that "first and foremost, I stood up for the agency at every turn. I never caved."
In that interview, when asked if he thought HHS Secretary Alex Azar or Trump could have done more to communicate consistent public health messaging, Redfield answered that "civic leaders, both at the federal and the state level, didn't echo the critical public health measures and mitigation messages that we were trying to put out in the spring and early summer."
In response to accusations in September that HHS was politicizing the CDC, Azar sent a statement to CNN.
"As the Secretary of Health and Human Services, I have briefed President Trump alongside the nation's top doctors and I have insisted that he have direct access to these doctors throughout the COVID-19 pandemic. He has always been receptive to the data and science presented by me and other members of the task force. President Trump's science-based decision making has saved lives," according to the statement.
'Emotionally extremely distressed'
On January 20, when President Joe Biden was sworn in, CDC-ers collectively let out a sigh of relief, the current and former officials say.
But they say it won't be easy to undo the mess created by the Trump administration because employees are tired and scarred from what happened last year.
"What we have here is an entire institution with post-traumatic stress disorder," said Foege, the former CDC director, who is in contact with current agency staffers. "The morale is so bad."
Cox, the former CDC flu team leader, said she remembers going back to her old agency for a meeting on February 27, just weeks into the outbreak.
"I was kind of shocked at how tired and haggard some people looked," she said.
Visiting the CDC's Emergency Operations Center, Cox spotted her friend, Dr. Nancy Messonnier, director of the CDC's National Center for Immunization and Respiratory Diseases.
Messonnier looked "really shaken," Cox remembers.
"I gave her a hug -- you could still hug people at that time -- and I cheered her on," Cox remembers.
Two days before Cox's visit, Messonnier had delivered a stern warning to the country: Covid-19 was spreading.
"We are asking the American public to work with us to prepare in the expectation that this could be bad," Messonnier said at a press briefing on February 25.
Sources later told CNN's Jake Tapper that after this briefing, Messonnier was instructed to "lay low" as Trump downplayed the threat of the coronavirus. She would give only a few more briefings and then was out of the public eye for nearly 10 months.
A spokesperson for Messonnier did not respond to multiple CNN requests for comment.
Cox says she watched as her former colleagues became "emotionally extremely distressed."
"They were afraid, because the way the Trump administration tended to operate was that someone at the very top leads by cursing and screaming and it goes down the chain. That has a real impact on people. I know people who were very distraught and upset," said Cox, who worked at the agency for more than three decades, from 1976 until 2014.
The CDC staffers interviewed for this story say most of the cursing and screaming happened behind closed doors, but every so often, something would slip out.
In September, Michael Caputo, a Trump operative who served as a spokesman for the Department of Health and Human Services, went on a conspiracy theory-laden rant against CDC scientists, alleging a "resistance unit" within the department and accusing CDC officials of "sedition." He later apologized.
In June, a CNN reporter sent an email to a communications specialist at CDC asking whether there would be a vaccine education program. The specialist referred the reporter to HHS, which oversees CDC.
The reporter reached out to Caputo, who then sent a sharply worded email to the CDC communications specialist.
"In what world did you think it was your job to announce an Administration public service announcement campaign to CNN?" Caputo wrote, copying top agency officials in the email, including Redfield, and asking for a meeting with the specialist's human resources representative.
That communications specialist said many CDC-ers are exhausted -- not just from being yelled at by Trump operatives, but also because of the enormous workload of the pandemic itself.
"For me and for other people entangled in this -- it's just never ending," she said. "I'm just tired. I'm sick of Covid. I think to myself -- am I going to be doing this in three months? Am I going to be doing this in six months? Am I going to be doing this in nine months? Can I keep doing this? Do I want to keep doing this? I'm not sure what the answer is."
Starting over by looking inward
While the Trump administration certainly took a toll, some of the CDC's difficulties during 2020 were of the agency's own making, the current and former officials said.
First, there was the testing rollout debacle at the start of the outbreak.
Some of the coronavirus tests developed by the CDC malfunctioned. CDC officials said they could fix it quickly, but it took about three weeks to sort out the mess.
"When the CDC, who (has) always been able to handle these things -- when they tell us they have this thing under control, who are we to say, 'You double Ph.D.s, MDs who have been doing this for years, no you're wrong,'" an administration official told CNN in April.
The agency still hasn't recovered from the lab testing debacle, the CDC officials interviewed for this article said.
"We did something really wrong in the beginning, and we haven't been able to dig ourselves out of that hole," the CDC communications official said.
That staffer and others also said there's a structural problem at the CDC -- the agency is too siloed into its different branches, leaving too few employees staffing the coronavirus response.
"I've been on this response since the beginning and I don't see an end to it in my future," the communications specialist said. "It's the same people, always working. Whenever anybody says, hey, we need more people, they say 'I can't,' or 'I don't really want to,' or 'sorry, things are really ramping up in diabetes,' I say f*ck no, nothing's ramping up in diabetes -- come help us!"
On top of that, this official and others complained about too much bureaucracy at CDC, and an aging data management system to handle health statistics coming in from 50 states.
This is what Dr. Rochelle Walensky, the new CDC director, is inheriting.
Formerly the chief of infectious diseases at Massachusetts General Hospital, Walensky has been on the job for just a few weeks, and she must deal with the Trump administration's aftermath as well as an agency that internally has had its shortcomings.
"We as an agency acknowledge that some mistakes have been made along the way. We are evaluating our performance carefully so that we can learn from it, and be better prepared when the next urgencies and emergencies arise," Walensky said in a written statement to CNN.
The CDC physician who biked around the airport has worked with Walensky before, and says he and other CDC-ers are optimistic about what she can do.
"People are thrilled because she is not only a well-respected infectious disease expert who has led the infectious disease division at one of the most prestigious hospitals in America, but she also is a social justice warrior," the physician said. "She is not only just a great clinician, but her patients love her. She cares about her patients deeply."
He said CDC employees are already "breathing easier" now that Trump has left and Walensky is at the helm. He said it "brings comfort" to CDC scientists that the agency is reviewing the Covid-19 guidelines on its website and updating them to stay current with the latest science.
In her statement to CNN, Walensky said that "CDC's greatest asset is its people."
"They are committed public health stewards who are deeply entrenched in the science and data that protects the health and safety of our country. Their experience and evidence-based decisions are heard and respected — not just at CDC, but as part of the foundation to our national response to this virus. Their diverse range of voices and expertise will join mine as CDC and America work doggedly to get out of the pandemic," according to the statement.
It appears that Walensky is aware of how her staff feels, telling MSNBC's Rachel Maddow Wednesday that the agency's staff had been "muzzled" and "beaten down."
Cox, the longtime CDC flu chief, advised Walensky to start her work inside the CDC's walls, reassuring beleaguered staffers that now, things will be different.
"There has to be a rebuilding of confidence that we're going to get back to public health and get the resources people need to do their jobs properly," Cox said. "There's an enormous amount of mending and healing that has to happen within the workforce at the CDC."