In defense of Rochelle Walensky

Biden's CDC has done the right thing — they say true things about public health

A recent profile of CDC Director Rochelle Walensky by the New York Times’ Apoorva Mandavilli recapitulated criticisms of her decision-making around masks and vaccinations that had previously circulated pretty widely online.

I want to stand up for Walensky, who I think did basically the right thing for basically the right reasons. The specific controversy is important, but I also think Walensky is tracing out a sounder and more appropriate role for the CDC in American life. I also think Mandavilli’s attitude in this regard is typical of a lot of the coverage she’s done in her influential role at the NYT, which is to just to kind of default to doomerism about everything.

The basic contour of the fight here is that after a few months of paralysis during the Trump/Biden transition, Walensky had the CDC say that there’s no reason vaccinated people need to wear masks. That, in turn, inspired several states to lift mask mandates and several national chains to say that vaccinated people no longer had to wear masks in their stores. Since you cannot tell by looking at someone whether or not they are in fact vaccinated, a store adopting that policy will, in practice, be allowing unvaccinated people to enter maskless. Many people, with some reason, felt that a shift to de facto masklessness was a little premature. But then many of those people, much less reasonably, felt that Walensky should not have made accurate statements about the pointlessness of the vaccinated keeping their masks on.

I don’t think that’s right. Walensky’s view that the CDC should provide accurate scientific and medical guidance is preferable to the idea that the CDC should try to manipulate the political system through bank shots.

It’s true that Greg Abbott and some other governors probably lifted their mask mandates a bit too soon. But the reasoning for keeping a mandate in place — lots of people haven’t yet had the chance to go through the vaccination process so we need to hold our horses a bit — was perfectly clear. Abbott and other Republicans rejected it for general political reasons, and there’s little reason to believe the CDC Director trying to work the system would have altered their calculus.

But beyond that, I’m just not even sure that the bank shot psychology analysis was right. Masks were a great tool in 2020 when we didn’t have vaccines. But now we do have vaccines, which are a much better tool. There’s a weird floating discourse where “taking Covid seriously” means something like “clinging to the behaviors of late-April 2020” when it ought to be “vaccinate, vaccinate, vaccinate.” What Walensky said — and what’s true — is that the vaccines are really good. If you’re worried about Covid, you should get vaccinated. And if you’re vaccinated, you shouldn’t worry.

Greg Abbott bent the curve

Now here I do want to be clear on something.

My view is that Greg Abbott jumped the gun by lifting the mask mandate on March 2. At the same time, I think blue states that still have masking rules in place are being too sluggish. Here’s how I would have advised a governor to handle it. First, you pick the date when all eligibility restrictions will be lifted for vaccine availability. Then you go forward eight weeks from that date. Then you say “vaccinations will be available to everyone on Day X, and then 56 days later we are lifting the rules, so go get vaccinated.” Then it’s all hands on deck to make sure the vaccine is widely accessible. Night and weekend clinics, that sort of thing.

I think my plan appropriately strikes the balance between the idea that people working in stores shouldn’t be exposed to Covid by maskless, unvaccinated customers, and normal people — including people who “take the virus seriously” — find mask mandates annoying and want to get rid of them.

Abbott went too soon by that standard. You had workers getting sprayed by thoughtless people’s aerosols before they had a chance to vaccinate.

But I also do think people should read Abbott’s case for his step:

The Governor noted that Texas has a surplus of personal protective equipment and can perform over 100,000 COVID-19 tests a day. The state has invested in a variety of anti-body therapeutic drugs that have kept thousands of Texans out of hospitals. Texans have also adopted daily habits that reduce the risk of COVID-19 exposure and infection. More than 2.5 million Texans who were lab confirmed for COVID-19 have recovered since the beginning of the pandemic, and experts note the total number of Texans who have recovered from COVID-19 is likely 4-5 times that amount. The number of active COVID-19 cases is the lowest since November—meaning more Texans are recovering from COVID-19 than contracting it.

The order also included a clause stating “if COVID-19 hospitalizations in any of the 22 hospital regions in Texas get above 15% of the hospital bed capacity in that region for seven straight days, a County Judge in that region may use COVID-19 mitigation strategies.”

This is a different logic than the logic I used. But note that it is very similar to the logic of bending the curve and raising the line that was in style among public health journalists last spring.

