83 Comments

“We need to have honest discussions about what went right and wrong with a focus on learning how to do better next time, not rewriting what happened.”

Precisely, thank you.

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Oh, boy, this really touched a nerve!

Make no mistake, I agree completely with this post. It touched a nerve because I served as Commissioner of Public Health in a large state and the mis- and disinformation regarding our pandemic response is more than just galling, it is a national security risk.

Why?

Because the Know-Nothing "post-truth" mis- and disinformation industry that thrives in the wake of the pandemic now has numerous and loud voices who say, "All authorities are lying to you. If you're smart, you will do the opposite of what they tell you [and, continue to monetize my content]."

In these Cabinet nominations, we see a thinly veiled version of this toxic, dangerous and erroneous meme. They have advanced their careers by exploiting the post-truth algorithm.

I believe the most glaring mistake in the pandemic response can be attributed to a failure of effective Crisis Communication. I capitalize "Crisis Communication" because it is a discipline in itself. The CDC is a good place to start learning about it: https://www.cdc.gov/cerc/php/about/index.html [God Bless my colleagues at the CDC, they can be more long-winded than needs be, but it's all very worthwhile.]

Chief among the errors in Crisis Communication at the national level was the failure to make clear that the risk to society from the COVID pandemic was that it would crash our inpatient hospital system, and NOT that is was going to have a fatality rate that would rival the Black Plague. I made exactly this point when I first briefed my Governor on 01/20/2020. My Governor "got it," and never pushed back on any of the medical or public health scientific input he received from me and other experts he consulted. That's a big deal, y'all!

My state's primary strategic goal was to slow the spread of the pandemic virus - reduce its prevalence - such that on any given day, the hospitals around the state had the capacity to handle those infected individuals who needed the sort of support that only a hospital can provide. In my state, we came close to exceeding that capacity through four sharply distinct spikes spaced across the emergency phase of the pandemic.

In effective Crisis Communication, "Science" must advise, but our highest ranking elected Executive must make the decisions. That's how it should be and to be effective, that's how it must be. And, as this YLE post points out, the decisions were not easy: social cohesion itself was at stake. Decisions had to be made with all deliberate speed because delay cost lives and invited catastrophe. All this in the face of the unknown and the unknowable - without any solid QUANTITATIVE paradigm that could spit out an answer to the question of "how much of each imperfect countermeasure is enough to achieve acceptable results?" We still don't have a quantitative paradigm and the data needed to fit into the decision making of the next pandemic. And, as YLE points out, we are really not looking, either.

Alas, effective Crisis Communication did not happen at the federal level.

The onset of the pandemic could have been and SHOULD have been the sitting President's "Winston Churchill Moment" with the America people.

Imagine if your had heard something like this: "This is a serious situation and we must take it seriously. Much is at stake. In the face of this danger, I am asking [not "mandating"] that each of you do everything you can to slow the spread of this virus and give our nation the time it needs to keep our hospitals functioning and optimize our response. If we do this, we will prevail. That is the American way."

I don't know about you, but I never heard that message from the top.

BTW, the duty and authority to convey this message sits squarely on the shoulders of elected officials. Put (overly) simply, elected officials are "Somebodies," while scientists and bureaucrats (like I was) are "Nobodies" in the mind of the public. So, the elected official must lead the Crisis Communication message and state their confidence in the scientists and agencies that are advising on the science and doing the operational work, e.g., distributing a novel vaccine that requires an seamless ultra-cold supply chain.

While I'm at it, here's another key element of effective Crisis Communication: to be trusted, you must be clear about what you know and what you don't know. Prepare the public for the fact that as knowledge accumulates, guidance may change. That is a strength, not a weakness. Again, imagine if that and other key elements of effective Crisis Communication were practiced and repeated. I believe every elected official and their staff could benefit from knowing and practicing Crisis Communication principles. I mean, gosh, isn't that part of the reason we elect them?

