Better in their words…

I have thought a great deal about the trajectory of the Covid-19 pandemic, particularly about the policies that attempted to control human behavior that were enacted on local, state, and federal levels over the past three years. During this time, I published approximately 50 OpEds in major media across the political spectrum–from the New York Times and Slate (extremely progressive) to Persuasion (centrist) and Reason and Unherd (right-leaning/libertarian, though by no means “far right”). I was an early and loud advocate for school reopening, which is how I met many other scientists and now friends I have co-authored alongside. I may be among the few progressives I know who will say they were against school closures at all, from the beginning– I never believed that they were justified as a “precaution” because the downsides were well known to be very high and there was no evidence closures would limit spread. In fact, there was early and reliable evidence that the model being used to justify school closures, that of influenza A, which spreads well in children and from children to adults, was not a good fit for SARS-CoV-2.

When Covid hit, I was on the faculty at a school of public health. No one else spoke out publicly against school closures except one pediatrician who had an affiliate appointment. Some of the faculty actively supported them. The rest, at least publicly and in faculty meetings where the subject came up, were quiet.

Now, three years later, as the dust settles on Covid policies, many have backed away from school closures and will say only that “we didn’t know” in defense of their previous silence or even support of them. Maybe there is a tacit agreement that we should never close schools for months on end again, but I am not sure there is.

But what about other Covid policies? Is there any shared understanding between those working in public health and in mainstream leftwing media, because those two groups are closely aligned, and the large segment of the population that has utterly lost faith in local and national public health institutions? I think there is not. Evidence for a “no” answer to that question lies in recent media pieces such as this reported article (not an opinion piece) in the Washington Post: Covid backlash hobbles public health and future pandemic response.

The article details a sustained backlash against public health mandates, noting that “Kelley Vollmar, health department director in Jefferson County, Mo., said the new law whittled her ability to fight covid and future infectious diseases.” The law she is referring to is a bill passed in 2021 in Missouri that “curtailed public health leaders’ ability to extend emergency orders without approval from elected officials.” I do not doubt she is correct that this legislation will make managing future pandemics more cumbersome. [American founders intended to make application of draconian measures “cumbersome” so as to prevent their use in only the extremely necessary cases. mrossol]

For context, the emergency orders in MO lasted 18 months and were terminated by the Governor in Aug. 2021. Oregon’s Governor Brown did not rescind the emergency orders until March of 2022; Gov. Newsom ended California’s in Feb. 2023. The federal emergency is set to expire May 11^th, having lasted approximately 1,185 days. One might ask, are these reasonable lengths of time to keep entire states, or a country, under public health emergency (PHE) orders? There have been four federal PHEs since 2006, when Congress created the Pandemic and All-Hazards Preparedness Act after Hurricane Katrina. Three were for infectious diseases (HIN1 flu; Zika Virus; and Covid-19) and one was for the opioid epidemic; the last one has been in effect for five years. Federal PHEs are mostly used to allow funds to transfer from the federal government to states and to suspend certain rules, e.g., around HIPAA or telehealth delivery requirements.

The article also notes that Vollmar “is dismayed by the way the narrative of the pandemic has become distorted. The basic facts have been lost, she said; these public health measures were stopgaps to protect people’s lives before vaccines and treatment were available. A majority of Americans in 2021 said they supported mask mandates and social distancing in both red and blue states, according to a Monmouth University poll.”

This would have been a perfect place for the reporters of this article to reflect on why that support evaporated in much of the country. Or to ask themselves whether PHEs that last more than one thousand days are, in fact, reasonable, particularly on the state level where PHEs give governors extraordinarily broad powers such as to shutter businesses, schools, churches, and temples. The underlying explanation the writers of this, and other similar articles, endorse is that this lack of buy in for public health measures arose because of “right wing misinformation” and/or because people will not tolerate any intrusion on civil liberties, even to protect their health and the health of others. I do not believe these explanations are correct. They may have some grains of truth but they certainly do not tell the whole story.

The first reason these explanations are incorrect is that stopgaps were widely accepted before treatments and vaccines became available. However, the stopgaps accrued so much political baggage it became difficult (but not impossible) to undo them. Nevertheless, this is what should have happened, and it is a major failure of health policy makers, school boards, mayors, governors, and a range of other appointed and elected officials that this did not occur. As soon as vaccines were widely available, vaccines which effectively made nearly everyone low risk for hospitalization, there was no further justification to maintain any policies that restricted school attendance, density of people, travel, business operations, or anything else. People can debate whether some of these policies were ever necessary (for example, I do not think mask mandates or vaccine mandates were ever justified based on available data and I am highly skeptical that business closures did anything useful) but, in any case, absolutely all of these policies should immediately have been sunsetted as soon as anyone who wanted one could get a vaccination. All state PHE orders should have also been lifted at that point.

