826 Comments

Really enjoyed this article. I do think it misses a key part of the story which is the seeming success of South East Asian, Australiasia and even European countries in supressing the virus compared to Britain and America. That really fed the narrative that the two English-speaking countries led by the hated populists had taken the virus lightly, and if we just had the common sense/determination to impose a proper lockdown then all would be well. This gets discredited as the virus spreads around Europe to the point that the UK is a middling rather than unusually bad performer, China proves to have been lying about its covid success, and other countries with the harshest lockdowns struggle to come out of them. And of course US/UK lead the world in developing and distributing vaccines. But I think in 2020 there was a real crisis of confidence in American and British science/medical communities that they had gotten this big call wrong

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As someone comparing notes in cdc vs nhs in real time I can tell you they weren’t the same. Cdc was much worse. It was consistently gaslighting the American people and losing all credibility. In general the debate in America was much more stupid and American actual level of vaccination is significantly lower than in peer countries.

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I am still pissed the CDC kept lying about surface transmission of covid even though we knew that was not a thing by May.

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I am still annoyed that a lot of fomite-based Covid rules are still in practice (QR code menus, non-functional water fountains, etc)... not to mention all those stupid permanent floor stickers nagging you to stay a magical 6 feet apart.

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The floor stickers still lingering around I'm guessing is just a matter of laziness/not wanting to pay to remove them, since they know everyone is just going to ignore them.

And I recall the QR code menus emerging before the pandemic as another cost saving mechanism. I don't like them myself but I can understand why some places are still trying to make them stick.

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The floor stickers might be harder to remove, but I still see signs up about masking (in contexts where staff are not masking) and distancing. I don't know why. But it's not a cost issue.

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If they're sticky signs stuck onto glass (which I still see a few of too), I can understand that on the same grounds as the floor stickers.

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Path dependence and laziness.

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founding

I appreciate QR code menus, because it enables me to zoom in, and to see the menu in good light, even when the restaurant is dark. If done right, it should also let the restaurant stay up-to-the-moment on which items are out of stock today.

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Oh for sure. They still bug me though, and they bugged me when they went down because it was clear they’d be stuck there for 10+ years.

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Their annoyance has been pushed out by my greater annoyance of all the increased nudges by machines to tip/donate on an increasingly higher number of purchases.

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I've heard one theory about the QR code menus is it makes it easier for restaurants to increase prices without anyone noticing, since they don't need to visually modify existing menus or order new ones every time - just update the website.

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That's the very rare conspiracy theory I can get on board with.

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Reagan pushed tax cuts so that he could indirectly subsidize the cocaine market so the CIA could fund the contras!

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Jul 10, 2023·edited Jul 10, 2023

I’ve been to a place where the qr menu was a low-quality scan of the paper menu. When I asked for the paper menu they gave me a printout of the file of the scan ie a clean paper on which was a big picture of a wrinkled old menu in low quality scan!

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Jul 10, 2023·edited Jul 10, 2023

I'd believe that if there was any evidence that restaurants actually bothered to update the pricing on their web menus -- instead a bunch of restaurants I patronize are just charging you $2 to $3 more per entrée than what the web menu claims the price is. (Likewise, most restaurants don't bother to update their electronic display menus either, in my experience -- in fact a couple near my office turned off their electronic display menus in the past year and now just have crude handwritten poster boards with prices, presumably because they couldn't be arsed to figure out how to update the display.)

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There was this Greek place that had not updated their website prices since 2008. He was cheap but not 2008 cheap.

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Those stickers are forever. The gym I joined has a “no phones in the locker room sign” with a 2002 Nokia as the clip art image.

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founding

The first time I flew after the start of covid, I saw signs in the security line warning people to watch out for Zika while traveling. In the locker room at Texas A&M there are even still a few signs warning people to watch out for swine flu.

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Although, one fomite-based Covid change I don’t mind at all: ubiquitous free hand sanitizer 🙌🏻

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The fact that fomite transmission is RELATIVELY unusual doesn't mean it doesn't exist. Other common respiratory viruses, not to mention gastrointestinal pathogens, are spread that way. Covid is so extremely transmissible through airborne particles that the amount of fomite transmission might seem trivial only by comparison.

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No no no. The *most* useless was those one-way aisles at grocery stores.

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No. Far more useless than that was the (mercifully brief) insistence at my local Trader Joe's and Safeway that you weren't allowed to bring your environmentally correct shopping bag from home. You had to switch to store-provided paper/plastic bags. Because apparently the fibers might harbor virules? (But no doubt one's clothing was assumed to be pristine!).

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Yes, my grocery store also shifted to one-way streets. The milk and dairy aisle seems to still be unofficially one-way because it somehow got burned into all of our brains

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deletedJul 10, 2023·edited Jul 10, 2023
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I was Designated Pen Cleaner for an entire eight-hour election shift. Democracy dies in darkness, you know.

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My new state started giving people paper straws to use on the touch pad. Then they kept doing that because they worked really well on the crappy touch screens.

I always enjoy my voting straw.

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To be fair, shared pens are filthy in general, so it’s not a bad idea to clean them. Maybe not for 8 hours straight, but occasionally.

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Maybe they just know their customers don’t wash their hands after wiping….

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I remember playing golf in TX during the Summer of 2020, walking in ~115 heat index. Because people thought COVID could survive on plastic for several days, golf courses removed both flags and water coolers. I remember needing to leave early due to heat exhaustion symptoms, having drank all the water I brought. Asinine stuff.

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I'm not familiar with this.

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I am also mad that the CDC straight up lied to the public repeatedly and justified it to themselves as being for the greater good, without remorse.

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Jul 10, 2023·edited Jul 10, 2023

A memorable item in a truly shocking list of failures, whose actual extent seems to me to be under appreciated by the average American who wasn’t (and still isn’t) fully aware of how much better the health establishment of other countries functioned.

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founding

Did others actually function a lot better? I thought they all had their own special failures (especially the countries where curfews were major policy, as though the virus sleeps during the day).

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For example..?

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failure on early testing, flip flop on masks and failure to instruct public on good masks, delayed booster approval, flip flop on vaccine mandates, failure on rapid testing....

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I think only delayed booster approval mattered in the end. Only low risk people (introverted Covid hawks) followed government advice, most of which was useless anyway. I remember all the crap about double masking.

Do you think it is for want of government advice on diet and exercise that people end up obese?

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We had the flip-flop on masks in Finland, too.

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I agree. But I didn't read your comment as being about the CDC & FDA.

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The flip/flop on vaccine mandates in the military was a huge mistake. It's taken by anti-vaccine types as evidence they were right.

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Michael Lewis’ book The Premonition details how overly cautious and scared the CDC was, which ultimately made them look incompetent anyway.

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Damn you Reagan for politicizing the CDC because you wanted gay men to die of AIDS.

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So the CDC prior to Reagan was organized more like the Fed with staggered terms overlapping presidential administrations.

Reagan turned the head of the CDC into a position appointed by the President. Previously a panel of medical and public health experts nominated the candidate. This all stemmed from the CDC trying to stop HIV from becoming endemic when it was first identified in the gay community. The leadership was contradicting the White House.

My satirical comment is in reference to the change in the leadership of the CDC that made it a political appointment. This means PR and risk aversion became more important than disease control.

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Outdoor masking for exercise is another one on the list!

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UK government advice on Covid was still emphasising handwashing well into 2021 - they only added "fresh air" to their Covid-prevention mantra in March 2021: https://www.gov.uk/government/news/public-reminded-they-must-stay-outside-when-meeting-others-to-reduce-the-spread-of-coronavirus-covid-19

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Jul 10, 2023·edited Jul 10, 2023

As Matt said, it'll be good to have a rigorous analytical breakdown of exactly what policies mattered the most, especially looking at something like cost per life saved or a similar measure.

Still, it's hard to deny that the US had one of the worst responses in the developed world in terms of our death rate per million. We're similar to the UK with around 3.3k deaths per million compared to Germany with 2k deaths. That compares to zero covid countries like Japan with 602 deaths/million, Taiwan with 739, and Australia with 837.

https://en.wikipedia.org/wiki/COVID-19_pandemic_death_rates_by_country

Obviously comparing raw numbers is problematic due to differing demographic profiles, but it at least gives some rough contours of the efficacy of various covid approaches.

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Worth noting that the US has a younger population pyramid than Japan and Germany do. On a demographic-adjusted basis, our performance is even worse.

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If we are accounting for age demographics, we also need to account for us having far more obesity

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Our death rates were vastly different by ethnicity. For ages 65-74, here are the death rates per 100k (from the CDC) by Race/Ethnicity:

Asian: 100

American Indian: 300

Black: 236

Hispanic: 300

Non-Hispanic White: 110

So most of those excess deaths come from Latino and Black populations. The age and death profiles of our White population was similar to Europe and Australia, and our Asian populations was similar to East Asia. I think it goes to show that the public policy part of the response was rather limited in effect, but personal health situations and personal precautions made a bigger difference.

