Best source of post-Covid discussion of pandemic successes and failures
January 13, 2024 6:35 AM Subscribe
It looks like there is a politically motivated show trial of Fauci going on right now. I am honestly too exhausted to read about it, but I know mistakes were made, even by well-meaning actors during the pandemic. I'm looking for a non-partisan, scientific evaluation of what we (I am in the US) did right and what mistakes were made during the pandemic. Some of it ended up being pointless and performative, but I don't trust the far right to make that determination.
I hope that it's possible to look at how both the left and the right sought to shape the Covid narrative, sometimes with the best intentions. And I'm not saying, "Oh, both sides made mistakes" Obviously the bulk of misinformation came from the MAGA crowd. But I'm also interested in mistakes made by well-intentioned actors in terms of public health communication and policy. Who is writing smart stuff in that space?
I hope that it's possible to look at how both the left and the right sought to shape the Covid narrative, sometimes with the best intentions. And I'm not saying, "Oh, both sides made mistakes" Obviously the bulk of misinformation came from the MAGA crowd. But I'm also interested in mistakes made by well-intentioned actors in terms of public health communication and policy. Who is writing smart stuff in that space?
Andy Slavitt used to be a Biden advisor, but his Preventable is pretty down the middle.
If you're looking for more of a polemic, John Nichols' Coronavirus Criminals and Pandemic Profiteers is more of one.
There's also David Quammen's Breathless, which is more about vaccine development (and, imo, not one of his best books).
posted by box at 7:26 AM on January 13, 2024 [3 favorites]
If you're looking for more of a polemic, John Nichols' Coronavirus Criminals and Pandemic Profiteers is more of one.
There's also David Quammen's Breathless, which is more about vaccine development (and, imo, not one of his best books).
posted by box at 7:26 AM on January 13, 2024 [3 favorites]
This is prologue and polemic: Journalist Hillary Johnson's The Why, about how the CDC essentially ignored epidemic instances of myalgic encephalomyelitis (which is commonly post-viral) starting in the 80s, explains how we got to where we were at the start of the pandemic.
Fauci relegated ME to the Office of Women's Health, which had effectively no funding and no influence, and that meant when people started falling ill with post-viral symptoms in the pandemic, research on how to help them was (and remains) way behind where it should be.
The treatment of people with ME in that volume will remind you very much of how those with long covid have been treated. It could have been different with a different kind of leadership.
posted by jocelmeow at 8:44 AM on January 13, 2024 [9 favorites]
Fauci relegated ME to the Office of Women's Health, which had effectively no funding and no influence, and that meant when people started falling ill with post-viral symptoms in the pandemic, research on how to help them was (and remains) way behind where it should be.
The treatment of people with ME in that volume will remind you very much of how those with long covid have been treated. It could have been different with a different kind of leadership.
posted by jocelmeow at 8:44 AM on January 13, 2024 [9 favorites]
The Lewis book may not be partisan, but it is neither good journalism nor even-handed: it is a story, from a very specific perspective. From Jennifer Szalai’s review in the NYT:
“Lewis is so good at getting a reader to identify with his characters’ frustrations that I found myself littering the margins with expletives and exclamation points while reading a particularly infuriating chapter on the problems with coronavirus testing. He describes a health care system whose for-profit operations are so entrenched that hospitals last spring couldn’t even avail themselves of a nonprofit lab that was faster and free, because the hospital computers were incapable of coding for a $0 test. Staffers at the lab eagerly awaited a shipment of precious nasal swabs from the Strategic National Stockpile that turned out to be a bunch of Q-Tips. A venture capitalist offering to help alleviate the nasal swab shortage procured 5,000 eyelash brushes.
This method of hewing so tightly to his characters’ perspectives gives Lewis’s narrative its undeniable propulsion, but it also comes at a cost. He doesn’t supply any endnotes, or even a sense of how many people he talked to. His main characters are presented to us as they would undoubtedly like to appear: charmingly obsessive, unwaveringly principled and unfailingly right.
At several points, he transcribes long block quotes from Hatchett’s journal entries — essentially handing him the mic. Lewis portrays Sonia Angell, the former public health director for California, who happened to be Dean’s boss and nemesis, as monstrously incompetent, which may be true, but he doesn’t include any comment from Angell. When a figure is about to get eviscerated in print, journalists are at least supposed to give her a chance to explain herself; Lewis may have done this, but his spellbinding narrative is so driven by Dean’s point of view that it doesn’t give any indication that he did.
As for Dean, who compares herself to David fighting Goliath and Noah building the ark, she wanted the government to consider local online dashboards that would allow everyone in a neighborhood to see exactly who had been infected with the coronavirus, who had been hospitalized and who had died. “The president would need to issue an executive order to make an exception for medical privacy laws,” Lewis writes, “but that seemed a small price to pay for a million American lives.” He doesn’t question Dean’s idea for extreme public shaming, nor quote anybody who does. Looking askance at the timidity of politicians, who get nervous about things like optics and blowback and the Constitution, Lewis has embedded himself with Team Technocrat.
