Story time (related to public health, but not necessarily to this post): a child vomited in my 9-year-old daughter's class yesterday. For whatever reasons I don't understand (and I assume they are valid), the child stayed in the classroom. My daughter chose to go to the nurse and request a mask, then decided to bring the whole box of masks back to share with the class. Many of the children accepted her offer. This blew my mind- she clearly learned something about the value of public health and that we don't just have to accept catching a nasty virus for no good reason. While her greatest strengths are in writing and communication, this morning she suggested that maybe someday she will study virology (my grad school field and forever passion) to "work on vaccines for noroviruses" (her words). While many were digging in their heels, crumbling, caving, and letting fear and politics guide their choices or obstruct their better judgment in the height of the COVID-19 pandemic, some were learning, growing, and being inspired to do well by others.
Gosh, thank you so much for this story! It makes my heart happy and gives me hope. Let me know if there's anything I can ever do to help support your daughter's endeavors.
You must be so proud of your amazing daughter. Clearly, she will be helping Humanity in the future... Thank you for raising a responsible, mature, intelligent young lady...
I have to push back on this. A kid vomiting in class means that all other kids should mask up? What is the increase in probability that an unmasked kid in that classroom will catch something after we get the added information that another kid has vomited? With some expertise in statistics (but none in epidemiology), I would have to think that the increase is pretty darn small (a few per cent at most). So is that enough to mask up every other kid? I would think not. (And I assume we're talking surgical masks self-applied by kids, not N95s fitted by professionals.)
Then there is the disruption to the class of having one kid go get masks, and the other kids then having to decide whether to wear them or not. This surely produced a social dilemma for those kids, and made them have to decide which group to belong to: the masked or the unmasked. I doubt their individual decisions were based on the latest epidemiology reports.
So Katelyn: this is actually a good example of the sort of thing your post is about. What is the best epidemiological advice for the situation where a kid throws up in class? Should everybody mask up, or not? Given that kids have been throwing up in class for hundreds of years (I did it myself), and nobody was masking up afterward, what should we be doing now?
Over two months later, I’m curious, do you happen to know if other kids got sick the next day?
The symptom of suddenly throwing up, then feeling fine, is common for norovirus-which runs rampant in many parts of the US Nov-Dec each year.
Norovirus is especially efficient spreading - one case study found over 50 people in a restaurant fell ill after a patron suddenly vomited mid meal, and from my unfortunate experience, this is unsurprising (hit our family almost instantaneously 2017 early December)
Just curious if you recall what happened after this event.
I really am not sure, but I had an extensive conversation with the school nurse about how decisions are made. She said they take into account each individual child and their health history (for example, does the child have athsma that causes coughing fits which might lead to vomiting). I still say that’s a pretty wild gamble and I would not personally want to sit through the rest of my school day feeling so unwell. The child was back in school the next day and all I could say to my daughter was, “then he must be fine!” In another interesting twist, other children alleged that the mess was not cleaned up well. Cringe^infinity.
One of the biggest problems with public-health messaging in the US is that it speaks to the lowest-common denominator. We saw this with masks/COVID: we were initially told masks didn't work not because the experts thought they didn't but because they didn't want people to run out and buy up all the PPE. We also see this with things like vaccine timing: "Get your flu shot whenever you can" rather than "Get your flu shot in mid-to-late-October." "Get your COVID booster anytime" rather than "Waiting at least 6 months to get a booster after an infection will improve efficacy."
Until public-health experts tell the nuanced truth regardless of how they think it will impact action, including admitting when the answer is "we don't know," nothing will change.
They truly didn’t think they worked though. The “we don’t want PPE shortages” was post-hoc. It was openly and privately discussed for decades they don’t work leading up to Feb 2020.
The politicians railing against public health workers, such as Trump and Desantis, are not leaders. They are nothing but narcissistic stooges interested in their own standing. Problem is, too many Americans are willfully ignorant and follow these types to their own detriment. And too many Americans are whiners about not having enough information to make rational decisions. Bull. Many are just too damn lazy or stupid.
I think it's worth mentioning that the brief of public health officialdom is to protect the society as a whole and not to serve as a bastion of individual liberties. During a health emergency, individual rights have to take a temporary back seat. Consider firefighters battling a blaze in a crowded urban area. Whole blocks might be cordoned off, denying entrance even to rightful homeowners in the affected area until the fire is brought under control. More broadly, the imposition of martial law--which hugely limits individual rights--has been deemed essential to the maintenance of civil order during emergencies (such as insurrections, foreign invasion or other circumstances when regular order breaks down and civil society itself is menaced). So too is the imposition of military conscription in times of war. Just ask anyone who has been inducted just how much their individual liberties were infringed. To me, the outbreak of a deadly, highly contagious virus is on par with a foreign invasion, and warrants all reasonable steps (including even severe restraints on movement and social contact) to contain it until less draconian steps are viable alternatives. These measures are not the the thin edge of the wedge of dictatorship. These measures are temporary and specific to the emergency at hand. We have used them many times before and lo, we are not in the gulag. If your society has not taught you the b=value of its own survival, so much the worse for your society.
That is all true BUT only if it was the right strategy from an infection-prevention/outcomes POV. Unfortunately, because the discussion around lockdowns (and everything else) is so politicized, we can't have a rational data analysis discussion around it.
If the public health field starts to cater to science-deniers, it will unravel entirely. Consider that there is little-to-nothing experts can do to persuade many science-deniers, but much distrust that could follow from those who embrace science and expertise if the field goes out of its way to coddle those who don't want it in the first place.
We have to remember CDC was the preeminent health agency we could count on. It was gutted by the GOP administration that had as their advisers, people without infectious disease experience. Their criteria was destroy science, make money. Healthcare, science, environmental sciences, social services, women’s rights have been eroded by those who would divide this country. We all used what we knew as best practices of the time and we learned over time what worked and didn’t work. We tried to save lives. We’ve lived some privileged lives here. The reason many of us are alive, is people believed in science and taking care of each other. Now we complain about it.
I agree that the CDC was preeminent; but Mandy is under the thumb of the neo-liberal WHCOS Jeff Zients who priorities economic gain over public health.
I am just a lay person, but I believe in science and was counting on our government and the CDC to guide us through the pandemic. Here in Minnesota we had a strong governor (Tim Walz) and public health team that kept us updated with regular televised briefings. We followed their guidance and did our part (social distancing, masks, and vaccines). Switching the channel to the national briefing was like watching a clown car (with the exception of Dr. Fauci when he wasn’t muzzled). “Bleach” from the mouth of a President? I agree that we have a long way to go to create a robust Public Health infrastructure in this country. Reading “The Premonition” by Michael Lewis gave me a good peek into our fragmented system and where we could be. I started following Dr. Osterholm (U of MN) for science based information as the pandemic spread. I found your SubStack and became a paid subscriber. The other day I went to my appointment at Walgreens to get my next Covid booster. I told the tech I had waited 4 months after having a bout of Covid in August. The tech said “good for you” after I mentioned following your guidance as an epidemiologist. She mentioned they follow Mayo and the Cleveland Clinic (rather than the CDC since they apparently follow “more than just the science”). I appreciate your insights and hope you stay focused on creating the national public health system that we all deserve.
P.S. I’m putting that in my letter to Santa this year, too, so get busy. Crooked grin.
I so appreciate what you have written here. I was enormously grateful to find people like Dr. Jetelina, Dr. Marr, Dr. Topol, Dr. Wachter, and a host of others who made it their charge, though they already had plenty else to do, to commit strongly to accurate public-facing communications, including straightforward acknowledgement of uncertainties and the need for course adjustments as new information arose (and arises).
