Matt, I've really appreciated reading Slow Boring--I've never paid for a newsletter before and have never been so satisfied with a purchase before.
I have a question following this article. What is your take on the WHO and in particular its early claim that asymptomatic carriers didn't exist? I get that anti-globalist Republicans made hay out of this for their own gain, but it really seems like in this case... they were right? That the WHO really just caved to China? And if they did, what IS the future of the WHO? As a globalist, I'd love to be proven wrong, but it feels hard to defend the WHO now.
This piece perfectly synthesizes what I also saw. This earned my subscription, which I guess you can use to purchase an extra latte a month while on your new yacht :-D
Whenever you try to mix capitalism with public health you’re going to get a bad result, even if you wanted to do the right thing, wear a mask and stay home, you had to go out to earn money, yeah, a lot of people were able to work from home, but a lot more people weren’t.
What blew my mind when I heard about it was that from day one the CDC mandated putting masks on suspected cases of COVID (or really any upper respiratory disease) because they have always thought it decreased spread. So you figure out why, if the source wearing a mask has some sort of preventative effect, why putting a mask on others wouldn't also be helpful?
I am shocked that the US hasn't been able to roll out near N95 masks to the general population. It's a real shame. Then again, many wouldn't wear them as they're generally not comfortable.
Let us be honest Matt: the answer is RACISM. Western elites believe that their healthcare experts are inherently superior to Asian countries and ignored the obviously-better Asian handling of the pandemic because white people ideas must be smarter because we're white and rich and what could those asians possibly have to teach our superior rich white brains?
Yeah, I have to agree with Drew...I think the bigger problem is our almost total lack of interest in critically examining what works in other countries. Health care surely is near the top of that list. Maybe there's a sprinkling of racist stereotypes or bad premises if they are bad in fact (i.e only Asians would be willing to wear masks in public...sort of right, sort of wrong!).
Maybe? In general, the US is skeptical of experts from other countries - not clear to me that we're more likely to listen to white experts from Finland or Germany than asian experts from Korea.
That said, there *were* lots of "Oh, yeah, <x> works in Asia, but it would never work here" takes that were pretty clearly based on racist stereotypes.
I am happy to hear the Biden campaign's message of listening to experts works politically, but I do find the increasing tendency of democratic party politicians to abdicate decision making responsibility to experts a bit concerning. Experts are great for producing data based statements about what is likely to be true and degrees of uncertainty, but I am not so sure we should trust their advice on thing that are not clearly based on data. This mask issue makes the point very clearly. Experts became worried that advocating masks would cause shortages, but this relied on a public health expert to make predictions about social and economic response of the population to their statements, which is a phenomenon well outside of their range of expertise. I hope that politicians seriously consider this type of limitation on expert advice, weight the evidence and come to their own decision that they are accountable to.
I don't think the public health people were only thinking about shortages. At that time I was being told by doctors I know that masks were genuinely harmful for normies and only good for doctors, because only doctors had practiced the special putting on mask techniques and you'd just rub virus all over your eyes if you tried it.
They were wrong of course, but they really believed it.
It seems to me there is much that is good in this post. I'm definitely a fan of post-mortems that emphasize improvement over recriminations.
However it also elides some key questions:
- after the initial mistakes, how much do our ongoing problems stem from the politicization of masks by trump (vs. lingering aftereffects of the early communications discussed here)? I still suspect that trump is the predominate factor--though the early failure was certainly a serious matter.
- more generally, granted the public-health community (especially its official manifestations) made serious errors, to what extent can they be attributed to failures of political leadership before and during the crisis? In other words, trump specifically and the GOP more generally are congenitally anti-science, anti-expert, anti-government. They did not prioritize pandemic preparations or response either before COVID or at onset. They've likely made public-health an undesirable and toxic place to work. (I liken it to FEMA in the pre-Katrina days--a place to downsize and to dump cronies, which I think contributed to the failed crisis response in that case.) So: how much better would a properly led public-health system have responded? James Fallows, for example, has argued that this was a big deal.
