Off topic: This is EXACTLY why we need a higher grade of up-to-date health/medical sciences & research taught at the high school level & I'm not talking about AP classes... I mean ALL students with the basics of microbiology, virology, hematology, etc. The younger generations need to learn the what Mother Nature was trying to teach all of us with plagues/pandemics: "What Happens to One of Us on One Side of the World, Happens to All of Us in the World... If one of us is not safe, then none of us are safe." Ignorance breeds & transmits diseases & plagues... not just the viruses...
Agreed. Further, aside from ignorance, when select humans live in relative ease, comfort & safety for generations, it becomes a mind bending event to accept living in a less secure world & buy into the possible solutions which all could/should benefit from.
Thanks for that review - I've often wondered how much of an overshoot some areas did and how much of an undershoot others did. For example, I live in Hawaii, where we went into a significant shutdown ("lockdown" is such a loaded word - people were NEVER "locked" out of anything). We suffered a severe economic impact from the loss of tourism, but our local ecology flourished. And when we did relax our restrictions, our hospitals came very close to being totally overwhelmed. I do think that those who aren't intimately involved involved with the healthcare system just don't understand how close we came to having a collapsed acute care system with horrible downstream impact on the treatment of a host of acute and chronic conditions.
Sweden won. That much is clear. They have the lowest excess deaths in the entire world. Lower than South Korea, Israel, Denmark, and New Zealand.*
Models are only as good as their inputs and assumptions. It is very easy to design your model to show the thing you think is true. It is quite another to apply that model to real world historical data and have it validated.
You cite this model saying "if England did X, then Y would have happened".
This is easily falsified by applying the model to Sweden, or California, or South Dakota, or Bulgaria, or Norway, and seeing the outputs don't match reality. This is basic stress testing. Authors of the model you cite made the mistake of goal seeking. Apply their model to any country now that we have historical and see if you can get desired results.
I mean this with sincerity Katelyn - you are at risk of clutching a failed hypothesis. It has become evident with each day the voices calling for lockdowns, argued for gain of function, wanted us to mask kids were on the wrong side of history.
This doesn't make them bad people anymore than Galen was wrong for advocating ingesting mercury - you use the knowledge available at the time.
If you follow science, then you adjust your hypothesis as facts come in. I understand you have 3 years of social media posts saying how important it was to mask kids, or claiming highly vaccinated countries would have better outcomes, but those theories have now been refuted. It is ok to be wrong. There is nothing shameful about it, being wrong advances science.
It took William Farr 9 years after he had overwhelming evidence his hypothesis was wrong to see his error - and all he had to do was admit his error privately to colleagues - he didn't have the baggage of Instagram and Substack. This is what made Farr more impressive than Snow. It is easy to be right. It is much harder to be wrong and admit you were wrong.
I implore to step back, re-review the evidence at hand, put aside your priors, and reevaluate your hypothesis. See if anything changes.
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*excess death analysis for anyone who wants to dive in my claim:
Hi Michael- Thanks for your comments. There’s a lot to unpack here, but I urge you to be careful making sweeping conclusions like “Sweden won” when thinking about future public health policies. Sweden also has an incredible level of trust, universal health care, social support, and cohesion. I would argue those are incredibly important confounders to account for. And, they *did* have NPIs, but not mandated but still many followed. But even with no NPI’s people change behavior (See #2 in my post)
Thanks for the reply - excess deaths is the most important metric to measure. It ensures not only that any discrepancies in counting are caught, but also any unforeseen repercussions would be caught as well. Through 2020 and mid 2021 this was a metric and talking point in Financial Times, The Guardian, New York Times, etc. I know I am not telling you anything you don't already know, just recapping for anyone else reading.
If we agree excess deaths is the most important metric, then the evidence does suggest Sweden "won", and I know there are better ways to phrase that, but it makes a point to capture attention.
Now my question is - why is this unfalsifiable? When the NYT, Guardian, and even Donald Trump predicted disaster in Sweden - why weren't they pointing out that it might be ok because of their "incredible level of trust, universal health care, social support"?
Now that Sweden approach has been validated, many are Monday-morning quarterbacking and saying this isn't surprising after all.
Why not simply admit they got that wrong?
You are, I suspect, repeating a claim you may not have double checked. I keep seeing the claim all over twitter (which I finally caved in and 'joined' last week) about their level of trust, health care, social support, and claim they made changes in behavior but evidence from Swedes suggest the opposite. [1]
That they had a "change in behavior" seems easily falsified by realizing they didnt keep kids out of school and didn't make them wear masks. Even newspapers in Norway are openly discussing this surprise noting "Schools were kept open. Children got to meet each other. Adults were allowed to go to a café and restaurant. All shops remained open." [2]
Furthermore, the hypothesis of "trust, univ health care, social support'" as explanation how Sweden got it right ignores all the countries that had these things and had much worse results. Does South Korea have lack of trust in their PH experts? Is that why all-cause mortality doubled spring 2022? I suspect not
Excess deaths? OK. As someone who's in the risk biz (I'm an insurance examiner) I've learned to be wary of anyone who swears by one particular KRI. None of them should be regarded as sacred cows, and getting too obsessed with one particular metric or set of metrics can have consequences that range from embarrassing to deadly.
Then which metrics would you suggest we gauge success or failure? Surely there has to be something? What could be better than the one metric that ignores bias of testing, individual discretion on qualifying cause of death, or any other confounder?
For the first 18 months this exact metric was being championed to show Sweden's failure. Now that it shows their success we are getting too obsessed with one metric?
Framed another way, what is Sweden doing differently than us where we still have 500 Covid deaths a day and they have effectively zero?
I think we just need to be on our toes, and be willing to change metrics depending on circumstances.
For instance another indicator would be change in life expectancy. Last I checked, the pandemic knocked a year or two off of life expectancy in the US.
I disagree on changing metrics, but I am looking at this from engineering perspective so that lens of wanting to optimize and evaluate ROI is why find the best metric and sticking with it seems best.
Of course, other metrics can and should be considered, and to your point Life Expectancy is interesting, but it requires a lot of information to properly calculate.
I also urge caution because life expectancy and "Years of Life Lost" weight deaths in a way where elderly deaths aren't as impactful to the model, and in the case of Covid, with 80% of all deaths being over the age of 65 that can be problematic. YLL for example would not count any years of life lost for the ~300K 85+ year olds as they are past the LE ceiling.
I think DeSantis has crowed about his success without acknowledging the effect of FL’s hot weather -- crowding outside not inside. And yes the Swedes are well socialized.
