Later On

A blog written for those whose interests more or less match mine.

People Don’t Trust Public-Health Experts Because Public-Health Experts Don’t Trust People

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David Wallace-Wells has an interesting take on the public-health issue in New York:

Almost as soon as the first marches to protest the killing of George Floyd began, in Minneapolis on May 26, conservatives and COVID contrarians seized on the rallies as a case study of liberal coronavirus hypocrisy. If the disease spread rapidly through the assembled protesters, they felt, it would show that those who’d spent the spring scolding Americans for resisting lockdowns didn’t care as much about public health as they did about advancing their own set of political values. (Liberals, of course, would put it differently: that the cause was worth the risk.) If there were relatively few new cases, the thinking went, it would demonstrate that the lockdowns themselves were unnecessary.

Three weeks later, we have the first results from the natural experiment: Across the country, from Minneapolis to California and New York City to Albany, the protests produced, at most, very few additional cases of COVID-19. The same, more or less, was observed in the aftermath of the much-derided Lake of the Ozarks Memorial Day party (where one sick partygoer may have infected as many as … one other). Does this mean we’re out of the COVID-19 woods, all clear for mass gatherings and the end of social distancing, and that the intrusive and intensely burdensome lockdowns of the spring were excessive? Well, no. The same week, a major study led by Berkeley’s Solomon Hsiang exploring the effect of lockdowns across the world found that, in the U.S., social distancing and shelter-in-place guidelines prevented as many as 60 million additional cases (since, at least in the early days of the epidemic, many more are believed to have been infected than were tested for the disease). And if those measures had been implemented sooner and more effectively, one review suggests, between 70% and 99% of American deaths could have been avoided. Instead of 120,000 deaths, we might have had fewer than 2,000.

These two findings would seem to contradict each other, but only if you are proceeding from the reductive assumption that either lockdowns were absolutely necessary or that no precautions at all were. But whatever your impression as a lay consumer of public-health guidance, scientists have known for months that “all or nothing” was a misleading way to approach the question of how to combat the spread of the disease — which could be substantially mitigated by warm weather, mask-wearing, and better hygienic practices (and whose lethality would be reduced significantly if those who were infected in environments like rallies were mostly young and healthy). Indeed, one recent analysis of more than 1,000 “super-spreader” events around the world, for instance, found that more than 97 percent of them took place indoors (most of them also during local flu seasons and in settings that put people into close contact with one another for long periods of time). As Emily Atkin, among others, has pointed out, this is what makes the president’s Tulsa rally tonight so much more dangerous than any of the protests he’s been trolling and threatening from the bunker of the White House over the last few weeks.

But all the way up through the beginning of the protests, and even after, America’s jury-rigged, Rube Goldberg health-messaging apparatus (epidemiologists, local public-health officials, civic-minded journalists, improvising and coordinating guidance in the total absence of any federal leadership) failed to communicate most of these nuances — suggesting, for instance, that Georgia’s reopening was a “death sentence,” and that its governor, Brian Kemp, had “blood on his hands,” rather than emphasizing relative risks and the precautions that might be taken to avoid them. The Atlantic ran a piece calling the state’s reopening “an experiment in human sacrifice.” Groups of scientists who would weeks later defend the marches on public-health grounds vociferously attacked Wisconsin’s in-person election. Even the same scientist who called reopening the economy “extraordinarily dangerous” in late May “wholeheartedly” defended and embraced the protests in early June.

And while there has been plenty of crowing among conservatives, recently, about what these reversals say about liberals’ true concerns, the failure on the right has been considerably larger — because while it is indeed the case that reopenings can be relatively safe if the right precautions are taken, conservative leaders in the states reopening first have done basically nothing to ensure that they are. In Arizona, where the pandemic is growing rapidly, the governor has even tried to prohibit local officials from offering mask-wearing advisories.

This erratic pattern of advisories wasn’t just about mass gatherings, in other words. And it wasn’t a sign that the underlying science had changed; it hadn’t. Instead, it reflects an unfortunate pattern from the first months of the pandemic, in which public-health messaging has had a considerably less stellar and considerably less reliable record than you might hope for — not just for those worrying about the coronavirus threat but anyone who is concerned about the status of scientific expertise and technocratic policy more generally.

In January, as the earliest scary research into the outbreak in Wuhan began arriving from China, public-health officials downplayed the threat and systematically advised coronavirus panic be channeled into vigilance about the flu, which they considered a bigger problem. In February, as initial data arrived from China showing a dramatic age skew in mortality, with the older at far greater risk than the young, and the very old at greater risk still, political leaders and public-health officials did practically nothing to protect the most vulnerable. Indeed, in New York, where now 6,000 have died in nursing homes, totaling roughly 6 percent of the nursing-home population, Governor Cuomo granted legal immunity to the executives who run those facilities; in California, where no such immunity was given, the toll was just 2,000, meaning less than one percent of its assisted-living population (though, to be fair, the total death toll outside nursing homes was much lower as well). In March, as evidence about the imperfect-but-still-significant efficacy of masks began rolling in, the WHO continued to advise against them. As recently as March 8, Anthony Fauci was advising the same thing on 60 Minutes, presumably to try and head off a possible mask run that would leave health workers undersupplied. In April, as it became clearer that outdoor transmission was significantly harder than indoor transmission, public officials across the country nevertheless continued closing parks and beaches.

All of this guidance was issued in something of the fog of war, of course, and each piece, taken on its own, might seem sensible — the science being new, and imperfect, and often contradictory, it’s reasonable to try and guide the public toward more caution rather than less. But taken together they suggest a perhaps concerning pattern, one familiar to me now from years of writing about climate change and its long-understated risks: Instead of simply presenting the facts — what they knew, how certain they were about it, and what they didn’t know — experts massaged their messaging in the hope of producing a particular response from the public (and with the faith that they can expertly enough massage it to produce that outcome).

This has been a global pattern, or at least was in the early days of the epidemic. But almost everywhere but America, the experts learned their lesson quickly. At first, . . .

Continue reading.

It should be noted that in fact wearing a mask makes an enormous difference. See this post by Kevin Drum. One chart from that post:

Written by LeisureGuy

22 June 2020 at 2:10 pm

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