Exactly why those situations and precautions differ so much, and why they might be similar to the continents of origin is obviously a whole can of worms that I personally don't understand very well. But that's what I see in the data.

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This is a key point, and of course you can point out that Trumpy areas have had worse death rates after the first few months of Covid that logically hit big “blue” cities. Some of the disparities are explained by types of work and housing environments, but some of it is cultural response. If you read carefully the analysis of “mask mandates don’t work,” it’s not really about masks not working. It’s not a coincidence that in my educated DC suburb, virtually nobody I knew well got Covid in the first year because they followed the rules. As a teacher who returned to the classroom in March 2021, I witnessed the same group of kids who didn’t follow rules NEVER actually mask correctly.

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Jul 10, 2023·edited Jul 10, 2023

Pet peeve of mine, but most Hispanics are White or at least mixed-race! They aren't "non-Whites"

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I’m skeptical of this kind of subset analysis where you treat Europe/Australia as a kind of homogenous control for white Americans, etc.

I know data is patchy to do the kind of ‘control for ethnicity’ analysis you’d want, but minorities seem to have higher covid in general, not just USA (see figure 9): https://www.oecd-ilibrary.org/docserver/6c2a96c9-en.pdf?expires=1689018603&id=id&accname=guest&checksum=4C3662C22654D60CA3A7404AF2B040BE

To me seems akin to saying, US covid rates look good if you: take out NY, NJ and the south; or ignore the poorest 40% of population, and so on.

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Those numbers fit my anecdata, but they're fascinating nonetheless. It would be interesting to try to control for economic status--not hard to imagine that a lot of those deaths are grandparents in multi-generational homes, or whatever.

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Yeah - it would be. I better run this morning, but you could further group by urbanization into rural / urban / suburban counties.

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How can you be so sure that those factors are important? Especially iven the contradictions (high latino / low asian, both multi-gen)

About half of Asian-Americans are from South Asian backgrounds, which I don't think have any particular pandemic experience. Also, the previous SARs thing only lasted a few months, so surely by winter 2020 everyone had roughly equal pandemic experience.

Fwiw - in "normal times" 2018-2019 the death rate for Hispanics aged 65-74 was almost double the rate for Asians of the same age group. In other words, I think pre-existing health is a better starting point in exploring the differences.

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founding

Link?

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Check if this works:

https://wonder.cdc.gov/controller/saved/D158/D348F854

But if not, go, google the CDC Wonder Underlying Cause of Death, group by race and hispanic origin and filter to ages 65-74. You can filter for covid only in the 110 cause of death list

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My guess would be that Whites (and Asians) are more likely to have jobs that could be done remotely and that this was a huge part of the discrepancy

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I see what you're saying and wonder about that, too, but then I think, how much would that really make a difference in the 65-74 age group? In that age bracket college degrees are not so common even among whites and probably Asians, too. A degree is a decent proxy for who can work from home, and only 30% of adults have a degree, but it's more like 40% for young adults and 20% for seniors.

So I could see it being part of the discrepancy because there are probably more 65 year old White accountants working from home and more 65 year old Hispanic Taqueria workers at the shop, but at the end of the day, the median 65 year old of whatever race is a retired truck driver or mailman or something like that.

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I will deny that the US had one of the worst responses in the developed world. The commonality between the successful countries you name (Japan, Taiwan, Australia, I'll add New Zealand) is that they're all islands controlled by a single government. The policy answer in those types of countries is very easy to both implement and gain public buy-in: heavy lockdowns until intra-country transmission stops combined with rigorous quarantine for new arrivals.

If you look at excess mortality by country, the US performed slightly worse than Western Europe (worse than France/Germany, better than Italy) and better than basically anywhere in Eastern Europe.

A good question to ask might be why Canada was so successful while the US was not, but I don't think there are any lessons to be learned by looking at island nations. There's a reason Madagascar is the hardest nation to beat in the Pandemic flash game.

https://ourworldindata.org/grapher/excess-deaths-cumulative-per-100k-economist

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founding

It's notable that South Korea, while not actually an island, is functionally an island, because its only neighbor is so shut in.

Vietnam is an interesting counterexample though, of a country that is in no way an island, but still managed to do as well as the island nations for several years.

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I have in-laws in Vietnam, and apparently the state hews pretty close to the Chinese model of COVID suppression: entry quarantines, enforced lockdowns, etc. One idea that's gone in and out of style to discuss is that well-managed authoritarian countries are probably better at managing disease outbreaks, since they have a robust state capacity for internal surveillance and enforcement, which also lets them make and enforce unpopular policies.

I agree that South Korea is an interesting example since it shows that a truly closed border offers the same benefits as being an island. For most countries that's not a realistic possibility; for all Trump's bluster about shutting the border with Mexico I was able to take a vacation in September 2020 with just a COVID test.

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According to this Natality-by-immigrant-country-of-origin dataset I'm looking at, Vietnamese immigrants just have really good health outcomes all around, and are at the far end of the distribution in terms of being small. And according to the CDC death database, death rates for US "Asian" immigrants are much lower than I think could be explained by SES factors. Obviously "Asian" is too broad category for the death rate data, but at the same time it at least approximates Vietnamese people to some degree.

These datasets have made me much more open to the idea that genetic / environmental factors were a big driver of covid outcomes, because they seem to drive every other health outcome I'm seeing in the data

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There's just no reasonable way to call Japan a "zero covid country".

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Fair. That was sloppy wording. Maybe something like an effective response within the country that effectively contained the spread of COVID?

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founding

Japan didn’t have much of a different official response to other countries. But the individuals in the population seemed to implement that moderate official policy much better than those in many other countries. Somewhat like Sweden.

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Yes. That makes sense in term of Japan's response leaning heavily on informal social norms rather than official rules.

OTOH, I thought the consensus was that Sweden did ok, but generally worse than its peers, suggesting that their lax approach did come at a relatively higher cost. Specifically, Sweden ended up with 2.3k Covid deaths per million, while Norway had 1k, Denmark had1.5k, and Finland had 1.8k.

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Well, excess mortality tells a different story, where Sweden, Norway and Finland has a cumulative excess mortality rate of around 5% during the pandemic (Denmark has 2 % and comes out on top. Denmark also have a much lower life expectancy than the other Nordic countries which probably explains some of the difference).

Se link here:

https://ourworldindata.org/grapher/cumulative-excess-mortality-p-scores-projected-baseline

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I wonder if there are intrinsic health differences in their population, too. Someone else suggested there could be previous immunity from prior SARS/Covid outbreaks in East Asia and I think that's ridiculous, but there could be other genetic or diet or environmental factors.

I'm studying differences in immigrant pregnancy outcomes right now and there are many variations that can't be explained by SES status or health care system (because I'm only looking at the US health care system). Immigrants from South America, Central America, South Asia, East Asia SE Asia, West Africa, East Africa, Polynesia, etc. have different rates of everything from infant mortality to gestational diabetes to frequency of twins. Not to mention height and weight.

Who knows how much covid rates were driven by these same variations?

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Why would the idea that people in East Asia may have antibodies that makes a virus that began in East Asia less deadly due to previous, similar viruses that circulated arouund East Asia be ridiculous? I mean that's how virsues work

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What Kenny said but yeah ... IDK. I feel like most of the early articles were critical about Japan's response being far too lax especially around the Olympics. I always took their low death rate as indicating: (1) much healthier elderly population and (2) something to the prior coronavirus antibody theory.

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ok i'm an American who was living in France and then the UK (moved internationally in September 2020, woooo!) during the pandemic, and the measures put into place were about 1000x harsher than they were pretty much anywhere in the US. I couldn't have anyone over for about six months, and even after there were limits on how many people could gather inside for another several months. For months on end, my only in person social contact was walks with *one* other person, and my two best friends and I *illegally* having lunch together outside (in the cold January/February air!).

I had to quarantine inside for 50 days in total, and the quarantines were actually enforced. I remember getting called by Track and Trace every day after I came back from America for my uncle's funeral in March 2021 (one of the few reasons you were allowed to travel abroad, and yes the airports were checking proof. I had to bring my uncle's obit along with me). About the only thing that was laxer in the UK than the US was the fact that we didn't have to wear masks outside.

So it's a bit concerning that the death rates were equally high in both countries. Of course, this could be because the anti covid measures did work but the NHS's excess capacity was nonexistent, whereas the US health care system has much more capacity but little political attitude for enforcing anti covid measures.

Still, overall I was happy to be in the UK, where things felt much less polarized. We locked down more harshly, but also returned to normal more quickly than blue cities like NYC or SF. Even today, there's a marked difference in the city centres of London versus West Coast cities.