I'll stop there. Like I said, this topic strikes a nerve with me.

Many thanks and kudos to YLE!

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Very thoughtful reply!

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Thanks you for all your work, your advocacy, and your willingness to share so much with all of us. It is SO appreciated, especially as we go forward in these frightening times.

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Thank you so, so much for this. These appointments reflect, overall, a “burn it all down” approach without any investigation or analysis of what worked and what didn’t. Instead, a lot of unevidenced pet theories (like the dreadful Great Barrington proposal) will be trotted out once again, likely with a vengeance. We are in for a world of hurt with this crew in charge, which makes me even more grateful Team YLE is here for us. Many, many thanks.

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You would serve yourself and your readers better by sticking to the area of your expertise, Epidemiology and not becoming another political ranter with more sturm and drang than substance.

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Thanks for your comment. I tend to agree with you that it seems *everything* is political these days. It's exhausting. Unfortunately, public health is inherently political. These HHS picks and policies and budget decisions directly impact my work as an epidemiologist. And, because of that, it is in my lane. I try to analyze with a steady and fair head. I hope that came through with this article.

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Thank you, Drs. Jetelina and Panthagani, once again, for your rational, straightforward, comprehensible, nuanced, science-based essays. Unfortunately, as I'm sure you know, nuance is lost on a lot of people, and no amount of evidence will sway them anyway.

Maybe after the odious RFK Jr. starts waving his magic wands and a few thousand people die of preventable diseases because of him, then they'll learn their lesson.

Or not.

As Livy put it 2,000 years ago: "Eventus stultorum magister est." Colloquially translated, "Fools must be taught by experience."

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Dr's Jetelina, you just keep doing what you do. Unfortunately critical thinking in our country has slipped some. One thing that we could improve is administration support when something like a world wide pandemic happens. Conversation about what went right and wrong is key 🔑. For myself and family we followed Dr Fauci's recommendations and even with CHF I and my 85 yr old father survived getting covid late in 2022 and we both used the paxlovd and at 85 my father bounced back in 3-4

days. I can imagine how isolation must have been difficult for those alone. Not sure how home schooling went but at least it was a fix worth trying.

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Thank you for keeping us informed. Personally, I'm wore out trying to deal with folks over this. My hope is that we are able to keep the vaccines for those of us that want them. I'm a Novavax fan and fear it will be the first casualty.

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This post is all substance! Epidemiology necessarily studies politics to understand public health.

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And you, Mr. McGraw, would do well not to erect straw man arguments and project onto others actions and motivations they haven't expressed.

Dr. Jetelina is not a "political ranter." She does stick to her area of expertise, which, judging from your bio (https://www.austinmacauley.com/author/mcgrawdonald-j), is a good deal greater than yours.

(And by the way, it's "sturm und drang," not that that matters.)

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What was she ranting about? And how is advocating for a middle ground, acknowledging mistakes (as opposed to intentional misinformation) and learning from them political?

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Fully agree with the other responses. Jetelina has presented a clear picture of issues both past, present and looking ahead. Agree also that PH is inherently political. If we look at the definition of the "body politic", it basically refers to a people organized into a single body, like the USA. PH addresses, by definition, the health and wellbeing of the body politic, and thus (in my view) is inherently political, but a politics that should be (and in her article is) based in science and fact. There is no ranting here, but rather a clear call for factual exploration and dialogue.

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DJ: Y’s thoughtful reflection was not a rant but a well reasoned and valuable statement. Where is/was your concern about Makary’s deadly rants ie Omni-cold and pandemic of lunacy?

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Katelyn,

My paper, currently under peer review for publication in Indoor Environments, cites numerous studies supporting the efficacy of masking and social distancing. I'm an industrial hygienist, formerly with a State Health Department and now with an engineering consulting firm. Throughout the pandemic, I have focused on investigation of COVID issues for schools and conducted research on transmission pathways and efficacy of control measures.