All the hot weather appears to do is alter when they get their waves, which allowed data-drudgers to cherry pick comparison points like the CDC study that claimed to show masked schools fared better -but all they did was run the study when Florida was in their wave and stop the study when the NE wave started. California is hot too and nearly identical excess death rate (20% vs 22%) despite population demographics slanted against FL.
As for "Swedes are well socialized" - what does that mean? Yeah, they did appear to be very social as they continued to send their kids to school unmasked, went to bars, concerts, parties, etc throughout the pandemic while still having the lowest excess deaths in the world.
Appreciate you double checking my claim. I think we all agree that different countries, states, regions can count covid deaths differently - there is a lot of gray area.
That's why Excess Mortality is the best measure - it bypasses differences in testing/classification of deaths. If you recall excess death was regularly cited by media to show how much *worse* Covid was than we realized.
Norway for example shows 5,175 Covid deaths yet they have 6,965 excess deaths 2020-2022. Meanwhile Sweden recorded 23K deaths but only has 10K excess deaths. This is why when only looking at covid deaths/population you get misleading results.
I attached in the google doc all excess mortality if you want to double check my work further.
Why don’t you publish your hypothesis, then. Put it out there. I can say this about people who take the lead on anything including Dr. Jetelina. She does what she can to get the information out there, knowing what she knows, seeing the big picture as a public health specialist, and understanding the impact of individuals as an epidemiologist. The best minds put themselves on the ground to save as many people as they could, including Dr. Jetelina. It’s easy to be an armchair general.
Completely agree it is "easy to be an armchair" general. I made the decision ~2 years ago not to publish, not to make yet another substack. There are enough substacks and Twitter accounts pointing out the data I am sharing, refuting the failed hypothesis. Another won't make a difference. Instead I spend ~$4,000/year reading everyone else, and politely correcting mistakes as I see them. I do this when Joel Smalley makes a claim like Germany excess deaths rose after vaccines and I find the data lacking, and I do this when I see YLE citing a model which is easily falsified.
Everyone seems to stick in their echo chambers, stay in their silos. Carl Heneghan makes his tweets and his followers nod in approval. Peter Hotez makes his tweets and his followers nod in approval. No one seems to be engaging with one another, no one seems to be interested in re-evaluating their claims, challenging one another to get to the bottom of what is and is not true.
Instead, I am doing what I would do in the private sector, when some consultant proposes some idea, projects some ROI - I triple check, I probe for weaknesses in the claim, and if I agree to the idea, I set up ways to measure success or failure.
There is no need for me to publish this, it seems more efficient to respond directly to ideas and arguments which appear to be false. If I publish all I do is set up my own echo chamber, I don't get any closer to truth.
Paul, it's important to always grant charity when you disagree with someone, give them the benefit of the doubt.
I don't think Katelyn had "an agenda from day 1". She's got a full time job, a new(ish) family, and a large social media brand to manage on top of writing this heavily researched substack. It's quite impressive.
Balancing rigorous skepticism with openness to new ideas is very difficult. It requires a slow and careful analysis of every idea. And time. Lots of time.
If you take shortcuts, by trusting an argument from authority without double checking it yourself, you may make mistakes.
I can understand for example how appealing the *SEVENTY* papers on mask efficacy shared by @nuanceORDEATH [1] might be to convince you masks work. She wants to quickly get information out to her followers, and places her trust in this person by uncritically passing it along arguing "I’m not entirely sure why the efficacy of mask use is still up for discussion". I can see how that can happen with good intentions.
I can also understand why she wouldn't have the time to carefully go through each paper to evaluate the claim. It took me months to graph the results to notice the inverse relationship between efficacy and study quality.
It would also take a lot of time to realize that nuanceORDEATH committed the fallacy of "counting your hits and forgetting your misses" - he selectively only included studies that found positive mask benefit, going so far as to include the sub-studies of any meta analysis that showed benefit and purposefully skipping studies in that same meta that didn't find benefit.
It would take a lot of time to cross reference retraction requests, note which had been pre-registered, replicate claims when possible, grade the quality. By the time she could have done this it would have been well into 2021.
This is what makes science so very difficult to get right. It so easy to slide into suprstiton.
"Science invites us to let the facts in, even when they don’t conform to our preconceptions. It counsels us to carry alternative hypotheses in our heads and see which best fit the facts. It urges on us a delicate balance between no-holds-barred openness to new ideas, however heretical, and the most rigorous skeptical scrutiny of everything-new ideas and established wisdom….. When we are self-indulgent and uncritical, when we confuse hope and facts, we slide into pseudoscience and superstition."
Your linked table has a huge fallacy - it shows mortality, not mortality rates (i.e. adjusted for country population size). Your conclusions are based on an inappropriate parameter. It could be made even more valid by showing age adjusted morality rates.
Already included those calculations, need to unhide columns O and P (I just did, should update for you too). Same result. Sweden at bottom with 98.9 excess deaths per 100K.
This is a rare instance though where I find relative rates more informative than absolute rates, even though the absolute rates also confirm my statement - happy to dive into that discussion if you'd like.
(I'm temporizing the idea that relative more useful than absolute - might be persuaded the other way - only been thinking about it a few days)
I don't think it's clear at all that "Sweden won." According to Worldometer, the "covid deaths per million" figure for Sweden stands at 2,320. For Denmark it's 1,421. For Norway it's an impressive 946. Norway and Denmark (with comparable health systems and demographics to Sweden) implemented more aggressive covid control measures and the beneficial results are palpable. https://www.worldometers.info/coronavirus/#countries And BTW, Norway and Denmark saw less economic damage too. Sweden's gdp lost 2.3% in 2020, Denmark's 2.0% and Norway 0.7%, according to Trading Economics.
As I addressed in an earlier comment, this is why NYT, FT, Guardian argued that Excess Deaths is the best metric (and I agree with them). It catches differences in counting. As I noted yesterday:
_____________
"Norway for example shows 5,175 Covid deaths yet they have 6,965 excess deaths 2020-2022. Meanwhile Sweden recorded 23K deaths but only has 10K excess deaths. This is why when only looking at covid deaths/population you get misleading results.
I attached in the google doc all excess mortality if you want to double check my work further."
_____________
I also want to bring up the point - why do we only get to compare Sweden to her neighbors? Why do we compare the US to South Korea, or Germany, or Germany, but Sweden is only ever compared to Norway or Finland every time a point is brought up how their outcome defied expectation?