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I had a similar trajectory to you - I moved to the UK in September 2021 from Finland, and the first thing I noticed was how much laxer everything seemed to be - which I think speaks to your "returned to normal more quickly" comment. The restaurants along the high street were full pretty much all the time, and basically the only thing you had to do was wear a mask in stores and on public transportation (and even that was effectively optional, as you could claim any reason you wanted for why you couldn't wear a mask). My university ditched its (basically unenforced) mask requirement in March 2022, if I remember correctly, and following that I soon stopped wearing masks altogether and haven't looked back.

The weird thing for me was that I sincerely did not understand what people meant by "lockdown" until fairly long after I arrived. Finland never had anything you could call a "lockdown" (stuff was closed, sure, and there were restrictions on gathering sizes, but there was never a "you are literally confined to your home" order) and I assumed that Western European responses were all more or less the same, so my first read was that "lockdown" was a loose synonym for "any restrictions."

Of course, I was totally wrong on that - I now know that lockdowns in the UK were worthy of the name. I imagine that they were hellish, so I'm sympathetic to people who had to live through them. Like you, though, I was also happy to be in the UK where it felt like there was more permission to leave the pandemic behind and less of the "not wearing masks all the time is literally genocide" rhetoric that was in the US among certain crowds.

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>We're similar to the UK with around 3.3k deaths per million compared to Germany with 2k deaths.<

I'd argue one needs to look at excess mortality. Covid death statistics are only as good as the relevant national authorities are at identifying such deaths. I think the US looks even worse on this score, though admittedly it's been a while since I've looked.

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Jul 10, 2023·edited Jul 10, 2023

Fair point, although I think recently the gap between excess mortality and covid deaths seems to be closing, at least in the US.

Currently, it looks like total excess deaths in the US are 1.27 million versus Covid deaths at 1.13 million.

https://ourworldindata.org/grapher/cumulative-excess-deaths-covid

https://covid.cdc.gov/covid-data-tracker/#datatracker-home

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I agree, otherwise you get weird results showing things like Mexico or Russia's COVID response is better than the USA's.

The USA has 3,970 dpm vs. 2,220 in France and 3,000 in Germany, using The Economist's numbers. https://ourworldindata.org/grapher/excess-deaths-cumulative-per-100k-economist

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Isn't islandness probably a pretty big confounder here? The zero covid countries you mentioned all had some combination of travel bans and quarantines that I don't think any non-island democracies managed to implement.

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Social determinants of health are likely to have played a significant role. The US has a lot of people in crowded housing. We also have a lot of people who did not have paid sick leave and those were the same people who couldn't afford to miss a day of work.

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Jul 10, 2023·edited Jul 10, 2023

“China proves to have been lying about its covid success”

I’m gonna need a cite on this one, because it seems you mean prior to late 2022?

China’s Zero COVID approach worked quite effectively against everything prior to Delta and passably against Delta.

Only when things fell apart under Omicron’s onslaught did they resort to lying about the final death toll, which will never be known, but even with their failure to use the two years they bought in the way Australia did and jab a good vaccine in the arm of anything that moved… their per capita death toll in the extreme scenarios is still likely much lower than the US.

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Totally. Comparing my life to what I saw coming out of New Zealand I absolutely believed there was a better way to manage the pandemic socially and that the US was doing a uniquely bad job.

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if only america were a remote island with five million inhabitants, the Kiwi policies might have worked.

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It *was* a better way to deal with covid for at least its first year. The mistake there was not buying vaccines early. NZ made a different set of good and bad calls, but it doesn’t mean there were no good and bad calls.

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I always assumed the successful East Asian countries strongly benefited from previous related viruses. Both social antibodies (understanding by the public/institutions what to do) but also literal antibodies. As the novel coronavirus has become less novel to our immune system it’s become much less deadly.

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For that to be a strong factor the number of people with previous antibodies would have to be in the high millions, if not a billion with a B. How would anything related to covid have circulated widely through East Asia but somehow missed the rest of the world? SARS-1 began to spread out of Asia right away, for example.

And even covid antibodies don't fully block transmission or infection to itself, appear to weaken over time, and are less good against different versions of covid. If something similar enough to COVID had already appeared, it would probably have caused similar kinds of infections and been noticed.

Or if not, it would have spread globally, like the 'common cold coronaviruses' or died out rapidly after a few thousand infections, like SARS-1.

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You need some variable that explains why Japan, but also Cambodia and Myanmar had COVID outcomes drastically better than Switzerland or Norway or... anywhere not-Asia.

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I don't need a better explanation to explain why the "previous immunity theory" can be ruled out.

But fwiw - I'm currently studying maternal and neonatal health data on immigrants from around the world, and there are vastly different results by regions of origin. Immigrants from Cambodia and Myanmar have some of the worst risk factors of any country in the data. But their natal health outcomes are really good.

Looking at this pregnancy data has given me some appreciation of how genetically diverse humans are, and it feels like a safe bet that that diversity interacted with covid and explained part of the difference results. The average mother from Myanmar is 5'1" and 125 lbs. From Nigeria it's 5'5" and 165 lbs. 1.8% of Myanmar mothers give birth to twins, 6.5% of Nigerian-born mothers have twins.

Despite Nigerian born mothers being much more highly educated than Myanmar mothers, rates of assisted ventilation for the newborn and visits to neonatal ICU units and are much higher for the former despite. Whatever it is that drives those differences in natality numbers could surely impact covid morbidity.

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That sounds like interesting research! I am continually reminded (again, now, in my nursing training) that we understand biological response and genetic factors so much less deeply than I think the average person realizes. It's easy to know some stuff, or even a lot of stuff, and let that cause you to forget that any system composed literally of a gazillion adaptive nano machines operating at the level of individual molecule construction and managing subatomic particle flows is just so ferociously, stupidly complex that it's almost certainly doing a bunch of stuff that you don't really understand.

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Here's a webapp I put together to explore aspects of the immigrant natal health. There's data on immigrant mothers from every country in the world: pregnancy outcomes, risk factors, SES status, total numbers, heigh / weight / disease statuses, self-id race, etc.

Just thought I'd mention it since you seemed interested. If you have any feedback I'm all ears!

https://theusaindata.pythonanywhere.com/immigrant_paradox

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The anti-bodies point would certainly point to the Japanese experience given that they never had that firm a lockdown and never had that bad a surge with covid.

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The Japanese have really small households, and impressive air purification in their indoor spaces. They also pretty closely adhered to voluntary mitigation efforts. They had really explosive spread post relaxation/Omicron suggesting they were keeping it at bay before that.

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The only real relaxation to speak of ahead of the Omicron surge was related to border controls, which were slightly loosened in 2021 and more so throughout 2022. There wasn't really anything else to relax given the lack of formal mask mandates etc.

Masking only fell significantly this spring when official guidance shifted from "it's a good idea to wear them indoors" to "it's up to you".

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I noticed that they really had the best public health messaging about what the actual risk factors for Covid transmission were with their "Three Cs" infographics. Plus effective contact tracing.

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Oh also fun story - Boris Johnson's version of 'flatten the curve' was 'Squash the Sombrero'

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BoJo gets a bad rap, but, 'flatten the curve' only tells you what you need to know if you already know what the shape of the curve is, whereas 'Squash the Sombrero' actually provides most of the useful information.

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The partygate business would’ve been much less newsworthy had it been about a former rather than sitting PM, certainly, so it would have had a smaller impact on his popularity.

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I'm kind of surprised Trump didn't pick up "Squash the Sombrero" for the double meaning.

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China wasn't "lying" about having almost completely suppressed COVID transmission, and doing so would be literally impossible given the current media environment. The *reason* for their (and Japan's) success is probably the biggest unresolved question relevant to the early pandemic though

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They clearly supressed numbers about how many people were dying from covid

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Suppressing a few hundred/thousand deaths in Wuhan itself, sure. But US intensity uncontrolled spread in a population with China's age pyramid would be obvious from space (or WeChat).

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Yea, I’m prepared to categorically state that China did not suffer from uncontrolled spread of COVID prior to Q4 2022.

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Yes. I recall there was extensive international news coverage of the Wuhan outbreak. People were shown collapsing in the street. China is not North Korea and there is just no way you could hide an uncontrolled outbreak.

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There have to be at minimum a couple of million people in the US—millions more in other countries—who have family in China and who text/talk regularly. PRC government hasn't begun censoring such personal communication (yet). There are also, needless to say, hundreds of thousands of foreigners residing in China (though a substantially smaller number than 4 years ago).

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The Chinese graph of officially "confirmed" deaths from covid is blatant horse shit. I won't pretend to have any actual sense of the scale of the lie, but anything short of like, "Many tens of millions" of uncounted deaths would be unsurprising.

