I'm open to the case that NPIs simply *cannot* work in 2020s USA. Indeed, if I were the American King for a Day when the next one hit, I'd probably just issue advice, and leave it at that. But still...NPIs seemed to work pretty well in Japan and Denmark and Australia.
Either your public is 40% comprised of low trust whack-jobs hunting online for horse medicine, or not.
"Masks don't work" always reminded me of "abstinence doesn't work." In both cases, I think the phrase was a shortened version of what the speaker MEANT to say. "Mask MANDATES don't work" is a coherent sentence. "Abstinence only EDUCATION" doesn't work. But not having sex is a pretty good way to not get pregnant, and wearing a mask has a >0 effect on reducing the spread of infectious disease (albeit varying by type).
Abstinence is 100% effective in preventing pregnancy. As you note, masks are variable but they are never 100%.
I think one problem is that people treated masks like some kind of force field where they thought wearing one made them safe, when the reality was a lot more complicated- especially for cloth and non-certified masks.
My favorite were the football coaches being forced to wear masks outdoors, dumb enough as is, but they'd still muscle memory their way into covering their faces further with their playsheets, still paranoid that someone might lip read them.
Two specific funny moments in this regard were Andy Reid wearing a fogged up face shield, and Bill Belichick putting an N95 *over* a neck warmer.
I don't think I've ever been angrier at policy than I was at that. I was a mushroom cloud laying motherfucker, Superfly TNT, Guns Of The Navarone at that, and also at the antivaxxers.
The real abstinence is shelter-in-place. If you never leave your home and only get things via delivery, you won’t get sick from a respiratory virus. Just like if you don’t have sex with anyone ever other than your equally lifelong monogamous partner (and also don’t get blood transfusions) you won’t get any diseases that are spread only through sex and blood.
Masks are like condoms, but less effective. (Maybe like how condoms are for herpes or whatever.)
I don't think there's any evidence that cloth masks have much of an effect in terms of preventing disease spread. A .02% effect is yes literally larger than 0, but it doesn't reach the level of statistical 'significance'.
I think properly worn and fitted N95 masks have a much larger effect, but that's not what most people were wearing
One of the problems with the fight over whether or not universal masking works is that we have a lot of really low quality data and a small amount of high quality data, and even those higher quality studies aren't great. Organizations like the CDC and NIH really dropped the ball in making sure that these studies did get done. Interestingly, some of the high quality studies were done by researchers from the Nordic countries. I don't know how much this had to do with the nordics having a less politicized response vs institutional characteristics, but this is one of those situations where we should be more like the Nordics.
The high quality data (RCTs, the occasional well-matched prospective observational study) tend to find either a null effect or a small effect. There is an abundance of low to terrible quality data showing that they are effective. Many people in (US) public health have concluded that RCTs are the wrong way to study them, and instead we should look at laboratory studies, ecological studies or the case control studies, but it's not clear what other interventions they would apply that standard of evidence to. We didn't do a lot of good quality science around it so we don't know why these RCTs aren't showing an effect. When it comes to cloth masks, it is entirely plausible that they have an extremely small effect on transmission and this is because the virus is transmitted primarily via aerosols and the cloth masks are not very good at blocking them. But we don't know that because we didn't have much high quality science investigating this.
Then there's the problem of whether a study is generalizable. If a study finds that an infectious person wearing an 95 is 99% less likely to infect the other people in the room, it does not follow that having people wear 95s everywhere they go will have a large effect. They need to seal properly and if people are doing things that are likely to break that seal and not notice that they've broken the seal, we would expect them to be less effective. SO if something works in a hospital, it's a good idea to run another study in the general population to see if it holds up in that population as well.
There’s also an important fight about whether a “high quality study” is an RCT on telling people to mask, or a lab study where we expose people to known-infected individuals and watch them wearing or not wearing the masks, or an aerosol study that sees how the mechanisms work, or what. Much of public health is based around the idea that the RCT is somehow most ecologically valid and statistically sound and is therefore the highest quality, but it doesn’t always test what you want to test (and in the case of masks you can’t do blinding).
Totally agree about the question of what is a high quality study. The fact that we did not do those kinds of studies is really disappointing. I think we should have done all of the above. At least then we'd have had better data to make decisions/
In my memory cloth masks had ~40% efficacy against the original strain (which is certainly not nothing, if everyone is wearing one you save a lot of lives vs. no one wearing one), but then it went to virtually zero vs. the much more contagious follow up strains.
Isn't funny that we once were so steeped in this debate (literally constantly debating effectiveness of NPIs), and now it feels like a bit of a distant memory. That's my experience at least.
Definitely not *everybody*! I know many people who got COVID for the first time between mid December 2021 and mid January 2022, including some people who got it apparently the day after we had Christmas dinner with them. But my partner and I somehow didn’t get it until May 2022 (and we were paying close attention to every cough for several years, and would have identified a minor viral cough as distinct from an allergic one).
Yep. I've found that some people literally think human bodies violate thermodynamics, but usually people mean "calories in, calories out is extremely difficult to adhere to because it relies on continuous long-term exertion of willpower and constant monitoring of calories eaten and expended."
Ehhhh… I’m not convinced that a bomb calorimeter is especially similar to human digestion. You don’t have to violate thermodynamics to suspect that some people’s bodies start to use fewer calories while they’re dieting.
Given the amount of calories expended in baseline metabolic processes that can speed up or slow down without you noticing, “constant monitoring” is basically impossible.
No, the admiral who said masks don't work in Feb was lying, with support from doctors who didn't understand basics of disease transmission due to innumeracy. Of course masks do work, as he said in March.
