Over at NRO, Jason Richwine says that the public health establishment has lost credibility. As it happens, I agree that the CDC and other public health experts have been too conservative in their advice, seemingly unwilling to state the facts clearly and simply for fear that the public will misinterpret them and go hog wild. At the same time, I can also understand their fear. Americans have not demonstrated a ton of self discipline in response to the pandemic.
But that's a general criticism. Richwine offers up four specific instances where he says the public health establishment blew it big time. But I don't think any of them hold water. Here they are:
Reversal on masking. This is the one people bring up constantly, but it's hardly some kind of unique CDC failing. Every European country reacted just like we did, and they reversed themselves for the same reason: because the science changed. At the start of the pandemic, epidemiologists simply weren't sure how the coronavirus spread or whether it could spread at all from asymptomatic individuals. Given this, it seemed as though masks were of little use to the general public unless they were already sick with COVID-19, so they recommended saving masks for healthcare professionals. There was really nothing wrong with this response, just as there was nothing wrong with reversing when the science evolved and it became clear that asymptomatic individuals could spread the virus.
Lockdowns. I don't quite get this one, but Richwine is annoyed that "the justification for lockdowns changed from avoiding overrun hospitals to minimizing transmission generally." I'm not quite sure what was wrong with adding new justifications as the science changed and the pandemic became far more serious, but Richwine says it caused "an endless hodgepodge of restrictions" that confused a lot of people. That's true, for two reasons. First, the science was evolving and there simply weren't firm answers about what practices were most effective. That's just the way things go when you encounter a brand new virus. Second, lockdowns are the purview of states and localities, and they were legally free to do whatever they wanted. There's nothing anyone could do about that, and in any case it doesn't reflect one way or the other on the public health establishment.
BLM protests. In early June a group of epidemiologists at the University of Washington wrote an open letter defending BLM protests on the grounds that racism was as big a threat to Black health as COVID-19. Therefore, protesting racism was important even if the protests might produce a small uptick in COVID-19 cases.
To be honest, I suspect this is a letter that was probably best left unwritten. At the same time, it was circulated on Twitter and the vast majority of the signers are students, activists, non-specialist doctors, and so forth. What's more, it got 1,200 signatures, which is a tiny number for an internet letter like this. It simply doesn't reflect anything in particular about the "public health establishment."
Schools. Richwine chides the CDC for recommending closure of schools even after "reasonable evidence" showed it was safe to open them. I'm sympathetic to this, since I mostly agree that this is what the evidence pointed to. At the same time, I followed this fairly closely and the science was far from settled. This is a legit criticism, I think, but given the state of our knowledge and the CDC's desire to provide conservative advice,¹ it's not a slam-dunk mistake.
I'm not in the profession of defending the CDC at all costs, and they certainly made some terrible mistakes—the testing debacle being the most obvious. But whenever I look into this stuff, I come away thinking they didn't do as badly as many people seem to think. Sometimes it's because the critics are assuming that any advice which got a lot of media attention was CDC advice, even when it wasn't. Other times it simply seems to reflect a personal ax to grind because the CDC declined to agree with their own personal read of the evidence. Or, I suppose, sometimes it's just part of a general dislike for the CDC that predates the pandemic.
In any case, the CDC's record isn't spotless by any means. But I think it's a lot better than people give it credit for, especially when it was forced to work under the idiot demands of Donald Trump and his acolytes.
¹This, of course, is a general criticism of the CDC, and one we can all reasonably disagree about. How conservative should the CDC be in the advice it gives? That's not an easy question to answer.
There is an inverse correlation between the level of consdervativeness of the advice and the likelihood that the advice will later have to be reversed or at least amended. And the latter is a problem because people don't understand how science works.
"Move Fast and Break Things" is encouraged in the tech world, but is unacceptable in health care.
Some countries, mostly in Asia, did greatly reduce the extent of the outbreak. There is a possibility that this was due to different strains or other factors outside the control of authorities. But it seems clear that all these countries were much more drastic in the measures taken against the coronavirus. Aside from the initial mistake about masks (most Asian countries did mandate mask wearing) the mistake of the Western countries appears to have been not recommending, or not being able to enforce, stricter measures. If the CDC hadn't been constrained by Trump, and if he hadn't told people to disregard their advice anyway, it is likely that they would have given stronger and more effective advice. The right of course wants to put all the blame on the CDC and further discredit science in general. Anything published by the National Review has to be viewed as written with this bias and there is no reason to think that Richwine's piece is different.