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This is a good point. And there are two important questions related to this. First, how deadly is the virus. This will determine what kind of social costs the government should impose. Second, how infectious is the virus. Japan achieved suppression without severe border controls or substantial lockdowns. As it turns out, in the Anglo world suppression was practically and politically infeasible which has as much to do with why it was the wrong approach as anything else. But these two questions related to mortality and infectiousness still had large uncertainty bars in March and April. The scientific community didn’t even have close to an accurate picture on how different interventions could change R0.

For me, one big lesson is that an appropriate response to a novel virus emerging is immediate imposition of extremely strict border controls to eliminate spread until more information is available. But the last appropriate date for when this would have been appropriate in the US was Feb 1, not mid-March. After that, local spread was practically unstoppable in the US at least

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The main problem is that "success" or "failure" in slowing spread is not systematically related to the costs of doing so. Maybe the US "failure" was worth it.

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this seems right to me (although I wouldn't characterise Jonson as a hated populist - people in the UK thought be was a buffoon but not evil.)

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I was talking more the online/progressive context that was shaping a lot of elite actors stances although plenty of people did hate Johnson. I do think there's actually a lot of similarities in how they handled the situation; would've been crucified for being racist if they had actually done some of the stuff that people came to claim they should have done, were deferential to the scientists to begin with to the point of getting the blame for some of the scientist's mistakes, lack of overall grip created problems, not personally inclinded to follow covid protocols and so got covid themelves, convinced conservatives to spend big on making lockdown possible, successfully pushed vaccines as a moonshot, ultimately became a moderate covid dove due to pressure from allies

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Jul 10, 2023·edited Jul 10, 2023

I had the very interesting experience of going into the pandemic as a public health person, but only on the undergraduate education side, and as an expert on pandemics specifically, but from a historical standpoint--that was my original academic training, and I had opened an exhibit on pandemics at Philadelphia's Mutter Museum at the end of 2019, literally a couple months before the actual pandemic (it was tied with a big Flu 1918 retrospective). So I knew a lot but had nothing to do with actual policy in any respect; I was just an observer. I had a lot of time to watch and think about what was happening. I did a little bit of writing about it on my blog that I think held up pretty well (if you're interested, website in my profile).

But one of the things I did both predict and watch happen in real time was a kind of breakdown amongst public health people who had actual or theoretical policy influence. Basically, you had a lot of people who I think in their heart of hearts believed that their expertise would matter more than it did. A lot of those folks kept thinking or even saying something along the lines of, "When it gets bad enough, people will realize that they should pay more attention to me / us." If you go back and re-read about Florida's reopening, for instance, you will find some great quotes along those lines. And a lot of those folks, or at least the smart ones, had a more or less accurate view of how bad it would be. I think we forget just how bad the numbers were: a lot of people died or were long-term disabled. Like, a lot a lot.

Since I had studied the history of pandemics, I knew that this would not happen. That's just not how it works. Public health people in Philadelphia got ignored while they were burying the dead in trench graves with steam shovels. Humans get comfortable with very surprising levels of suffering at astonishing speed, in a this-is-fine-dog-meme kind of way. The moment was never going to come for my colleagues where everyone was like, "This is your moment! Lead us! We agree with you about all kinds of things that we didn't agree with you about earlier!"

And I think a kind of sincere bitterness or disappointment over that drove at least some of the counterintuitive hardcore Covid doomerism amongst some of the public health community, because those folks kept expecting (and, because they were human, kind of secretly wanting) their moment to come, and it was never going to come. At least, that was one of my impressions.

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I remember reading a very smart comment early in the pandemic to the effect of: "Public Health, as a profession, implicitly embraces a lot of normative commitments that are not shared by the broader public, and they're going to have a lot of trouble getting buy in."

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A thing I used to do at the beginning of my public health survey courses was to walk my undergraduates through an exercise where I would say, "let's do a thought experiment," and then we would go through the proper public health response to ebola (and most hemorrhagic fevers), which is that you...

1) Go door to door asking if people have developed a fever in the last X hours, and

2) when people say "yes," take those people away and lock them in a room with a bunch of people who have ebola, so that you can...

3) wait for them to die, after which you will douse the body in bleach and burn it, so that...

4) you can properly contain the outbreak by ensuring that healthy people see their loved ones suddenly carried away, never to be seen again, by people in scary hazmat gear.

Oh, and of course there are some percentage of people who developed fever who end up in an ebola ward because they had the flu or a stomach bug and really bad timing, and some percentage of those folks end up dying of ebola-secondary-to-public-health.

And I want to be clear: if you are operating on highly constrained resources in sub-Saharan Africa in a rural community with a rapidly-developing ebola outbreak, what I described is absolutely, 100% what you should do.

But if you can't predict that the people in that village are 1) going to hate you, 2) going to start telling you lies about their health status, and 3) likely going to start attacking the health workers, then you are so deep down into public health brain that you have stopped understanding how humans behave. And that's why pretty much every epi-/pandemic ends up being bad for public health people at some point. They will always eventually hate you, and that's honestly a pretty understandable reaction.

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OK, so, two things...

First of all, assuming you have the resources, you should *not* "lock them in a room with a bunch of people who have Ebola." Ideally, you should give each person a tiny room of their own, like in an SRO, where they can ride out the disease isolated from other infected people. That way, if a person turns out to have been mistakenly diagnosed with Ebola, you don't condemn them to needless death by locking them in with a bunch of Ebola patients. Of course, as you say, in a resource-limited country like Africa, that may not be feasible.

Second, you make the public health response sound as horrible as possible: "Oh no, scary people in hazmat gear are taking my loved ones away to die!!!" But the point of Ebola (correct me if I'm wrong) is that it's pretty much incurable, and once you get it you have ~40% chance of dying of it. So the question is not, "Do I or do I not want to die of Ebola?" It's "I have Ebola and I'm likely doomed anyway; while I'm still alive, do I want to spread the disease to the loved ones - my spouse, children, parents - who live in the same household as me Y/N?" If you're a decent person, the answer should be a resounding NO, and the best way to make sure you don't spread the dread disease to your beloved children is to distance yourself from said children asap.

TL;DR: The way to frame this should be not "Scary people are dragging me away from my family," it's "This is absolutely horrible, but at least there's a place for me to go such that, if I must die, at least I will have reduced the risk of spreading this disease to my loved ones."

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Right. This is exactly the mistake. You and I totally agree on the rationale for quarantine. And you and I totally agree on what you would ideally do (i.e. single rooming people).

But my thought exercise is based on examples of actual things that happened in various epidemic events in the world, and so the obvious question becomes, "Why? If we can agree on a better approach, why did the worse thing happen?" And when you try to parse it out with stuff like interviews after the fact--as you can imagine, "why did the health workers get attacked?" is a research question of interest to health workers--it turns out that people's lived experience of the event looks more or less like what I described (I did leave some things out like "outsiders," as in, "outsiders in scary hazmat suits").

The problem is that at least some percentage of scared people do not understand the situation in the way that you do, so their behavior is not irrational, precisely, but it simply does not and will not follow the logical process that you and I agree on. And I'm not even talking necessarily ebola epidemic. Choose your public health intervention--treating local water supplies for guinea worm, vaccination, golden rice--and you are going to find examples of workers getting chased by angry mobs and individuals refusing or breaking quarantine.

The dirty secret on single-rooming people is that even in wealthy, relatively educated communities, people always always always break quarantine. Always. This is why every few years you see stories in the U.S. about people with exotic resistant TB strains getting chased down by the cops and locked up in the hospital. So if you want to do quarantine, you have to use a locked unit. It might be "nice" locked--in the US, maybe the patient has to walk past the nurses' station to get out, so you don't have to keep a padlock on the door or whatever, because you are substituting surveillance. But make no mistake: quarantine only works if you have the ability to contain people to a greater or lesser degree against their will.

So that's extremely hard if you are in a place without a bunch of multi-room facilities with good building controls, which is why I set our story in a non-urban community in sub-Saharan Africa, which is also, not coincidentally, where most Ebola outbreaks begin. In that circumstance, what you often end up with is that there are only a few secure rooms in the geographic proximity, so they get turned into multi-bed Ebola wards. That's not totally insane, because generally you are giving these folks at least some supportive care, you hope, and that allows you to cluster the care. And a lot of times "multi-bed" is like three or four patients in a room; this is not a miles-of-beds Crimean War situation. But broadly speaking, I have described even the recent history with reasonable accuracy. It's just a tough situation in a lot of places.

So to circle back to your comment, "This is absolutely horrible, but at least there's a place for me to go such that, if I must die, at least I will have reduced the risk of spreading this disease to my loved ones," is a statement that only makes sense when the disease is not caused by God's judgement for your sinful behavior and therefore not normally infectious or not actually a scheme for the government to control you or not actually brought in by the outsiders themselves or whatever. And when people get scared, they often turn to those other explanations with astonishing speed and regularity for reasons that seem to be deeply embedded in how our social-primate brains function.