RJH: "Norway and Denmark (with comparable health systems and demographics to Sweden) implemented more aggressive covid control measures and the beneficial results are palpable."
1) Norway and Denmark also returned kids to school May 2020 and like Sweden had among the lowest mask use rates in the world. If your argument is the Nordic data shows the US could have returned to school May 2020 without obsessively masking kids, then we are in agreement.
2) There is no palpable benefit though. Yes, DNK, FIN, NOR all have among the lowest excess deaths in the world, but still higher than Sweden. How is that "palpable"
3) Why shift to loss of GDP in 2020? Statista graphs don't show anything remarkable (https://www.statista.com/statistics/1274468/gdp-per-capita-nordic-countries/) and this "whataboutism" only leads to bickering over how much impact closing borders has on import/export, the pitfalls of a service-oriented economy, tourism, etc.
The subject at hand is whether we can be confident the things we did actually made a difference, or, are we clinging to sunk-cost fallacy as we realize it probably didn't matter if we kept kids in school, wore masks, cancelled prom, had vaccine passports, etc
I do believe that you are 1) moving some goalposts around, 2) are setting up some straw man arguments (I'm not sure ANYBODY is claiming EVERYTHING different countries, including the various states of the United States was correct, and 3) as to agendas and "clinging", I think a bit of a bias is evident in your desire to claim Sweden "won" in the "What to do about COVID" sweepstakes. My thoughts at this point, based on your posts on this particular thread, as well as earlier ones, is that we are going to have to agree that we see things somewhat differently as to how various countries responded and the subsequent trade-offs involved.
I set the goalpost as excess deaths may 2020, and here, March of 2023, I stand by that goalpost.
I have had others, including co-author Dr. Yamey on twitter today, shift the goalposts to stringency index, GDP, covid deaths/population, yet I remain at the original goal post - excess deaths.
It's not just the GBD physicians providing testimony that's worrisome. Some of the subcommittee members are big offenders in terms of spreading misinformation and lies. Marjorie Taylor Greene compared mask mandates to the Holocaust, saying "vaccine Nazis" are ruining our country. Although the list of ingredients is publicly available, she just recently claimed, "We have no idea what's in Covid vaccines," and in 2021, MTG referred to proposed vaccine “passports” as the mark of the beast.
Debbie Lesko opposed vaccine mandates and passports and raised the issue of vaccine death count theories with the CDC.
Ronny Jackson has publicly stated Dr. Anthony Fauci has “the blood of millions of Americans” on his hands for his management of the Covid-19 pandemic.
Rich McCormick, a physician, had a role in the success of Trump's Operation Warp Speed, but pivoted to a position of vaccine skepticism when announcing a bid for Congress in 2021, stating, “If a 12 or 15-year-old doesn't want to get the vaccination, and their parents don't want them to get the vaccination—who really cares?”
Michael Cloud called Covid vaccines “experimental” and derided the Biden Administration for vaccine mandates along wit his quest to end legal protections given to vaccine manufacturers subject to emergency use authorization. This is scary!
So, these are the people you want or trust to be in charge of making public health policy? Not me. Everything I mentioned has been reported by credible sources, so I'm not certain why it's Gish gallop.
It seems like where we've ended up is the era of *personal choice*, which means sometimes healthy people are still opting to be careful, and sometimes vulnerable people are opting to be risky. People, not the government, should decide whether they are willing to bear the individual cost of building herd immunity.
Perhaps the lesson learned is that Public Health's role in all this is to provide the education and information people need to make informed choices. This isn't perfect, but it's preferable to taking away people's civil liberties, livelihoods and hope for extended periods of time.
Part of the problem is Public Health doesn't seem to be giving us all the information we need in a straightforward manner. We are told, for instance "people who are overweight may be at increased risk." May be at increased risk - really? If we were told "overweight people are 10 times more likely to die from covid" (I'm making up numbers), overweight people could understand their personal risk better and decide for themselves. But, for some reason, it's more important not to shame people, so we're fed this wishy-washy language of uncertainty.
When looking at the costs of lockdown, we need to look at *all* the costs, not just the risk of dying from covid. Teen mental health has suffered, and to the extent overdoses and suicides have increased, lockdown has likely played a role.
You demean the role of public health. The DPH's main role and efficacy extends far beyond communication, it inherently involves systemic changes that protect population health. Let's take water supply. We are used to safe drinking water right from the tap. What if public health was not inspecting (see Flint, Michigan) and safety interventions were lax, would you be helped by clear communication of the risks and given responsibility to protect yourself?
Sorry, can't agree. Our public health agencies gave us the information they had when they had it, and did so in the face of politically motivated FUD (fear, uncertainty, and doubt) pushed by the far right. The CDC didn't know the full extent of the novel Coronavirus from day one because it was, in fact, novel. As in: new.
And BTW, using inflammatory and bogus language about "taking away people's civil liberties, livelihoods and hope for extended periods of time" doesn't exactly add clarity. If you're going to push propaganda, expect a push back.
When you say *this* would only be possible - I'm not sure which "this" you're referring to.
I agree with all your points, yet, *individual choice* is what we've evolved to, it's the only thing people will tolerate, and the only question is, why didn't we get here sooner?
I do think in the very beginning, when Public Health was trying to get their hands around what was going on - how deadly? mechanism of transmission? how infectious? who is most at risk? - it was appropriate for Public Health to tell people to stay home.
But really, unvaccinated tennis star Novak Djokovic still isn't allowed to set foot in the US despite having natural immunity. Three years in to the pandemic, this feels heavy handed and archaic.
There's another side to revisionism, and that’s silence. What happened to the vaccine mandates that were so important to stopping the pandemic that is was justified to take away a person’s livelihood? Now nobody talks about the vaccine mandates, they just bury their head in the sand.
Remember the days when it was mis/disinformation to suggest that past infection conferred immunity? This too has been forgotten, which is another form of revisionism.
How ironic that your last two paragraphs are, themselves, cases of revisionist history. Either that, or your memory is simply selective. Nobody ever said "vaccine mandates that were so important to stopping the pandemic that is was justified to take away a person’s livelihood". And nobody ever said that "it was mis/disinformation to suggest that past infection conferred immunity."
The disinformation was claiming that so-called "natural" immunity was safer and more long-lasting than vaccine-induced immunity. That was wrong then and it still is.
This whole "Public Health didn't inform us" theme is a popular one some commenters here, but it is, at best, an oversimplified and exaggerated version of reality.
Fascists generally aren’t too keen on finding, dealing with, or spreading the truth.