Anything published by the Buckley Review has to be viewed as written with this bias and there is no reason to think that Richwine's piece is different.
FIFY
The CDC and public health in general were cut under Trump well before the pandemic, and if I recall correctly, the Trump's pandemic budget tried to the cut the CDC even further.
skeptonomist
There may be a variety of factors that lead to Asian countries performing better than we did during the pandemic
They were more amenable to restrictions in their lives so shut downs were a lot more tolerable to the populace
Also - mask wearing seems to be the "norm" there, Many times we see pictures of people in Asian countries wearing masks be it for cold, flu, or to protect against pollution - to them it's no big deal.
WE are our own worst enemy and look for any excuse NOT to do things that inconvenience us. At the same time we wonder how they have longer lifespan, lowered infant mortality and better health overall. We want to believe we are exceptional as a country with unprecedented freedoms - and rail against a freakin mask mandate while Asian countries lock down wear masks and re-open sooner with less trouble and lowered cases.............
The criticism of an equally feckless & malign Centers for Disease Control & Prevention makes sense when we remember the already Atlanta-based office of the Department of Health, Education, & Welfare was beefed up in the late seventies by corrupt Georgia peanut plantation operator James Earl Carter, Jr., as a giveback for the machinations that made the incompetent Lester Maddox deputy the 39th president.
Better than your usual. Liked.
Monty has been on a bit of a tear, though sometimes goes for a bridge too far.
I try to be a z-grade Tesco Vee, but I sometimes end up at Undead Seth Putman.
Lol, that's some great Monday-morning quarterbacking, especially from such a noted expert in epidemiology as Dr. Jason Richwine. I'll certainly remember to follow out HIS advice next time a pandemic rolls through, and of course to criticize it afterward if something doesn't go to my liking.
What a crock. Why waste electrons even reading it, much less commenting on it? (And come to think of it, this applies to the NRO generally.)
Per the Woodward conversation, Trump knew early on that the virus was very dangerous and easily passed through the air. Fauci must have had the same information, so the early mask recommendations, it seems to me, had less to do with the evolving science and mostly to do with the fear there would be a run on masks that would leave healthcare workers scrambling for protection.
I agree, but Fauci isn't CDC.
In fact, I thought I heard Fauci pretty much admit that in an interview a few weeks ago. That officials statements on masks were affected by the fears that there wouldn’t be enough masks for health care workers.
Remember that Trump rejected at least one offer early in the pandemic to fire up idle factories to produce protective items and later refused to order 3m and others to ramp up production of masks, etc., opening the door to desperate buying of fake, mostly Chinese masks. (My union unknowingly provided me with one of the Chinese N95 masks. I may keep it as a memento.)
On the other hand, I remember construction companies and others, even individual DIY homeowners , donating boxes and cases of N95 masks to local hospitals. So, it was all Trump’s plan to bring us closer together, right?
3M at least were already ramping up production at the first reports out of China. Links in some of my comments on Kevin’s earlier posts on the virus at MoJo.
El Jefe, much like his GQP president predecessor George "Dubya" Bush, is a uniter, not a divider.
I suspect the only people as haunted by Tuskegee are public health types who remember thalidomide and the 1970s swine flu episode.
What about the makers of OTC diet pill AYDS?
The CDC issued their guidelines based on the best science available at the time. That best science, and therefore the guidelines, evolved over time. Conservatives, as is typical, then freaked out because change and uncertainty makes them uncomfortable. Why should our reaction to them be anything but contempt?
Disagree on masks... All the Asian countries where they had experience with SARS and comparable experts got it right. That the CDC failed along with the Europeans doesn't change anything. The Asians weren't looking at different data. The science was leaning far more towards airborne transmission and to a somewhat lesser extent asymptomatic. A failure is a failure, this isn't a curve.
Yet another commenter that doesn't understand how science works.
Noted that you didn't include how the CDC failed or how everyone was to get masks while our hospitals couldn't.