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Jul 10, 2023·edited Jul 10, 2023

If you want another version of this, my book on radiation therapy is partially about how people who literally know better talk themselves into misperceiving risks to the point of widespread death. All those early radiation therapists could describe the risks of radiation exposure, which they saw in both their own and their patients' bodies from literally the very beginning. All those early radiation therapists also died of radiation exposure. Many of them died after publishing papers about why radiation was not dangerous for reasons that look like hilarious exercises in motivated reasoning when you read them, but turn dark when you know what subsequently happened to the authors.

It was a fascinating study in human psychology--the book has some amazing, metal quotes--but it also raises some really difficult questions because: oof. Humans. We are NOT good grokking risk.

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Very thoughtful and insightful and also depressing comment.

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Derp, just realized I referred to Africa as a country, which of course it’s not; trying to comment in a hurry.

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No worries. We all do it. I knew what you meant.

I always at some point early in the semester gave the kids some version of, "I'm going to proceed to make one or more of the following mistakes at some point in this class, and you should just point it out, and I will curse and apologize, and we will all know that we all like each other and want to make everyone feel good about being here." And "Africa is not a country" is on that list.

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Haha, thanks this is so well stated that it feels obvious, even though lots of genuinely smart people never seemed to put this together.

Matt has written a lot about how public officials should have simply stated facts instead of trying to galaxy-brain things by trying to predict human psychology. This was mostly about things like the early period where you had people saying masks wouldn't help because they didn't want the public to believe masks were 100% effective and then take unnecessary risks.

However, you bring up an excellent point that public health officials really do need to account for the public's reaction to policy changes. They just need to do a better job of it I guess.

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This is such a good point and it’s one I’ve seen Matt make a handful of times - we routinely ignore public health officials.

And imo it’s kind of reasonable If you followed everything public health officials said you’d never eat a rare steak or a sunny side up egg or change radio stations while driving or have a drink or put a pool in your backyard or…

And surely the officials must know this! And yet they all thought people would just listen to them during COVID. Why?!

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“a lot of people… were long-term disabled.”

Were they really? I know the Lorenz-style “Long COVID affects 10% of the population” folks want to say so but that claim is startlingly lacking in evidence.

Genuine post-viral syndrome cases are as few and far between as they are for any other upper respiratory illness; more in absolute terms of course but still not many. Meanwhile, as the COVID hawks lost their grip on the narrative, the number of people with “Long COVID” seems to have dropped precipitously.

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Yes. A lot of people were long-term disabled. I think the numbers on "Long Covid" can be inflated, and I also think that it disproportionately affected certain groups, and I also also think that some significant portion of Long Covid sufferers will eventually improve. So if you had Long Covid symptoms from an early infection and improved two years later, that still really sucked for you, and you were still "long-term disabled," since most long-term disability kicks in on some timeline of 6-18 months. But you would ALSO expect the numbers of sufferers to decline markedly over time, and that is in fact seems to be what has happened.

But like you said below, post-viral syndromes are a very well-described, though poorly understood, phenomenon. And even if the rates on Long Covid are super low--say, one in a thousand or even one in ten thousand--then you are talking about a large number of people, especially depending on whether you are talking lifetime or per infection.

I do think this comes back to what I said about how the experience of even a really bad disease event is hard to parse. Hundreds of thousands of people could suffer Long Covid symptoms, and it is totally plausible that any given individual would not know any sufferers, or at least not know any of them well enough to perceive it as a "real thing" in the world. It's also important to remember that most of us tend to write off the suffering of people in our lives. It's a thing we don't mean to do, but it's an extremely normal and predictable response of the brain--we immediately reach for "well, this is explicable because X" (obese, old, bad behavior, etc.) and write it off. I see it all the time now, in my training as a nurse, and even though it was a thing I know to look for because of my prior training, it is still kind of striking as a behavior to observe in doctors and nurses.

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Ok, I can square the circle on your (reasonable) view with the understanding that you and I define "a lot" somewhat differently in context.

I'm so used to folks who say things like that being Lorenzites that I wrongly suspected you were pointing in the same direction.

A few hundred thousand is, in absolute terms, a lot of suffering. But in population terms it's not a lot of people, IMO.

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founding

"Long Covid" is the fibromyalgia version of Covid.

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Post-viral syndrome is a real thing and enough folks got seriously sick that I expect to see plenty of it, and I would be *unsurprised* to find that a novel virus which evolved to deal with the hyper-charged immune system of bats left more people with such problems than a bad flu might.

But we’re talking about tenths of a percent, here.

Taylor Lorenz is deliberately hurting people to feed the maw of her ego and should be “deplatformed” both on Twitter and at the Post.

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The damaged from COVID I think if is more post ICU morbidity. That's separate from long COVID. If you end up in an ICU and die there's a good chance you'll have permanent lung damage, kidney failure, etc.

The people you could do something for (40 thru 70 somethings) were likely to leave the ICU with new health problems. If everyone got it you'd have to deal with that.

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>If you end up in an ICU and die there's a good chance you'll have permanent lung damage, kidney failure, etc.<

Very permanent!

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There were also a lot of people who had minor symptoms, like losing their smell for a lot longer than the duration of the virus. But I agree it was totally irresponsible for mediaites like Lorenz to lump them in with the ICU comorbidities.

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Assuming you're right, which mostly hinges on the definition of the word "likely" in the second paragraph, we had roughly 1 million people in the ICU over the course of COVID (back-of-envelope: 10k average in ICU for COVID 2020-22, 12 day average stay, 1100 days in those three years).

Half of them died, which leaves a survivor population of 500,000, of whom a fraction have trauma to internal systems from ICU treatment. That's, at most, another tenth of a percent.

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This is an interesting parallel.

Fibromyalgia involves real pain - real nerve cells firing. It’s just that the pain doesn’t have a known physiological source.

Like fibromyalgia, I suspect that some small portion of Long Covid will eventually be shown to have a real physiological source.

But the rest is likely some mix of social contagion and psychosomatic symptoms. “Awareness” culture is the true villain here, because it creates more suffering than it prevents or alleviates.

It’s still important, though, to be absolutely clear that the symptoms are real. It’s more complicated than just, “people are making it up”.

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How about "Vulnerable people are being conned into feeling unnecessary pain by the Taylor Lorenz's of the world?"

I find it... less than coincidental... that "long COVID" symptoms declined precipitously as COVID mostly exited media coverage and the popular consciousness since mid-to-late 2022.

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You should probably unfollow or even mute or block Taylor Lorenz. You’ve brought her up in multiple different comments. I doubt it is good for your brain or soul to invest so much into disliking her. Similarly, I doubt that your internet disparagement will have any positive benefit: for most people you’re just you’re just preaching to the choir or making a meaningless reference to someone they don’t know. At worst, you contribute to radicalizing someone into the gamer gate-style harassment clubs.

It’s an overused observation, but this does seem like a perfect example of the “living rent-free in your head” trope.

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Lol. I have read a single quote-tweeted post from Lorenz, and precisely none of her published works, over the last six months that I can recall.

That does nothing to prevent her name from being a convenient shorthand for “batshit insane, patently delusional COVID hawks,” which is how I use it.

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Jul 10, 2023·edited Jul 10, 2023

I think it is way too early to tell. I live in an area with lots of Lyme Disease, and I see a lot of parallels with how the long COVID situation is playing out.

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Any disease without a clear diagnostic will be mis-diagnosed overall. When the diagnosis is mostly based on symptoms, it's unavoidable. But that doesn't mean over-diagnosed or under-diagnosed. Some people with similar symptoms will get mis-diagnosed with the condition, including mis-diagnosing themselves. But others never get diagnosed because they don't seek help or the healthcare system isn't good at triggering a test.

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Jul 10, 2023·edited Jul 10, 2023

I agree in the sense that fibromyalgia is one of those things that is real, and causes real suffering, but which a lot of people feel comfortable being really cruel about, in terms of writing off other people's suffering. It's a very normal human response--like a lot of human @ssholery--and I even see a ton of it now in my work in hospital settings, with health care providers who should know better. So it's totally understandable that people do it, especially in discussions on the internet where comments are divorced from the experience of real people's suffering.

But it still makes me sad. Even if there are constraints on what you can do for people, ignoring or denying or writing off or (worst of all) mocking suffering is bad for everyone involved, in a Biblical Pharaoh's-heart-was-hardened kind of way.

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Wholeheartedly agreed. That’s what dismays me the most here. We should be focusing on the bad actors who exacerbate the social contagion, not piling onto the contagion’s victims.

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Or gluten allergy: it definitely exists but people are much more likely to imagine they have it then actually have it

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Presented with white toast: “I am gluten intolerant”

Presented with handmade tortellini: [Face stuffing noises]

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"Meanwhile, as the COVID hawks lost their grip on the narrative, the number of people with “Long COVID” seems to have dropped precipitously."