Right - I read “Intervention “ in NPI as meaning a mandated or strongly suggested public health program. That doesn’t stop me from trolling through CDC NPI literature to find ways to personally survive a pandemic. However, since I don’t work, let alone in healthcare or in an essential function, I have freedom that others may not have. Maybe we went on too long with the strict, legally and peer-enforced NPIs, but with anything new we should pull out all the stops to protect employees. Probably not possible in this political climate, alas.
And also showed that NPIs can be enforced well past any reasonable timeframe of when they should be enforced. Oh and also showed that NPI enforcement can be used as excuse to extend authoritarian tendency.
Yes on both those things. I’m certainly not lauding how they handled it, but it was nice of them to do the experiment for us. I do find it hard to understand how people continue to argue NPI’s don’t work to stop the spread of disease when China’s zero covid heyday’s just sitting there for all to see.
Fair, but it was hard to hide the deaths when they lifted the restrictions (tho the government lied like crazy about it). Just as it was hard to hide the fact that Chinese people were living life pretty much as normal while we were locked down, due to mass testing, manic-level contract tracing, and their extreme restrictions on exposed and infected people’s movements. A lot of Chinese people were happy about it.
As we saw in China, NPIs do work for awhile when vigorously enforced. But, it's only possible to keep that up for so long, and when the measures lift, the population doesn't have immunity, and everyone gets sick anyway.
In the long run, unless NPI is able to completely eradicate the virus quickly, it accomplishes very little.
Yes, authoritarian governments are good at enforcement. But ultimately much of it was just a time-shift. China eventually had to stop its attempt at a zero-Covid policy and immediately lots of people got sick and died - how many we don’t know because the government isn’t honest.
They were arguably the gold standard in 2020 and early 2021. Even then they weren't flawless: they prioritized vaccinating working aged people, but, as that effort ramped up, made little/no effort to pivot back to the elderly. So the seeds of their far less successful approach after the midpoint in 2021 were sewn early. And needless to say, living in a dictatorship, millions of Chinese suffered horribly from policy overreach throughout this period, with no recourse.
Also don’t think a lot of people have really made the connection between openly flouting mask mandates and a lot of subsequent disorder.
People are very quick to blame the Floyd protests but really don’t want to talk about the downstream effects of “40% of the country is willing to get fired rather than comply with a vaccine mandate.”
Agreed. Also, whether to do NPI's really depends on the severity of the disease. What if instead of the 1% fatality rate of COVID we had the 10% fatality rate of SARS, or God forbid the 33% fatality rate of MERS???
I would submit that with something like MERS the only proper response is absolutely everyone stays inside until transmission literally stop with pretty draconian enforcement.
Not to be Clintonian but claims like "NPIs worked in [x] country" seem to hinge a lot on the definition of "worked". It's true that when people obeyed them, the disease spread more slowly. But importantly, Covid spread much too easily to ever be defeated by NPIs, which meant that for it to "go away" in the sense it has now, it basically required the vast majority of people's immune systems encountered it.
Which is to say, pretty much everyone has to get it eventually. Those low numbers don't seem like much of a victory if you pull the timeframe out and you end up in the same place.
Now I think there's an argument to be made here in favor, but I don't buy general claims that "they worked" without unpacking more specificity:
- They can be used to temporarily tamp down the infection rate at a time when hospitals are overwhelmed. This happened for a few moments in a few places but generally was not a common circumstance during the pandemic. (Hilariously this was the plan during the first couple of weeks which everyone forgot once everything got politicized)
- They can be used to minimize the number of infections that occur before vaccines are available. But remember that vaccines arriving in a year was a huge surprise, an amazing best case scenario. So unless you were willing to restrict long and aggressively enough to tamp down cases for a *year* or more, this is also pointless.
Ultimately I think a retrospective case can easily be made for limited, strategic NPIs for particular time frames or populations. And a lot of people made these arguments correctly in real time - including the leadership of Sweden, and Trump's national health pick.
A lot of this is right. But we now know that the 12 month time frame for the vaccine involved a lot of last-minute making an mRNA vaccine supply chain for the first time ever, and then waiting several months for tests of effectiveness.
But updating an mRNA vaccine should only take a few weeks, and if we come up with plans for more expedited testing (and maybe not worry about the details of effectiveness testing before beginning some of the rollout) it could be brought down quite a bit.
They already had the mRNA sequence and the first synthesized mRNA in January 2020 within a week and a half of isolation in patients.
Sure, I can imagine a future scenario where all of the parameters line up in such a way to justify NPIs. But I don't trust our public health establishment (ugh that sounds Trumpy) to make that call, nor would have the population listen to it, wolf having already been cried.
I really hope there is some way to draw useful conclusions from this. For example, what's the best way to encourage people to wear masks or get vaccinated without prompting backlash that makes the net situation worse? I feel that just saying "hey, please wear masks and get vaccinated but there are zero consequences if you don't" doesn't get very far, but workplace vaccine mandates and many mandatory NPIs prompted a level of backlash that made things worse. Even the military had to back off from COVID vaccine mandates.
I really wish the US had tried just paying people to get vaccinated.
I worry that with Dale Gribbles sorting into the Republican Party there's no good answer. If we have another pandemic, it's either with RFK Jr. making important decisions or with 40% of the population primed to do the opposite of good medical advice out of spite.