Public health policy is supposed to be based on reality. On actual data. We can negotiate on how to promote vaccine use based on differences in political view. We cannot and should never be debating about whether or not they work when all available emperical data says that they do. The Republicans left the public health arena when they decided to claim vaccines were causing deaths and not COVID. They pushed their supporters to do the same. That is where this divide mainly exists.
Galea appears to be ignoring a glaring problem, today's conservatives don't believe in the common good and therefore do not want there to be a successful public health program. There is never going to be a successful public health program that will appeal to them and we should not be compromising everyone else health to appease those that will never be appeased.
The Republican Party found massive gains in exploiting all things related to Covid precaution. Our Public Health Officer received constant threats and pushback by moronic City Council Members here in Northern California. (She resigned as a result) Entire School Boards have been replaced with MAGA Majority as well as local held offices. Local Fire Captains, High Ranking Law Enforcement all buying into 3rd grade level Covid misinformation. It's disgusting watching this epidemic of Conspiracy Theory spread throughout our Nation.
I will read the book, and perhaps come back with some thoughts. But re your comment about dismissing new information: one should *never* view anything through a lens even remotely tainted by politics. My goal -- only occasionally attained -- is to take "the view from nowhere," a view of total detachment. And often it helps. The philosopher Thomas Nagel's book of the same name set me down this path... it's worth a read.
Another option: try to read peer-reviewed research if you can (instead of secondary or tertiary interpretations). Not always easy or accessible to the general public, but your best bet for high-quality information.
I spent the primary period of the pandemic reading peer- and pre-reviewed literature. In fact, i read virtually every article as if I was reviewing it, which meant I spent a lot more time on each on, and provided comments and feedback, than if I’d skimmed the articles or accepted others’ interpretations. I still read nearly 1000 in the first 8 months, and now have a personal archive of well past 3000. That said, keeping them straight was problematical. However, I spent a lot of time trying to be open to new findings, and new Ideas.
I also participated, for about a year, in nightly online discussions with 3 different clinician groups. We discussed a lot about what had happened that day, with clinical pearls that allowed the group-think to form opinions and new hypotheses, often leading to changes in clinical care. One of those provided a VERY early thought that COVID was really a vascular actor, well before the media ever heard that idea, and long before a note to a major journal proposed the idea.
My biggest failing, I think, (I’m sure I have blind spots) was in communication. Most of my missives were too technical, because I was trying to get information out but was sensory-overloaded. I can usually talk to the patient or family pretty well, and seeing the Public at large as my patient should have been reasonable for me, but I ended up with a proof-reader and editor who translated what I’d written for the leadership and occasionally the membership of my organization, because A) I wrote with too much detail and B) was too technical. I’m trying to establish, within the organization, a team to better communicate for the next outbreak.
This is such a common issue and I think what makes YLE so special. She tackled that issue head on, along with other groups like Those Nerdy Girls and Unbiased Science Podcast.
P.S. I highly recommend Sense of Style by Steven Pinker and a great course on Coursera called Writing in the Sciences if you’re interested in rethinking scientific communication. Both of these sources improved my communication skills dramatically (I work in clinical trials).
Totally agree. Except... we're seeing a small but increasing percentage of peer reviews that are anything but. I use a lot of peer-reviewed research in my work, and a worryingly large (OK, still small, but nonetheless) number of papers are being retracted. Definitely far more than, say, 5+ years ago. Maybe it's a volume problem: too many papers (absolutely), too little time spent on the review process. Sigh.
I think that this is the case, there's just so many papers and the incentive structures encourage it . If you use a lot of peer-reviewed research, it's worth educating yourself on some of the causes and concerns around dodgy science and how to spot it. I was unaware until recently, for example, about 'paper mills'. It's well worth downloading the Pub Peer extension to your browser and spending a bit of time reading Retraction Watch and other websites which look at research integrity. I've written a couple of articles about it if you are interested.
I've been a reviewer in several fields for over 20 years now. I don't participate in fields where I can't hold my own. I've refused to accept papers because they didn't meet my standards, and authors were unwilling to address my comments. Unfortunately, I've seen several of those pushed out to lesser journals with little review requirement.
A long time ago, I worked in a lab with a poster in our library/conference room. I still remember it today: Perish -- Or Publish the Thought. That lab encouraged us to publish on a lot of our work (partial and total artificial heart research, clinical mechanical support of the failing circulation, and transplant research. ALL of our research that was pushed out for publication, however, had to be submitted to reputable journals.
For what it's worth, though, the other poster in the conference room was more to the point: "We don't read the literature... we WRITE the literature".
I spent a lot of time reviewing articles during the first several years of COVID. Now I'm a bit more selective, letting a lot of the review work be done by others. That doesn't mean I don't have my critical analysis hat on whenever I'm reading, but that, instead, today, of reading and fact checking every article, I'm reading it critically but assuming that, for the most part, the peer review process is working again. Obviously that's not the case on the preprint servers, and while I do still venture there regularly, each of those articles I read is literally read as a reviewer (I really am usually Reviewer #2) and provide feedback to the authors.
You misunderstand the concept. Taking a view from nowhere *is* being aware of your own sub-conscious biases ("positionality"?) and doing just that. It's not a fantasy, but it's definitely aspirational. And if we can't aspire to it, we might as well give up.
Which seems to be what most Americans -- I'm a Brit, so full deniability :) -- have done. And why your next president -- sorry, dictator, the US is clearly done with democracy -- will be Trump. (I wish I could say I was joking here, but...)
And yet "being aware of your positionality and taking it into account" is pretty much his position -- or at least as applicable to the real world rather than academic discourse.
the politicization of science will take a long time to come back from. No more mandates (lockdown, masks, vaccine) that infringe on liberties and freedoms, that aren't backed by scientific evidence, and for which no cost-benefit analysis has been done. And no more calling people "science-deniers" for questioning things. "Science" by definition is about asking questions and testing hypotheses.
there's some biased and confounded observational studies and lab studies that support masking. The best available data (RCTs and macro-level real-world data) offer no evidence supporting masks or mask mandates.
The call for randomized clinical trials has become shrill in the COVID era when we didn't have time to engage in those for the simple reason that people were dying. Thus, real-world experiments, where the distribution of patients was dictated by natural occurrence and a valid observational analysis was utilized became frequently the only viable path. RCT is time consuming and can also be confounded.
For a number of reasons, RCT for masking is almost completely non-feasible. However, engineering analysis can, and has demonstrated their efficacy. Similarly, historical evaluations of prior respiratory outbreaks have demonstrated relative efficacy of mask usage.
Personal experience Paul. When I stopped wearing my N95 mask, is when I contracted SARS COV 2. So I will use my personal experience as proof that an N95 does in fact help mitigate contracting SARS COV 2. As well as studies posted by YLE over the height of the pandemic and the effectiveness of wearing a mask to prevent contracting the virus.
There are people in my small town, my very Trump supporting town who died to Covid 19. Died because they chose to listen to 3rd grade level conspiracy theory, a clown for a POTUS, and shared misinformation with like minded.
Thanks for bringing this book to our attention and for summarizing its topics.
In terms of what future Public Health should look like, two thoughts come to mind:
1) Under what circumstances is it morally permissible for government to take away civil liberties and essentially force people to do things (ie, lockdowns, mask mandates, vaccine mandates)?