I think one of the things that broke the collective mind of the United States last year was that public health thought-leaders pressed for this curve-bending strategy but then kind of quietly abandoned it without telling anyone. But to my eye, what basically every red state (with the exception of outlier irresponsible South Dakota) did was follow the logic of the original curve-bending philosophy. The goal of the policy was not to reduce Covid transmission to zero or to avoid all deaths. It was to ensure that all Covid cases could be treated in the hospital to prevent the case fatality rate from spiking. I was critical of bend-the-curve mania back in Spring 2020 when it was all the rage among liberals, and so I agree that Abbott’s approach to reopening was too aggressive.

But that’s all he and other Republican governors were doing with the mask mandate. Even in conservative areas we have high vaccination rates among the elderly. That means you can sustain a genuinely very high caseload without crashing your hospitals. So the red states opened up.

The CDC couldn’t have stopped this

If there were some federal agency with the authority to institute a national mask mandate, I think it would have been entirely reasonable for Biden to direct that agency to issue such a mandate and to keep it in place longer than Abbott thought appropriate. But there isn’t.

And the underlying premise of Walensky’s critics is that had she pretended it is critically important to public health for vaccinated people to keep wearing masks, this would have somehow tricked Abbott into not issuing his order, which is insane. It’s just the opposite. Given the high level of polarization and insanity around everything, the CDC needs to jealously horde its credibility. And note that Abbott, like most Republican governors, has been promoting vaccination.

The people who feel so confident that they could have threaded a perfect bank-shot of mask/vaccine rhetoric to keep the mandates in place longer if they were in Walensky’s shoes aren’t seeing the whole field. If the CDC was running around saying “no, you need to keep wearing your mask even if you’re vaccinated,” would that have spurred even more anti-vax agitation? Would it have undermined the state/federal cooperation on vaccine distribution?

I think the odds of backfiring are decently high. At a minimum, there is an element of uncertainty.

And it’s precisely the uncertainty that militates in favor of technical experts trying to stick to their expertise. We famously had a huge early pandemic fiasco where public health officials didn’t want to say “we don’t want the public hoarding surgical masks because we need them for hospitals,” so instead you got tremendous hand-waving and bogus explanations for why masks would be useless to the general public. What the experts didn’t know is that apparently, it’s pretty easy to make a cloth mask. There’s no particular reason a medical doctor would or should know this fact about textile manufacturing, but that’s precisely why it’s useful for people to voice their actual expert opinion.

“Dr. So-and-So says he’s afraid of running out of procedure masks” is information that people who are knowledgable about textile manufacturing, but don’t know anything about the national supply of surgical masks, can put to use on their own. But you have to say what you mean.

A clear statement, like the one that Walensky made, lets politicians make policy decisions that are informed by the facts rather than assuming they know the right policy decision and then trying to rationalize the facts in accordance with the policy.

Blue states aren’t as hardcore as they think

I’ve seen some folks get a little too cute with the scatterplots and try to argue that the more restrictive states haven’t been any more successful at all in curbing Covid. That is pretty clearly wrong, and an artifact of the extreme severity of the early outbreak in the NY/NJ/CT area where the virus spread rapidly before countermeasures were in place.

What is true, though, is that the impact of Covid restrictions has been modest.

I think some conservatives have convinced themselves, contrary to the facts, that Texas and Florida did just as well as California with the virus. The truth is more boring. On a per-capita basis, Florida had 8% more deaths and Texas had 12%. That is not nothing. But Texas’ motor vehicle fatality rate is 37% higher than California’s and Florida’s is 63% higher. I have no idea what accounts for those gaps. But whatever it is, we manage to not be having entrenched culture war fights about it.

All of which is just to say that the sign on the correlation for blue state Covid policy seems to be correct, but the magnitude of the difference is small relative to the amount of passion that went into the debate.

So why is that? I think the biggest reason is that in practice, the actual enforcement of all these rules was very lax. I don’t really mind that when I ride Metro these days I see lots of people breaking mask rules, but the handful of times I was on transit pre-vaccination I also saw people breaking mask rules. D.C. had all kinds of quarantine rules for travelers in place (my wife even made me follow them when I went to Austin for the Joe Rogan Experience) but absolutely no enforcement of that. And most of all, even though there was some kind of rule against in-home gatherings, the cops were not busting up house parties, and it seemed weirdly taboo to even discuss them even though it was clearly happening.