If Covid had happened under Bush or Obama, the politics would likely have been a bit different. Under Bush, the anti-vax movement was clearly left wing. Under Obama, the stupidity of the anti-vax movement was helping to snuff it out on the left. (That's why outbreaks tended to be in small social groups specifically targeted by anti-vaxers, like the Amish or Somalis in Minnesota.) If Rubio had become president in 2016 instead of Trump, it's very likely conservatives wouldn't have had the social pressure to turn antivax the way they did.
I will never got over the fact that the pandemic started in March 2020 and began to wind down in December of 2020 when the first shots were administered. Most of what everyone recalls from the pandemic - locks downs, etc. occurred during the Trump administration. And yet he gets zero blame even though he was the guy in charge.
I would probably repeat what Deadpan Troglodytes already said- NPIs were virtually all run at the state level, and Democratic states (or Dem cities in red states) were much much harsher on the NPIs than red states were. Voters are in general not what I would call 'bright', but they're not stupid, and they do recall the NPI-Democrat connection. They remember who was closing playgrounds, mandating masks in restaurants, closing schools, etc. I think that mental connection is now pretty permanently fixed in voters' psyches
It didn’t help that a non-zero number of progressives were openly trying to use COVID as a pretext for a lot of unrelated radical transformational changes.
Aside from using NPIs well past the point they were necessary, they also wanted to make a lot of targeted pandemic relief permanent — remember the whole “Biden promised us $2000” discourse from early 2021?
It will also never cease to amaze me that there are hundreds of thousands of extra people unnecessarily dead because DJT got jealous that Andrew Cuomo was getting such fawning coverage* in the press and overshadowed him.
I continue to maintain that his “liberate Michigan” tweet is one of the deadliest tweets in history. It gave the signal to his followers that Covid was “fake news” and not to be taken seriously.
To tie it back to Matt’s post. One huge danger clearly signaled by RFK jr’s nomination is that it’s basically Trump indulging in anti-vaccine insanity about everything. RFK jr could be completely ineffective at HHS, a real viable H1N1 vaccine could be developed and one Truth Social post could mean half the country refuses the vaccine.
*I’ve noted before that my wife used to work extensively in NY politics. Which she means she’s known longer than most what POS Cuomo is. Upshot is we own a “Cuomosexual” mug as an ironic reminder of that moment when Cuomo was quasi celebrity
NPIs were administered at the state and local levels: what is a president's responsibility there, leadership?
He could have fired Fauci, whose public equivocations damaged institutional trust, but there's no universe in which blue locales would have followed his successor's lead. We already know what they thought of Bhattacharya!
If you listened to what Fauci actually said he was quite moderate as far as public health people go. The rupture with Trump occurred when Donald went into mad King at a press conference and Fauci had to correct him.
The red blue divergence happened when Trump decided covid would end by Easter and decided everything needed to open to boost the economy. Red states opened up and blue states extended/increased the intensity of the early lockdowns that made sense in March/April.
I'd also say that Jay Bhattarachia wrote a bunch of op ads early on claiming covid was milder than the flu. Dude's a hack who happened to be correct a few times.
Take a look at Europe. Those countries all had very different public reactions as far as polarization around NPI's went. The country that saw a schism like us is Brazil and the chief executives explain that.
Matt's contention that low uptake vaccine vis a vis our peer countries is because people don't like needles is one of his worst takes. There are people who hate needles literally in every country. There's no way that explain why a much higher percentage of people are vaccinated in Germany than America.
But more to your point. The low levels of vaccination in American and Brazil are amazing examples to me that the "great men of history" thesis of how history unfolds has merit. As usual with these things, it's never one thing (hard not to cite UK's unique geographic position as to why industrialization took off there first as an important example). But the huge delta in per capita death rates is a morbid example that your leaders really do matter.
I do think needles are an important factor in vaccine hesitancy, though I don’t think it explains US exceptionalism. Unfortunately, everyone in public health learned to get over needles in their first year of graduate education, so they underestimate how valuable it would be to get non-needle-based vaccines.
I'm not a Fauci hater. I think he did a lot of great work through his career, through multiple public heath crises. But he screwed up COVID and it wasn't just changing his mind as the evidence changed.
First, there's the story everyone knows: his early dismissal and then subsequent support of masks. The story is complicated, but it is clearly not simply a matter of evolving science. As Slate's writers put it in "The Noble Lies of COVID-19":
> One thing is beyond a doubt, however: One of those two statements [on masks] did not accurately reflect the evidence as Fauci saw it. Such high-profile mixed messages in a short time frame, without substantive new data to justify the change, generated confusion and a backlash from politicians, other experts, and the general public.
But that's not all. He also made knowingly false estimates of the herd immunity threshold, by his own words! Some part of these revisions were related to new data, but as Donald McNeil wrote in the New York Times, Fauci had been deliberately withholding his real analysis:
> Dr. Fauci acknowledged that he had slowly but deliberately been moving the goal posts. He is doing so, he said, partly based on new science, and partly on his gut feeling that the country is finally ready to hear what he really thinks.(https://www.nytimes.com/2020/12/24/health/herd-immunity-covid-coronavirus.html)
Other times, Fauci just admits to being concerned with the consequences of communicating the truth, rather than disseminating knowledge. For example, in early 2021, he said of switching to a "first shots first" strategy:
I mean ... he's right, but if you're paying attention and reading that in March 2021, it's becoming increasingly harder to take anything he says at face value anymore.
His people would follow him over a cliff. If Trump had decided "A strong response to the pandemic is my ticket to a second term" we would have looked a lot more like Canada or Australia in terms of excess mortality.
