I am not sure how much blame we should put on public health officials vs politicians. I just think of all those politicians who have exposed for breaking the own rules. The Austin mayor telling people not to see their family for thanksgiving while at Mexican vacation spot.
American and European politicians seems too weak and decadent to take the necessary steps to combat this pandemics. Even after they gained access to proper information about the viruses, they didn't take the successful measures that Asian and Australia did. Instead they only harped on about mask, while reopening in door bars and dining. Instead, they should have closed all airports for nothing but essential travel. Like Australia, they should quarantine entire cities whenever they were any cases in said city, preventing nonessential workers from entering or leaving. If they should have opened schools at any time, they should have opened them in the summer when outdoor classes were possible and cases were significantly lower. They should have forced anyone who was exposed to covid to quarantine with their family in a government run quarantine hotel. Masks are extremely helpful but American politicians treated them as a magic bullet to avoid any of the harsh but truly effective measures. I
It really lowed the destroyed my esteem in whole classes of Democratic governors and mayors. Cuomo, London Breed, Gavin Newsom, Lori Lightfoot, etc .They all talked a good game but all were too cowardly and delusional to actually combat this virus. Them endorsing masks doesn't make them significantly better than Republican politicians when both classes handled covid in a failing manner. Neither party truly believes in science, they only believe in stuff that lines up with their prior beliefs, in just so happens that science is on the Democrat's side more than Republicans. But this pandemic has truly exposed that Democratic politicians adherence to science is just as disloyal as Republicans.
This strikes me as another area where the breakdown of Congress as an institution is a problem. When committees were strong, there would have been every incentive for chairs to initiate investigations of this sort of thing, but in a leadership driven Congress, the incentives are different. (Personally I’m really interested in what has gone wrong with long-term care facilities, but it sure looks like we’ll never have a reckoning with that, either.)
"Orange man bad" has been a correct take regarding basically every issue the past ~5 years, but we're unironically dumping too much of the blame on him at this point.
The lionization of Cuomo, who objectively made horrible decisions (and then wrote a book halfway through the pandemic?) is another wild thing. Fauci is another weird case where he got things very wrong and lied to the American people in a way that led to mass deaths, so the hailing of him as a hero is crazy to me.
I'd go beyond your stance regarding the after action report and say that we actually do need to engage in finger pointing. Between the foolishness about masks and the inconsistency regarding ventilation, I think heads need to roll in the public health establishment.
I'm not in charge though, and I really shouldn't be.
FYI, good masks ARE readily available, but maybe that's just because it seems no one cares. Even in the super-educated progressive multimillionaire retirement community I live in (Boulder), few people are wearing even KN95s, and I'm the only person I see wearing a P100.
But KN95s are cheap and readily available, and P100s are pretty inexpensive and available on Amazon (~$40 for mask and filters, which are reusable for the duration of the pandemic). The only thing you have to do with the P100 is tape a surgical mask over the exhalation valve, because the air you exhale isn't filtered, and you presumably want to protect others in case you're infected.
Also, it's pretty hilarious that pretty much everyone in Boulder will put on their mask for the 2 seconds while I pass them on my bicycle at a minimum distance of 6ft, but indoor dining and even bars were open (and packed!) until very recently.
I still believe that if the surgeon general's tweet was truly believed by American public health officials until early April. They really did believe they were preventing a shortage of maskes for medical workers (that were useful) by telling the public not to wear them (which they honestly believe did nothing). Apparently public health is a field where a lot of people just don't know what they are talking about. Much like a lot of other fields.
It's going to be hard to convince Americans to trust the experts when Americans have witnessed experts getting it wrong so much (i.e. the "full employment of 2015).
We had exactly the same situation in France. Experts played down the need for masks in the context of a mask shortage and out of a concern about ensuring healthcare providers got them first. The concern was legitimate; the messaging unforgivable. What would have been the problem with just being candid about the mask shortage and the need to give priority to first-line defenders? Well, experts make mistakes just like other people. Does that mean we pay no attention to them in the future? I suspect there was a lot of pressure on them from the political side which further proves the old adage that when you mix science and politics bullshit is the result.
This is all correct. However, as a Dutch person in DC I do think Americans overestimate how much worse their government response has been than in Europe. The Dutch government only started recommending mask use somewhere by the end of September after Anthony Fauci himself urgently advised the head of the RIVM (Dutch CDC) to start keeping up with the literature. Public health experts opinions are still divided about mask use; it is so strange. The Dutch were way later than the rest of Europe, but this shows that the US response has not been much worse than in Europe (yes Trump is horrible but policy in Europe was also very bad except for Germany).
South East Asia has really been so much better than the rest of the world and I really appreciated your calls to start learning from this context instead of Europe.