- one other big question is the extent to which pernicious aspects of American culture made an effective response impossible (thus letting trump, in some sense, "off the hook"). In general I don't think American society would have been incapable of responding to this disease effectively--I don't think an iron law said Americans would rebel against masks "because freedom." However it does seem likely that in the current political climate, and with the anti-science bent of the GOP and right-media, even absent trump the epidemic response would still have been instantly politicized in ways that made it impossible to get more than 60% of the population to do anything.
Thank you for writing this series on the US public health response to the pandemic. If I might be so bold as to suggest two more questions to investigate:
1. Did the CDC or any state and local health departments have plans prepared for random sampling of the population for infection (as a function of the available testing capacity), as is being done in the UK? Do we have random sampling studies going on now? Along the same lines, were there any plans ready for wide-scale testing and tracing?
2. Did the CDC or any state and local health departments have epidemiological forecast models like the one from Imperial College (which is, of course, not without its flaws)? When Nancy Messonnier said on February 25th, "Disruption to everyday life might be severe", what was her statement based on? Likewise, when Dr. Fauci said in early March, "If you're a healthy, young person, if you want to go on a cruise ship, go on a cruise ship", did he just make an informed guess or was he using some sort of combination of data and a model?
A large, confounding problem about the Trump years: people paid way more attention to ways the government was functioning, poorly, and laid those complaints at the feet of Donald Trump.
In some cases, warranted. In other cases, it was just how things had been and we hadn't found a resolution or cleared out the cobwebs. A couple that come to mind: refugee policies and an inability to guarantee a fast hearing; military inability to provide a coherent strategy for Afghanistan; the general mismanagement of the VA; state-level election administration; local police over-militarized and unaccountable; ICE being similar.
Unfortunately, I am afraid that Trump will be the sin eater for our federal government. It's hard to unwind four chaotic years and properly bucket problems so that we can focus on things uniquely related to Trump vs. problems longstanding in our poor administrative approach. COVID and public health may be another victim in this saga. Simple, incorrect ideas can be very hard to dislodge.
Part of the problem is there just isn't a bright line between Trump Problems and Not Trump Problems. For instance, a sclerotic bureaucracy was the proximate cause of the testing bottlenecks early in the crisis, but it is not a co-incidence that the country where the leader explicitly did not want more tests screwed up its testing system.
Similarly, our Afghanistan (and Syria) strategy's continued incoherence has a lot to do with the fact that despite Trump wanting out and not really caring at all about the humanitarian and credibility concerns that stayed Obama's hand, he and his appointees are too incompetent to do anything more than issue snap withdrawal orders, rather than force the military to generate a sane withdrawal plan.
Yeah, they did nothing to help. The only positive may be convincing oppositional people care more about these issues. For the intervening 4 years, they were just throwing sand into the gears of a slow machine. It's just problematic that people can focus on Trump when they think of how bad these last 4 years were, and in some cases, it's the wrong place to put your psychological effort.
Also, in case it's not clear. Trump is an incompetent, lazy fool of the highest order. He had no business as the boss of anything larger than a family business (and he is not great at that). I only make the point because I want us to be clear-eyed about the struggles we'll have moving forward, regardless of who is in charge.
I'm not sure that the comparison between the US and Europe as a monolithic whole is that useful. The Europe numbers are driven by France/Italy/Spain, none of which are shinning examples of public policy implementation or functional governance. They also are countries with lower GDP per capita (~2/3rds of the US). Germany is a much better analogue (western democracy, wealthy, relatively diverse, large) and they, even after a recent surge, are running at about a quarter of the deaths per capita as the US. It's not a perfect framework, but I kind of see the difference between the US and Germany/Canada as the "Trump Penalty", i.e. where the US could have been had our response been rational and consistent, and where we are. Obviously countries like Vietnam and Taiwan have done even better, but by utilizing policies that it was probably not realistic to think that the US would ever implement. I also think that the comparison of the US to EUR highlights one of the key elements of the dysfunctionality of the US federal response. We acted like Europe, a loose conglomeration of smaller independent countries, with independent governments and relatively porous borders, rather than a single country with a consistent coherent response and access to tremendous resources.