Now, no doubt a lot of MAGA enthusiasts would in principle reject saving a few hundred thousands lives if that meant a motorcycle rally got cancelled one year, or they had to get take out instead of dining in at a crowded Chick-fil-A. Freedom isn't free, after all.
But still, given Trump's utterly messianic hold over tens of millions of American conservatives, it seems obvious we could have had a very different 2020. Hell, Trump could have couched the effort in terms of "fighting the CCP's efforts to harm us."
But Trump thought his ticket to reelection wasn't saving American lives, but rather, opening up the economy as rapidly as possible—public health consequences be damned.
Well trodden ground here at Slow Boring. Something that's been chewed over, what, three hundred times? I get it: the partial and irritating NPIs were history's greatest crime.
That’s true, but they were following, perhaps overzealously, the official federal guidance from the CDC. That guidance had a tremendous impact on policy, at least for blue states.
I suspect that any non-Trump president would have at least explored some coordination of NPIs. It is obvious that states with open borders running completely autonomous semi-lockdowns is a recipe for failure. It really was a situation that required the one thing most lacking in the Trump presidency, strong leadership.
Be that as it may, it would only be a positive from the perspective of NPI supporters. BZC is saying that Trump is responsible for blue state mask mandates and school closures, which is what I'm responding to.
That claim is obviously silly and I am not attempting to make it sound less-so. I am making a very narrow and specific claim. I am not certain that someone could have successfully organized the states to act in concert but it absolutely should have been seriously attempted.
Not acting like a crazy person early on. People forget, the country was relatively unified and he had the highest approval of his presidency pre press conference meltdown.
How many people were actually tracking what Fauci said from day-to-day, rather than absorbing vibes second-hand from their ideological fellow travelers? This critique always seemed to me to assume that everyone has the same media diet.
I think we just gotta attribute this to some fundamental differences in the electorate. The way this stood out to me egregiously was that during the campaign, Harris would talk about what her plans were and get pilloried with comments such as, "You're in power NOW, why aren't you doing any of this???", completely ignoring the historically pretty well-known fact that VPs are, uh, cartoonishly powerless.
(I'm not cutting her slack here, it cuts both ways, running as a sitting VP when times are good also affords one credit they also most likely do not deserve.)
But Trump was still somehow running as an outsider despite having already had the chance to do the things he is proposing. The comedian Theo Von, who interviewed Trump prior to the election, had on fellow comedian Stavros Halkios (who is disdainful of ALL politicians, but is certainly of the left) the other day, and was saying that he voted for Trump because he represented something different, someone who might change things, and Halkios was laughing at him and said something to the effect of, "what are you talking about?!? He was already President before!"
Clip here, should start at the timestamp. He also stomps on Vance, which is fun.
Some of it is attributable to differences in the electorate, yes, but Trump really did literally go hard against much of his own government's (that is, the United States Government's) efforts to battle a public health crisis. And I strongly suspect it helped him in 2020 and in 2024 with at least some cohorts (if not on net in 2020), by increasing his support among working class Americans for whom forced unemployment (yes, even with fat checks) was highly stressful and unpleasant. And those memories were still fresh for many two weeks ago. It's not hard for me to believe the GOP's inroads among young Hispanic men, for instance, were given a nice boost by Trump's seizure of the "Let's get America back to work" brand. Many working class Americans saw Trump as championing their right to earn a paycheck and resume their lives. Which, of course, in a large sense he was.
We might be talking to different people then, because I know people who voted for him specifically because they got big checks and *didn't* have to work.
There's a difference between:
(1) NPIs don't work....and:
(2) NPIs that aren't enforced don't work.
I'm open to the case that NPIs simply *cannot* work in 2020s USA. Indeed, if I were the American King for a Day when the next one hit, I'd probably just issue advice, and leave it at that. But still...NPIs seemed to work pretty well in Japan and Denmark and Australia.
Either your public is 40% comprised of low trust whack-jobs hunting online for horse medicine, or not.
"Masks don't work" always reminded me of "abstinence doesn't work." In both cases, I think the phrase was a shortened version of what the speaker MEANT to say. "Mask MANDATES don't work" is a coherent sentence. "Abstinence only EDUCATION" doesn't work. But not having sex is a pretty good way to not get pregnant, and wearing a mask has a >0 effect on reducing the spread of infectious disease (albeit varying by type).
That's a good analogy!
Abstinence is 100% effective in preventing pregnancy. As you note, masks are variable but they are never 100%.
I think one problem is that people treated masks like some kind of force field where they thought wearing one made them safe, when the reality was a lot more complicated- especially for cloth and non-certified masks.
Sure, but not 100% effective =! doesn't work.
But yes, the masks were less effective against subsequent variants.
Where I really lost it on masks is when I was told we still had to wear them after we were vaccinated. That makes zero sense.
See also morons wearing masks, but not helmets, while riding bikes. What a world.
My favorite were the football coaches being forced to wear masks outdoors, dumb enough as is, but they'd still muscle memory their way into covering their faces further with their playsheets, still paranoid that someone might lip read them.
Two specific funny moments in this regard were Andy Reid wearing a fogged up face shield, and Bill Belichick putting an N95 *over* a neck warmer.
https://youtu.be/ZtJM8J_qfPk?si=ezLkVlpsaAvTRLeA
I don't think I've ever been angrier at policy than I was at that. I was a mushroom cloud laying motherfucker, Superfly TNT, Guns Of The Navarone at that, and also at the antivaxxers.
I had to wear a mask while delivering Amazon packages in spring 2021 because of paranoid people with Ring doorbells.
Ridiculous.
Very true! But people aren’t good with probabilities and the advice boiled down to a binary: masks=safe, not wearing masks=unsafe.