Your critique of Federal communication on these issues is correct. Scientific literature supporting masking was not clearly presented and risk communication was ineffective. How might the new Congressional report best be challenged?

I'd be glad to share my paper with you and collaborate on issues within my expertise (40-year specialization in Indoor Air Quality). Let me know if you're interested in further discussion.

Keep up the great work!

Ed Light, CIH, Senior Scientist

Building Dynamics, LLC

464 Township Rd. 355

South Point OH 45680

(240) 899-6926

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As I've grown old (73) next week I have embraced a simple way of viewing things. Here's how I view the recent election…

1 Trump is a convicted felon;

2 Trump is a convicted rapist;

3 Varying estimates put the number of covid deaths (or excess deaths as some studies call them) at between 1.5 MILLION and 3 MILLION in the period ending January 20, 2021.

With a resumé as colorful as this one, you'd think Trump would not get anywhere close to the Oval Office, again. As we know today, that's not going to be the case.

What explains this? Simple… COVID AMNESIA. The near–majority of Americans have collectively wiped clean from their minds 2020 and 2021. They suddenly woke up January 2022, found the price of a Big Mac had risen 25% (by today that's now 40%) and took this out on poor old Biden (and Harris).

So, go ahead and do your post mortem on how you all responded to covid. Put your conclusions in your YLE email. But don't expect to get much traction with the general public. They have forgotten or moved on. They say you can't fix stupid. H5N1 might disagree.

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"Vaccines were really good—particularly the primary series—which saved more than 3 million adult lives in 2 years and more than $1.5 trillion. This was partly due to Operation Warp Speed by President-elect Trump—getting us a safe and effective vaccine in less than 9 months."

You have absolutely no evidence to make a claim that millions of lives were saved by these vaccines. Not when the only clinical trials conducted showed zero mortality benefit. You simply can't let go of these narratives. This has nothing to do with Trump or Biden or any politician.

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This is a really weird argument you are making.

You said "when the only clinical trials conducted showed zero mortality benefit". That is true that no one died in the clinical trials conducted by Pfizer - if my notes on this are correct, 2 unvaccinated people died in the Moderna study. (Of course, you do understand that in human trials, we don't want to see deaths). There are 4 journal articles which describe those initial studies in quite a bit of detail, and they provide very convincing evidence that the vaccines were effective.

Many, many real world studies have been done that show mortality benefit from RNA vaccines. It is absolutely clear that the CoVID vaccinations saved a lot of lives.

If you are interested in getting citations, I can provide them.

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Citations, please.

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We made mistakes, but also learned a lot of good, new, and even practical information. Let's hope we can use what we learned (beyond vaccinations) and utilize them to control and prevent COVID and other diseases

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I have been thinking more about the many valuable insights in this post, and specifically the need right now for “genuine conversations,” which I heartily endorse—particularly conversations with those who have points of view that differ from our own.

In those early days of the pandemic, we were all having to make decisions in the face of very scary unknowns. When our governmental officials, even locally, were not responsive to legitimate concerns, our sense of alarm at being left totally to our own devices with no support came to the fore, often necessarily.

Here’s an example of what I mean: in the semi-rural area where I lived at the time, no public official was paying any attention to the needs and problems faced by older people who were NOT living in institutions. It was as if we didn’t exist. I finally realized that, however altruistic I wanted to be about other demographics (and I did want to do that), all my available energy would have to go to making the voices of such older people heard, as no one else was doing this. The fight to get masks, to arrange for vaccines, to get food in safely (there was no such thing as home delivery for quite a while) was a straight uphill battle. It was dispiriting and infuriating in turn.

Going through this kind of thing creates a dynamic where various groups in need are each fighting for scraps, the opposite of pulling together as a community. I think we may underestimate the extent to which the failure of many people to vote at all, along with voting for the current administration, is due to further fall-out from that dynamic.