I find it very understandable that Mayor Bowser did not want to send the MPDC to bust up in-home gatherings or try to forcibly quarantine travelers. I think that would have been a hard sell even in the policing politics of 2011. After Michael Brown and George Floyd, there’s just no way. And even a non-enforced rule can have some value — I think telling people on transit to wear masks led to more mask-wearing than the absence of a rule would have, even though enforcement was weak.

But in practice, the policy distance between “strict rules that we don’t enforce” and “weak rules but most people try to be cautious” is not nearly as great as the political fighting would imply. And a lot of the dialogue on “do Covid mitigation measures work?” has, I think, failed to properly distinguish between the measures and the policies.

Lots of people in the red states avoided indoor gatherings, wore masks, and otherwise behaved cautiously. And lots of people in the blue states went to house parties or family Christmas gatherings, and others behaved incautiously. In China they were welding people’s doors shut, and all throughout Asia the virus was suppressed with stern measures like mandatory centralized quarantine, not “the restaurant is closed, let’s go hang out at your friend’s place.”

Accurate information is very helpful

In other words, in practice, basically everyone’s safety was governed more by their personal labor market conditions, family situation, and personal choices than by their governor’s policies. It was here, though, that the Trump-era CDC utterly failed on the level of “equip people with accurate information.”

The cloth masks were a great stopgap during the spring mask shortage. But the public messaging on masks never moved up the pipeline from “wear any mask you can get” to “wear a really good mask.” When Trump himself briefly flirted with being a good mask-wearer, he had a cloth one. The CDC never gave people good information about this. Nor did they give people good information about buying quality HEPA filters for their stores, restaurants, or homes. Basic ideas like “we don’t think you should have people over to your house, but if you do open a window and wear a sweater” weren’t out there.

And of course, I can hear people yelling “if you suggest opening the windows that will only encourage house parties.”

But will it? I don’t think we really know. There was a lot of discourse about experts and “the science” in the neighborhood of the pandemic, but the great difficulty of a novel pathogen outbreak is you don’t really have any such thing as an experienced SARS-Cov-2 expert. Everyone is trying to figure it out. Under the circumstances, making clear factual statements and updating them in accordance with new information is probably the best you can do. Trying to rope in other domains of knowledge really serves to increase the extent to which things can misfire.

A lot of people have constructed a kind of weird dichotomous mindset in which “Donald Trump” was one thing and “public health officials” were another. But that’s wrong. Up until January 20, 2021, the public health officials were part of a federal executive branch that Trump headed. He, in some sense, favored some kind of curve-bending, harm reduction approach to national policy. But not only did he never get the government’s ducks in a row about articulating harm reduction ideas, he personally disseminated tons of misinformation about masks, hydroxychloroquine, Regeneron, and everything else under the sun.

A return to normalcy

The Biden administration, in a good way, has not simply been the carbon copy inverse of Trump on Covid.

Biden, for example, did not reverse Trump’s efforts to get K-12 public schools to reopen this spring. He tried to lower the temperature and be more of a nudger than a yeller, calculating (reasonably I think) that a measured approach would generate more actual schooling. He’s not running around talking about “the China virus,” but he is initiating stepped-up inquiries into Covid’s origins. And his CDC Director is trying to emphasize to people how good the vaccines are and how if you take them you don’t need to worry anymore, rather than saying that the opposite of Covid denialism is some kind of deranged maximum panic.

I think that all of that is good. And in fact, it’s in line with Biden’s larger promise to bring back a sense of normalcy to America. Which is to say don’t counter Trump’s zaniness with equal and opposite zaniness, counter it by being measured and normal.

To the extent that I have any criticism of Biden’s handling of this is that I think he should be more aggressive at pushing the vaccines along the normalization chain. If we are very confident in the vaccines, and absolutely every expert seems to be, then they should have full FDA authorization rather than Emergency Use Authorization. If they are fully authorized, then the vaccine makers can run ad campaigns on their behalf. That means you don’t need to appeal to LeBron James out of the goodness of his heart to record a PSA for Pfizer, you can do what anyone else who wants LeBron to advertise their product does and pay him money. Then Moderna could pay Trump to do one. And we’d have a blue vaccine and a red one and we could make polarization work for us. With full authorization, you could also make it mandatory in the military and other places like that.

But beyond that, they have basically done the right thing — sorted out logistical snags, scaled up vaccine production, made them widely available, and tried to encourage blue America to shake off its cobwebs and recognize that the vaccines are really good. That’s what Walensky did, and she was right.