While I realize that Trump made things worse, I don't see how the CDC's failure to implement an effective test/trace/quarantime regime isn't a big black mark on their record.
When we first started, I thought that the time we bought by staying home would be used to put a test and trace scheme in place. Certainly, such a scheme would be part of any epidemic management. But it never happened, even though suitable tests were developed.
'Cuz we're 'Merikans, dammit. TL;DR: There's research and then there's development and seldom does the twain ever meet.
Testing, yes, CDC failed that, ummm, test.
But public health is done locally--so on the ground testing, tracing and quarantines have to be done at the state and local levels. CDC can only offer guidelines. And when those guidelines were being filtered by the Trump administration--or countered by them, then...yeah....
No. The CDC really did bungle the development of a US covid test, due to use of a faulty reagent:
https://www.sciencemag.org/news/2020/02/united-states-badly-bungled-coronavirus-testing-things-may-soon-improve
Not that this problem (as serious as it was) should have caused the havoc it did in America: the Chinese ramped up production of a covid test more rapidly than the US, but they, too, didn't have (anywhere near) adequate supplied in the Hubei stage. As a work around they made covid diagnoses in the early going based on symptoms and a chest x-ray.
You can't trace in this country unless people cooperate. And there have been lots of people who don't want to admit that they were out eating or drinking at their favorite bar or restaurant out of fear that the place would be shut down.
I take issue with Kevin's #4, schools. The issue was -- and is -- not whether schools are safe to reopen. It's whether schools are safe to reopen _with_ _proper_ _precautions_ _implemented_. Big difference.
You want to keep students six feet apart with each desk under a plastic hood? I got no problems with reopening schools. You want to open classroom windows and call it a day? Well, I do have problems with that. A lot of problems. And the fact is, the people baying the loudest for the schools to reopen are most often the ones who want to invest the least amount of money, time, and effort into implementing those safeguards.
TL;DR: This wasn't about the CDC at all. It was about reckless parents.
The parents suing schools to get them to reopen sports programs sound like the ones who'd be first in line to sue if their child got infected.
Big Weiss Family of Pittsburgh energy.
Trouble is, "science" is presented as something which must be obeyed by laypersons unquestioningly - "because science!" An absolute. And is presented (either directly, or via the Telephone Game) as fact rather than "current understanding." So when it evolves it naturally evokes reactions such as:
Look, but don't Touch!
Touch, but don't Taste!
Taste, but don't Swallow!
https://www.youtube.com/watch?v=RGR4SFOimlk
well you got your known unknowns and you have your unknowns unknowns....
😉
(Rumsfeld's quote for the ages)
As I prefer it, the Will Rogers version goes something like "you don't know what you don't know."
A more applicable W. R. quote (or was it Twain?) goes something like "It's not what you don't know that can kill you; it's what you do know that ain't so."
Words to live by in either case.
From the Quote Investigator:
The target saying evolved incrementally over time. Instances have been attributed to a variety of humorists such as Mark Twain, Josh Billings, Artemus Ward, Kin Hubbard, and Will Rogers. However, there is no substantive evidence that the saying was crafted by one of these funny men. The ascription remains anonymous.
So Kevin defends the public health establishment by admitting that they were wrong on the four issues under discussion, but claiming that on two issues it was a defensible error, and only two of the four errors are indefensible. I don't think most of us would hire a plumber who made understandable mistakes half the time, and flat out screwed up the other half.
Seeing as trying to get a handle on a comple public health crisis is pretty much just like fixing a leaky faucet, you make a trenchant point...
Well, you might if (for the sake of argument) you knew they had made 1,000 decisions and the vast majority of those had been correct. Not saying that's happened here, just that the cherrypicking of these four decisions (granted, high-profile decisions) isn't as meaningful as Richwine would have it.
Kevin and your opinions on whether the CDC was correct aren't the final answer in all of this. The BLM letter seems particularly out of scope for a discussion about the "public health establishment". The mask question might have been an error, but only in hindsight and with a President who refused to support masks perhaps irrelevant. The schools debate has always seemed to exclude the at risk populations working at the schools and focused only on the kids.
So, a public health agency led at the time by the guy who lobbied Reagan to do nothing about AIDS and under pressure from the Trump Kult (just ask fauci and birx how much fun that was) made a few boo boos along the way. Who could have suspected that? Did Trump and Robert Redfield come up in that NR article? (No, I’m not gonna read it)
Remember this little gem from December?
