The meager guidelines for safely reopening the country released this week are the latest sign of the Trump administration’s efforts to sideline the Centers for Disease Control and Prevention and the increasing tension between the White House and the world-renowned public health agency.

With Americans waiting for expert advice on how to resume a semblance of normal life during the pandemic, the CDC released just six short “decision trees” Thursday while the rest of its lengthy proposal remains under review at the White House, where it has been for weeks.

Instead of assuming its traditional lead role in a public health crisis, the 73-year-old agency has become just one of many voices providing often contradictory instructions to a confused and imperiled public.

“Punishing the agency by marginalizing and hobbling it is not the solution,” the venerable British medical journal the Lancet noted Friday in a stinging editorial that called the U.S. response “inconsistent and incoherent.”

“Only a steadfast reliance on basic public health principles, like test, trace, and isolate, will see the emergency brought to an end, and this requires an effective national public health agency.”

Increased friction between the White House and the CDC was predictable as President Trump, who often takes a dim view of scientific expertise, campaigns to revive the moribund economy.

But White House officials also said they are frustrated by what they consider the agency’s balky flow of data and information, the leak of an early version of the CDC’s reopening recommendations, and the agency’s crucial early failure to create and roll out a test for the virus, according to three administration officials who spoke on the condition of anonymity to discuss internal disagreements.

Last month, the government awarded an unusual $10.2 million contract to a Pittsburgh information technology company, TeleTracking Technologies, to collect data on available hospital beds, hospital capacity, covid-19 patients and deaths caused by the coronavirus — information it already receives from the CDC.

The White House-led task force also is sparring with public health experts, inside and outside the CDC, about whether covid-19 death counts collected and disseminated by the CDC are inflated.

Some in the White House, including coronavirus task force coordinator Deborah L. Birx and Trump’s chief of staff, Mark Meadows, have begun to take aim at the leadership and communication skills of the CDC’s director, Robert Redfield.

Director of the Centers for Disease Control and Prevention Robert Redfield said April 22 that his statement on covid-19 in the fall is "accurately quoted." (The Washington Post)

“We should be thought partners,” one official said. “The CDC is not fulfilling requests, they’re not collaborating and they’re disorganized. They’re not speaking with one voice.”

One senior administration official, speaking on condition of anonymity to discuss these problems, said the soft-spoken, deeply religious Redfield has few allies in the rough-and- tumble internal politics of the Trump administration. During a task force meeting last week, he apologized for the leak of the reopening recommendations from his agency, an earnest gesture seen by others as a sign of weakness.

“He just has no power over his agency. He has no loyal politicals. He is a man on an island,” that person said.

Redfield did himself no favors with Trump’s inner circle when he told The Washington Post on April 21 that a second wave of covid-19 disease this winter could be more challenging than the first because it will coincide with flu season. Redfield was forced to appear at a White House briefing that day to soften his remarks, after Trump surprised the agency by publicly demanding a new statement.

A spokeswoman for the CDC declined to answer questions for this story. Most officials who agreed to discuss the tensions between the White House and the agency asked for anonymity to address sensitive relations between government agencies.

Trump spokesman Judd Deere said “the White House and CDC have been working together in partnership since the very beginning of this pandemic to carry out the president’s highest priority: the health and safety of the American public. The CDC is the nation’s trusted health protection agency and its infectious disease and public health experts have helped deliver critical solutions throughout this pandemic to save lives.

“We encourage all Americans to continue to follow the CDC’s guidelines as state and local leaders implement the president’s data-driven phased approach to responsibly opening up America.”

In task force meetings, however, Birx has questioned whether the CDC death count is inflated. In early April, the agency revised its methodology to include deaths probably attributable to covid-19, the disease caused by the virus, along with fatalities confirmed by laboratory tests. Supporters of the president have publicly expressed the same doubts.

During a task force meeting early this month, a heated discussion broke out between Birx and Redfield over the CDC’s system for tracking virus data, according to four people present for the discussion or later briefed on it.

“There is nothing from the CDC that I can trust,” Birx said, according to two of the people.

Experts such as Anthony S. Fauci, the task force’s top infectious disease specialist, have said the number of covid-19 fatalities is likely undercounted.

Fauci took that position publicly at a Senate hearing Tuesday. Asked by Sen. Bernie Sanders (I-Vt.) about whether the official death toll — listed at more than 85,000 Friday — was 50 percent too low, Fauci said: “I’m not sure, Senator Sanders, if it’s going to be 50 percent higher. But most of us feel that the number of deaths are likely higher than that number.”

In an interview, Robert Anderson, chief of the mortality statistics branch at the CDC’s National Center for Health Statistics, said he is also confident the number of U.S. covid-19 deaths is undercounted.