In Baltimore we have the curious combination where you must wear a mask outdoors at ALL times (under threat of arrest, 1 year jail/$5,000 fine) but you can dine indoors! This is something that would only make sense to someone with a doctorate in public health -- for the rest of us it's nonsensical. Fortunately, the Baltimore City Police Department is not enforcing this rule. (The link to the order can be found here https://coronavirus.baltimorecity.gov/ page 3 of the dashboard.)
Similar to air purifiers, the wide availability of KN95 masks, despite few being used by the public, seems to me like yet another public health messaging failure.
While cloth masks are much better than nothing, as I understand it, they're not nearly as good as surgical masks, and surgical masks aren't nearly as good as KN95 masks. Now that KN95 masks are widely available shouldn't this should be the standard guidance? Scott Gottlieb did some tweets about this a few months ago, but the "expert community" isn't really pushing this message, as best as I can tell.
It seems like the message now shouldn't be "wear a mask," but rather "wear a KN95 mask."
“And they should have used the Defense Production Act to ensure that good masks were widely available.”
This is my pet peeve. This long into the pandemic, we should be delivering N95 masks to Americans for free. Instead, many people are wearing useless bandanas and such.
Very good post and thanks for the information on air purifiers. We have been buying Dysons, and it looks like we have not optimized.
Trump is a convenient scapegoat to throw over the cliff. But, the numbers don't lie. The great divide between the effectiveness of the response is between East and West.
In short, in our response to Covid, we in the West have spectacularly failed the famous "marshmallow test."
I still often think about all the folks who were blindly repeating, without context, that *actually* if you improperly wear an N95 because you aren’t “trained” to use one...it’s more likely to make you sick than a regular cloth or surgical mask.
Of course the full context of that is basically that’s only true in an ER / triage setting where blood and spit is literally everywhere and you are trying to decontaminate...it has no bearing on wearing one inside a bank or school for 30 minutes at a time.
Your comment that "the actual policy choices [across states] have not been all that different and the outcomes also haven’t been different" is very important.
As the comments to this thread show, people latch onto the mask as a panacea, when studies and experience have shown a negligible effect on transmission rates. Forced quarantine, travel bans, mass and intrusive contract tracing are the only thing shown to truly work. But the masks do serve a vital purpose: to separate out the 'good' from the 'bad'. We want so desperately to blame someone for the virus and the mask (of the lack thereof) is a visual, public way to identify those who should be shunned.
In terms of effect size, I think the much more stringent lockdowns and travel bans/restrictions of Pacific nations played a larger role than masks, no? I agree with the tenor of the previous COVID failure post, that travel restrictions were really effective, and I think that's what drove the biggest difference in outcome between East and West, which the East seemed to learn from their SARS experiences.
Politically it's tough though. Any admission of mistakes by "experts" will only be laundered through the right wing propaganda echo chamber and used against those of us still engaged in reality-based politics. I hope the public health authorities learn the lessons from COVID that SARS taught Eastern nations, and god forbid we need to apply those lessons again, we do, but I don't know how much good an airing of expert failure would be.
Then again, if experts don't air their post-mortems, the right will suddenly become expert in critiquing the early response. Damned if you do, damned if you don't. It's hard when one side will say literally anything to gain an advantage.
The mask controversy was an own-goal that only fed mistrust of authority. It smacks of disinformation and cover-up. Isolation would have been the best strategy but nobody was willing to take the heat. We dramatically failed the marshmallow test and extended and exacerbated the pandemic far more than we could have.
The mask debacle, as well as the the inability or unwillingness to immediately and dramatically increase PPE production, should be in public health textbooks in 50 years as cautionary tales. Andrew Cuomo's disastrous order to send COVID19 patients into nursing homes is another epic failure that likely led to thousands of excess deaths (despite his administration's reports claiming the contrary, widely looked at by outside experts as unconvincing).
The ventilation story is another big one. When universities and K-12 school districts were holding open fora, webinars, etc leading up to the start of the academic year in the Fall (I watched several of these because I work at a university and have two school-aged kids), they prominently featured some Facilities guy talking in excruciating detail about air purifiers and ventilation. However, when they actually sent kids and teachers back into the classroom, there was deafening silence on this point as they either couldn't pull it off or just forgot about it. For my kid's middle school gym class, they walk around in a circle outside and aren't allowed to exert themselves to avoid heavy breathing. Talking is also forbidden during lunch time and everyone is at their own table. What happened to the ventilation plans!?
In the end, some universities did OK this Fall semester (including my own) because of high fidelity in terms of mask wearing, lower density populations on campus, and probably most importantly, high-quality testing regimes. For example, two tests within 2 weeks upon reentry, and then surveillance testing of everyone once a month (supplemented with symptom checks). When small outbreaks occurred, it was largely among students living off campus. Some interesting insights here:
I am not sure how much blame we should put on public health officials vs politicians. I just think of all those politicians who have exposed for breaking the own rules. The Austin mayor telling people not to see their family for thanksgiving while at Mexican vacation spot.
