The United States' response to the COVID-19 pandemic is haphazard, uncoordinated and sorely missing the guidance of the U.S. Centers for Disease Control and Prevention, that agency's former director told USA TODAY on Tuesday. 

And the "extraordinary" absence of the nation's lead public health agency at the forefront of the coronavirus fight makes Tom Frieden feel "less safe."

Now president of the nonprofit Resolve to Save Lives, Frieden advises other nations on how to organize against epidemics. He said global best practice is to designate one incident manager reporting to a health department official who then communicates to the head of state.

That's not how it's working in the U.S. 

“We’ve heard that FEMA’s in charge. We’ve heard that the vice president’s in charge. We’ve heard that (U.S. Ambassador-at-Large) Dr. (Deborah) Birx is the coordinator. We’ve heard that (Health and Human Services Secretary Alex) Azar is in charge of the task force. Who’s on first here?” Frieden told USA TODAY’s Editorial Board on a video call.

The one agency that definitely isn’t in charge is the CDC, which Frieden directed from 2009 to 2017.

It's a stark reversal from the past, when the CDC not only took the lead in the U.S. but globally against the threat of infectious disease. From the SARS epidemic in 2002, to the 2009 H1N1 flu, the beginning of the Ebola outbreak in 2014 and through the 2015 Zika virus outbreak, the CDC held frequent and sometimes daily briefings as the coordination center for the U.S. government and beyond. 

This time, however, the agency that has led every major epidemic response in the nation for the past seven decades is just not there, Frieden said. Its 700 professionals specifically focused on infectious and lung disease appear sidelined. 

“Fighting an epidemic without CDC involved at the decision table and at the podium is like fighting with one hand tied behind your back,” he said.

In previous outbreaks, the CDC had often daily calls with reporters. This time, the CDC has had multiple news conferences canceled “because if the White House is having a press conference, they can’t have one,” Frieden said. The last one archived on the CDC’s media page is from March 9.

Asked about Frieden's comments, the CDC responded that it is still actively engaged in the country's COVID-19 response and working with the entirety of the federal government.

Robert Redfield, the current director of the CDC, is a member of the White House Coronavirus Task Force but has rarely appeared in its almost daily video briefings.

Why Tom Frieden disagrees with Trump administration's focus on high-throughput coronavirus testing

In a wide-ranging conversation with the editorial board, Frieden also said testing for the coronavirus is being mismanaged.

The drive to get everyone everywhere tested for COVID-19  is simply wrong from a public health perspective, he said. In areas with many cases, no one other than people who need to be hospitalized for the illness caused by the virus should be tested.

“There’s every reason to not get tested,” he said. "If you’ve got mild symptoms, stay home!" Trying to get tested just means using up protective equipment, staff time and scarce test kits and might infect others.

“If you’re positive, it’s not going to make any difference. You’re going to be told to stay home unless you’re having trouble breathing. Then you need to go to the hospital."

In places with relatively few COVID-19 cases, however, testing makes sense, Frieden said. In these areas public health officials can track contacts, call for self-isolation and slow the spread of the disease. 

He also disagreed with the focus of the Trump administration's task force on "high-throughput" testing. Quick-turnaround is what’s needed, Frieden said.

“That may sound like a technical difference but it’s a big difference,” he said.

High-throughput testing requires using centralized labs and can take between a day to four days to get results. That’s useless to front-line medical professionals seeing large numbers of people in emergency rooms, he said. They need to know within an hour whether someone has coronavirus and should be admitted and put into quarantine.

And that's going to be increasingly important if, as Frieden predicted, a big wave of infections comes crashing down on the United States.

“The severely ill patients today were infected 10 to 12 days ago. It takes about 10 days to get sick and 5 five days to get very sick,” he said. “There will be an exponential increase in cases."

That worries the 35-year public health veteran. The decentralization of the U.S. health system only works if there is clear guidance from the top, Frieden said. 

“We can expect innovation and proactive action from states and local areas," he said. "But we really need to have clear guidance and coordination at the federal level."