The GOP has a huge advantage here: there is almost no constituency for any pandemic measure now ***or in the future.***
Most don’t care—right now, with 500 dying a day. Fascism is merely the organization, cultivation, and weaponizing of sociopathic narcissism. Our country’s hyper-individualist, hyper-capitalist values deeply encourage sociopathic narcissism.
We are all generally fine with 1.5m deaths from mostly acts of omission, the bulk of which were preventable. It’s definitely a step to killing millions by acts of commission, yes.
How short a step? Virtually all of us are completely complacent, whatever we say, about destroying the human future via carbon.
Public Health and Libertarianism cannot co-exist, to state the obvious; most critical thinkers knew the GBD codified a limited and inhuman view. The American Institute for Economic Research wants to put an end to all government regulation.
Sadly, it seems likely the people failing to seriously study and implement "lessons learned" from this pandemic will be the same ones blaming everyone else when we're not prepared for the next pandemic.
This is an important observation, analysis and discussion. To this day I have not seen a realistic compilation of how many Americans are "high risk". You cannot just total the prevalence of various conditions as some people fit into several categories. There is obvious confusion, even in the midst of the pandemic I heard Dr. Califf, head of the FDA, say pregnancy was not a high risk condition. Even as the official emergency passes, protecting high risk individuals is important. I know some chronically ill elderly people who have not gone out in 3 years except to get groceries and visit their doctor. Are they more safe now that we think incidence is lower but there are fewer public health measures used in the community? We need to know this!
Thank you and I am still concerned that those in government are still extremely polarized based on political views and not fact-based science. I hope we can bridge the gap and be more prepared and in step with each other. For instance, I feel like there is no discussion on how we are exiting the pandemic and entering the endemic stage. In all your free spare time (wink wink) I would greatly appreciate an article on that subject. I know it is difficult as we all have different health needs and have different risk levels; however, it is important to live our lives and we can do small things to help those that are immunocompromised. Truly appreciate all that you are doing for us!
excellent comment about logistics. I have yet to hear, even once, since GBD was proposed exactly _how_ one would protect the (ill defined) vulnerable population as they claim was needed, when the single biggest risk to the vulnerable individuals seems to be a high level of circulating virus in the general population. It's 'let me just worry about me' libertarianism disguised as a public health policy, and as is typical for those, it actually glosses over the details of how it might actually work. (If we had the ability to effectively shield the high risk, wouldn't we have done so?) It's often typically the same people advocating for GBD that fight every measure that would have actually protected the vulnerable and allowed people to go about their everyday lives.
In the US, high levels of lockdown did not prevent high levels of circulation. All they accomplished was to reduce it a bit and spread it out over a little longer time frame.
Decrease the risk in the short run but cancel out that benefit by increasing the duration of the risk. No way to ever test which approach would have the best results long term, but my money is on the GBD approach with local adjustments as necessary. GBD would not work well as a top down nationally mandated strategy. It works best when individuals and local officials use the information provided to make their own decisions on how best to protect themselves.
except there is no 'gbd approach' to put money on. it's an empty 'just let us go do what we want because centralized response to a threat is bad'. If there was actually a practical way to implement GDB, i'd love to hear it. I've been waiting 3 years now.
First, what an excellent summarization! Second, the GBD was an out growth if the Lives vs. Livelihoods debate that has raged during the entire life of the pandemic. But my state's Governor Kate Brown, took the politically courageous step of choosing lives. Her reasoning was correct: lives are required to enjoy livelihoods- a business can be reestablished but a life once lost is gone forever. Third, no one saw long Covid as a significant factor in the equation for half a year into the pandemic and once we knew how large a problem it was, it immediately made the GBD argument obsolete. Fourth and finally, public health became politicized during the pandemic precisely because large economic issues were involved and our two political parties found themselves in opposition, yet again. Economics, rather than ethics seems to drive decision making here more's the pity.
I put a like on your comment because I enjoy well-formed arguments made on any side of an issue! And I don't necessarily disagree with your conclusion, no one likes paternalism. But there ARE things worse and who knows that public health may be inflicting a minor harm on you now in order to avoid a more major harm done to you from other agency later. Any curtailment of your liberty does you a harm, say, seatbelts. But while you may not like them, your wife and children certainly hope you are wearing them should by ill fortune you run into a tree! We aren't isolated individuals rolling around like BBs on a plate! We are linked to other individuals who love us and we owe them something. As they feel they owe us. "Non nobis nascimur" after all is said and done.
"Can we please have a serious conversation about the COVID-19 pandemic and how to prepare for the future? Our lives depend on it." - Absolutely, but that depends on the participants' willingness to genuinely understand (though not necessarily agree with) others' points of view. How do we get to that place; do we have relevant models to learn from? (What would it take to even agree on what the questions should be?)
Take for example the turbulence following recent publication of the Cochrane report on masking (and other measures) in light of 2 potential questions: (1) Does recommending (or even mandating) masking reduce population burden of Covid under real-world conditions? (2) How much less likely am I to catch Covid sitting on a 4-hour flight next to an unmasked person with Covid if I wear a well-fitted N95 mask vs. no mask? (Yes there are nuances - just want to highlight the importance of knowing the question)
Excellent article! As you point out the purpose of the sub-committee is not to move the discussion forward it is to put a different spin on failed policies. Thank you for the insight
Thank you. Very timely and very well written. There is considerable "revisionist" history occurring now that ignores key elements of the historical record. As you noted, once folks thought that serious illness or death was around the corner, they self-isolated. As I remember, in some states that opened up early, the hospitals filled up and the only room was in the parking lot. The Phoenix area comes to mind. Congressional investigative time would be better spent on generating better structures and surge capacity to better manage the next health care crisis. For example - how best to manage the trade-off between "protection" and the need for in person classes. Insuring better ventilation in schools. etc. Again - great material.
Off topic: This is EXACTLY why we need a higher grade of up-to-date health/medical sciences & research taught at the high school level & I'm not talking about AP classes... I mean ALL students with the basics of microbiology, virology, hematology, etc. The younger generations need to learn the what Mother Nature was trying to teach all of us with plagues/pandemics: "What Happens to One of Us on One Side of the World, Happens to All of Us in the World... If one of us is not safe, then none of us are safe." Ignorance breeds & transmits diseases & plagues... not just the viruses...
Agreed. Further, aside from ignorance, when select humans live in relative ease, comfort & safety for generations, it becomes a mind bending event to accept living in a less secure world & buy into the possible solutions which all could/should benefit from.