I don’t know how we put back the pieces, but without genuine conversations that work, among other things, toward rebuilding community across difference, I think we are going to be in deep, deep trouble for a very long time.

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There was a playbook - nit the Obama one but a 2019 exercise which showed we were abysmally unprepared for the real thing.

https://www.nytimes.com/2020/03/19/us/politics/trump-coronavirus-outbreak.html

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I wonder who the folks were who proposed "Warp Speed" in the first place, as it is unlikely in my opinion that the then-president came up with this idea. How do we keep them around?

Edit: I posted this and then realized it may not be safe to come up with any names in today's climate. Just hoping they stay safe.

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"Limiting transmission through social distancing was important before vaccines were available. In winter 2020, we were losing ~3,500 people per day. And that’s with restrictions largely in place, like working from home and eating outside, and many schools were still closed. And it worked. In fact, social distancing measures were so impactful that a common strain of influenza disappeared from the planet."

That this paragraph is written by public health professionals is scary actually. You think a strain of influenza disappeared because people worked from home and kids didn't go to school? Zero evidence to support this. There is no evidence that any of the NPIs worked. You have no credibility until you are willing to deal with the reality that this virus was never controllable.

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Quote: "You have no credibility until you are willing to deal with the reality that this virus was never controllable."

So in other words we should've just thrown up our hands and done nothing. You're insisting that nothing is good enough unless it's perfect. Talk about an unrealistic assessment. And a recipe for disaster.

I don't know how Dr. Jetelina has the patience to deal with all you vaccine-deniers and people happy to throw the baby out with the bathwater. The "Likes" you've given to such people as indicated in your profile speak volumes.

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There's no evidence that closing schools, social distancing, or mask-wearing had any effect on viral spread. I know this is an uncomfortable statement for people that invested so much into the COVID suppression narrative, but it's the reality. The first step to regaining some credibility is to admit that the NPIs and the associated mandates and restrictions failed to realize any benefits.

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Would you provide evidence for your statement?

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This is all well to say in hindsight. But given the novel and unknown nature of the virus and its transmission, I (a grandmother of school-age children) did and still do appreciate the caution that laid the foundation for these restrictions. I shudder to think what might have happened had we not imposed restrictions and later understood that they would have saved lives. We must now address the fallout, of course, but let's not deride the care and concern for our populace that prompted their caution.

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Actually, he is mistaken on these points with respect to me masking and social distancing especially. The school closures is a more complex issue as best I can tell.

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Au contraire. There is simple, real world evidence - look at Canada versus the US in 2020 - 2022. Also, look at New Zealand & Australia.

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The "Likes" he has made show a pretty distinct lack of knowledge....

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Good to see others in her audience willing to raise inaccuracies, or propaganda. Who else do you read Paul?

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Paul is mistaken with respect to making and social distancing.

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Mr Bill - without any studies my own life experiences tells me he is right. Our entire lives and for the past hundreds of years we never needed either. What changed w the covid virus?

Nothing and you know it.

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Mr DT, of course masking and social distancing work if people actually do these. Ordinary experience shows that. If you are interested in reading technical papers on those subjects I can send you links that provide detailed evidence...

BTW, I was a microbiologist, so I've actually done experiments to show that these things work.

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They may work when applied and used correctly, however, this is not what happened in practice. When things were beginning in 2020 my office was in the med school area of a college campus. I was walking outside behind a woman wearing a surgical mask and the wind caught it and tore it half off her face. She grabbed it, started to put it back on and correctly thought better of it because it was now potentially contaminated.

Compare that to what happened in public practice. Folks wearing cloth rags, often for multiple uses, touching them, pulling them up and down while stuffing food in their face, etc. Where I worked, folks were required to wear them while not in their offices or cubes. What did everyone do? Keep a dirty appliance to throw over their face when going to the bathroom or kitchen. It was stupid. They became nothing better than a talisman, hygiene theater, and a salve to assuage the fearful at best and a symbol of oppression at worst.