IDK, I think a lot of this can be explained by the fact that we didn't realize the importance of asymptomatic transmission. The thinking was, "If you're healthy, a mask doesn't protect you. If you're sick, better to just stay home." This is true as far as it goes. Only a properly-fitted N95 or better is able to provide significant protection from others' droplets, and without training people don't even use N95s well enough. If you are sick, you should isolate rather than going out and relying on a mask. Of course this logic overlooks asymptomatic transmission. Funnily enough, this would have been reasonable advice for SARS, which has negligible asymptomatic transmission.
IMO, successes abroad are better attributed to actual lockdowns, centralized quarantine, and robust contact tracing than to early mask adoption. For instance, I don't think everyone in New Zealand was walking around masked in early March.
I’ve been thinking about the failures of public health officials a lot in the past few weeks and, although it doesn’t excuse a lot of this, a clear issue at play here was the lack of top level leadership synthesizing information from different subject area experts and basing messaging and policy on that. Instead lots of stuff fell to public health officials that really shouldn’t have.
One place where I think we can clearly blame politicians more than public health exerts is the grounds on which restrictions were explained. You don't go to the office because you can infect other people there and on the way. And things that were closed down were closed or restricted not because they were less "essential" (that just fed the churches/bars dichotomy that right-wingers loved) but because they could not be made safe. From the beginning part of the case for Congressional aid to states and local governments should have been to fund investments that made schools and businesses safer. Why not have used the infamous PPP to fund making it safer for firms to remain open?
Nevertheless, the economic damage that is attributed to "lockdowns" is vastly overestimated because it it is voluntary hesitance to go out much more than government restrictions that have hammered travel, hospitality, and bricks and mortar retail.
Matt -- I understand your point about the missteps made by our public health community during the pandemic. However, I feel that the lessons of our experience are pretty clear. If we're faced with this again, we're screwed if we don't impose immediate/draconian travel restrictions (anyone coming into the country goes into mandatory quarantine at centers run by the federal government for two weeks) followed by aggressive contact tracing/testing to contain any outbreaks from people who entered prior to the travel ban. Better mask wearing, social distancing, etc. will definitely reduce the number of people who die, but the numbers will still be massive -- and the impact to the economy will be just as great. I hope I'm missing something here, because I have zero confidence that we'll take these sorts of steps the next time. Any thoughts?
Matt, I've really appreciated reading Slow Boring--I've never paid for a newsletter before and have never been so satisfied with a purchase before.
I have a question following this article. What is your take on the WHO and in particular its early claim that asymptomatic carriers didn't exist? I get that anti-globalist Republicans made hay out of this for their own gain, but it really seems like in this case... they were right? That the WHO really just caved to China? And if they did, what IS the future of the WHO? As a globalist, I'd love to be proven wrong, but it feels hard to defend the WHO now.
This article is why I pay for this content.
This piece perfectly synthesizes what I also saw. This earned my subscription, which I guess you can use to purchase an extra latte a month while on your new yacht :-D
Whenever you try to mix capitalism with public health you’re going to get a bad result, even if you wanted to do the right thing, wear a mask and stay home, you had to go out to earn money, yeah, a lot of people were able to work from home, but a lot more people weren’t.
What blew my mind when I heard about it was that from day one the CDC mandated putting masks on suspected cases of COVID (or really any upper respiratory disease) because they have always thought it decreased spread. So you figure out why, if the source wearing a mask has some sort of preventative effect, why putting a mask on others wouldn't also be helpful?
I am shocked that the US hasn't been able to roll out near N95 masks to the general population. It's a real shame. Then again, many wouldn't wear them as they're generally not comfortable.
Let us be honest Matt: the answer is RACISM. Western elites believe that their healthcare experts are inherently superior to Asian countries and ignored the obviously-better Asian handling of the pandemic because white people ideas must be smarter because we're white and rich and what could those asians possibly have to teach our superior rich white brains?
It makes me (a white guy) boiling mad.
Yeah, I have to agree with Drew...I think the bigger problem is our almost total lack of interest in critically examining what works in other countries. Health care surely is near the top of that list. Maybe there's a sprinkling of racist stereotypes or bad premises if they are bad in fact (i.e only Asians would be willing to wear masks in public...sort of right, sort of wrong!).
Maybe? In general, the US is skeptical of experts from other countries - not clear to me that we're more likely to listen to white experts from Finland or Germany than asian experts from Korea.