That’s on topic enough for me! 🙂
Thanks for that review - I've often wondered how much of an overshoot some areas did and how much of an undershoot others did. For example, I live in Hawaii, where we went into a significant shutdown ("lockdown" is such a loaded word - people were NEVER "locked" out of anything). We suffered a severe economic impact from the loss of tourism, but our local ecology flourished. And when we did relax our restrictions, our hospitals came very close to being totally overwhelmed. I do think that those who aren't intimately involved involved with the healthcare system just don't understand how close we came to having a collapsed acute care system with horrible downstream impact on the treatment of a host of acute and chronic conditions.
Sweden won. That much is clear. They have the lowest excess deaths in the entire world. Lower than South Korea, Israel, Denmark, and New Zealand.*
Models are only as good as their inputs and assumptions. It is very easy to design your model to show the thing you think is true. It is quite another to apply that model to real world historical data and have it validated.
You cite this model saying "if England did X, then Y would have happened".
This is easily falsified by applying the model to Sweden, or California, or South Dakota, or Bulgaria, or Norway, and seeing the outputs don't match reality. This is basic stress testing. Authors of the model you cite made the mistake of goal seeking. Apply their model to any country now that we have historical and see if you can get desired results.
I mean this with sincerity Katelyn - you are at risk of clutching a failed hypothesis. It has become evident with each day the voices calling for lockdowns, argued for gain of function, wanted us to mask kids were on the wrong side of history.
This doesn't make them bad people anymore than Galen was wrong for advocating ingesting mercury - you use the knowledge available at the time.
If you follow science, then you adjust your hypothesis as facts come in. I understand you have 3 years of social media posts saying how important it was to mask kids, or claiming highly vaccinated countries would have better outcomes, but those theories have now been refuted. It is ok to be wrong. There is nothing shameful about it, being wrong advances science.
It took William Farr 9 years after he had overwhelming evidence his hypothesis was wrong to see his error - and all he had to do was admit his error privately to colleagues - he didn't have the baggage of Instagram and Substack. This is what made Farr more impressive than Snow. It is easy to be right. It is much harder to be wrong and admit you were wrong.
I implore to step back, re-review the evidence at hand, put aside your priors, and reevaluate your hypothesis. See if anything changes.
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*excess death analysis for anyone who wants to dive in my claim:
https://docs.google.com/spreadsheets/d/18LOqhWWVsVrvGL0pfnP6riMw0bshyS9UABYmtUb7ZqY/edit?usp=sharing
Hi Michael- Thanks for your comments. There’s a lot to unpack here, but I urge you to be careful making sweeping conclusions like “Sweden won” when thinking about future public health policies. Sweden also has an incredible level of trust, universal health care, social support, and cohesion. I would argue those are incredibly important confounders to account for. And, they *did* have NPIs, but not mandated but still many followed. But even with no NPI’s people change behavior (See #2 in my post)
Thanks for the reply - excess deaths is the most important metric to measure. It ensures not only that any discrepancies in counting are caught, but also any unforeseen repercussions would be caught as well. Through 2020 and mid 2021 this was a metric and talking point in Financial Times, The Guardian, New York Times, etc. I know I am not telling you anything you don't already know, just recapping for anyone else reading.
If we agree excess deaths is the most important metric, then the evidence does suggest Sweden "won", and I know there are better ways to phrase that, but it makes a point to capture attention.
Now my question is - why is this unfalsifiable? When the NYT, Guardian, and even Donald Trump predicted disaster in Sweden - why weren't they pointing out that it might be ok because of their "incredible level of trust, universal health care, social support"?
Now that Sweden approach has been validated, many are Monday-morning quarterbacking and saying this isn't surprising after all.
Why not simply admit they got that wrong?
You are, I suspect, repeating a claim you may not have double checked. I keep seeing the claim all over twitter (which I finally caved in and 'joined' last week) about their level of trust, health care, social support, and claim they made changes in behavior but evidence from Swedes suggest the opposite. [1]
That they had a "change in behavior" seems easily falsified by realizing they didnt keep kids out of school and didn't make them wear masks. Even newspapers in Norway are openly discussing this surprise noting "Schools were kept open. Children got to meet each other. Adults were allowed to go to a café and restaurant. All shops remained open." [2]
Furthermore, the hypothesis of "trust, univ health care, social support'" as explanation how Sweden got it right ignores all the countries that had these things and had much worse results. Does South Korea have lack of trust in their PH experts? Is that why all-cause mortality doubled spring 2022? I suspect not
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[1] https://twitter.com/freddiesayers/status/1633066547982876674?s=43&t=RBHc5hN8-J-Ljr19lEUfdw
[2] https://forskning.no/covid19-virus/fikk-anders-tegnell-rett-om-korona-strategien-likevel/2165554
Excess deaths? OK. As someone who's in the risk biz (I'm an insurance examiner) I've learned to be wary of anyone who swears by one particular KRI. None of them should be regarded as sacred cows, and getting too obsessed with one particular metric or set of metrics can have consequences that range from embarrassing to deadly.
Then which metrics would you suggest we gauge success or failure? Surely there has to be something? What could be better than the one metric that ignores bias of testing, individual discretion on qualifying cause of death, or any other confounder?
For the first 18 months this exact metric was being championed to show Sweden's failure. Now that it shows their success we are getting too obsessed with one metric?
Framed another way, what is Sweden doing differently than us where we still have 500 Covid deaths a day and they have effectively zero?
I think we just need to be on our toes, and be willing to change metrics depending on circumstances.
For instance another indicator would be change in life expectancy. Last I checked, the pandemic knocked a year or two off of life expectancy in the US.
I disagree on changing metrics, but I am looking at this from engineering perspective so that lens of wanting to optimize and evaluate ROI is why find the best metric and sticking with it seems best.
Of course, other metrics can and should be considered, and to your point Life Expectancy is interesting, but it requires a lot of information to properly calculate.
I also urge caution because life expectancy and "Years of Life Lost" weight deaths in a way where elderly deaths aren't as impactful to the model, and in the case of Covid, with 80% of all deaths being over the age of 65 that can be problematic. YLL for example would not count any years of life lost for the ~300K 85+ year olds as they are past the LE ceiling.
I think DeSantis has crowed about his success without acknowledging the effect of FL’s hot weather -- crowding outside not inside. And yes the Swedes are well socialized.
All the hot weather appears to do is alter when they get their waves, which allowed data-drudgers to cherry pick comparison points like the CDC study that claimed to show masked schools fared better -but all they did was run the study when Florida was in their wave and stop the study when the NE wave started. California is hot too and nearly identical excess death rate (20% vs 22%) despite population demographics slanted against FL.