There is also the part about surgical masks saying right on the box that they are not designed to stop viral transmission, and they're not. They're designed to prevent droplets and spittle going into open wounds while attending a patient, but somehow, they still became a symbol. Whether it is a symbol of good or ill I guess depends on your political persuasion.

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A

. Fauci wearing that worthless Washington Generals cloth face mask is iconic vis a vis the mask debate. Like trying to stop a mosquito with a chain link fence. Pure theater - virtue signaling. One is worthless, two are better, three are …

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I agree with you that the public health measures must actually be implemented to have a good effect. It is my impression from my travels that folks in Canada "better obeyed" the masking and social distancing mandates than folks in the US. There have been more doses of vaccine administered in per person in Canada than the US, and Canada has had significantly less deaths from CoVID than the US.

I also agree that cloth & surgical masks, especially if old, will not be terribly effective.

However - I want to be clear - if people are able to obey these measures and do obey them, they are effective! (But not perfectly so).

I might note that there are many other public health measures enacted in my lifetime that have a little of this flavor - i.e. resisted loudly and vigorously by some - but were effective. Specifically - seat belt laws for cars, no smoking on airplanes & most other public places, and work place safety regulations about wearing protective foot coverings etc. If you aren't as old as I am, you may find some of these a little surprising.

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The extremists on both sides, who refuse to acknowledge complex truths, dominate the airwaves. Thank you for this more honest, calm, nuanced assessment.

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As always, thank you for your thoughtful and nuanced comments. Could you please comment on what happened in countries that did try to establish “natural herd immunity” before the distribution of vaccines? I have a recollection, possibly erroneous, that Sweden tried this, the death rate skyrocketed, health care facilities were overwhelmed, and the policy was abandoned.

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An article that might help:

"Sweden hoped herd immunity would curb COVID-19. Don't do what we did. It's not working.

Sweden's approach to COVID has led to death, grief, and suffering. The only example we're setting is how not to deal with a deadly infectious disease."

-signed by 25 Swedish doctors and scientists

https://www.usatoday.com/story/opinion/2020/07/21/coronavirus-swedish-herd-immunity-drove-up-death-toll-column/5472100002/

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Latest data shows Swedens excess death rates are below those for most of Europe. 60% of U.S. see https://www.economist.com/graphic-detail/coronavirus-excess-deaths-tracker

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See my note above to Easy Ed. IMO there are other issues than the formal policies enacted by governments.

Quick Extract showing Excess Deaths

USA 417

Canada 239

Sweden 240

Denmark 170

Norway 265

Germany 393

Finland 390

Australia 172

New Zealnd 13

Britain 445

Thanks for posting the link !

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Good article, thanks for posting, saved me a lot of looking around. My quick take is that Sweden lost people early, and that the measures the other Scandinavian countries took meant that people lived a little longer. (i.e. died in 2022 rather than 2020).

But there is more complexity here - look at Australia & New Zealand - these were countries that were able to do the "best possible" thing - fully isolate & lock down until they had vaccinated everyone who was willing to be vaccinated (& they had pretty high vax rates). They did better than Sweden.

The other thing that I've noticed, is that generally larger countries do worse, and countries that have high numbers of outside visitors do worse. (e.g. look at US vs. Canada). The simple comparisons of country to country are not as useful as one might hope.

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Excellent perspective- unfortunately, many in my community buy wholesale into the myths refuted here (everything was a giant failure followed by a giant cover up.) I feel like this newsletter is vital in keeping me connected to reality!

Question for anyone reading this in the NYC/NJ area: where can I find a COVID vaccine for a 6-12 month old baby? I’ve struck out with our pediatrician, local health department, and all local pharmacies … frustrated with how difficult it is to follow the CDC’s recommendation to vaccinate as young as 6 months.

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I am nominating you for NIH director! We need evidence-based, reasonable and rational people now!!!

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