It wasn't clear what the chance of Long COVID was after a breakthrough infection. In practice it turned out to be (AFAIK) extremely small.
The real abstinence is shelter-in-place. If you never leave your home and only get things via delivery, you won’t get sick from a respiratory virus. Just like if you don’t have sex with anyone ever other than your equally lifelong monogamous partner (and also don’t get blood transfusions) you won’t get any diseases that are spread only through sex and blood.
Masks are like condoms, but less effective. (Maybe like how condoms are for herpes or whatever.)
Probably depends on the type of mask. I imagine the masks we had in the army where pretty close to 100%
They were also rated against chemical attacks
I don't think there's any evidence that cloth masks have much of an effect in terms of preventing disease spread. A .02% effect is yes literally larger than 0, but it doesn't reach the level of statistical 'significance'.
I think properly worn and fitted N95 masks have a much larger effect, but that's not what most people were wearing
One of the problems with the fight over whether or not universal masking works is that we have a lot of really low quality data and a small amount of high quality data, and even those higher quality studies aren't great. Organizations like the CDC and NIH really dropped the ball in making sure that these studies did get done. Interestingly, some of the high quality studies were done by researchers from the Nordic countries. I don't know how much this had to do with the nordics having a less politicized response vs institutional characteristics, but this is one of those situations where we should be more like the Nordics.
The high quality data (RCTs, the occasional well-matched prospective observational study) tend to find either a null effect or a small effect. There is an abundance of low to terrible quality data showing that they are effective. Many people in (US) public health have concluded that RCTs are the wrong way to study them, and instead we should look at laboratory studies, ecological studies or the case control studies, but it's not clear what other interventions they would apply that standard of evidence to. We didn't do a lot of good quality science around it so we don't know why these RCTs aren't showing an effect. When it comes to cloth masks, it is entirely plausible that they have an extremely small effect on transmission and this is because the virus is transmitted primarily via aerosols and the cloth masks are not very good at blocking them. But we don't know that because we didn't have much high quality science investigating this.
Then there's the problem of whether a study is generalizable. If a study finds that an infectious person wearing an 95 is 99% less likely to infect the other people in the room, it does not follow that having people wear 95s everywhere they go will have a large effect. They need to seal properly and if people are doing things that are likely to break that seal and not notice that they've broken the seal, we would expect them to be less effective. SO if something works in a hospital, it's a good idea to run another study in the general population to see if it holds up in that population as well.
There’s also an important fight about whether a “high quality study” is an RCT on telling people to mask, or a lab study where we expose people to known-infected individuals and watch them wearing or not wearing the masks, or an aerosol study that sees how the mechanisms work, or what. Much of public health is based around the idea that the RCT is somehow most ecologically valid and statistically sound and is therefore the highest quality, but it doesn’t always test what you want to test (and in the case of masks you can’t do blinding).
Totally agree about the question of what is a high quality study. The fact that we did not do those kinds of studies is really disappointing. I think we should have done all of the above. At least then we'd have had better data to make decisions/
Really? I think the data I saw showed that cloth masks were more effective than .02%, but now I'd have to go find that data again...
In my memory cloth masks had ~40% efficacy against the original strain (which is certainly not nothing, if everyone is wearing one you save a lot of lives vs. no one wearing one), but then it went to virtually zero vs. the much more contagious follow up strains.
Isn't funny that we once were so steeped in this debate (literally constantly debating effectiveness of NPIs), and now it feels like a bit of a distant memory. That's my experience at least.
Like most of the pandemic experience.
~40% efficacy vs the OG strain is close to the figure I remember. I do remember it dropping off for subsequent variants. I don't know how much though.
https://www.mwra.com/biobot/biobotdata.htm
Per wastewater data from Boston, EVERYBODY got COVID around 1/1/22, so Omicron was ferocious.
Definitely not *everybody*! I know many people who got COVID for the first time between mid December 2021 and mid January 2022, including some people who got it apparently the day after we had Christmas dinner with them. But my partner and I somehow didn’t get it until May 2022 (and we were paying close attention to every cough for several years, and would have identified a minor viral cough as distinct from an allergic one).
My first (and so far only) confirmed case was October 2022.
What LF said is how I remembered. The properly worn and fitted part is also what makes it just a piss poor policy to implement.
See also: "calories in, calories out doesn't work."
It doesn't work IF YOU DON'T DO IT
Yep. I've found that some people literally think human bodies violate thermodynamics, but usually people mean "calories in, calories out is extremely difficult to adhere to because it relies on continuous long-term exertion of willpower and constant monitoring of calories eaten and expended."
Ehhhh… I’m not convinced that a bomb calorimeter is especially similar to human digestion. You don’t have to violate thermodynamics to suspect that some people’s bodies start to use fewer calories while they’re dieting.
Well we KNOW that people’s bodies start to use fewer calories as they age (hence, “dad bods.”)
I do find it intriguing how much slimmer my grandparents were compared to my parents at similar ages.
Given the amount of calories expended in baseline metabolic processes that can speed up or slow down without you noticing, “constant monitoring” is basically impossible.
The people who think this are very obviously lying about their calories in.
No, the admiral who said masks don't work in Feb was lying, with support from doctors who didn't understand basics of disease transmission due to innumeracy. Of course masks do work, as he said in March.
Right - I read “Intervention “ in NPI as meaning a mandated or strongly suggested public health program. That doesn’t stop me from trolling through CDC NPI literature to find ways to personally survive a pandemic. However, since I don’t work, let alone in healthcare or in an essential function, I have freedom that others may not have. Maybe we went on too long with the strict, legally and peer-enforced NPIs, but with anything new we should pull out all the stops to protect employees. Probably not possible in this political climate, alas.