2) What is the appropriate philosophical mindset for Public Health regarding an individual’s capability to make decisions that are in their own best interest? Essentially, how dumb is the public? Are some groups dumber than others? Is it enough for Public Health to provide accurate and scientific data to the public (Covid mortality risk factors by group, efficacy by vaccine manufacturer, etc) and trust individuals to make decisions that are best for them and their families? When it comes to providing actionable data, is it ever appropriate for Public Health to “stack the deck” and “encourage” certain behaviors?
Regarding #1, at the very beginning, I believe it was morally permissible to temporarily lock down the public to prevent hospitals from collapsing and to study the virus and understand what we were dealing with. But lockdown went on waaay too long, and it’s harder to defend the rest of the mandates. One could even argue that at the time the vaccine mandates were put in place, officials already knew that vaccines didn’t stop infection or transmission, even though the public was being told otherwise. Maybe if the vaccines had been much better and herd immunity was possible this would have been morally acceptable, but knowing what we know now, this never should have happened. Which makes me question just how good vaccines and boosters are at preventing severe disease, hospitalization and death - though I do get an annual jab as a hedge.
When it comes to making tradeoffs between different groups, children should always be prioritized.
Agree! And I think a big part of this is people have a natural tendency to want black and white answers because they are scared and they want reassurance. "Does X mitigation work" or "Is X activity safe". Science is always a hedge - it's the best information we have at the time, with acceptance that new information may mean revisiting conclusions. Something "working" or being "safe" is almost always relative to the conditions or the risk/benefit tradeoff, which can vary quite a bit for different individuals. Nuance isn't reassuring. But it's necessary. And Public Health can't guarantee an outcome for an individual because its whole purpose is maximizing the most effective (which is sometimes actually just the most achievable) and least harmful outcome for the population as a whole.
I think this is where public health failed. Instead of saying- oh, hey! New info! So, we are changing our guidance- they kept and keep beating the same drum. Nuance is absolutely necessary. And it has been very lacking.
Even when I said that explicitly, I was pilloried for changing my opinion. In almost every case there was no recognition that I had stated the information had changed. Just the attacks.
New research is showing that designing messaging to spur action doesn't actually have the impact we once thought it did. Often, it backfires, and you end up with a really big mess.
A serious question: What makes you think our agenda in PH was anything more than trying to provide guidance to protect the largest number of people possible?
Perhaps this isn’t your intention, but the way in which you phrase your question comes across as an attempt to put words in my mouth that misrepresents what I wrote and what I believe . If you’d like to rephrase your question, I’m happy to try again.
You stated that data presented was 'cherry-picked', and implied that was due to an agenda beyond, at least in my case, trying to help keep my organization safe and functioning. I'm not trying to be disrespectful or put anything in your mouth. I'm really trying to understand.
Hi Gerry - You seem like a nice person, and I do appreciate your contributions to the YLE message board. Here's a brief response (busy time of year) about what I mean by the word "agenda." PH made a decision early on that vaccines were the way out of the pandemic. Jab enough arms and the virus would disappear. There were other agendas, too, such as around masks, but let's focus on vaccines.
What this meant is PH emphasized (exaggerated?) every reason to take a vaccine and omitted (censored?) every reason not to. In other words, cherry-picking, manipulation, etc.
Here are some examples:
1) Charts from CDC showing that unvaccinated are appx 20x more likely to end up with severe disease/hospitalized than vaccinated - but failing to correct for the fact that vaccinated people are likely to be more careful (masks, social distancing) and failing to mention that the benefit is likely short lived
2) Nearly every other country has moved to a vaccine/booster recommendation system based on age (i.e., 65 and over). Some countries do not recommend certain mRNA vaccines for young men. Who is right, the US or the long list of other countries? When it comes to guidance for young men, if the US reversed course, this would be viewed as validating the maligned Surgeon General from Florida, which is a win for DeSantis. Oh, no, we cannot have that! I'm not accusing PH of bowing down to politics at the expense of the lives and health of young men - but I'll admit the thought has crossed my mind. (For context, I voted for Biden)
3) There is a lot of negative stuff coming out about the Pfizer shots. Poland and Romania refuse to buy them, and in return, Pfizer is suing them. Researchers at Cambridge University recently found that one in four who were vaccinated with Pfizer experienced "unintended immune response," which if I understand correctly means the vaccine is a dud. For over 2 years a friend of mine who does research in this space has told me "Get Moderna, you'll be better protected." (Now he says to get Novavax.) PH offers us the vaccines as if they were equally good and interchangeable - but they are not. Why can't PH tell us which vaccine is best for which type of person?
Because PH backed lockdowns and mandates, they are now reluctant to say or do anything negative that diminishes the "vaccines are wonderful" narrative. Otherwise they open themselves up to criticism: "But, you locked us down. But, you took away my job!" Lockdown and mandates have painted PH in to their own self-created corner.
4) In the early days of the pandemic, before vaccines had been released, PH seemed to quash any efforts by others to research or deploy early treatments. Yes, I know that Ivermectin and Hydroxychloroquine are hugely controversial and (supposedly) debunked, and I'm not here to argue their merits. But there were many other meds being considered for repurposing (I was indirectly involved with this so I know). Why were these efforts stymied? Is it because PH didn't want to give people reasons not to get vaccinated?
And here's another question - why did it take Paxlovid more than 2 years to be released, and only after PH had done everything within its power to encourage vaccine uptake, including mandates? Was it because PH didn't want to give people reasons not to vaccinate? It's incredible that vaccines were faster/easier to deliver than Paxlovid.
Think of all the lives that could have been saved if Paxlovid had been released a year earlier!
I do genuinely believe that people in PH were trying to save lives and keep people safe - and that PH was handed a set of extremely difficult tradeoffs. I am thankful to anyone who accepted the challenge. Yet, in situations like this, unchartered and unknown, it's important for PH to have a set of "guiding principals" to aid policy making.
Cherrypicking and omissions, force and mandates, overly-optimistic assumptions (herd immunity) without worst-case-scenario planning (vaccines that do little to prevent infection/transmission), stymying alternative therapeutics and early treatments (drug repurposing), restricting freedoms and removing autonomy, censorship, politics over policy -- none of these are appropriate guiding principals (whether explicitly stated or unintended outcomes), even during a global emergency like a pandemic.
I agree wholeheartedly. And, as to your last point, I have become a skeptic about the efficacy of the vaccines and their necessity for those not in a high risk group. I was, previously, for the mandates, and my family was vaccinated the second we were eligible. But, especially seeing how sick my stepmother was just six weeks after her latest vaccine...I wonder if it did anything at all. Paxlovid is what turned the course for her. I guess you could argue she may have been sicker had she not had the vaccine six weeks ago (despite having five previous vaccines and Covid in 2022 that was not this bad for her) but maybe she would have been less sick. And certainly if there is zero protection six weeks out from getting very sick, what is the point? Avoiding hospitalization and death? I credit that to the Paxlovid. Maybe a pan corona vaccine will change the playing field. Or maybe we have to accept we cannot vaccinate away Covid. And maybe better anti virals are the better solution. All that is to say that I understand why the public has lost trust in the public health machine.
One big problem with mRNA vaccines is that it is very difficult to maintain the necessary cold temperature throughout the entire distribution process. As a result, once they reach the intended pharmacy or doctor’s office, in some instances their efficacy has likely been compromised (meaning they offer less or no protection).