WASHINGTON (AP) — A senior manager with the Centers for Disease Control and Prevention told congressional investigators she was ordered to delete an email suggesting attempted political interference by the Trump administration in coronavirus reports to the public, according to a transcript released Thursday.
Trying to herd cats is a losing proposition. Every. Damn. Time.
I think there's something wrong with how people look at this question: as if there was a correct "answer" at the outset and that any change over time means incompetence. While it may be true that certain countries with deeper experience with recent epidemics and different cultures regarding protecting the community vs. individual perceived "liberties" got it better at the outset, the reality is that the world changes over time. And it is also true that conditions vary from place to place. Anyone who thinks that there is one correct solution for all places at all times is on a fool's errand. This whole question of whether the CDC should be credible at this point cannot be judged simply based on the experience of this pandemic under the previous administration, which had gutted the public health agencies.
People need to chill out and recognize reality.
Well said.
pack43
Well said
One thing people forget is that for the most part "public" requirements such as seat belts in cars, hard hats for construction workers and disposing of needles once used are put in place as a result of people dying. They are, as one person told me regulations written with other peoples blood
Public health regulations - social distancing, shut down of bars and restaurants were the main problems for most folks who were so used to living in a world w/o the need for these things that they could not adjust, and some out right refused to adjust. The punishment for a construction worker NOT wearing a hard hat is an OSHA penalty against his company, set belts results in a civil penalty(which if repeated results in higher insurance premiums, and needle re-use is OSHA penalties again.
What were the punishments for not wearing a mask? No service. For over crowding or open bars whiles shut downs were in effect? Non felony trespass on some states
But here's the problem with INH, and CDC - they issued warnings and assigned PPE use based upon old guidance for cold flu. Wipe surfaces avoid crowds cover your face when sneezing. All of this is based upon larger particle sized droplets. Once they came to the realization that aerosols were the MAIN source of spread that changed the game to more wide spread restrictions on indoor activities - no school, no church, only essential business being allowed to operate.
In the future I would hope the agencies involved would approach this from a standpoint of "Aerosol transmission requires the MOST STRINGENT public health restrictions and assume it to be aerosol UP FRONT.
I don't know whether Asian countries did this or whether they "knee jerked" their reactions. Did they have science that showed aerosol transmission earlier than we did? If so, our science community failed us. If they reacted CORRECTLY w/o the science available then our politicians failed us by not taking the hard fast action needed.
Either way the public's reaction to this was dismal. OUR reaction was the main problem here. Politicians did not want to piss off the public. They therefore sought out ANY evidence they could find to justify their fear of the public reaction
Seems like the whole schools are safe idea is suspect. Lots of youth sports superspreaders in places like Michigan. I suppose this isn't technically school, but it does show that kids are superspreaders.
Oh well.
https://www.nbcnews.com/news/us-news/michigan-governor-urges-halt-high-school-classes-youth-sports-n1263722
I wonder how much of the persistence of COVID spread in Michigan is linked to my 70 year old uncle who has been antivaxxx for nearly half a century, & may or may not have had ties to the Michigan Militia in its daycare-incinerating heyday.
School in Florida have been open since last August with no issues. I don't know the specifics about what's going on in MI but I'd look to FL as the success story and how schools could have been open successfully. (There may regional factors that produced different results, however.) In general through, it really is a crime that some areas still don't have schools open. It's such an injustice to those students and parents.
"Over at NRO..."
Annnnd scene.
+1
NRO = Never Really On-Point.
I kind of disagree with Kevin on the mask advice. I'm an engineer, and right at the start when I heard the health officials implying that masks were NOT protective, I couldn't believe it. I knew that any kind of barrier would reduce your chance of inhaling virus particles because it's called "filtration." I knew the reason was to discourage people from buying up N95 masks and depleting the supply, but they should have made that clear, instead of crafting the talking points in a way that people would infer that masks would NOT protect them. So even Dr. Fauci, who is one of the most admirable people that ever walked the earth, fell into this trap. Afraid that telling the truth would prompt people to buy up N95 masks, they chose to conceal the truth to get an outcome they thought would be better in the end. I think it's always better to tell the truth.