As for "Swedes are well socialized" - what does that mean? Yeah, they did appear to be very social as they continued to send their kids to school unmasked, went to bars, concerts, parties, etc throughout the pandemic while still having the lowest excess deaths in the world.
An interesting claim for sure. I just went to Our World in Data, and this is what the data show.
Deaths per million: Sweden - 2250; Finland - 1613; Denmark - 1408; Norway - 959.
Appreciate you double checking my claim. I think we all agree that different countries, states, regions can count covid deaths differently - there is a lot of gray area.
That's why Excess Mortality is the best measure - it bypasses differences in testing/classification of deaths. If you recall excess death was regularly cited by media to show how much *worse* Covid was than we realized.
Norway for example shows 5,175 Covid deaths yet they have 6,965 excess deaths 2020-2022. Meanwhile Sweden recorded 23K deaths but only has 10K excess deaths. This is why when only looking at covid deaths/population you get misleading results.
I attached in the google doc all excess mortality if you want to double check my work further.
OK - excess mortality P scores: Denmark = 180; Finland = 152; Norway = 176; Sweden = 193.
Show your math
Why don’t you publish your hypothesis, then. Put it out there. I can say this about people who take the lead on anything including Dr. Jetelina. She does what she can to get the information out there, knowing what she knows, seeing the big picture as a public health specialist, and understanding the impact of individuals as an epidemiologist. The best minds put themselves on the ground to save as many people as they could, including Dr. Jetelina. It’s easy to be an armchair general.
Completely agree it is "easy to be an armchair" general. I made the decision ~2 years ago not to publish, not to make yet another substack. There are enough substacks and Twitter accounts pointing out the data I am sharing, refuting the failed hypothesis. Another won't make a difference. Instead I spend ~$4,000/year reading everyone else, and politely correcting mistakes as I see them. I do this when Joel Smalley makes a claim like Germany excess deaths rose after vaccines and I find the data lacking, and I do this when I see YLE citing a model which is easily falsified.
Everyone seems to stick in their echo chambers, stay in their silos. Carl Heneghan makes his tweets and his followers nod in approval. Peter Hotez makes his tweets and his followers nod in approval. No one seems to be engaging with one another, no one seems to be interested in re-evaluating their claims, challenging one another to get to the bottom of what is and is not true.
Instead, I am doing what I would do in the private sector, when some consultant proposes some idea, projects some ROI - I triple check, I probe for weaknesses in the claim, and if I agree to the idea, I set up ways to measure success or failure.
There is no need for me to publish this, it seems more efficient to respond directly to ideas and arguments which appear to be false. If I publish all I do is set up my own echo chamber, I don't get any closer to truth.
Michael- for my part, I have enjoyed your posts. My perspective has evolved with the pandemic.
Paul, it's important to always grant charity when you disagree with someone, give them the benefit of the doubt.
I don't think Katelyn had "an agenda from day 1". She's got a full time job, a new(ish) family, and a large social media brand to manage on top of writing this heavily researched substack. It's quite impressive.
Balancing rigorous skepticism with openness to new ideas is very difficult. It requires a slow and careful analysis of every idea. And time. Lots of time.
If you take shortcuts, by trusting an argument from authority without double checking it yourself, you may make mistakes.
I can understand for example how appealing the *SEVENTY* papers on mask efficacy shared by @nuanceORDEATH [1] might be to convince you masks work. She wants to quickly get information out to her followers, and places her trust in this person by uncritically passing it along arguing "I’m not entirely sure why the efficacy of mask use is still up for discussion". I can see how that can happen with good intentions.
I can also understand why she wouldn't have the time to carefully go through each paper to evaluate the claim. It took me months to graph the results to notice the inverse relationship between efficacy and study quality.
It would also take a lot of time to realize that nuanceORDEATH committed the fallacy of "counting your hits and forgetting your misses" - he selectively only included studies that found positive mask benefit, going so far as to include the sub-studies of any meta analysis that showed benefit and purposefully skipping studies in that same meta that didn't find benefit.
It would take a lot of time to cross reference retraction requests, note which had been pre-registered, replicate claims when possible, grade the quality. By the time she could have done this it would have been well into 2021.
This is what makes science so very difficult to get right. It so easy to slide into suprstiton.
"Science invites us to let the facts in, even when they don’t conform to our preconceptions. It counsels us to carry alternative hypotheses in our heads and see which best fit the facts. It urges on us a delicate balance between no-holds-barred openness to new ideas, however heretical, and the most rigorous skeptical scrutiny of everything-new ideas and established wisdom….. When we are self-indulgent and uncritical, when we confuse hope and facts, we slide into pseudoscience and superstition."
-Carl Sagan, The Demon-Haunted World
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[1] https://twitter.com/nuanceORDEATH/status/1279144399897866248
Buzz off, troll.
Your linked table has a huge fallacy - it shows mortality, not mortality rates (i.e. adjusted for country population size). Your conclusions are based on an inappropriate parameter. It could be made even more valid by showing age adjusted morality rates.
Already included those calculations, need to unhide columns O and P (I just did, should update for you too). Same result. Sweden at bottom with 98.9 excess deaths per 100K.
This is a rare instance though where I find relative rates more informative than absolute rates, even though the absolute rates also confirm my statement - happy to dive into that discussion if you'd like.
(I'm temporizing the idea that relative more useful than absolute - might be persuaded the other way - only been thinking about it a few days)
I don't think it's clear at all that "Sweden won." According to Worldometer, the "covid deaths per million" figure for Sweden stands at 2,320. For Denmark it's 1,421. For Norway it's an impressive 946. Norway and Denmark (with comparable health systems and demographics to Sweden) implemented more aggressive covid control measures and the beneficial results are palpable. https://www.worldometers.info/coronavirus/#countries And BTW, Norway and Denmark saw less economic damage too. Sweden's gdp lost 2.3% in 2020, Denmark's 2.0% and Norway 0.7%, according to Trading Economics.
As I addressed in an earlier comment, this is why NYT, FT, Guardian argued that Excess Deaths is the best metric (and I agree with them). It catches differences in counting. As I noted yesterday:
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"Norway for example shows 5,175 Covid deaths yet they have 6,965 excess deaths 2020-2022. Meanwhile Sweden recorded 23K deaths but only has 10K excess deaths. This is why when only looking at covid deaths/population you get misleading results.
I attached in the google doc all excess mortality if you want to double check my work further."
