Friday, May 22, 2020

Epidemic Response: A critique




I don’t often express my own opinion at any length on this forum, especially on “hot topics.” Typically, I doubt the fruitfulness of the exercise. That said, in this case, I think it is worth putting a couple thoughts out there on this question of the response to Wuhan Coronavirus.

I should start with the obligatory caveat that yes, I do think that the virus is more serious than your typical seasonal flu, and that, yes, of course, we should act responsibly and especially do our part to protect vulnerable folks.

My critique is this: during this pandemic, our public health officials and the press corps have badly handled their direction and communication of the situation. I think a scientist and public health official should be clear, honest, and sober. In such a case, the press need only give them a platform. I don’t think that has happened.

Let me explain my dissatisfaction.

Science is all about observation, gathering evidence, and testing theories to explain what you see. In a case like this, when you are facing a novel virus, it is common sense that there is a great deal you would not know: it's new. So, tell the public that. Be transparent on what we have proven and what we merely guess or surmise. Be equally honest about how you may have initially been wrong. If goals have to change, make it quite clear that the goal is changing and why new evidence necessitates the change. I'm not seeing that.

So far, I can recall being told:
-- There is no evidence of human-to-human transmission
-- There is no threat to the United States
-- The virus can be spread even by those who are asymptomatic
-- It can take two weeks to manifest symptoms
-- Some infected people never actually manifest symptoms
-- Wash your hands and don't touch your face
-- Don't wear a mask unless you are sick or a medical professional. Cloth masks are useless with a virus and give a false sense of security.
-- The virus can live 7 days on some surfaces, so wipe everything down
-- The is a national medical emergency that necessitates shuttering the nation
-- We need to flatten the curve to keep from overwhelming our medical facilities, even though this will prolong the epidemic
-- Wear a mask. This is primarily to protect others
-- The chance of transmission from inanimate surfaces is low
-- Most healthy people who become infected have no symptoms or have mild symptoms
-- The chance of asymptomatic transmission is less than that from one manifesting symptoms
Now we even have some public officials in certain places talking about continuing restrictions until there is a vaccine or “cure.”

Please note: I’ve got no problem with any of this progression, insofar as it is based on the new evidence and experience that we gained. Indeed, I am excited that we continue to learn more about this pathogen and will be better able to stop its spread and treat those who contract it.

I am troubled, though, at this tendency to “update” the recommendations and “facts” about the disease without an admission that earlier recommendations and theories about it were, in fact, erroneous. I am concerned, too, that the public is lectured to like fools and treated as an ignorant, selfish, and “anti-science” should there be any questioning of these recommendations or policies. If you want the public to cooperate, you’ve got to give clear goals, convincing reasons, and sensible recommendations. You need to be clear, honest, and sober. We have had shifting goals, appeals to authority, and mandates that often don’t make sense. That doesn’t work. The tone from too many officials and press outlets has been contradictory, politically charged, and alarmist.

For instance, the policy of trying to “flatten the curve” made good sense. So why have we abandoned it? What was wrong with that? You need to explain why that is no longer an appropriate strategy, not just introduce a new one and accuse those asking questions with not caring about how many people die.

I also want to note: life involves risks. The argument that it is worth it to remain “locked down as long as it takes” or utterly changing society on a permanent basis if it would even save a single life from the Coronavirus is, frankly, nonsense. Public policy should be about the promotion of the common good; the common good involves, not just what’s best for some, or even the majority, but what is just and tends to general human flourishing. To impose long-term quarantines that result in catastrophic economic and societal consequences demands that there be a yet more serious danger in not doing so. Right? Utterly overwhelmed medical facilities where folks can’t even get treatment for emergencies unrelated to the Wuhan Coronavirus; that’s worth avoiding, for sure. “Flatten the curve.” That makes sense. That’s not a threat right now in most places, though. Again, life involves risk. We can never totally avoid it; we should responsibly manage it. Striking that balance takes prudence and sobriety.

Finally, I think the adversarial attitude of the press towards the President and my own governor here in Georgia is counterproductive. Of course, the comments of President Trump have been inconsistent, confusing, and too often off-the-cuff. Anyone who knows Donald Trump knows that while he is to be taken seriously, his off-the-cuff comments should not be taken so seriously. The press, however, doesn't take him seriously, but takes every word he says way too seriously, and ultimately misses the point. I’m not defending the President’s delivery or his tendency to speak off-the-cuff or on Twitter. I am saying that, by now, the press should know how he works and stop giving so much attention and time to these statements. It's a distraction that makes it look like their priority is really just to discredit the president. I know they can do this: they seem to know how to take particular comments of Joe Biden with a grain of salt!

I should say, in closing, that I think my own governor here in Georgia has done a comparatively good job and has been at the receiving end of a great deal of dishonest and ill-informed ridicule.

In the end, I write all of these things hoping and praying for the best and acknowledging my own ignorance of much of the complexities of public policy and public health. On the other hand, if policy makers and health experts want the support of someone like me, they might note that what they are doing now isn’t working too well. I do fear they may have cried wolf a few times too many in this crisis, and I am concerned that folks are just going to stop listening. I don’t think that would be a good thing, in the end.

Let us pray for one another.

Live well!