Endorse
I'm an engineer as well and agreed with your assessment. Got 25 painters masks in mid March for me and my friends. As to the efficacy of masks, some health care professionals went so far as to say virus was an airborne *molecule*, and hence impossible to filter without a HAZMAT outfit. If that's the case, it's game over for Homo Sapiens.
They are essentially right. Masks have limited and inconsistent impact.
+1 👍
KDrum: At the start of the pandemic, epidemiologists simply weren't sure how the coronavirus spread or whether it could spread at all from asymptomatic individuals. Given this, it seemed as though masks were of little use to the general public unless they were already sick with COVID-19, so they recommended saving masks for healthcare professionals. There was really nothing wrong with this response ...
If they "weren't sure how the coronavirus spread" then why were people told to wash hands frequently,but not wear inexpensive, easy to make, cloth masks?
When you've got a deadly, fast-spreading coronavirus disease, and not sure how it spreads, why not recommend all options that may protect the public? Especially since previous mask wearing (in Asia) has been shown to be effective.
Advising *against* mask wearing is a dishonest way to prevent a run on N95 masks. Health agencies owe the public correct information about what's happening.
Plus, it didn't work N95 makes were immediately impossible to find. I don't think very many people believed that masks were useless. I sure didn't.
"At the start of the pandemic, epidemiologists simply weren't sure how the coronavirus spread or whether it could spread at all from asymptomatic individuals. Given this, it seemed as though masks were of little use to the general public unless they were already sick with COVID-19, so they recommended saving masks for healthcare professionals."
i think the significant emphasis about masks had less to do with how the virus spread and mostly to do with the expectation that Americans -- given to panic-driven hoarding -- would deplete the mask supply that was critically needed for healthcare workers and first responders. If they truly believed that masks were not needed because of the way the virus spread, then there wouldn't have been an overwhelming need to save all the masks for medical staff. The CDC's expectation concerning the irresponsibility of the American people was justified, but their failure was in not recommending that private citizens sit down at their sewing machines and produce millions of their own masks. The people did that thinking for the CDC. V The experts couldn't "think outside the box."
Lockdowns flopped anyways. They shouldn't have ever existed.
The people who market breakfast cereal and political candidates use A/B testing on their messages. It ain’t physics, but it is empirical, it’s applied social science. We need to rebuild a robust public-health system at local, state and national levels, and it needs to include communications groups who develop strategies based on quantified data on response behavior.
Well, let's see. What happened in countries that were able to effectively implement best practices to combat the virus -- essentially what the CDC recommended: masking, social distancing, and strict lockdowns *that weren't lifted too early*? That would be places like New Zealand, Australia, and China. They're in pretty good shape, I'd say. Now let's look at countries that said "Fuck it! Party time!" or "Follow mitigation rules for a brief period...and then go nuts!": Brazil, Sweden, Mexico, the UK, most of the US. Uh...not so good.
There was nothing wrong with the CDC (or the WHO or virtually every other public health agency in the world) recommended. The problem was half this country (and many others) is filled with a bunch of WATB's whose notion of democratic citizenship essentially boils down to "Shut up! You can't tell me what to do!" Which is also why seeing one or two dozen people shot each week by assault weapon-wielding lunatics is apparently no reason to question the ridiculous availability of assault weapons across the country.
"Science" didn't change. Our knowledge of the virus and the syndrome it causes, and how to treat it, changed, and continues to change as variants rise and fall. But the focus should be on the fact that when this pandemic started, we knew next to nothing about the virus or how to treat Covid. We know more now, but there's still a lot to learn. Saying "the science changed" carries the danger that people will think that there's no point in paying attention to what health officials say because it might change tomorrow for no reason. It might change, but there's always a good reason.
The only things I'd add to your first point are a) all those countries were following the lead of the Chinese, who originally indicated the virus spread by surface transmission, and b) why wasn't this conclusion more strongly questioned at the outset, because I can't think of a major virus focused on the lungs not spread by aerosols.
In the end, I suspect for all of them the fear of panic when limited mask supplies ran out played a role.
"How conservative should the CDC be in the advice it gives? That's not an easy question to answer."
It can't be conservative enough to avoid causing the right wing noise machine to make right wing noise.