“I think the evidence points to the fact that we’re underestimating rather than overestimating,” said Anderson, whose agency is part of the CDC. “The system is designed to collect data on causes of death, not on whatever condition the person might have had.”

As recently as April 7, Birx took an expansive position on counting covid-19 deaths. At a White House briefing, she said anyone who tests positive for the coronavirus and dies should be counted as a covid-19 death, regardless of whether he or she had underlying conditions.

“The intent is, right now, that … if someone dies with covid-19, we are counting that as a covid-19 death,” she said.

The agency was sidelined soon after Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, warned the public Feb. 25 that the virus could soon change everyday life dramatically. The stock market plummeted on her remarks, enraging the president as he returned from a trip to India, several senior administration officials have said.

Messonnier, who had played a leading role until then, was moved off the response, sending a chill through the agency, three current and former officials said. The next day, Trump named Vice President Pence head of the task force, replacing Health and Human Services Secretary Alex Azar, whose agency oversees the CDC.

The CDC, which has not held a briefing since early March, has repeatedly asked the White House to resume its sessions for the media, according to two senior administration officials, but has not received permission, and has finally given up.

The White House also pushed back when the CDC recommended that all Americans wear face masks when they go out in public. Aides to Pence were particularly resistant, only wanting to demand masks in “hot spot” areas. Trump undermined the advice when he announced it, saying he would not comply.

More conflict has accompanied the White House’s delay in moving on the detailed CDC recommendations that describe how houses of worship, schools, day care facilities and other places might safely reopen. Top officials viewed those guidelines as overly prescriptive and many of them were challenged during a robust editing process that involved the task force, the Office of Management and Budget, and the Domestic Policy Council.

Now, as Trump has promised a reignited economy heading into the November election, the CDC is in the awkward position of producing the information Trump wants least — the reminder that the covid-19 death rate has plateaued at nearly 2,000 per day.

The government may be pursuing other ways to collect information through its contract with TeleTracking, which has not previously been reported.

On March 29, Pence wrote to hospital administrators across the country, instructing them to file daily reports on the spread of covid-19 to the CDC’s National Healthcare Safety Network, which collects information on health care-associated infections and other issues.

The network’s website has two new “modules” that hospitals and long-term care facilities, such as nursing homes, can use to report critical information about patients, staffing and beds. The section for long-term care facilities also offers a spot for reporting on supplies and personal protective equipment.

“The data we are now asking you to report is necessary in monitoring the spread of severe covid-19 illness and death, as well as the impact to hospitals,” Pence wrote.

But on April 6, public records show, the government hired TeleTracking to do some of the same things. The $10.2 million, six-month contract, which was not competitively bid, requires the company to set up a “covid-19 rapid deployment plan for real-time healthcare system capacity reporting,” according to a copy of the contract listed on the Federal Procurement Data System website.

The company was hired by the Office of the Assistant Secretary for Preparedness and Response, part of the Department of Health and Human Services.

On April 10, Azar wrote to hospital administrators again, offering them several options for reporting daily information: via TeleTracking, through the CDC site, straight to HHS through an IT vendor or by publishing it on the hospital’s website.

“The completeness, accuracy and timeliness of the data will inform the covid-19 task force decisions on capacity and resource needs to ensure a fully coordinated effort across America,” Azar wrote.

An HHS spokeswoman said not every hospital was using the CDC’s National Healthcare Safety Network and the addition of TeleTracking is capturing additional data.

“Both TeleTracking and CDC’s National Healthcare Safety Network (NHSN) are tools to help hospitals input data in to HHSProtect,” the agency’s new “streamlined data collection platform,” she said in a statement.

Information from across the federal government, state, local and tribal governments, health care facilities, and colleges and universities is used to “gain insight into how COVID-19 is spreading, and how the federal government can best apply resources to mitigate and prevent spread,” she said.

Chris Johnson, president of TeleTracking, said his company was hired to help HHS collect more data on the capacity and availability of beds in U.S. hospitals, as well as about covid-19 cases.

“My belief is that, given the fragmented nature of health care, there are people that report in many different ways,” Johnson said. “And what they’re trying to do is reach as many as possible.” He said more than 4,000 hospitals are using TeleTracking to report their daily data.

Richard J. Jackson, a professor emeritus at the University of California at Los Angeles’s Fielding School of Public Health, who also worked at the CDC, said it is “unprecedented that you’d set up a competing system separate from the CDC. To set up a competing process to do this would appear to really undermine the CDC.”

The decision to award the contract was not made at the coronavirus task force level and was not briefed to the task force, said two people with knowledge of the regular meetings.

But the adviser and a senior administration official said Trump’s son-in-law and senior adviser, Jared Kushner, and many of his allies do not trust government agencies and prefer to work with officials in the private sector.