That said, there *were* lots of "Oh, yeah, <x> works in Asia, but it would never work here" takes that were pretty clearly based on racist stereotypes.
I am happy to hear the Biden campaign's message of listening to experts works politically, but I do find the increasing tendency of democratic party politicians to abdicate decision making responsibility to experts a bit concerning. Experts are great for producing data based statements about what is likely to be true and degrees of uncertainty, but I am not so sure we should trust their advice on thing that are not clearly based on data. This mask issue makes the point very clearly. Experts became worried that advocating masks would cause shortages, but this relied on a public health expert to make predictions about social and economic response of the population to their statements, which is a phenomenon well outside of their range of expertise. I hope that politicians seriously consider this type of limitation on expert advice, weight the evidence and come to their own decision that they are accountable to.
I don't think the public health people were only thinking about shortages. At that time I was being told by doctors I know that masks were genuinely harmful for normies and only good for doctors, because only doctors had practiced the special putting on mask techniques and you'd just rub virus all over your eyes if you tried it.
They were wrong of course, but they really believed it.
It seems to me there is much that is good in this post. I'm definitely a fan of post-mortems that emphasize improvement over recriminations.
However it also elides some key questions:
- after the initial mistakes, how much do our ongoing problems stem from the politicization of masks by trump (vs. lingering aftereffects of the early communications discussed here)? I still suspect that trump is the predominate factor--though the early failure was certainly a serious matter.
- more generally, granted the public-health community (especially its official manifestations) made serious errors, to what extent can they be attributed to failures of political leadership before and during the crisis? In other words, trump specifically and the GOP more generally are congenitally anti-science, anti-expert, anti-government. They did not prioritize pandemic preparations or response either before COVID or at onset. They've likely made public-health an undesirable and toxic place to work. (I liken it to FEMA in the pre-Katrina days--a place to downsize and to dump cronies, which I think contributed to the failed crisis response in that case.) So: how much better would a properly led public-health system have responded? James Fallows, for example, has argued that this was a big deal.
- one other big question is the extent to which pernicious aspects of American culture made an effective response impossible (thus letting trump, in some sense, "off the hook"). In general I don't think American society would have been incapable of responding to this disease effectively--I don't think an iron law said Americans would rebel against masks "because freedom." However it does seem likely that in the current political climate, and with the anti-science bent of the GOP and right-media, even absent trump the epidemic response would still have been instantly politicized in ways that made it impossible to get more than 60% of the population to do anything.
Thank you for writing this series on the US public health response to the pandemic. If I might be so bold as to suggest two more questions to investigate:
1. Did the CDC or any state and local health departments have plans prepared for random sampling of the population for infection (as a function of the available testing capacity), as is being done in the UK? Do we have random sampling studies going on now? Along the same lines, were there any plans ready for wide-scale testing and tracing?
2. Did the CDC or any state and local health departments have epidemiological forecast models like the one from Imperial College (which is, of course, not without its flaws)? When Nancy Messonnier said on February 25th, "Disruption to everyday life might be severe", what was her statement based on? Likewise, when Dr. Fauci said in early March, "If you're a healthy, young person, if you want to go on a cruise ship, go on a cruise ship", did he just make an informed guess or was he using some sort of combination of data and a model?
A large, confounding problem about the Trump years: people paid way more attention to ways the government was functioning, poorly, and laid those complaints at the feet of Donald Trump.
In some cases, warranted. In other cases, it was just how things had been and we hadn't found a resolution or cleared out the cobwebs. A couple that come to mind: refugee policies and an inability to guarantee a fast hearing; military inability to provide a coherent strategy for Afghanistan; the general mismanagement of the VA; state-level election administration; local police over-militarized and unaccountable; ICE being similar.
Unfortunately, I am afraid that Trump will be the sin eater for our federal government. It's hard to unwind four chaotic years and properly bucket problems so that we can focus on things uniquely related to Trump vs. problems longstanding in our poor administrative approach. COVID and public health may be another victim in this saga. Simple, incorrect ideas can be very hard to dislodge.
Part of the problem is there just isn't a bright line between Trump Problems and Not Trump Problems. For instance, a sclerotic bureaucracy was the proximate cause of the testing bottlenecks early in the crisis, but it is not a co-incidence that the country where the leader explicitly did not want more tests screwed up its testing system.