I dunno, could there by any other reason for those numbers to drop other than mendacity? Like, the disease is far less prevalent now and most people get better over time?

The "people are bad, with terrible motivations" is mostly not a good look.

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I mean, if "psychosomatic illness" is equivalent to "mendacity," then sure. But we *know* how psychosomatic illness works, and salience is a huge part of it.

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I can only speak about myself and the people I have met who have also experienced long covid, but I was a perfectly healthy 20 something year old who was active (ran and worked out every day etc) and never had prior health issues , who contracted covid, and then a month later experienced debilitating fatigue, and neurological symptoms similar to that of a concussion. I did not think covid would be a big deal when I got it given my age and health status, but I all the sudden had my eyes inflamed, could not walk more than 10 minutes at a time, could not drive, or read, and could not live independently. It is now 2 years later and I am finally seeing improvement, but it has been truly a disabling event that has robbed me of some years in my 20s. I hopefully will continue to see recovery. I had gone to the Mayo Clinic when I first had these new health issues and they found I had brain inflammation and a high level of cytokines. In short, covid can cause real health issues that are not psychosomatic. Anecdotally, I know more people with post viral issues from covid than any from another type of virus such as the seasonal flu. The only similar issues I can think of are with mono and lyme disease. I would like to see that policy concern about long covid not be considered alarmism, but considered supporting those who now find themselves randomly disabled by this virus and their lives changed. I am lucky to have my family's financial support, but not everyone who finds themselves disabled by covid have the same resources, and the health care system has left them behind. A lot of doctors are uninformed about long covid and supplements that can help are expensive and uncovered by insurance.

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With respect, you’re describing one of the main proposed casual mechanisms for post-viral syndrome; it’s speculated that in addition to causing systemic inflammation that leads to elevated pain levels, cytokines can cross the blood-brain barrier and cause the fatigue and neurological symptoms commonly described.

I am in no way advocating that we ignore those who have post-viral syndrome or post-ICU physical trauma causing similar symptoms. There isn’t a ton that medicine can do, to my knowledge, but treating this as a genuine disability for the duration of folks’ suffering is warranted.

Valorizing that suffering, however, is not. I‘ve seen estimates that psychosomatic cases of long COVID may be as much as ten times as prevalent as those rooted in physical causes, and the figure was likely higher when COVID was more salient. Thus I’m willing to say that the charlatans pushing wildly overblown narratives about long COVID need to be cut down to size because they’re doing vastly more harm than good.

I can’t speak to “supplements which can help.” My reading suggests that there are none and almost every improvement is down to placebo effects, but perhaps that’s due to a lack of sufficient research. Post-viral syndrome is surely going to attract more attention on that front going forward, so hopefully there will one day be targeted drugs that can suppress or clear cytokines and other inflammatory agents to get at the heart of the matter.

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Great comment. I really wish that one of the lessons learned from this mess among the MPH set is that they were humbled into learning that they were not competent in setting policy, and that they had to defer to policymakers in that regard.

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What's interesting is that I think they actually could be competent in setting policy, but you have to take a very hard-nosed, realistic look at what the constraints on that policy are, and a serious constraint is the make-up of the policymakers. In the US, that was elected politicians in the framework of our divided levels of government, and that is super frustrating, but it is what it is.

I feel like a lot of the dumbest public health fail stuff in the pandemic was a product of people trying to make a bank-shot around constraints rather than confronting them head on. See: masks. We had some serious constraints around supply. But instead of honestly confronting that, you got a lot of weird double-speak and some straight up lies in an effort to manipulate people around the problem, and in the end it 1) didn't solve the problem and 2) destroyed a bunch of people's credibility, which (IMO) is the single most irreplaceable resource for a public health person.

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Due to the Quebec smokes, our local paper ran a "local health department recommends masks" article that seemed clearly influenced by a Very Smart Person thinking "ah, now that we have introduced this concept via covid, the population has a newfound respect for our wisdom blah blah blah".

I was so pissed I couldn't see straight. Utter and befuddling lack of a clue.

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Is wearing a mask a bad idea when air quality is horrific? Was that bad advice?

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Not sure, but the "trust us!" bridge is ashes.

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What should public health people have done early on about masks, knowing that (when used properly) they could be effective, but that they were in short supply and people being people, they would rush out and buy up all the supplies, leaving healthcare professionals deprived of them?

Lying, and losing credibility, is not good, but neither is having healthcare people who desperately need the masks not being able to get any.

If there was a good and obvious solution to this conundrum, I guess I missed it, but sometimes life just faces you with terrible choices in a very bad situation.

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Jul 10, 2023·edited Jul 10, 2023

I genuinely think that there was not a good solution. But I also think--and what I practiced--is that of the bad solutions, you always need to err on the side of telling the truth, because credibility is priceless, and once you lose it, that's it--you can't beg, borrow, or steal it back. Lying to people is a burn-the-bridges, break-glass, single-use option. You get to do it once, and you will not be able to do other things in the future because you did it that once. And like using the little canister fire extinguisher behind the glass, you will often find that having broken the glass, you are still not equipped to stop the fire.

I can tell you what I honestly did at the beginning of the pandemic. We sent the kids (meaning my undergraduate students) out on Spring Break in 2020 with the university still waffling around about what it would do and talking out of both sides of its mouth. So I sat my students down on that last day of in-person class and said, "This is what you need to know, and this is how this is going to go down, starting with: ignore the university, you will not be coming back in person."

And what I said to them about masks was the truth, as best as I could manage. I told them that they were young and unlikely to get super-sick, not because I have special knowledge, but because the old people ALWAYS have high mortality, even in events like the 1918 pandemic that also disproportionately hit young adults. So you could kind of guess that the mortality profile would look like it always did (babies were not relevant to that conversation, but a thing I would have gotten wrong is that I would have assumed that babies and young children were also high-risk, for the same reason that they are always high-risk for respiratory viral stuff like flu and RSV).

On masking, I said that there weren't enough masks to go around, so please do not go out and hoard masks, because nurses and old people need them more than you do. But I had three guys planning to fly down to Florida together for Spring Break, and they were staying with one of the guys' grandparents. And I specifically said, "You three are an exception: buy a pack of masks and wear them the whole time you are traveling because congested airports are a great place to get exposed, and this thing is probably more widespread than we currently realize, and you are literally going to visit old people."

To be clear: I have no idea whether they followed the suggestion--those guys were buddies and more conservative and a little skeptical of me from the jump and ended up being Covid truthers, which made me sad. But on the other hand, the reason I know they were Covid truthers is that two of them stayed in touch with me after the semester ended and asked me questions about the garbage they were seeing on Facebook and forwarded me some links to some of the nutty trash that they were watching on YouTube. So it's not a win--they didn't totally believe me--but they also concluded that I was not a person who lied to them, even if they thought I was wrong about stuff. And I think that's a big step forward; it at least kept the line open. I think that would not have been the case if they had pegged me for a liar.

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I don't want my government lying to me, but truth telling is not an absolute good that trumps all other courses of action. There are times (many times!) when it's better for the government not to tell the whole truth and maybe shade the truth in certain ways that would be unacceptable under other circumstances.

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I will definitely cop to being a zealot on truth-telling in public health circumstances. I think the Covid experience strengthens my case, but a lot of folks disagree with me in good faith about health communication. And it's a really thorny set of problems, as I can say all over again having to grapple with versions of these same issues again in the nursing context. I'm still pretty hardcore Team Truth, but that's definitely an ideological position (partly downstream of my academic bioethics training, which people have very strong feelings about both pro and con), and I can certainly see the other side of it, even if I don't land there.

I agree with you that in non-health contexts, it all gets a lot murkier. The CIA definitely should be telling some lies.

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I accept the government hiding things on foreign policy and military matters. I don’t accept it on matters of public health.

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I personally share your view on this Marc, and was in no way butt hurt about having been white-lied to regarding masks in early 2020. People get so self-righteous with this whole "We were lied to! I am shocked I say, shocked! You now have zero credibility...". Makes me wonder what the real axe they wanted to grind was...

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The government should have told people masks are great and to go buy them at all costs. If those costs are too much then to make a mask as a cloth mask is better than no mask.

To deal with the shortages:

Government provides a minimum bid via a Futures contract for 12 months and 24 months in the future so that 3M or whoever else brings on additional production capacity for new masks.

The same thing should be happening now for Artillery shells and guided missiles for Ukraine now. New capacity isn't coming on line because everyone can't rely on future demand.

The problem isn't too much demand (we needed a ton of masks urgently!) it was that building production capacity for a short term and uncertain demand spike isn't profitable.

To prevent hoarding, allow price gouging.