This act alone would have accomplished a great deal in preventing where we are today. Because this did not happen, legislatures in 30 states where they could do this (e.g., where republicans dominate) passed laws limiting the powers of their public health authorities and school boards. A few democratic state legislatures or state school boards also limited, for example, the ability of schools to shut down or go remote, as I wrote about here with Dr. Margery Smelkinson. I have seen very little honest discussion in left-wing media about the misstep of prolonging these pandemic policies past vaccination availability. Instead, we have been delivered endless pieces such as the one quoted here, or pieces in which public-health officials hand-wring about how right wing misinformation on social media has destroyed trust in public health. This piece in the NYT is a rare exception; Paul Offit is quoted exhorting the CDC to tell the truth and make their data publicly available.

The second reason is the internet. For the first time in history during a pandemic, everyone with access to the internet could access masses of data. Even when SARS hit, the last time there were major travel restrictions and business closures (though not domestically in the USA), and widespread infection panic, most people had limited access to public health data and little concept of where such data might be found. It was 2003; there were very few smartphones and about 50% of Americans did not have access to internet at home. I don’t recall whether state health departments had public-facing websites twenty years ago, but they certainly did not have millions of data points readily accessible to the public and people were much less sophisticated about how to find information on the internet.

These data posed a major counterfactual to the narratives that many public officials, including the CDC, were putting out. The most generous interpretation of these narratives is that they were spun because policy makers were afraid that if people did not fear a Covid-19 infection adequately they would behave recklessly. Recently leaked Whatsapp chats by UK leaders, for example, demonstrate this phenomenon explicitly.

But problems quickly arose with this rationale, because anyone could go look at data. Pres. Biden said the unvaccinated were facing “a winter of severe illness and death” in December of 2021, long after anyone who wanted to could be vaccinated. Hospitalizations were not surging and did not, throughout Omicron, though incidental hospitalizations ‘with’ Covid rose due to Omicron’s high infectivity. The Oregon Health Authority (OHA), for example, continued to push boosters for young children as a life saving measure, despite the fact that anyone could see on their website that few, if any, children were at risk of a severe Covid infection. 16 children under 19 in Oregon died of Covid during the last three years, and this figure does not account for incidental deaths which, according to the CDC, is likely at least half of total deaths. So, some number likely less than eight, most of whom—if not all—had major underlying health issues. At the same time, in 2021 alone 73 young people (under 24 years old) in Oregon died of fentanyl poisoning/overdoses. In 2021, 92 Oregon youth died from firearms. Yet the overwhelming barrage of information (email, Facebook posts, etcetera) about children’s health the OHA put out in 2020, 2021, and 2022 was about the importance of boosting children for Covid. The mismatch between the truth of what was—and still is– killing children and the narrative was in plain sight, and anyone could find it with a one-minute Google search.

George Carlin once said “Tell people there’s an invisible man in the sky who created the universe, and the vast majority will believe you. Tell them the paint is wet, and they have to touch it to be sure.” Public health, and to a large extent mainstream media, does not seem to realize that somewhere between 2000 and 2022, they went from being the people saying there is an invisible man in the sky, and being believed regardless of verifiability, to being the people saying the paint is wet. Even worse, they said the paint was wet and it wasn’t, and anyone and everyone could reach out and touch it for themselves in a matter of seconds spent at the computer. Of course, the paint was wet in some places (e.g.,very old people are still at risk of Covid hospitalization, and should get boosted and vaccines were very important for immune naïve people over fifty or with risk factors) but it wasn’t wet everywhere (children are incredibly low risk and do not need boosters or possibly even to be vaccinated at all) and it never was.

There is a solution to public health’s wet paint problem, though I am not confident that public health authorities will adopt it. So far, there is little evidence that self-reflection is on the table, though I am not privy to conversations happening inside these institutions.

Steven Pinker wrote an essay on countering irrational beliefs, published in Persuasion recently and titled “Reason to Believe”, that said in part:

Though each of us is blind to the flaws in our own thinking, we tend to be better at spotting the flaws in other people’s thinking, and that is a talent that institutions can put to use. An arena in which one person broaches a hypothesis and others can evaluate it makes us more rational collectively than any of us is individually….Wikipedia, surprisingly reliable despite its decentralization, achieves its accuracy through a community of editors that correct each other’s work, all of them committed to principles of objectivity, neutrality, and sourcing.  [I agree that others critique of our logic is really, really valuable. We should leverage this.  On the issue of Wikipedia: true in concept, but in principle, those who oversee Wikipedia have allowed the platform to become politicized and used as a means of ‘censorship’.  Input following or supporting “Correct narratives” is allowed, but most of what is outside the ‘official narrative’ is deleted. mrossol]

Many, many, people across the USA looked at the available data and quickly realized that policies that were being, in many cases, forced on them simply were not supported by those data. And they said so–in effect, they tried to be community editors of the irrational policies that were being imposed on them in their towns, at school board meetings, at their children’s universities, in online forums, and everywhere they could think of. But university administrators, the CDC, state and county health departments and public health authorities at every level, instead of drawing on our collective rationality, on the wisdom of crowds, as it were, ignored us. They would be wise to harness this collective rationality instead of trying to steamroll over it. In fact, it is the only way forward if public health leaders want a sizeable portion of the public to ever listen to them again. We are in a Wikipedia world now, whether they like it or not, and there is no going back.