Similarly, our Afghanistan (and Syria) strategy's continued incoherence has a lot to do with the fact that despite Trump wanting out and not really caring at all about the humanitarian and credibility concerns that stayed Obama's hand, he and his appointees are too incompetent to do anything more than issue snap withdrawal orders, rather than force the military to generate a sane withdrawal plan.
Yeah, they did nothing to help. The only positive may be convincing oppositional people care more about these issues. For the intervening 4 years, they were just throwing sand into the gears of a slow machine. It's just problematic that people can focus on Trump when they think of how bad these last 4 years were, and in some cases, it's the wrong place to put your psychological effort.
Also, in case it's not clear. Trump is an incompetent, lazy fool of the highest order. He had no business as the boss of anything larger than a family business (and he is not great at that). I only make the point because I want us to be clear-eyed about the struggles we'll have moving forward, regardless of who is in charge.
I'm not sure that the comparison between the US and Europe as a monolithic whole is that useful. The Europe numbers are driven by France/Italy/Spain, none of which are shinning examples of public policy implementation or functional governance. They also are countries with lower GDP per capita (~2/3rds of the US). Germany is a much better analogue (western democracy, wealthy, relatively diverse, large) and they, even after a recent surge, are running at about a quarter of the deaths per capita as the US. It's not a perfect framework, but I kind of see the difference between the US and Germany/Canada as the "Trump Penalty", i.e. where the US could have been had our response been rational and consistent, and where we are. Obviously countries like Vietnam and Taiwan have done even better, but by utilizing policies that it was probably not realistic to think that the US would ever implement. I also think that the comparison of the US to EUR highlights one of the key elements of the dysfunctionality of the US federal response. We acted like Europe, a loose conglomeration of smaller independent countries, with independent governments and relatively porous borders, rather than a single country with a consistent coherent response and access to tremendous resources.
IDK, I think a lot of this can be explained by the fact that we didn't realize the importance of asymptomatic transmission. The thinking was, "If you're healthy, a mask doesn't protect you. If you're sick, better to just stay home." This is true as far as it goes. Only a properly-fitted N95 or better is able to provide significant protection from others' droplets, and without training people don't even use N95s well enough. If you are sick, you should isolate rather than going out and relying on a mask. Of course this logic overlooks asymptomatic transmission. Funnily enough, this would have been reasonable advice for SARS, which has negligible asymptomatic transmission.
IMO, successes abroad are better attributed to actual lockdowns, centralized quarantine, and robust contact tracing than to early mask adoption. For instance, I don't think everyone in New Zealand was walking around masked in early March.
I’ve been thinking about the failures of public health officials a lot in the past few weeks and, although it doesn’t excuse a lot of this, a clear issue at play here was the lack of top level leadership synthesizing information from different subject area experts and basing messaging and policy on that. Instead lots of stuff fell to public health officials that really shouldn’t have.
One place where I think we can clearly blame politicians more than public health exerts is the grounds on which restrictions were explained. You don't go to the office because you can infect other people there and on the way. And things that were closed down were closed or restricted not because they were less "essential" (that just fed the churches/bars dichotomy that right-wingers loved) but because they could not be made safe. From the beginning part of the case for Congressional aid to states and local governments should have been to fund investments that made schools and businesses safer. Why not have used the infamous PPP to fund making it safer for firms to remain open?
Nevertheless, the economic damage that is attributed to "lockdowns" is vastly overestimated because it it is voluntary hesitance to go out much more than government restrictions that have hammered travel, hospitality, and bricks and mortar retail.
Matt -- I understand your point about the missteps made by our public health community during the pandemic. However, I feel that the lessons of our experience are pretty clear. If we're faced with this again, we're screwed if we don't impose immediate/draconian travel restrictions (anyone coming into the country goes into mandatory quarantine at centers run by the federal government for two weeks) followed by aggressive contact tracing/testing to contain any outbreaks from people who entered prior to the travel ban. Better mask wearing, social distancing, etc. will definitely reduce the number of people who die, but the numbers will still be massive -- and the impact to the economy will be just as great. I hope I'm missing something here, because I have zero confidence that we'll take these sorts of steps the next time. Any thoughts?