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That's not a solution for the next month or two when you will desperately need masks and other PPE for people working in hospitals. If the price of depriving those folks of the gear for a month or two is acceptable, then I guess that's a different conversation.

Even with the CDC's position on masks, it was *really* hard for hospitals (let alone senior care facilities) to get masks and other equipment.

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Yeah, and there wasn't a good solution to that problem. Masks went from not especially important to the best way to save your life and the lives of your family. It's going to take some time to not have a massive shortage.

Once the can of worms was opened where the government is intentionally lying to accomplish X goal where X isn't maximize the chance my own family is alive then people are going to go get their information from other sources and so it doesn't matter what the government says when it comes to any of the stuff they were right on which cost way more than having to use the same mask for an entire shift or for a Dr. to use a homemade mask or whatever else would have happened if the public knew the truth 2 weeks earlier.

There is no good solution when "allow price gouging" in the future is the best I can come up with.

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> knowing that (when used properly) they could be effective

It's not clear that they did know this - pre-Covid studies on masks were really bad. The CDC certainly didn't adopt the recommendation against mask use as a Noble Lie to prevent shortages, because the recommendation predated the Covid pandemic by years. See section 5 of https://slatestarcodex.com/2020/03/23/face-masks-much-more-than-you-wanted-to-know/ .

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"they would rush out and buy up all the supplies, leaving healthcare professionals deprived of them?"

Here's the thing: basically all the masks were bought up before the vast majority of people were paying any attention to covid (or public health authorities).

In February 2020, I was doing some insulation work in my basement, and I found that mice had made several homes in fiberglass insulation (and pooped a lot). I didn't want to get hantavirus, so I went to Home Depot to buy some masks. I couldn't find any, so I asked a worker who said I had looked in the right aisle, but they were all gone. That was kind of a "oh shit" moment for me. I looked on Amazon and managed to find a 3-pack of N95 masks (ordered February 22, 2020 for $16.89 apparently), but the pickings were already super slim. A few days later there was basically nothing left on Amazon. The CDC mentioned that "some partners are reporting higher than usual demand for select N95 respirators and face masks" back on February 12, 2020 [1]. For context, Bill de Blasio infamously told New Yorkers to party on March 2 [2], the WHO didn't declare covid a pandemic until March 11, and the US didn't declare a national emergency until March 13.

So, not only did lying about masks hurt the credibility of public health officials, it wasn't even useful! The masks were already gone!

[1] https://www.cdc.gov/media/releases/2020/t0212-cdc-telebriefing-transcript.html

[2] https://twitter.com/BilldeBlasio/status/1234648718714036229

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They weren't lying about masks, the policy long predated Covid. See part 5 of https://slatestarcodex.com/2020/03/23/face-masks-much-more-than-you-wanted-to-know/. It's important to realise that pre-Covid, the studies done on mask use were almost all badly-designed and statistically underpowered.

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Jul 12, 2023·edited Jul 12, 2023

If they didn't believe that masks were useful for reducing transmission, then why, on February 12 [2], did the CDC recommend wearing masks when near people with suspected covid cases?

"CDC does not currently recommend the use of face masks for the general public. This virus is not spreading in the community. If you are sick or a patient under investigation and not hospitalized, CDC recommends wearing a face mask when around other people and before entering a health care provider’s office, but when you are alone, in your home, you do not need to wear a mask. ***People who are in close contact with someone with novel coronavirus, for example, household contacts and care givers of people with known or suspected [covid] should wear a face mask if they are in the same room as the patient and that patient is not able to wear a face mask.***"

So, were they lying when they said that you should wear masks or when they said that you shouldn't?

Clearly, the CDC was talking out of both sides of its mouth. On the one hand, they clearly thought that masks were useful for reducing the spread of covid. On the other hand, they later said that normal people shouldn't wear them --- even after covid clearly was spreading in the community, which was their above justification for why the general public shouldn't wear masks in early February.

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As someone who detests Ron DeSantis in general, I view Florida as one of the better responses. Their Covid age-adjusted death rate was similar to California's. They opened in-person schooling relatively early on. Their initial vaccination campaign was good in that they prioritized older people over essential workers and had the vaccine administered through Publix, which was highly trusted by the public.

DeSantis got a lot of flack for banning mask mandates, but the Cochrane Review of high quality studies found that universal masking had little to no effect on transmission of respiratory viruses. (We should have done more high quality science on masking to figure out why they weren't working, but for much of the pandemic, it was considered unethical to even suggest that we do RCTs.) That doesn't mean that you don't make N95s available and teach people to wear them properly, but it's important to acknowledge the real limitation of mask mandates. DeSantis's biggest failing in the pandemic was not expanding Medicaid and for some reason he doesn't get much flack for that.

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I agree wholeheartedly with that last sentence, but I also want to add in playing footsie with the anti-vax people, especially by putting a kook in as his surgeon general. The Medicaid thing is worse, though.

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That was the big surprise, that many people were SO indifferent to the risks. Even when they personally witnessed family members and friends become severely ill and die.

I get it. How do you do your job to protect people who just don't want protection? People in public health often go into it as a form of public service and your big moment turns out to be a nightmare.

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And of course, while the masses and much of the government ignored those public health folks, on social media there was a large cadre of people ready to give our hearts and RTs for maximalist public health advice, up to and including “let’s stop getting together for holidays in the winter, forever” (one I actually saw). Which gave the MPHs a big, appreciative audience for their frustrated exaggerations.

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Excellent observation. That one was new to me, and in the Covid sphere I don't see much that is.

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I'm a liberal, but even I felt the public health community's permissive and politicized response to the BLM protests was incredibly damaging to their credibility. Conservatives responded, with some justice: "Ah, so protesting police violence is important but going to church isn't? Go to hell".

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We knew by summer 2020 that Covid doesn’t spread outdoors

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Nope. That’s not how it went. There was a strong official line against outdoor gatherings with much disdain of the right-wing protests as bad *from a health perspective* and a shocking reversal with the post-Floyd madness. they weren’t even trying to hide it. They were claiming that the “racial reckoning” just outweighs the speed of the virus. Extraordinary moment of failure.

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Right - the issue was the inconsistency. There hadn't been any indication from public health officials prior to the protests that "outside is OK," even if it was. The overriding message was still stay home, full stop. It changed on a dime specifically for the protests, not to mention a lot of "racism is a public health issue" messaging that was clearly destructive to the overall goal of compliance with NPIs.

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Jul 10, 2023·edited Jul 10, 2023

It exposed that so many epidemiologists were American upper-middle class liberals first and scientists second. Very disappointing and more importantly revealing a societal level failure and structural weakness.

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founding

There is no single “how it went”. Both of you are pointing to important strains in the discourse. Of course the hypocritical strain in the discourse both does better on Twitter at the time, and is more memorable after. But it was far from the only thing going on.

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Which is something Matt touches on (if only briefly). Everyone remembers something different about how the pandemic went, and most of those memories are somewhat true

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100%

People at the time were trashing on Florida for having the beaches open, while saying the protests were fine.

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Depends on where you were. My local park (San Mateo County) was open and there were no efforts on the part of officialdom to dissuade park-goers. I hiked multiple times in the Santa Cruz mountains—again, county and state parks were open. Same thing when I relocated to Seattle later that summer. These are hardly MAGA bastions (every other building in Seattle had a "WE BELIEVE..." sign).

Some areas/officials in the US were crazy. Some less so. Certainly the commanding heights of US governance (ie, the White House) weren't heckling people to stay indoors.

That, said, at least early enough in the pandemic, a *modicum* of prudence with respect to "gatherings" seems understandable, at least given sufficiently crowded conditions (6 family member playing frisbee? 11,000 people attending Shakespeare in the Park? "Gathering" can mean lots of different scales). In hindsight people love to say "we knew" such and such wasn't dangerous, but who is "we"? There's no automatic system I'm aware of ensuring that, once a particular public health finding appears to be solid, the information is instantaneously transferred into the mind and awareness of every relevant official everywhere. Consensus, unfortunately, can take time.

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You cannot compare the clusterfuck of spring 2020 to the era of Covid that followed. After the initial lockdowns (which ended by May), the message turned to masking and doing things outdoors. Covid cases were remarkably low by mid-summer 2020 (I believe Florida had a surge though).

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Speaking solely of my own experience, what I remember about why it was "ok" to protest was because everyone was wearing masks. I learned "outside is safer than inside" from Slow Boring, which didn't start until November 2020.

I'm not saying *you* didn't know, but as someone who read a *LOT* about Covid and BLM protests in 2020, generally from a progressive viewpoint (Vox, etc), I did not know in the summer of 2020 that outdoor transmission was nearly as rare as it was.

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It was that stupid letter, they could have written “the protests are outside so it’s okay” but that would have retroactively justified the right wing protests so instead they said “racial injustice is a worse disease than COVID” which just shattered any belief that they were nonpartisan actors. Also we knew that outside was better than inside in like late March but my blue state governor kept playgrounds closed until November.