It is interesting to me that when Paul Offit provided nuanced guidance- like maybe boosters for all is not a good strategy- his character was maligned. To me, when someone with the depth of knowledge and experience he has examines the data and develops an opinion contrary to the narrative, I find him for more believable. I think that is what is most difficult for me personally. I trusted “trusted voices” the whole pandemic. And now, I feel like it’s about a narrative not what the science may actually be saying.
Offit and I have disagreed publicly and privately, and we both have and maintain our own opinions. I can envision situations where continued boosters are not viable, but we also have more and better information about infection-derived and vaccine-derived immune responses and durability, with more information evolving all the time, AND we’re learning more about T-cell vulnerability to SARS-CoV-2, and imprint deficiencies from repeated multitalented vaccines.
No one I worked with was interested in a dystopian environment, and our PH discussions were nuanced and very active: What do we know, and what can we tell people we know authoritatively? How can we communicate this with a real recommendation to mitigate adverse outcomes? It never was about hiding controversial or disparate data, but on evaluating it to the best of our abilities and making sure we told people how we evaluated it. And the secondary explanations were usually ignored by people who preferred to criticize our efforts, often on “personal freedoms” grounds.
Yes! The question isn’t whether Public Health is *becoming* illiberal, but rather what was the nature of past tactics? Illiberal or something worse?
It’s one thing for Public Health to act on the best information it has available at the time. But it’s another thing entirely to base actions on exaggerated “science” while concealing contradictory data.
When propaganda-like language (misinformation, disinformation, science-deniers, etc) is conjured up and dispatched to silence and censor anyone who dares to contradict Public Health, America starts to resemble an Orwellian dystopia.
My issue with Offit was with the practical implications of not having official CDC recommendations for annual boosters. Unfortunately the only way to ensure that vaccines are covered by health insurance without cost sharing is a full throated ACIP rec, so we were already painted into a corner.
He really has nothing to do with ACIP, not on the committee nor a vote. He has stated his position and he is not without a valid point. However, to keep things simple, I do agree with recommending new monovalent boosters for everyone. I should point out he did vote to approve the new monovalent booster in VRBPAC at the FDA.
Right, and that's why I wasn't too worried about him running his mouth on the subject. I wish there was more acknowledgment in the media about the actual "legal realism" of public health
Right, but then it is a financial decision and not a health decision. Too many decisions during the pandemic have been made around the almighty dollar and not true evidence based healthcare.
Isn't it always though? Even if we aren't dealing directly with money, and regardless of the prevailing economic system, we're still dealing with allocation of scarce resources.
there was never any science to support "lockdown" In fact, pandemic planning guidance that existed in March 2020 specifically recommended against it. Lockdowns were the product of mass hysteria and groupthink. Public health will never regain trust if they fail to admit that lockdowns not only failed but were a massive intrusion on civil liberties and freedom.
At a minimum, *temporary* lockdowns are morally permissible in instances where hospitals are on the verge of collapse and we need to “tap on the brakes” to slowdown intake. Hospitals are a public good and even during pandemics, if a person has a heart attack or stroke, emergency medical care should always be available.
If we allow hospitals to collapse, people will be dying on the sidewalks. Not only is this traumatizing and unhygienic for society, but at some point doctors and nurses say “F- it” and permanently quit. This is bad for everyone.
Waving in New York City to anyone who thinks that stay at home guidelines (which were never lockdowns in the USA) and remote school and work were unnecessary.
County level Public Health Departments have a substantial impact on health policies in California.
In the Bay Area, we have many professional & capable department heads that still connect monthly since the Aids Era. Early adoption of CV 19 airborne risk factor (March 2020) was spot-on.
(1) In order to improve Public Health we also need to include the PSYCHIATRIC ISSUES of those politicians & their minions of morons... who, somehow, overnight transformed masks into a "tool of oppression" instead of a "tool of prevention" to stop spreading a deadly virus that turned the world upside down. That's NOT "Leadership"... That's "Indoctrination" -- aka PSYCHIATRIC WARFARE... (or perhaps "Mass Psychotic Delusional Disorder/DSM-V) -- (2) PR needs to use more Humor & Sarcasm (yes Sarcasm) to get health care "F-A-C-T-S" (remember those?) across to the masses lest they become hijacked (once again) by the toxic, Sociopathic Politicians --esp. those who never passed Basic Hygiene in High School Health Class. [Insert Vomit Emoji Here] -- HUMOR breaks down/thru psychological barriers to reach those who are not easy to reach... I thank God for experts like yourself still fighting for Humanity on this battlefield called Earth! Keep going!
I think "Within Reason" makes the wrong diagnosis. Public health did not become illiberal; it strove to preserve society's "Moral Sentiments" (Adam Smith's phrase), in the face of a virulent, irrational, hostile assault from the highest levels of official government which was craven, selfish and immoral. Unfortunately, time is out of joint and these sentiments have taken hold in a significant segment of American culture, the part dominated by the Republican Party. Public health, that is the protection of the common welfare from environmental and infectious threat by systemic and preventive means, inherently requires the best scientific information available, dealing with uncertainty, having values, expressing paternalism, making hard judgements, and the exertion of (unpleasant) authority. Public health is not liberal or illiberal; it is a functionality to protect communal living.
A worldwide examination of COVID outcomes (Pandemic preparedness and COVID-19: an exploratory
analysis of infection and fatality rates, and contextual factors associated with preparedness in 177 countries, from Jan 1, 2020, to Sept 30, 2021, www.thelancet.com, published online February 1, 2022 https://doi.org/10.1016/S0140-6736(22)00172-6) examined many parameters and found that the best outcomes were correlated with trust in government and in neighbors. In a society where trust has atrophied, the problem is way beyond the traditional means of public health, which should not change.
Jetelina is interested in building her brand within public health, of monetizing her blog’s relative fame. I don’t buy her quite obvious about-face over the past year or so, one matched by the CDC itself.
Dr. Jetelina, I want to thank you and all of those who did for pushing back hard on the Great Barrington Declaration. I remember so well, as an older person, reading about that with such dismay, as if older people are not human, but something like canned goods on a shelf that can be moved around at will. Here’s a personal anecdote that relates. When the pandemic began, we sought out the best advice available and, recognizing we were at greater risk, we did of course isolate. Having done that, one thing we knew would be paramount for preserving both our mental and physical health would be to get exercise and fresh air daily. In the area of the Hudson Valley, NY, where we lived at the time, there are few suitable walking trails, but we do have a wonderful rail trail. Our county, however, during the early part of the pandemic, put up signs advising that anyone over 70 could not use them. (Needless to say, I did contact the county, who, in typical pass-the-buck fashion, blamed the state. We walked anyway, but we were glad when the signs were finally removed.) I can only imagine how much worse it would have been for us had you, Dr. Jetelina, and others not protested.
Story time (related to public health, but not necessarily to this post): a child vomited in my 9-year-old daughter's class yesterday. For whatever reasons I don't understand (and I assume they are valid), the child stayed in the classroom. My daughter chose to go to the nurse and request a mask, then decided to bring the whole box of masks back to share with the class. Many of the children accepted her offer. This blew my mind- she clearly learned something about the value of public health and that we don't just have to accept catching a nasty virus for no good reason. While her greatest strengths are in writing and communication, this morning she suggested that maybe someday she will study virology (my grad school field and forever passion) to "work on vaccines for noroviruses" (her words). While many were digging in their heels, crumbling, caving, and letting fear and politics guide their choices or obstruct their better judgment in the height of the COVID-19 pandemic, some were learning, growing, and being inspired to do well by others.