Yep. If you have to MANDATE mask-wearing, you're dealing with a population that's not cooperative to begin with.
China especially managed to prove the efficacy of enforced NPI’s.
And also showed that NPIs can be enforced well past any reasonable timeframe of when they should be enforced. Oh and also showed that NPI enforcement can be used as excuse to extend authoritarian tendency.
Yes on both those things. I’m certainly not lauding how they handled it, but it was nice of them to do the experiment for us. I do find it hard to understand how people continue to argue NPI’s don’t work to stop the spread of disease when China’s zero covid heyday’s just sitting there for all to see.
Unsurprisingly, people don't trust the data coming out of China.
Fair, but it was hard to hide the deaths when they lifted the restrictions (tho the government lied like crazy about it). Just as it was hard to hide the fact that Chinese people were living life pretty much as normal while we were locked down, due to mass testing, manic-level contract tracing, and their extreme restrictions on exposed and infected people’s movements. A lot of Chinese people were happy about it.
As we saw in China, NPIs do work for awhile when vigorously enforced. But, it's only possible to keep that up for so long, and when the measures lift, the population doesn't have immunity, and everyone gets sick anyway.
In the long run, unless NPI is able to completely eradicate the virus quickly, it accomplishes very little.
If it delays mass infection until everyone is vaccinated, it saves a lot of deaths. See Australia and New Zealand.
Yes, authoritarian governments are good at enforcement. But ultimately much of it was just a time-shift. China eventually had to stop its attempt at a zero-Covid policy and immediately lots of people got sick and died - how many we don’t know because the government isn’t honest.
Australia and New Zealand did it with effective vaccination, so there wasn’t just a time shift in deaths.
They were arguably the gold standard in 2020 and early 2021. Even then they weren't flawless: they prioritized vaccinating working aged people, but, as that effort ramped up, made little/no effort to pivot back to the elderly. So the seeds of their far less successful approach after the midpoint in 2021 were sewn early. And needless to say, living in a dictatorship, millions of Chinese suffered horribly from policy overreach throughout this period, with no recourse.
The Chinese vaccine also wasn't that good (but at least better than the Russian one), which undermined elderly trust in it.
Also don’t think a lot of people have really made the connection between openly flouting mask mandates and a lot of subsequent disorder.
People are very quick to blame the Floyd protests but really don’t want to talk about the downstream effects of “40% of the country is willing to get fired rather than comply with a vaccine mandate.”
This was surely connected to the rise in air rage and traffic deaths.
Agreed. Also, whether to do NPI's really depends on the severity of the disease. What if instead of the 1% fatality rate of COVID we had the 10% fatality rate of SARS, or God forbid the 33% fatality rate of MERS???
I would submit that with something like MERS the only proper response is absolutely everyone stays inside until transmission literally stop with pretty draconian enforcement.
Not to be Clintonian but claims like "NPIs worked in [x] country" seem to hinge a lot on the definition of "worked". It's true that when people obeyed them, the disease spread more slowly. But importantly, Covid spread much too easily to ever be defeated by NPIs, which meant that for it to "go away" in the sense it has now, it basically required the vast majority of people's immune systems encountered it.
Which is to say, pretty much everyone has to get it eventually. Those low numbers don't seem like much of a victory if you pull the timeframe out and you end up in the same place.
Now I think there's an argument to be made here in favor, but I don't buy general claims that "they worked" without unpacking more specificity:
- They can be used to temporarily tamp down the infection rate at a time when hospitals are overwhelmed. This happened for a few moments in a few places but generally was not a common circumstance during the pandemic. (Hilariously this was the plan during the first couple of weeks which everyone forgot once everything got politicized)
- They can be used to minimize the number of infections that occur before vaccines are available. But remember that vaccines arriving in a year was a huge surprise, an amazing best case scenario. So unless you were willing to restrict long and aggressively enough to tamp down cases for a *year* or more, this is also pointless.
Ultimately I think a retrospective case can easily be made for limited, strategic NPIs for particular time frames or populations. And a lot of people made these arguments correctly in real time - including the leadership of Sweden, and Trump's national health pick.
A lot of this is right. But we now know that the 12 month time frame for the vaccine involved a lot of last-minute making an mRNA vaccine supply chain for the first time ever, and then waiting several months for tests of effectiveness.
But updating an mRNA vaccine should only take a few weeks, and if we come up with plans for more expedited testing (and maybe not worry about the details of effectiveness testing before beginning some of the rollout) it could be brought down quite a bit.
They already had the mRNA sequence and the first synthesized mRNA in January 2020 within a week and a half of isolation in patients.
Sure, I can imagine a future scenario where all of the parameters line up in such a way to justify NPIs. But I don't trust our public health establishment (ugh that sounds Trumpy) to make that call, nor would have the population listen to it, wolf having already been cried.
I really hope there is some way to draw useful conclusions from this. For example, what's the best way to encourage people to wear masks or get vaccinated without prompting backlash that makes the net situation worse? I feel that just saying "hey, please wear masks and get vaccinated but there are zero consequences if you don't" doesn't get very far, but workplace vaccine mandates and many mandatory NPIs prompted a level of backlash that made things worse. Even the military had to back off from COVID vaccine mandates.
I really wish the US had tried just paying people to get vaccinated.