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“Retroactively justified” gets at something I’m seeing a lot of in this thread. There’s a lot of Monday morning quarterbacks using 2023 science to complain about 2020 decisions.

Knowing what we know now, you could’ve drastically cut back on the spring 2020 lockdowns in many parts of the country. But that doesn’t mean the lockdowns were necessarily the wrong call. There could’ve been a different scenario where the original virus was much more transmissible and virulent than it actually was. I really don’t want to enter another pandemic with the “well we kinda overdid it with Covid” mindset

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Jul 10, 2023·edited Jul 10, 2023

If you look at the letter from the public health experts on June 2020, it explicitly distinguishes good protests (protesting against racism) which should be allowed to go forward and bad protests (white supremacists protesting stay at home orders):

"As of May 30, we are witnessing continuing demonstrations in response to ongoing, pervasive, and lethal institutional racism set off by the killings of George Floyd and Breonna Taylor, among many other Black lives taken by police. A public health response to these demonstrations is also warranted, but this message must be wholly different from the response to white protesters resisting stay-home orders."

"We can show that support by facilitating safest protesting practices without detracting from demonstrators’ ability to

gather and demand change. This should not be confused with a permissive stance on all gatherings, particularly protests against stay-home orders. Those actions not only oppose public health interventions, but are also rooted in white nationalism and run contrary to respect for Black lives."

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I was pretty Covid cautious but had started doing outdoor gatherings in June 2020, so I'm sure that there was information at that point that showed it was safer outside.

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My point was to provide my own experience of the coverage of the justification of the protests by public health officials. I’m sure some people knew that outside was safer by summer 2020, but I didn’t, even though I read several news items about public health personalities saying that protesting was ok as long as everyone was masked.

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Yeah, I remember going to a few protests that summer. One was rather crowded but literally everyone was masked, and there were protest coordinators handing out masks and telling anyone without one to mask up. The other was a "car protest" where everyone drove in their own car in a little parade. (It was wholesome actually. We brought our baby.)

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If I recall correctly, some states were still banning outdoor church gatherings or other large (>100 people or so) events even in the summer of 2020.

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In addition to what Joey says I’ll point out that the problems continued long after, eg in vaccine approvals , boosters etc. I really don’t remember all the details now but inwas following the evolving official line in real time and in kept being bad and behind te rest of the world well into 2021 if not later

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That was not the message communicated to the public, nor the one adopted by progressives and radicals till they decided to burn our cities down. There seems to be a willful misremembering here.

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You made a post earlier about how dishonest progressive reaction to Covid made you conservative, and now you're spreading dishonest crap about our cities being burnt down. I don't think you've learned a thing.

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I learned a fair bit actually: how good sections of Chicago were burnt down or otherwise ravaged, including my friend’s Camera shop that had been in the neighborhood for decades, in the name of justice for George Floyd. My family in Portland lived through riots, burnings, looting, my friends in Seattle had a whole neighborhood occupied by radical anarchists. 2020 radicalized a heck of a lot of people, including me. While I will never vote for a MAGA Republican, I will never support a Democratic Party enthralled to a radical progressive wing. You simply don’t get it, do you, the sheer damage the progressives have done to alienate not simply working class people, but nearly all families trying to raise their kids in peace.

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Yes, the jump from a few blocks in a couple of cities sustaining riot damage to "they burned our cities down" is definitely reasonable. Hell, in the year 2023, there are still a significant amount of conservatives who believe that NYC is an anarchic wasteland out of Mad Max and the only way to save it is by bringing in manly conservative vigilantes with guns.

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You honestly don’t get it. It is 2023, not 2020, things are not the same now as they were then. But the continued insistence by progressives, displayed here by you with the very words you type, to excuse mass mob violence as if it were nothing, as if it didn’t ruin lives and livelihoods, is vile. And if too online progressives ever put down their phones and actually touched grass, they would understand how such excuses bring about incredible hatred toward them by nearly everyone else. We aren’t MAGA idiots for hating you, no, we are simply Democrats who hate you for hijacking our party. Stop making excuses for violence. Stop making excuses for rioting. Stop making excuses for looting. And for the sake of your own mental health, put down the phone.

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I’m on your side, in part: I despise all violence, including property destruction, and I don’t accept “but we’re angry” as an excuse. I think the “violence and looting is excusable because racism” line is reprehensible (see e.g. current commentary about France), and I am very disappointed that such thinking took over a vocal faction of what we would call contemporary progressivism in 2020, and is still lingering. As a former resident of Capitol Hill in Seattle, I was disgusted by CHOP - and glad that the NYT ran a series of articles exposing it as the mini Reign of Terror that it was.

Where I depart from your take is that I resist catastrophizing these things (which is not to say I never catastrophize - ask me about Christian Nationalism sometime). I don’t need to extrapolate the destruction of mid-2020 to “cities burned down” because a single home, business or car is already unacceptable, as far as I’m concerned. While some prominent Democratic politicians - with the notable exception of Biden - made extremely ill-advised blanket statements of support for BLM-inspired protests / defund the police and either downplayed or denied the adjacent looting, “making ill-advised blanket statements about matters of public salience” is just sort of what politicians *do,* and I don’t see it as having irreparably poisoned the whole party (yet!). While I strenuously disagree with the DiAngelo/Kendi-esque strain of anti-racist thought and am dismayed that it was so eagerly and widely taken up across a wide swath of the managerial class, it’s pretty clear to me that contemporary American progressivism is, like all influential political movements, itself a coalition and there are signs that the DiAngelo/Kendi faction is fading in prominence (I would roughly compare its arc to that of the “alt-right,” which went from being all that anyone could talk about in 2016-2018 to “who are they, again?”).

Which is all to say that I think the things you cite are things to be angry about, for sure - but perspective is also important. I absolutely understand the appeal of using language like “them” and “you” and (paraphrasing) “they’re/you’re deluded and we see things clearly,” because I have done it and I’m often tempted to do it. I would just suggest that it’s ultimately pointless and destructive, to one’s own outlook and well-being if nothing else.

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founding

There's some willful misremembering here for sure. But I think there's also a lot of willful conflation of the things that many different groups were saying at many different times, often in contradiction to each other, rather than in hypocrisy as a single individual.

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You knew, but if you turned on CNN or MSNBC or your local news how likely would you be to encounter that info?

I remember arguing with people on BloodyElbow, a combat sports website full of Bernie Bro types, of all places, over this research what was originally published in Sep 2020:

https://www.utsa.edu/today/2021/01/story/2021-covid-spread-outdoor-conditions.html

The tl;dr is some grad students used simulation data to "prove" that outdoor sneezes ad coughs can transmit the virus, undiluted, up to several kms away outdoors. This was the kind of thing some left-wing types were still sharing and shouting back in at least Sep 2020

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I am a fluid dynamicist by training and profession, and even if I weren't, back-of-the-envelope order-of-magnitude estimates would (and eventually did) tell you that worrying while outdoors was essentially absurd. But I know for a fact that I drove to the lake trail in summer 2020 and then just kept on driving because the number of people I saw spooked me, and I did carry a mask in my back pocket when going to a state park (staying outdoors) that fall.

So there was at least some stickiness to our early worries.

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And yet, in Los Angeles where some very big BLM protests happened (I took part!), our playgrounds and swimming pools were closed for much of the summer. We who were trying to open them didn’t get any support from the public health community.

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I'm not sure we know that now, in 2023, if the outdoor area in question is sufficiently crowded, do we (at least based on your categorical phrasing)? Sunlight and air are marvelously protective, but I doubt masking, in, say, a football stadium would be excessively, crazily hawkish.

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Jul 10, 2023·edited Jul 10, 2023

The CNN chyron quoting public health people saying not to go outside unless protesting about racial justice sticks in my mind as a moment I truly understood and felt empathy for my political opponents who think democrats are all hypocritical morons

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founding

Two comments:

1. The deaths from COVID are now, and always have been, concentrated among the very old (75+) and already unhealthy. The age-based mortality rate was ignored or downplayed for reasons I still cannot understand, resulting in intense arguments among the rest of us around masking, schooling, travel and parties.

2. Matt doesn't mention the BLM protests and government/media reactions which took off at the same time as another polarizing and divisive issue.

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Jul 10, 2023·edited Jul 10, 2023

I don't think the age-based mortality rate was ignored at all. Everyone knew it and talked about it. People who wanted universal masking (not just masking for elderly) supported it because they believed that universal masking would help best protect the vulnerable populations, such as the elderly. (The main population that I saw that didn't seem to internalize the age-based mortality rates were parents of young children, who seemed to treat their babies and toddlers were at high risk, even though they very much were not...but I think parents of young children often have a hard time assessing risk when it comes to their own child)

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