American and European politicians seems too weak and decadent to take the necessary steps to combat this pandemics. Even after they gained access to proper information about the viruses, they didn't take the successful measures that Asian and Australia did. Instead they only harped on about mask, while reopening in door bars and dining. Instead, they should have closed all airports for nothing but essential travel. Like Australia, they should quarantine entire cities whenever they were any cases in said city, preventing nonessential workers from entering or leaving. If they should have opened schools at any time, they should have opened them in the summer when outdoor classes were possible and cases were significantly lower. They should have forced anyone who was exposed to covid to quarantine with their family in a government run quarantine hotel. Masks are extremely helpful but American politicians treated them as a magic bullet to avoid any of the harsh but truly effective measures. I
It really lowed the destroyed my esteem in whole classes of Democratic governors and mayors. Cuomo, London Breed, Gavin Newsom, Lori Lightfoot, etc .They all talked a good game but all were too cowardly and delusional to actually combat this virus. Them endorsing masks doesn't make them significantly better than Republican politicians when both classes handled covid in a failing manner. Neither party truly believes in science, they only believe in stuff that lines up with their prior beliefs, in just so happens that science is on the Democrat's side more than Republicans. But this pandemic has truly exposed that Democratic politicians adherence to science is just as disloyal as Republicans.
This strikes me as another area where the breakdown of Congress as an institution is a problem. When committees were strong, there would have been every incentive for chairs to initiate investigations of this sort of thing, but in a leadership driven Congress, the incentives are different. (Personally I’m really interested in what has gone wrong with long-term care facilities, but it sure looks like we’ll never have a reckoning with that, either.)
You've hit the nail on the head here.
"Orange man bad" has been a correct take regarding basically every issue the past ~5 years, but we're unironically dumping too much of the blame on him at this point.
The lionization of Cuomo, who objectively made horrible decisions (and then wrote a book halfway through the pandemic?) is another wild thing. Fauci is another weird case where he got things very wrong and lied to the American people in a way that led to mass deaths, so the hailing of him as a hero is crazy to me.
I'd go beyond your stance regarding the after action report and say that we actually do need to engage in finger pointing. Between the foolishness about masks and the inconsistency regarding ventilation, I think heads need to roll in the public health establishment.
I'm not in charge though, and I really shouldn't be.
FYI, good masks ARE readily available, but maybe that's just because it seems no one cares. Even in the super-educated progressive multimillionaire retirement community I live in (Boulder), few people are wearing even KN95s, and I'm the only person I see wearing a P100.
But KN95s are cheap and readily available, and P100s are pretty inexpensive and available on Amazon (~$40 for mask and filters, which are reusable for the duration of the pandemic). The only thing you have to do with the P100 is tape a surgical mask over the exhalation valve, because the air you exhale isn't filtered, and you presumably want to protect others in case you're infected.
Also, it's pretty hilarious that pretty much everyone in Boulder will put on their mask for the 2 seconds while I pass them on my bicycle at a minimum distance of 6ft, but indoor dining and even bars were open (and packed!) until very recently.
I still believe that if the surgeon general's tweet was truly believed by American public health officials until early April. They really did believe they were preventing a shortage of maskes for medical workers (that were useful) by telling the public not to wear them (which they honestly believe did nothing). Apparently public health is a field where a lot of people just don't know what they are talking about. Much like a lot of other fields.
It's going to be hard to convince Americans to trust the experts when Americans have witnessed experts getting it wrong so much (i.e. the "full employment of 2015).
We had exactly the same situation in France. Experts played down the need for masks in the context of a mask shortage and out of a concern about ensuring healthcare providers got them first. The concern was legitimate; the messaging unforgivable. What would have been the problem with just being candid about the mask shortage and the need to give priority to first-line defenders? Well, experts make mistakes just like other people. Does that mean we pay no attention to them in the future? I suspect there was a lot of pressure on them from the political side which further proves the old adage that when you mix science and politics bullshit is the result.
This is all correct. However, as a Dutch person in DC I do think Americans overestimate how much worse their government response has been than in Europe. The Dutch government only started recommending mask use somewhere by the end of September after Anthony Fauci himself urgently advised the head of the RIVM (Dutch CDC) to start keeping up with the literature. Public health experts opinions are still divided about mask use; it is so strange. The Dutch were way later than the rest of Europe, but this shows that the US response has not been much worse than in Europe (yes Trump is horrible but policy in Europe was also very bad except for Germany).
South East Asia has really been so much better than the rest of the world and I really appreciated your calls to start learning from this context instead of Europe.
