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Republican senators argued that Americans are losing faith in the CDC during a hearing of the Senate Health, Education, Labor, and Pensions Committee on Tuesday.

And two Republican committee members took aim at the NIH as well, arguing a link between the agency and a Chinese lab that Democrats characterized as a conspiracy theory.

"I used to have the utmost respect for the guidance from the CDC," said Sen. Susan Collins (R-Maine). "I always considered the CDC to be the gold standard. I don't anymore."

In explaining her change of heart, Collins laid out examples of "conflicting, confusing guidance" that she felt undermined the public's confidence in the agency.

She began with a report that the American Federation of Teachers had into making "verbatim" changes to draft guidance on school reopenings.

Second, she cited a article that argued the agency had overstated the risk of outdoor transmission with COVID-19, which CDC estimated was responsible for less than 10% of cases. "'There is not a single documented COVID infection anywhere in the world from casual outdoor interactions, such as walking past someone on a street or eating at a nearby table,'" said Collins, reading aloud from the article.

Third, she pointed to experts' evaluations of the CDC's summer camp guidance, including a pediatric immunologist at Columbia University who characterized it as and the editor-in chief of JAMA Pediatrics who called it

CDC Director Rochelle Walensky, MD, MPH, defended herself and the agency against each individual claim.

Regarding school reopenings, she said more than 50 different stakeholders were engaged in order to see what could be done to improve the agency's draft guidance. During one of those interactions the agency learned that it had addressed the issue of immunocompromised children but neglected to provide any recommendations regarding how to deal with immunocompromised teachers.

"We used CDC-based science to make that addition," she said.

On the risk of outdoor transmission, Walensky said CDC had gotten its figures from a meta-analysis in the . "The top-line result was less than 10%," Walensky said.

As to the issue of summer camp, Walensky can sympathize, she said. Her own 16-year-old loves camp and is anxious to return. But with new COVID-19 infections hitting roughly 38,000 per day, she said, cases are higher than they were last summer and "we sent a lot of kids home and camps were closed."

Later in the hearing, Walensky noted that as vaccinations ramp up in 12- to 15-year-olds, "our summer camp guidance is probably going to have to change in those settings."

Sen. Bill Cassidy, MD (R-La.) piled on to the criticism, noting that until only recently Americans were told by the CDC to wear masks outside, which makes little sense for him, particularly if there are 20 mile per hour winds. "So much of what you say is patently not true," he said.

Cassidy cited what he viewed as delays between new findings and implementation of the agency's' recommendations. "You gotta be more real time," he said.

He also asked witnesses whether previous COVID-19 infection would offer immunity, and argued that advising these individuals to be vaccinated seemed "out-of-step."

NIAID Director Anthony Fauci, MD, the chief medical advisor to President Biden, tried to explain that while there is some degree of immunity, the duration is still unknown. He also cited research suggesting that vaccinating a person who has already been infected with COVID-19 leads to an "extraordinarily high" level of neutralizing antibodies and T cells.

The Louisiana senator cut Fauci off before he could finish to argue that there are increased side effects among people who get the second dose of the vaccine who have been previously infected and suggested that those individual's may have "topped out [their] immunological response."

Peter Marks, MD, PhD, the Director of the FDA's Center for Biologics Evaluation and Research, said there are studies underway to look at the "first versus second dose" question, but repeated what Fauci had said regarding the already-existing research showing that after vaccination individuals have sufficiently higher antibody titers.

Marks noted "that the post-vaccination immune response ... is likely superior to natural infection, in this case, in preventing against some of these variants."

In contrast to Cassidy and Collins, whose frustrations about getting life back-to-normal were shared by some Democrats, Sen. Rand Paul, MD (R-Ky.) once again attacked Fauci, this time claiming a link between the NIH and a lab in Wuhan, China that he implied might be responsible for "juicing up" the virus that started the pandemic.

"With all due respect, you are entirely and completely incorrect," Fauci responded. "The NIH has not ever and does not now fund in the Wuhan Institute."

Fauci agreed that the source of the pandemic should be investigated, but was compelled to refute the suggestion around a link between a Wuhan lab and the NIH at least four more times.

Tina Smith (D-Minn.) asked Fauci about the impact of "conspiracy theories" -- including those "peddled" by Paul and others -- on Americans' willingness to take a COVID vaccine.

"Theories are not helpful in what we're trying to do," said Fauci. "I guess I can say that with some degree of confidence."

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