I worry that with Dale Gribbles sorting into the Republican Party there's no good answer. If we have another pandemic, it's either with RFK Jr. making important decisions or with 40% of the population primed to do the opposite of good medical advice out of spite.
If Covid had happened under Bush or Obama, the politics would likely have been a bit different. Under Bush, the anti-vax movement was clearly left wing. Under Obama, the stupidity of the anti-vax movement was helping to snuff it out on the left. (That's why outbreaks tended to be in small social groups specifically targeted by anti-vaxers, like the Amish or Somalis in Minnesota.) If Rubio had become president in 2016 instead of Trump, it's very likely conservatives wouldn't have had the social pressure to turn antivax the way they did.
Eh, the stupid was very clearly being unleashed on the right during the Obama years.
I will never got over the fact that the pandemic started in March 2020 and began to wind down in December of 2020 when the first shots were administered. Most of what everyone recalls from the pandemic - locks downs, etc. occurred during the Trump administration. And yet he gets zero blame even though he was the guy in charge.
I would probably repeat what Deadpan Troglodytes already said- NPIs were virtually all run at the state level, and Democratic states (or Dem cities in red states) were much much harsher on the NPIs than red states were. Voters are in general not what I would call 'bright', but they're not stupid, and they do recall the NPI-Democrat connection. They remember who was closing playgrounds, mandating masks in restaurants, closing schools, etc. I think that mental connection is now pretty permanently fixed in voters' psyches
Trump also coded himself as anti-lockdown at a time when anti-lockdown sentiment was becoming most salient to people.
Which is ironic because wasn't he fighting with Governor Kemp in Georgia about opening up *too early*?
It didn’t help that a non-zero number of progressives were openly trying to use COVID as a pretext for a lot of unrelated radical transformational changes.
Aside from using NPIs well past the point they were necessary, they also wanted to make a lot of targeted pandemic relief permanent — remember the whole “Biden promised us $2000” discourse from early 2021?
It also didn't help that several notable Dem pols seemed hypocritical in violating NPI measures or creating exemptions for cronies.
It will also never cease to amaze me that there are hundreds of thousands of extra people unnecessarily dead because DJT got jealous that Andrew Cuomo was getting such fawning coverage* in the press and overshadowed him.
I continue to maintain that his “liberate Michigan” tweet is one of the deadliest tweets in history. It gave the signal to his followers that Covid was “fake news” and not to be taken seriously.
To tie it back to Matt’s post. One huge danger clearly signaled by RFK jr’s nomination is that it’s basically Trump indulging in anti-vaccine insanity about everything. RFK jr could be completely ineffective at HHS, a real viable H1N1 vaccine could be developed and one Truth Social post could mean half the country refuses the vaccine.
*I’ve noted before that my wife used to work extensively in NY politics. Which she means she’s known longer than most what POS Cuomo is. Upshot is we own a “Cuomosexual” mug as an ironic reminder of that moment when Cuomo was quasi celebrity
NPIs were administered at the state and local levels: what is a president's responsibility there, leadership?
He could have fired Fauci, whose public equivocations damaged institutional trust, but there's no universe in which blue locales would have followed his successor's lead. We already know what they thought of Bhattacharya!
If you listened to what Fauci actually said he was quite moderate as far as public health people go. The rupture with Trump occurred when Donald went into mad King at a press conference and Fauci had to correct him.
The red blue divergence happened when Trump decided covid would end by Easter and decided everything needed to open to boost the economy. Red states opened up and blue states extended/increased the intensity of the early lockdowns that made sense in March/April.
I'd also say that Jay Bhattarachia wrote a bunch of op ads early on claiming covid was milder than the flu. Dude's a hack who happened to be correct a few times.
The mask mandates on airplanes, airports, and public transit were issued at the federal level.
Good point - I would say it's fair to blame him for those.
This is why I've always felt that the reactions among the public were going to be broadly similar regardless of who was president.
Take a look at Europe. Those countries all had very different public reactions as far as polarization around NPI's went. The country that saw a schism like us is Brazil and the chief executives explain that.
Matt's contention that low uptake vaccine vis a vis our peer countries is because people don't like needles is one of his worst takes. There are people who hate needles literally in every country. There's no way that explain why a much higher percentage of people are vaccinated in Germany than America.
But more to your point. The low levels of vaccination in American and Brazil are amazing examples to me that the "great men of history" thesis of how history unfolds has merit. As usual with these things, it's never one thing (hard not to cite UK's unique geographic position as to why industrialization took off there first as an important example). But the huge delta in per capita death rates is a morbid example that your leaders really do matter.
I do think needles are an important factor in vaccine hesitancy, though I don’t think it explains US exceptionalism. Unfortunately, everyone in public health learned to get over needles in their first year of graduate education, so they underestimate how valuable it would be to get non-needle-based vaccines.
“ leadership”
Um…yeh?
>He could have fired Fauci, whose public equivocations damaged institutional trust<
Are "public equivocations" similar to "changing his mind as the evidence changes"?
[Edited to add details]
I'm not a Fauci hater. I think he did a lot of great work through his career, through multiple public heath crises. But he screwed up COVID and it wasn't just changing his mind as the evidence changed.
First, there's the story everyone knows: his early dismissal and then subsequent support of masks. The story is complicated, but it is clearly not simply a matter of evolving science. As Slate's writers put it in "The Noble Lies of COVID-19":
> One thing is beyond a doubt, however: One of those two statements [on masks] did not accurately reflect the evidence as Fauci saw it. Such high-profile mixed messages in a short time frame, without substantive new data to justify the change, generated confusion and a backlash from politicians, other experts, and the general public.