Gosh, thank you so much for this story! It makes my heart happy and gives me hope. Let me know if there's anything I can ever do to help support your daughter's endeavors.
I will share your comment with her and she will be extra proud! Thanks! :)
You must be so proud of your amazing daughter. Clearly, she will be helping Humanity in the future... Thank you for raising a responsible, mature, intelligent young lady...
I sure am trying! :)
I have to push back on this. A kid vomiting in class means that all other kids should mask up? What is the increase in probability that an unmasked kid in that classroom will catch something after we get the added information that another kid has vomited? With some expertise in statistics (but none in epidemiology), I would have to think that the increase is pretty darn small (a few per cent at most). So is that enough to mask up every other kid? I would think not. (And I assume we're talking surgical masks self-applied by kids, not N95s fitted by professionals.)
Then there is the disruption to the class of having one kid go get masks, and the other kids then having to decide whether to wear them or not. This surely produced a social dilemma for those kids, and made them have to decide which group to belong to: the masked or the unmasked. I doubt their individual decisions were based on the latest epidemiology reports.
So Katelyn: this is actually a good example of the sort of thing your post is about. What is the best epidemiological advice for the situation where a kid throws up in class? Should everybody mask up, or not? Given that kids have been throwing up in class for hundreds of years (I did it myself), and nobody was masking up afterward, what should we be doing now?
Wash your hands
That is inspiring 👌
Over two months later, I’m curious, do you happen to know if other kids got sick the next day?
The symptom of suddenly throwing up, then feeling fine, is common for norovirus-which runs rampant in many parts of the US Nov-Dec each year.
Norovirus is especially efficient spreading - one case study found over 50 people in a restaurant fell ill after a patron suddenly vomited mid meal, and from my unfortunate experience, this is unsurprising (hit our family almost instantaneously 2017 early December)
Just curious if you recall what happened after this event.
I really am not sure, but I had an extensive conversation with the school nurse about how decisions are made. She said they take into account each individual child and their health history (for example, does the child have athsma that causes coughing fits which might lead to vomiting). I still say that’s a pretty wild gamble and I would not personally want to sit through the rest of my school day feeling so unwell. The child was back in school the next day and all I could say to my daughter was, “then he must be fine!” In another interesting twist, other children alleged that the mess was not cleaned up well. Cringe^infinity.
One of the biggest problems with public-health messaging in the US is that it speaks to the lowest-common denominator. We saw this with masks/COVID: we were initially told masks didn't work not because the experts thought they didn't but because they didn't want people to run out and buy up all the PPE. We also see this with things like vaccine timing: "Get your flu shot whenever you can" rather than "Get your flu shot in mid-to-late-October." "Get your COVID booster anytime" rather than "Waiting at least 6 months to get a booster after an infection will improve efficacy."
Until public-health experts tell the nuanced truth regardless of how they think it will impact action, including admitting when the answer is "we don't know," nothing will change.
They truly didn’t think they worked though. The “we don’t want PPE shortages” was post-hoc. It was openly and privately discussed for decades they don’t work leading up to Feb 2020.
Keep in mind that the mode of viral transmission of Influenza was not firmly established at the time either. This has changed, not the mask.
And what happened people bought up all the ppe anyway
The politicians railing against public health workers, such as Trump and Desantis, are not leaders. They are nothing but narcissistic stooges interested in their own standing. Problem is, too many Americans are willfully ignorant and follow these types to their own detriment. And too many Americans are whiners about not having enough information to make rational decisions. Bull. Many are just too damn lazy or stupid.
I think it's worth mentioning that the brief of public health officialdom is to protect the society as a whole and not to serve as a bastion of individual liberties. During a health emergency, individual rights have to take a temporary back seat. Consider firefighters battling a blaze in a crowded urban area. Whole blocks might be cordoned off, denying entrance even to rightful homeowners in the affected area until the fire is brought under control. More broadly, the imposition of martial law--which hugely limits individual rights--has been deemed essential to the maintenance of civil order during emergencies (such as insurrections, foreign invasion or other circumstances when regular order breaks down and civil society itself is menaced). So too is the imposition of military conscription in times of war. Just ask anyone who has been inducted just how much their individual liberties were infringed. To me, the outbreak of a deadly, highly contagious virus is on par with a foreign invasion, and warrants all reasonable steps (including even severe restraints on movement and social contact) to contain it until less draconian steps are viable alternatives. These measures are not the the thin edge of the wedge of dictatorship. These measures are temporary and specific to the emergency at hand. We have used them many times before and lo, we are not in the gulag. If your society has not taught you the b=value of its own survival, so much the worse for your society.
That is all true BUT only if it was the right strategy from an infection-prevention/outcomes POV. Unfortunately, because the discussion around lockdowns (and everything else) is so politicized, we can't have a rational data analysis discussion around it.
why is no one mentioning the burden of misinformation/disinformation
Nailed it. And these conflicting ideals are brought into sharper relief depending on the scope and severity of the problem.
So agree. As a species we are interdependent whether we like it or not. Often, we're unaware of how society functions this way, but it does.
If the public health field starts to cater to science-deniers, it will unravel entirely. Consider that there is little-to-nothing experts can do to persuade many science-deniers, but much distrust that could follow from those who embrace science and expertise if the field goes out of its way to coddle those who don't want it in the first place.
We have to remember CDC was the preeminent health agency we could count on. It was gutted by the GOP administration that had as their advisers, people without infectious disease experience. Their criteria was destroy science, make money. Healthcare, science, environmental sciences, social services, women’s rights have been eroded by those who would divide this country. We all used what we knew as best practices of the time and we learned over time what worked and didn’t work. We tried to save lives. We’ve lived some privileged lives here. The reason many of us are alive, is people believed in science and taking care of each other. Now we complain about it.
I agree that the CDC was preeminent; but Mandy is under the thumb of the neo-liberal WHCOS Jeff Zients who priorities economic gain over public health.
I agree with this.
I am just a lay person, but I believe in science and was counting on our government and the CDC to guide us through the pandemic. Here in Minnesota we had a strong governor (Tim Walz) and public health team that kept us updated with regular televised briefings. We followed their guidance and did our part (social distancing, masks, and vaccines). Switching the channel to the national briefing was like watching a clown car (with the exception of Dr. Fauci when he wasn’t muzzled). “Bleach” from the mouth of a President? I agree that we have a long way to go to create a robust Public Health infrastructure in this country. Reading “The Premonition” by Michael Lewis gave me a good peek into our fragmented system and where we could be. I started following Dr. Osterholm (U of MN) for science based information as the pandemic spread. I found your SubStack and became a paid subscriber. The other day I went to my appointment at Walgreens to get my next Covid booster. I told the tech I had waited 4 months after having a bout of Covid in August. The tech said “good for you” after I mentioned following your guidance as an epidemiologist. She mentioned they follow Mayo and the Cleveland Clinic (rather than the CDC since they apparently follow “more than just the science”). I appreciate your insights and hope you stay focused on creating the national public health system that we all deserve.
P.S. I’m putting that in my letter to Santa this year, too, so get busy. Crooked grin.
I so appreciate what you have written here. I was enormously grateful to find people like Dr. Jetelina, Dr. Marr, Dr. Topol, Dr. Wachter, and a host of others who made it their charge, though they already had plenty else to do, to commit strongly to accurate public-facing communications, including straightforward acknowledgement of uncertainties and the need for course adjustments as new information arose (and arises).