In Baltimore we have the curious combination where you must wear a mask outdoors at ALL times (under threat of arrest, 1 year jail/$5,000 fine) but you can dine indoors! This is something that would only make sense to someone with a doctorate in public health -- for the rest of us it's nonsensical. Fortunately, the Baltimore City Police Department is not enforcing this rule. (The link to the order can be found here https://coronavirus.baltimorecity.gov/ page 3 of the dashboard.)
Similar to air purifiers, the wide availability of KN95 masks, despite few being used by the public, seems to me like yet another public health messaging failure.
While cloth masks are much better than nothing, as I understand it, they're not nearly as good as surgical masks, and surgical masks aren't nearly as good as KN95 masks. Now that KN95 masks are widely available shouldn't this should be the standard guidance? Scott Gottlieb did some tweets about this a few months ago, but the "expert community" isn't really pushing this message, as best as I can tell.
It seems like the message now shouldn't be "wear a mask," but rather "wear a KN95 mask."
“And they should have used the Defense Production Act to ensure that good masks were widely available.”
This is my pet peeve. This long into the pandemic, we should be delivering N95 masks to Americans for free. Instead, many people are wearing useless bandanas and such.
Very good post and thanks for the information on air purifiers. We have been buying Dysons, and it looks like we have not optimized.
Trump is a convenient scapegoat to throw over the cliff. But, the numbers don't lie. The great divide between the effectiveness of the response is between East and West.
In short, in our response to Covid, we in the West have spectacularly failed the famous "marshmallow test."
I still often think about all the folks who were blindly repeating, without context, that *actually* if you improperly wear an N95 because you aren’t “trained” to use one...it’s more likely to make you sick than a regular cloth or surgical mask.
Of course the full context of that is basically that’s only true in an ER / triage setting where blood and spit is literally everywhere and you are trying to decontaminate...it has no bearing on wearing one inside a bank or school for 30 minutes at a time.
Your comment that "the actual policy choices [across states] have not been all that different and the outcomes also haven’t been different" is very important.
As the comments to this thread show, people latch onto the mask as a panacea, when studies and experience have shown a negligible effect on transmission rates. Forced quarantine, travel bans, mass and intrusive contract tracing are the only thing shown to truly work. But the masks do serve a vital purpose: to separate out the 'good' from the 'bad'. We want so desperately to blame someone for the virus and the mask (of the lack thereof) is a visual, public way to identify those who should be shunned.
In terms of effect size, I think the much more stringent lockdowns and travel bans/restrictions of Pacific nations played a larger role than masks, no? I agree with the tenor of the previous COVID failure post, that travel restrictions were really effective, and I think that's what drove the biggest difference in outcome between East and West, which the East seemed to learn from their SARS experiences.
Politically it's tough though. Any admission of mistakes by "experts" will only be laundered through the right wing propaganda echo chamber and used against those of us still engaged in reality-based politics. I hope the public health authorities learn the lessons from COVID that SARS taught Eastern nations, and god forbid we need to apply those lessons again, we do, but I don't know how much good an airing of expert failure would be.
Then again, if experts don't air their post-mortems, the right will suddenly become expert in critiquing the early response. Damned if you do, damned if you don't. It's hard when one side will say literally anything to gain an advantage.
The mask controversy was an own-goal that only fed mistrust of authority. It smacks of disinformation and cover-up. Isolation would have been the best strategy but nobody was willing to take the heat. We dramatically failed the marshmallow test and extended and exacerbated the pandemic far more than we could have.
The mask debacle, as well as the the inability or unwillingness to immediately and dramatically increase PPE production, should be in public health textbooks in 50 years as cautionary tales. Andrew Cuomo's disastrous order to send COVID19 patients into nursing homes is another epic failure that likely led to thousands of excess deaths (despite his administration's reports claiming the contrary, widely looked at by outside experts as unconvincing).
The ventilation story is another big one. When universities and K-12 school districts were holding open fora, webinars, etc leading up to the start of the academic year in the Fall (I watched several of these because I work at a university and have two school-aged kids), they prominently featured some Facilities guy talking in excruciating detail about air purifiers and ventilation. However, when they actually sent kids and teachers back into the classroom, there was deafening silence on this point as they either couldn't pull it off or just forgot about it. For my kid's middle school gym class, they walk around in a circle outside and aren't allowed to exert themselves to avoid heavy breathing. Talking is also forbidden during lunch time and everyone is at their own table. What happened to the ventilation plans!?
In the end, some universities did OK this Fall semester (including my own) because of high fidelity in terms of mask wearing, lower density populations on campus, and probably most importantly, high-quality testing regimes. For example, two tests within 2 weeks upon reentry, and then surveillance testing of everyone once a month (supplemented with symptom checks). When small outbreaks occurred, it was largely among students living off campus. Some interesting insights here:
https://www.wbur.org/commonhealth/2020/11/25/on-campus-testing-colleges-broad
Routine testing has been underutilized.