(https://slate.com/technology/2021/07/noble-lies-covid-fauci-cdc-masks.html)
But that's not all. He also made knowingly false estimates of the herd immunity threshold, by his own words! Some part of these revisions were related to new data, but as Donald McNeil wrote in the New York Times, Fauci had been deliberately withholding his real analysis:
> Dr. Fauci acknowledged that he had slowly but deliberately been moving the goal posts. He is doing so, he said, partly based on new science, and partly on his gut feeling that the country is finally ready to hear what he really thinks.(https://www.nytimes.com/2020/12/24/health/herd-immunity-covid-coronavirus.html)
Other times, Fauci just admits to being concerned with the consequences of communicating the truth, rather than disseminating knowledge. For example, in early 2021, he said of switching to a "first shots first" strategy:
> We’re telling people [two shots] is what you should do … and then we say, ‘Oops, we changed our mind’?” Fauci said. “I think that would be a messaging challenge, to say the least.” (https://www.washingtonpost.com/health/2021/03/01/fauci-defends-two-shot-strategy/)
I mean ... he's right, but if you're paying attention and reading that in March 2021, it's becoming increasingly harder to take anything he says at face value anymore.
Please spell out what that would have looked like, accounting for Trump's uniquely polarizing effect on the population.
His people would follow him over a cliff. If Trump had decided "A strong response to the pandemic is my ticket to a second term" we would have looked a lot more like Canada or Australia in terms of excess mortality.
Now, no doubt a lot of MAGA enthusiasts would in principle reject saving a few hundred thousands lives if that meant a motorcycle rally got cancelled one year, or they had to get take out instead of dining in at a crowded Chick-fil-A. Freedom isn't free, after all.
But still, given Trump's utterly messianic hold over tens of millions of American conservatives, it seems obvious we could have had a very different 2020. Hell, Trump could have couched the effort in terms of "fighting the CCP's efforts to harm us."
But Trump thought his ticket to reelection wasn't saving American lives, but rather, opening up the economy as rapidly as possible—public health consequences be damned.
This branch of the discussion is about changing blue state policies, like mask mandates and school closures, not vaccine uptake.
Well trodden ground here at Slow Boring. Something that's been chewed over, what, three hundred times? I get it: the partial and irritating NPIs were history's greatest crime.
People hold Biden responsible for global inflation - it’s not fair but there it is.
That’s true, but they were following, perhaps overzealously, the official federal guidance from the CDC. That guidance had a tremendous impact on policy, at least for blue states.
There's something to that, but I can't think of a plausible action Trump could have taken that would have changed blue state policies.
I suspect that any non-Trump president would have at least explored some coordination of NPIs. It is obvious that states with open borders running completely autonomous semi-lockdowns is a recipe for failure. It really was a situation that required the one thing most lacking in the Trump presidency, strong leadership.
Be that as it may, it would only be a positive from the perspective of NPI supporters. BZC is saying that Trump is responsible for blue state mask mandates and school closures, which is what I'm responding to.
That claim is obviously silly and I am not attempting to make it sound less-so. I am making a very narrow and specific claim. I am not certain that someone could have successfully organized the states to act in concert but it absolutely should have been seriously attempted.
Not acting like a crazy person early on. People forget, the country was relatively unified and he had the highest approval of his presidency pre press conference meltdown.
How many people were actually tracking what Fauci said from day-to-day, rather than absorbing vibes second-hand from their ideological fellow travelers? This critique always seemed to me to assume that everyone has the same media diet.
It coud have helped in blue states, too, but at least we coud have avoided a lot of economic harm in red states.
>And yet he gets zero blame even though he was the guy in charge.<
He pulled off the neat trick of going to war with his own government—he somehow managed to make himself look like the (not so) Loyal Opposition.
I think we just gotta attribute this to some fundamental differences in the electorate. The way this stood out to me egregiously was that during the campaign, Harris would talk about what her plans were and get pilloried with comments such as, "You're in power NOW, why aren't you doing any of this???", completely ignoring the historically pretty well-known fact that VPs are, uh, cartoonishly powerless.
(I'm not cutting her slack here, it cuts both ways, running as a sitting VP when times are good also affords one credit they also most likely do not deserve.)
But Trump was still somehow running as an outsider despite having already had the chance to do the things he is proposing. The comedian Theo Von, who interviewed Trump prior to the election, had on fellow comedian Stavros Halkios (who is disdainful of ALL politicians, but is certainly of the left) the other day, and was saying that he voted for Trump because he represented something different, someone who might change things, and Halkios was laughing at him and said something to the effect of, "what are you talking about?!? He was already President before!"
Clip here, should start at the timestamp. He also stomps on Vance, which is fun.
https://youtu.be/4KBQaT_DYzg?si=IDFTfRrIEbQZ5wF2&t=6813
Some of it is attributable to differences in the electorate, yes, but Trump really did literally go hard against much of his own government's (that is, the United States Government's) efforts to battle a public health crisis. And I strongly suspect it helped him in 2020 and in 2024 with at least some cohorts (if not on net in 2020), by increasing his support among working class Americans for whom forced unemployment (yes, even with fat checks) was highly stressful and unpleasant. And those memories were still fresh for many two weeks ago. It's not hard for me to believe the GOP's inroads among young Hispanic men, for instance, were given a nice boost by Trump's seizure of the "Let's get America back to work" brand. Many working class Americans saw Trump as championing their right to earn a paycheck and resume their lives. Which, of course, in a large sense he was.
We might be talking to different people then, because I know people who voted for him specifically because they got big checks and *didn't* have to work.