Public health policy is supposed to be based on reality. On actual data. We can negotiate on how to promote vaccine use based on differences in political view. We cannot and should never be debating about whether or not they work when all available emperical data says that they do. The Republicans left the public health arena when they decided to claim vaccines were causing deaths and not COVID. They pushed their supporters to do the same. That is where this divide mainly exists.
Galea appears to be ignoring a glaring problem, today's conservatives don't believe in the common good and therefore do not want there to be a successful public health program. There is never going to be a successful public health program that will appeal to them and we should not be compromising everyone else health to appease those that will never be appeased.
The Republican Party found massive gains in exploiting all things related to Covid precaution. Our Public Health Officer received constant threats and pushback by moronic City Council Members here in Northern California. (She resigned as a result) Entire School Boards have been replaced with MAGA Majority as well as local held offices. Local Fire Captains, High Ranking Law Enforcement all buying into 3rd grade level Covid misinformation. It's disgusting watching this epidemic of Conspiracy Theory spread throughout our Nation.
So agree! Not only to those on the right not prioritize the common good, but some strive to undermine our common understanding of truth
I will read the book, and perhaps come back with some thoughts. But re your comment about dismissing new information: one should *never* view anything through a lens even remotely tainted by politics. My goal -- only occasionally attained -- is to take "the view from nowhere," a view of total detachment. And often it helps. The philosopher Thomas Nagel's book of the same name set me down this path... it's worth a read.
Another option: try to read peer-reviewed research if you can (instead of secondary or tertiary interpretations). Not always easy or accessible to the general public, but your best bet for high-quality information.
I spent the primary period of the pandemic reading peer- and pre-reviewed literature. In fact, i read virtually every article as if I was reviewing it, which meant I spent a lot more time on each on, and provided comments and feedback, than if I’d skimmed the articles or accepted others’ interpretations. I still read nearly 1000 in the first 8 months, and now have a personal archive of well past 3000. That said, keeping them straight was problematical. However, I spent a lot of time trying to be open to new findings, and new Ideas.
I also participated, for about a year, in nightly online discussions with 3 different clinician groups. We discussed a lot about what had happened that day, with clinical pearls that allowed the group-think to form opinions and new hypotheses, often leading to changes in clinical care. One of those provided a VERY early thought that COVID was really a vascular actor, well before the media ever heard that idea, and long before a note to a major journal proposed the idea.
My biggest failing, I think, (I’m sure I have blind spots) was in communication. Most of my missives were too technical, because I was trying to get information out but was sensory-overloaded. I can usually talk to the patient or family pretty well, and seeing the Public at large as my patient should have been reasonable for me, but I ended up with a proof-reader and editor who translated what I’d written for the leadership and occasionally the membership of my organization, because A) I wrote with too much detail and B) was too technical. I’m trying to establish, within the organization, a team to better communicate for the next outbreak.
This is such a common issue and I think what makes YLE so special. She tackled that issue head on, along with other groups like Those Nerdy Girls and Unbiased Science Podcast.
P.S. I highly recommend Sense of Style by Steven Pinker and a great course on Coursera called Writing in the Sciences if you’re interested in rethinking scientific communication. Both of these sources improved my communication skills dramatically (I work in clinical trials).
I'll look into it when I have a few spare cycles. Which, unfortunately, won't be real soon. Couple of masters-level programs I'm looking at right now.
Totally agree. Except... we're seeing a small but increasing percentage of peer reviews that are anything but. I use a lot of peer-reviewed research in my work, and a worryingly large (OK, still small, but nonetheless) number of papers are being retracted. Definitely far more than, say, 5+ years ago. Maybe it's a volume problem: too many papers (absolutely), too little time spent on the review process. Sigh.
Could also be viewed as improving rigor in the process of cleaning out the dirt! I hope that's the case. Probably a combination of factors.
I think that this is the case, there's just so many papers and the incentive structures encourage it . If you use a lot of peer-reviewed research, it's worth educating yourself on some of the causes and concerns around dodgy science and how to spot it. I was unaware until recently, for example, about 'paper mills'. It's well worth downloading the Pub Peer extension to your browser and spending a bit of time reading Retraction Watch and other websites which look at research integrity. I've written a couple of articles about it if you are interested.
I've been a reviewer in several fields for over 20 years now. I don't participate in fields where I can't hold my own. I've refused to accept papers because they didn't meet my standards, and authors were unwilling to address my comments. Unfortunately, I've seen several of those pushed out to lesser journals with little review requirement.
A long time ago, I worked in a lab with a poster in our library/conference room. I still remember it today: Perish -- Or Publish the Thought. That lab encouraged us to publish on a lot of our work (partial and total artificial heart research, clinical mechanical support of the failing circulation, and transplant research. ALL of our research that was pushed out for publication, however, had to be submitted to reputable journals.
For what it's worth, though, the other poster in the conference room was more to the point: "We don't read the literature... we WRITE the literature".
I spent a lot of time reviewing articles during the first several years of COVID. Now I'm a bit more selective, letting a lot of the review work be done by others. That doesn't mean I don't have my critical analysis hat on whenever I'm reading, but that, instead, today, of reading and fact checking every article, I'm reading it critically but assuming that, for the most part, the peer review process is working again. Obviously that's not the case on the preprint servers, and while I do still venture there regularly, each of those articles I read is literally read as a reviewer (I really am usually Reviewer #2) and provide feedback to the authors.
Sorry, the "view from nowhere" is a fantasy. You need to be aware of your positionality and take it into account.
You misunderstand the concept. Taking a view from nowhere *is* being aware of your own sub-conscious biases ("positionality"?) and doing just that. It's not a fantasy, but it's definitely aspirational. And if we can't aspire to it, we might as well give up.
Which seems to be what most Americans -- I'm a Brit, so full deniability :) -- have done. And why your next president -- sorry, dictator, the US is clearly done with democracy -- will be Trump. (I wish I could say I was joking here, but...)
Thanks, but I've read Nagel and don't misunderstand. It's a fantasy.
And yet "being aware of your positionality and taking it into account" is pretty much his position -- or at least as applicable to the real world rather than academic discourse.
the politicization of science will take a long time to come back from. No more mandates (lockdown, masks, vaccine) that infringe on liberties and freedoms, that aren't backed by scientific evidence, and for which no cost-benefit analysis has been done. And no more calling people "science-deniers" for questioning things. "Science" by definition is about asking questions and testing hypotheses.
Paul, whether you like it or not, we are an interdependent species. You are incorrect about masking-there's so much available data...
there's some biased and confounded observational studies and lab studies that support masking. The best available data (RCTs and macro-level real-world data) offer no evidence supporting masks or mask mandates.
The call for randomized clinical trials has become shrill in the COVID era when we didn't have time to engage in those for the simple reason that people were dying. Thus, real-world experiments, where the distribution of patients was dictated by natural occurrence and a valid observational analysis was utilized became frequently the only viable path. RCT is time consuming and can also be confounded.
For a number of reasons, RCT for masking is almost completely non-feasible. However, engineering analysis can, and has demonstrated their efficacy. Similarly, historical evaluations of prior respiratory outbreaks have demonstrated relative efficacy of mask usage.
Personal experience Paul. When I stopped wearing my N95 mask, is when I contracted SARS COV 2. So I will use my personal experience as proof that an N95 does in fact help mitigate contracting SARS COV 2. As well as studies posted by YLE over the height of the pandemic and the effectiveness of wearing a mask to prevent contracting the virus.
There are people in my small town, my very Trump supporting town who died to Covid 19. Died because they chose to listen to 3rd grade level conspiracy theory, a clown for a POTUS, and shared misinformation with like minded.