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I also want to bring up the point - why do we only get to compare Sweden to her neighbors? Why do we compare the US to South Korea, or Germany, or Germany, but Sweden is only ever compared to Norway or Finland every time a point is brought up how their outcome defied expectation?
RJH: "Norway and Denmark (with comparable health systems and demographics to Sweden) implemented more aggressive covid control measures and the beneficial results are palpable."
1) Norway and Denmark also returned kids to school May 2020 and like Sweden had among the lowest mask use rates in the world. If your argument is the Nordic data shows the US could have returned to school May 2020 without obsessively masking kids, then we are in agreement.
2) There is no palpable benefit though. Yes, DNK, FIN, NOR all have among the lowest excess deaths in the world, but still higher than Sweden. How is that "palpable"
3) Why shift to loss of GDP in 2020? Statista graphs don't show anything remarkable (https://www.statista.com/statistics/1274468/gdp-per-capita-nordic-countries/) and this "whataboutism" only leads to bickering over how much impact closing borders has on import/export, the pitfalls of a service-oriented economy, tourism, etc.
The subject at hand is whether we can be confident the things we did actually made a difference, or, are we clinging to sunk-cost fallacy as we realize it probably didn't matter if we kept kids in school, wore masks, cancelled prom, had vaccine passports, etc
I do believe that you are 1) moving some goalposts around, 2) are setting up some straw man arguments (I'm not sure ANYBODY is claiming EVERYTHING different countries, including the various states of the United States was correct, and 3) as to agendas and "clinging", I think a bit of a bias is evident in your desire to claim Sweden "won" in the "What to do about COVID" sweepstakes. My thoughts at this point, based on your posts on this particular thread, as well as earlier ones, is that we are going to have to agree that we see things somewhat differently as to how various countries responded and the subsequent trade-offs involved.
I set the goalpost as excess deaths may 2020, and here, March of 2023, I stand by that goalpost.
I have had others, including co-author Dr. Yamey on twitter today, shift the goalposts to stringency index, GDP, covid deaths/population, yet I remain at the original goal post - excess deaths.
It's not just the GBD physicians providing testimony that's worrisome. Some of the subcommittee members are big offenders in terms of spreading misinformation and lies. Marjorie Taylor Greene compared mask mandates to the Holocaust, saying "vaccine Nazis" are ruining our country. Although the list of ingredients is publicly available, she just recently claimed, "We have no idea what's in Covid vaccines," and in 2021, MTG referred to proposed vaccine “passports” as the mark of the beast.
Debbie Lesko opposed vaccine mandates and passports and raised the issue of vaccine death count theories with the CDC.
Ronny Jackson has publicly stated Dr. Anthony Fauci has “the blood of millions of Americans” on his hands for his management of the Covid-19 pandemic.
Rich McCormick, a physician, had a role in the success of Trump's Operation Warp Speed, but pivoted to a position of vaccine skepticism when announcing a bid for Congress in 2021, stating, “If a 12 or 15-year-old doesn't want to get the vaccination, and their parents don't want them to get the vaccination—who really cares?”
Michael Cloud called Covid vaccines “experimental” and derided the Biden Administration for vaccine mandates along wit his quest to end legal protections given to vaccine manufacturers subject to emergency use authorization. This is scary!
So, these are the people you want or trust to be in charge of making public health policy? Not me. Everything I mentioned has been reported by credible sources, so I'm not certain why it's Gish gallop.
Oh shit I thought you were team troll when I saw the link dump, deleted my original comment
No worries!
It seems like where we've ended up is the era of *personal choice*, which means sometimes healthy people are still opting to be careful, and sometimes vulnerable people are opting to be risky. People, not the government, should decide whether they are willing to bear the individual cost of building herd immunity.
Perhaps the lesson learned is that Public Health's role in all this is to provide the education and information people need to make informed choices. This isn't perfect, but it's preferable to taking away people's civil liberties, livelihoods and hope for extended periods of time.
Part of the problem is Public Health doesn't seem to be giving us all the information we need in a straightforward manner. We are told, for instance "people who are overweight may be at increased risk." May be at increased risk - really? If we were told "overweight people are 10 times more likely to die from covid" (I'm making up numbers), overweight people could understand their personal risk better and decide for themselves. But, for some reason, it's more important not to shame people, so we're fed this wishy-washy language of uncertainty.
When looking at the costs of lockdown, we need to look at *all* the costs, not just the risk of dying from covid. Teen mental health has suffered, and to the extent overdoses and suicides have increased, lockdown has likely played a role.
You demean the role of public health. The DPH's main role and efficacy extends far beyond communication, it inherently involves systemic changes that protect population health. Let's take water supply. We are used to safe drinking water right from the tap. What if public health was not inspecting (see Flint, Michigan) and safety interventions were lax, would you be helped by clear communication of the risks and given responsibility to protect yourself?
You are reasoning by false analogy.
No, actually, he's not. He's trying to provide you with some real-world information.
Sorry, can't agree. Our public health agencies gave us the information they had when they had it, and did so in the face of politically motivated FUD (fear, uncertainty, and doubt) pushed by the far right. The CDC didn't know the full extent of the novel Coronavirus from day one because it was, in fact, novel. As in: new.
And BTW, using inflammatory and bogus language about "taking away people's civil liberties, livelihoods and hope for extended periods of time" doesn't exactly add clarity. If you're going to push propaganda, expect a push back.
The laissez faire approach would only work if
1. Our individual choices didn't impact the health and well being of others
2. The risks and benefits were easy to calculate
3. Safe choices were readily available to people who need them
When you say *this* would only be possible - I'm not sure which "this" you're referring to.
I agree with all your points, yet, *individual choice* is what we've evolved to, it's the only thing people will tolerate, and the only question is, why didn't we get here sooner?
I do think in the very beginning, when Public Health was trying to get their hands around what was going on - how deadly? mechanism of transmission? how infectious? who is most at risk? - it was appropriate for Public Health to tell people to stay home.
But really, unvaccinated tennis star Novak Djokovic still isn't allowed to set foot in the US despite having natural immunity. Three years in to the pandemic, this feels heavy handed and archaic.
There's another side to revisionism, and that’s silence. What happened to the vaccine mandates that were so important to stopping the pandemic that is was justified to take away a person’s livelihood? Now nobody talks about the vaccine mandates, they just bury their head in the sand.
Remember the days when it was mis/disinformation to suggest that past infection conferred immunity? This too has been forgotten, which is another form of revisionism.