Thanks for bringing this book to our attention and for summarizing its topics.
In terms of what future Public Health should look like, two thoughts come to mind:
1) Under what circumstances is it morally permissible for government to take away civil liberties and essentially force people to do things (ie, lockdowns, mask mandates, vaccine mandates)?
2) What is the appropriate philosophical mindset for Public Health regarding an individual’s capability to make decisions that are in their own best interest? Essentially, how dumb is the public? Are some groups dumber than others? Is it enough for Public Health to provide accurate and scientific data to the public (Covid mortality risk factors by group, efficacy by vaccine manufacturer, etc) and trust individuals to make decisions that are best for them and their families? When it comes to providing actionable data, is it ever appropriate for Public Health to “stack the deck” and “encourage” certain behaviors?
Regarding #1, at the very beginning, I believe it was morally permissible to temporarily lock down the public to prevent hospitals from collapsing and to study the virus and understand what we were dealing with. But lockdown went on waaay too long, and it’s harder to defend the rest of the mandates. One could even argue that at the time the vaccine mandates were put in place, officials already knew that vaccines didn’t stop infection or transmission, even though the public was being told otherwise. Maybe if the vaccines had been much better and herd immunity was possible this would have been morally acceptable, but knowing what we know now, this never should have happened. Which makes me question just how good vaccines and boosters are at preventing severe disease, hospitalization and death - though I do get an annual jab as a hedge.
When it comes to making tradeoffs between different groups, children should always be prioritized.
Agree! And I think a big part of this is people have a natural tendency to want black and white answers because they are scared and they want reassurance. "Does X mitigation work" or "Is X activity safe". Science is always a hedge - it's the best information we have at the time, with acceptance that new information may mean revisiting conclusions. Something "working" or being "safe" is almost always relative to the conditions or the risk/benefit tradeoff, which can vary quite a bit for different individuals. Nuance isn't reassuring. But it's necessary. And Public Health can't guarantee an outcome for an individual because its whole purpose is maximizing the most effective (which is sometimes actually just the most achievable) and least harmful outcome for the population as a whole.
I think this is where public health failed. Instead of saying- oh, hey! New info! So, we are changing our guidance- they kept and keep beating the same drum. Nuance is absolutely necessary. And it has been very lacking.
Even when I said that explicitly, I was pilloried for changing my opinion. In almost every case there was no recognition that I had stated the information had changed. Just the attacks.
You would be in a minority. And definitely on a national level, this was not happening.
THIS!
New research is showing that designing messaging to spur action doesn't actually have the impact we once thought it did. Often, it backfires, and you end up with a really big mess.
Yes! Messaging based on data that is cherry picked comes across as manipulative and paternalistic. The Public can sniff an agenda from a mile away.
A serious question: What makes you think our agenda in PH was anything more than trying to provide guidance to protect the largest number of people possible?
Perhaps this isn’t your intention, but the way in which you phrase your question comes across as an attempt to put words in my mouth that misrepresents what I wrote and what I believe . If you’d like to rephrase your question, I’m happy to try again.
You stated that data presented was 'cherry-picked', and implied that was due to an agenda beyond, at least in my case, trying to help keep my organization safe and functioning. I'm not trying to be disrespectful or put anything in your mouth. I'm really trying to understand.
Hi Gerry - You seem like a nice person, and I do appreciate your contributions to the YLE message board. Here's a brief response (busy time of year) about what I mean by the word "agenda." PH made a decision early on that vaccines were the way out of the pandemic. Jab enough arms and the virus would disappear. There were other agendas, too, such as around masks, but let's focus on vaccines.
What this meant is PH emphasized (exaggerated?) every reason to take a vaccine and omitted (censored?) every reason not to. In other words, cherry-picking, manipulation, etc.
Here are some examples:
1) Charts from CDC showing that unvaccinated are appx 20x more likely to end up with severe disease/hospitalized than vaccinated - but failing to correct for the fact that vaccinated people are likely to be more careful (masks, social distancing) and failing to mention that the benefit is likely short lived
2) Nearly every other country has moved to a vaccine/booster recommendation system based on age (i.e., 65 and over). Some countries do not recommend certain mRNA vaccines for young men. Who is right, the US or the long list of other countries? When it comes to guidance for young men, if the US reversed course, this would be viewed as validating the maligned Surgeon General from Florida, which is a win for DeSantis. Oh, no, we cannot have that! I'm not accusing PH of bowing down to politics at the expense of the lives and health of young men - but I'll admit the thought has crossed my mind. (For context, I voted for Biden)
3) There is a lot of negative stuff coming out about the Pfizer shots. Poland and Romania refuse to buy them, and in return, Pfizer is suing them. Researchers at Cambridge University recently found that one in four who were vaccinated with Pfizer experienced "unintended immune response," which if I understand correctly means the vaccine is a dud. For over 2 years a friend of mine who does research in this space has told me "Get Moderna, you'll be better protected." (Now he says to get Novavax.) PH offers us the vaccines as if they were equally good and interchangeable - but they are not. Why can't PH tell us which vaccine is best for which type of person?
Because PH backed lockdowns and mandates, they are now reluctant to say or do anything negative that diminishes the "vaccines are wonderful" narrative. Otherwise they open themselves up to criticism: "But, you locked us down. But, you took away my job!" Lockdown and mandates have painted PH in to their own self-created corner.
4) In the early days of the pandemic, before vaccines had been released, PH seemed to quash any efforts by others to research or deploy early treatments. Yes, I know that Ivermectin and Hydroxychloroquine are hugely controversial and (supposedly) debunked, and I'm not here to argue their merits. But there were many other meds being considered for repurposing (I was indirectly involved with this so I know). Why were these efforts stymied? Is it because PH didn't want to give people reasons not to get vaccinated?
And here's another question - why did it take Paxlovid more than 2 years to be released, and only after PH had done everything within its power to encourage vaccine uptake, including mandates? Was it because PH didn't want to give people reasons not to vaccinate? It's incredible that vaccines were faster/easier to deliver than Paxlovid.
Think of all the lives that could have been saved if Paxlovid had been released a year earlier!
I do genuinely believe that people in PH were trying to save lives and keep people safe - and that PH was handed a set of extremely difficult tradeoffs. I am thankful to anyone who accepted the challenge. Yet, in situations like this, unchartered and unknown, it's important for PH to have a set of "guiding principals" to aid policy making.
Cherrypicking and omissions, force and mandates, overly-optimistic assumptions (herd immunity) without worst-case-scenario planning (vaccines that do little to prevent infection/transmission), stymying alternative therapeutics and early treatments (drug repurposing), restricting freedoms and removing autonomy, censorship, politics over policy -- none of these are appropriate guiding principals (whether explicitly stated or unintended outcomes), even during a global emergency like a pandemic.
I agree wholeheartedly. And, as to your last point, I have become a skeptic about the efficacy of the vaccines and their necessity for those not in a high risk group. I was, previously, for the mandates, and my family was vaccinated the second we were eligible. But, especially seeing how sick my stepmother was just six weeks after her latest vaccine...I wonder if it did anything at all. Paxlovid is what turned the course for her. I guess you could argue she may have been sicker had she not had the vaccine six weeks ago (despite having five previous vaccines and Covid in 2022 that was not this bad for her) but maybe she would have been less sick. And certainly if there is zero protection six weeks out from getting very sick, what is the point? Avoiding hospitalization and death? I credit that to the Paxlovid. Maybe a pan corona vaccine will change the playing field. Or maybe we have to accept we cannot vaccinate away Covid. And maybe better anti virals are the better solution. All that is to say that I understand why the public has lost trust in the public health machine.
One big problem with mRNA vaccines is that it is very difficult to maintain the necessary cold temperature throughout the entire distribution process. As a result, once they reach the intended pharmacy or doctor’s office, in some instances their efficacy has likely been compromised (meaning they offer less or no protection).
It is interesting to me that when Paul Offit provided nuanced guidance- like maybe boosters for all is not a good strategy- his character was maligned. To me, when someone with the depth of knowledge and experience he has examines the data and develops an opinion contrary to the narrative, I find him for more believable. I think that is what is most difficult for me personally. I trusted “trusted voices” the whole pandemic. And now, I feel like it’s about a narrative not what the science may actually be saying.
Offit and I have disagreed publicly and privately, and we both have and maintain our own opinions. I can envision situations where continued boosters are not viable, but we also have more and better information about infection-derived and vaccine-derived immune responses and durability, with more information evolving all the time, AND we’re learning more about T-cell vulnerability to SARS-CoV-2, and imprint deficiencies from repeated multitalented vaccines.
No one I worked with was interested in a dystopian environment, and our PH discussions were nuanced and very active: What do we know, and what can we tell people we know authoritatively? How can we communicate this with a real recommendation to mitigate adverse outcomes? It never was about hiding controversial or disparate data, but on evaluating it to the best of our abilities and making sure we told people how we evaluated it. And the secondary explanations were usually ignored by people who preferred to criticize our efforts, often on “personal freedoms” grounds.
Yes! The question isn’t whether Public Health is *becoming* illiberal, but rather what was the nature of past tactics? Illiberal or something worse?
It’s one thing for Public Health to act on the best information it has available at the time. But it’s another thing entirely to base actions on exaggerated “science” while concealing contradictory data.
When propaganda-like language (misinformation, disinformation, science-deniers, etc) is conjured up and dispatched to silence and censor anyone who dares to contradict Public Health, America starts to resemble an Orwellian dystopia.
My issue with Offit was with the practical implications of not having official CDC recommendations for annual boosters. Unfortunately the only way to ensure that vaccines are covered by health insurance without cost sharing is a full throated ACIP rec, so we were already painted into a corner.
He really has nothing to do with ACIP, not on the committee nor a vote. He has stated his position and he is not without a valid point. However, to keep things simple, I do agree with recommending new monovalent boosters for everyone. I should point out he did vote to approve the new monovalent booster in VRBPAC at the FDA.
Right, and that's why I wasn't too worried about him running his mouth on the subject. I wish there was more acknowledgment in the media about the actual "legal realism" of public health
Right, but then it is a financial decision and not a health decision. Too many decisions during the pandemic have been made around the almighty dollar and not true evidence based healthcare.
Isn't it always though? Even if we aren't dealing directly with money, and regardless of the prevailing economic system, we're still dealing with allocation of scarce resources.
there was never any science to support "lockdown" In fact, pandemic planning guidance that existed in March 2020 specifically recommended against it. Lockdowns were the product of mass hysteria and groupthink. Public health will never regain trust if they fail to admit that lockdowns not only failed but were a massive intrusion on civil liberties and freedom.
At a minimum, *temporary* lockdowns are morally permissible in instances where hospitals are on the verge of collapse and we need to “tap on the brakes” to slowdown intake. Hospitals are a public good and even during pandemics, if a person has a heart attack or stroke, emergency medical care should always be available.
If we allow hospitals to collapse, people will be dying on the sidewalks. Not only is this traumatizing and unhygienic for society, but at some point doctors and nurses say “F- it” and permanently quit. This is bad for everyone.
Waving in New York City to anyone who thinks that stay at home guidelines (which were never lockdowns in the USA) and remote school and work were unnecessary.
yeah, "experts" and politicians told everyone that stay at home orders were necessary. But that wasn't backed by any science or evidence.
Where is the evidence that lockdowns mean fewer patients in the hospital? There's no evidence to support that argument.
County level Public Health Departments have a substantial impact on health policies in California.
In the Bay Area, we have many professional & capable department heads that still connect monthly since the Aids Era. Early adoption of CV 19 airborne risk factor (March 2020) was spot-on.
(1) In order to improve Public Health we also need to include the PSYCHIATRIC ISSUES of those politicians & their minions of morons... who, somehow, overnight transformed masks into a "tool of oppression" instead of a "tool of prevention" to stop spreading a deadly virus that turned the world upside down. That's NOT "Leadership"... That's "Indoctrination" -- aka PSYCHIATRIC WARFARE... (or perhaps "Mass Psychotic Delusional Disorder/DSM-V) -- (2) PR needs to use more Humor & Sarcasm (yes Sarcasm) to get health care "F-A-C-T-S" (remember those?) across to the masses lest they become hijacked (once again) by the toxic, Sociopathic Politicians --esp. those who never passed Basic Hygiene in High School Health Class. [Insert Vomit Emoji Here] -- HUMOR breaks down/thru psychological barriers to reach those who are not easy to reach... I thank God for experts like yourself still fighting for Humanity on this battlefield called Earth! Keep going!
I just met Dr. Galea this year and saw him yesterday. Very wise and measured man! Thanks for the rec.
I think "Within Reason" makes the wrong diagnosis. Public health did not become illiberal; it strove to preserve society's "Moral Sentiments" (Adam Smith's phrase), in the face of a virulent, irrational, hostile assault from the highest levels of official government which was craven, selfish and immoral. Unfortunately, time is out of joint and these sentiments have taken hold in a significant segment of American culture, the part dominated by the Republican Party. Public health, that is the protection of the common welfare from environmental and infectious threat by systemic and preventive means, inherently requires the best scientific information available, dealing with uncertainty, having values, expressing paternalism, making hard judgements, and the exertion of (unpleasant) authority. Public health is not liberal or illiberal; it is a functionality to protect communal living.
A worldwide examination of COVID outcomes (Pandemic preparedness and COVID-19: an exploratory
analysis of infection and fatality rates, and contextual factors associated with preparedness in 177 countries, from Jan 1, 2020, to Sept 30, 2021, www.thelancet.com, published online February 1, 2022 https://doi.org/10.1016/S0140-6736(22)00172-6) examined many parameters and found that the best outcomes were correlated with trust in government and in neighbors. In a society where trust has atrophied, the problem is way beyond the traditional means of public health, which should not change.
Jetelina is interested in building her brand within public health, of monetizing her blog’s relative fame. I don’t buy her quite obvious about-face over the past year or so, one matched by the CDC itself.
Dr. Jetelina, I want to thank you and all of those who did for pushing back hard on the Great Barrington Declaration. I remember so well, as an older person, reading about that with such dismay, as if older people are not human, but something like canned goods on a shelf that can be moved around at will. Here’s a personal anecdote that relates. When the pandemic began, we sought out the best advice available and, recognizing we were at greater risk, we did of course isolate. Having done that, one thing we knew would be paramount for preserving both our mental and physical health would be to get exercise and fresh air daily. In the area of the Hudson Valley, NY, where we lived at the time, there are few suitable walking trails, but we do have a wonderful rail trail. Our county, however, during the early part of the pandemic, put up signs advising that anyone over 70 could not use them. (Needless to say, I did contact the county, who, in typical pass-the-buck fashion, blamed the state. We walked anyway, but we were glad when the signs were finally removed.) I can only imagine how much worse it would have been for us had you, Dr. Jetelina, and others not protested.