How ironic that your last two paragraphs are, themselves, cases of revisionist history. Either that, or your memory is simply selective. Nobody ever said "vaccine mandates that were so important to stopping the pandemic that is was justified to take away a person’s livelihood". And nobody ever said that "it was mis/disinformation to suggest that past infection conferred immunity."
The disinformation was claiming that so-called "natural" immunity was safer and more long-lasting than vaccine-induced immunity. That was wrong then and it still is.
This whole "Public Health didn't inform us" theme is a popular one some commenters here, but it is, at best, an oversimplified and exaggerated version of reality.
Fascists generally aren’t too keen on finding, dealing with, or spreading the truth.
The GOP has a huge advantage here: there is almost no constituency for any pandemic measure now ***or in the future.***
Most don’t care—right now, with 500 dying a day. Fascism is merely the organization, cultivation, and weaponizing of sociopathic narcissism. Our country’s hyper-individualist, hyper-capitalist values deeply encourage sociopathic narcissism.
We are all generally fine with 1.5m deaths from mostly acts of omission, the bulk of which were preventable. It’s definitely a step to killing millions by acts of commission, yes.
How short a step? Virtually all of us are completely complacent, whatever we say, about destroying the human future via carbon.
good post; thank you.
Public Health and Libertarianism cannot co-exist, to state the obvious; most critical thinkers knew the GBD codified a limited and inhuman view. The American Institute for Economic Research wants to put an end to all government regulation.
Sadly, it seems likely the people failing to seriously study and implement "lessons learned" from this pandemic will be the same ones blaming everyone else when we're not prepared for the next pandemic.
This is an important observation, analysis and discussion. To this day I have not seen a realistic compilation of how many Americans are "high risk". You cannot just total the prevalence of various conditions as some people fit into several categories. There is obvious confusion, even in the midst of the pandemic I heard Dr. Califf, head of the FDA, say pregnancy was not a high risk condition. Even as the official emergency passes, protecting high risk individuals is important. I know some chronically ill elderly people who have not gone out in 3 years except to get groceries and visit their doctor. Are they more safe now that we think incidence is lower but there are fewer public health measures used in the community? We need to know this!
Thank you and I am still concerned that those in government are still extremely polarized based on political views and not fact-based science. I hope we can bridge the gap and be more prepared and in step with each other. For instance, I feel like there is no discussion on how we are exiting the pandemic and entering the endemic stage. In all your free spare time (wink wink) I would greatly appreciate an article on that subject. I know it is difficult as we all have different health needs and have different risk levels; however, it is important to live our lives and we can do small things to help those that are immunocompromised. Truly appreciate all that you are doing for us!
excellent comment about logistics. I have yet to hear, even once, since GBD was proposed exactly _how_ one would protect the (ill defined) vulnerable population as they claim was needed, when the single biggest risk to the vulnerable individuals seems to be a high level of circulating virus in the general population. It's 'let me just worry about me' libertarianism disguised as a public health policy, and as is typical for those, it actually glosses over the details of how it might actually work. (If we had the ability to effectively shield the high risk, wouldn't we have done so?) It's often typically the same people advocating for GBD that fight every measure that would have actually protected the vulnerable and allowed people to go about their everyday lives.
In the US, high levels of lockdown did not prevent high levels of circulation. All they accomplished was to reduce it a bit and spread it out over a little longer time frame.
Decrease the risk in the short run but cancel out that benefit by increasing the duration of the risk. No way to ever test which approach would have the best results long term, but my money is on the GBD approach with local adjustments as necessary. GBD would not work well as a top down nationally mandated strategy. It works best when individuals and local officials use the information provided to make their own decisions on how best to protect themselves.
except there is no 'gbd approach' to put money on. it's an empty 'just let us go do what we want because centralized response to a threat is bad'. If there was actually a practical way to implement GDB, i'd love to hear it. I've been waiting 3 years now.
First, what an excellent summarization! Second, the GBD was an out growth if the Lives vs. Livelihoods debate that has raged during the entire life of the pandemic. But my state's Governor Kate Brown, took the politically courageous step of choosing lives. Her reasoning was correct: lives are required to enjoy livelihoods- a business can be reestablished but a life once lost is gone forever. Third, no one saw long Covid as a significant factor in the equation for half a year into the pandemic and once we knew how large a problem it was, it immediately made the GBD argument obsolete. Fourth and finally, public health became politicized during the pandemic precisely because large economic issues were involved and our two political parties found themselves in opposition, yet again. Economics, rather than ethics seems to drive decision making here more's the pity.
I put a like on your comment because I enjoy well-formed arguments made on any side of an issue! And I don't necessarily disagree with your conclusion, no one likes paternalism. But there ARE things worse and who knows that public health may be inflicting a minor harm on you now in order to avoid a more major harm done to you from other agency later. Any curtailment of your liberty does you a harm, say, seatbelts. But while you may not like them, your wife and children certainly hope you are wearing them should by ill fortune you run into a tree! We aren't isolated individuals rolling around like BBs on a plate! We are linked to other individuals who love us and we owe them something. As they feel they owe us. "Non nobis nascimur" after all is said and done.
"Can we please have a serious conversation about the COVID-19 pandemic and how to prepare for the future? Our lives depend on it." - Absolutely, but that depends on the participants' willingness to genuinely understand (though not necessarily agree with) others' points of view. How do we get to that place; do we have relevant models to learn from? (What would it take to even agree on what the questions should be?)
Take for example the turbulence following recent publication of the Cochrane report on masking (and other measures) in light of 2 potential questions: (1) Does recommending (or even mandating) masking reduce population burden of Covid under real-world conditions? (2) How much less likely am I to catch Covid sitting on a 4-hour flight next to an unmasked person with Covid if I wear a well-fitted N95 mask vs. no mask? (Yes there are nuances - just want to highlight the importance of knowing the question)
Excellent article! As you point out the purpose of the sub-committee is not to move the discussion forward it is to put a different spin on failed policies. Thank you for the insight
Thanks for this sanity. And we're till learning things that should adjust future policy and behavior.
Thank you. Very timely and very well written. There is considerable "revisionist" history occurring now that ignores key elements of the historical record. As you noted, once folks thought that serious illness or death was around the corner, they self-isolated. As I remember, in some states that opened up early, the hospitals filled up and the only room was in the parking lot. The Phoenix area comes to mind. Congressional investigative time would be better spent on generating better structures and surge capacity to better manage the next health care crisis. For example - how best to manage the trade-off between "protection" and the need for in person classes. Insuring better ventilation in schools. etc. Again - great material.