Lewis knows that one person’s story will never convey the entire picture. “Anyone on the inside could tell a more or less coherent story about whatever they had done, and why,” he writes. Yet to judge by the morality tale he offers in “The Premonition,” his own method is to choose a side and run with it.
He ends with what’s apparently intended as a heartwarming epilogue about Dean’s decision, a year into the pandemic, to enter the private sector. She has named her venture The Public Health Company. “We’re going to do private government operations, like Blackwater,” she says. For some readers, her reference to a notorious mercenary force might sound ominous, but there’s no skepticism and no pushback from Lewis, nothing to suggest that he might see it differently from how Dean does: as the brilliant idea of an honorable person whose only intention is to do the right thing.”
posted by rrrrrrrrrt at 10:42 AM on January 13, 2024 [4 favorites]
“Lewis is so good at getting a reader to identify with his characters’ frustrations that I found myself littering the margins with expletives and exclamation points while reading a particularly infuriating chapter on the problems with coronavirus testing. He describes a health care system whose for-profit operations are so entrenched that hospitals last spring couldn’t even avail themselves of a nonprofit lab that was faster and free, because the hospital computers were incapable of coding for a $0 test. Staffers at the lab eagerly awaited a shipment of precious nasal swabs from the Strategic National Stockpile that turned out to be a bunch of Q-Tips. A venture capitalist offering to help alleviate the nasal swab shortage procured 5,000 eyelash brushes.
This method of hewing so tightly to his characters’ perspectives gives Lewis’s narrative its undeniable propulsion, but it also comes at a cost. He doesn’t supply any endnotes, or even a sense of how many people he talked to. His main characters are presented to us as they would undoubtedly like to appear: charmingly obsessive, unwaveringly principled and unfailingly right.
At several points, he transcribes long block quotes from Hatchett’s journal entries — essentially handing him the mic. Lewis portrays Sonia Angell, the former public health director for California, who happened to be Dean’s boss and nemesis, as monstrously incompetent, which may be true, but he doesn’t include any comment from Angell. When a figure is about to get eviscerated in print, journalists are at least supposed to give her a chance to explain herself; Lewis may have done this, but his spellbinding narrative is so driven by Dean’s point of view that it doesn’t give any indication that he did.
As for Dean, who compares herself to David fighting Goliath and Noah building the ark, she wanted the government to consider local online dashboards that would allow everyone in a neighborhood to see exactly who had been infected with the coronavirus, who had been hospitalized and who had died. “The president would need to issue an executive order to make an exception for medical privacy laws,” Lewis writes, “but that seemed a small price to pay for a million American lives.” He doesn’t question Dean’s idea for extreme public shaming, nor quote anybody who does. Looking askance at the timidity of politicians, who get nervous about things like optics and blowback and the Constitution, Lewis has embedded himself with Team Technocrat.
Lewis knows that one person’s story will never convey the entire picture. “Anyone on the inside could tell a more or less coherent story about whatever they had done, and why,” he writes. Yet to judge by the morality tale he offers in “The Premonition,” his own method is to choose a side and run with it.
He ends with what’s apparently intended as a heartwarming epilogue about Dean’s decision, a year into the pandemic, to enter the private sector. She has named her venture The Public Health Company. “We’re going to do private government operations, like Blackwater,” she says. For some readers, her reference to a notorious mercenary force might sound ominous, but there’s no skepticism and no pushback from Lewis, nothing to suggest that he might see it differently from how Dean does: as the brilliant idea of an honorable person whose only intention is to do the right thing.”
posted by rrrrrrrrrt at 10:42 AM on January 13, 2024 [4 favorites]
I wonder whether you’d get further reading about another pandemic. My hunch is that it is too soon for this one. Or perhaps, for anyone to evaluate such a book fairly. I just read And the Band Played On, a book about AIDS. It was written just a few years in, so the author did not have the full picture, but I thought it made a good read from 40 years out. I saw some familiar mistakes and that did give me some perspective on what we all have gone through with this one — it felt singular to us, but in some ways it really was not.
I wonder too if reading a 2019 era book about pandemic preparedness would help, though I don’t have any recommendations. I suspect that would clarify what the people in charge were aiming for, which things were creditable ideas that just didn’t work in practice and which were just not best practice to start with.
posted by eirias at 11:00 AM on January 13, 2024 [7 favorites]
I wonder too if reading a 2019 era book about pandemic preparedness would help, though I don’t have any recommendations. I suspect that would clarify what the people in charge were aiming for, which things were creditable ideas that just didn’t work in practice and which were just not best practice to start with.
posted by eirias at 11:00 AM on January 13, 2024 [7 favorites]
Stephen Thrasher's The Viral Underclass takes a longer look at public health responses than just COVID.
Also a longer look, Dan Werb's Invisible Siege.
posted by gingerbeer at 11:43 AM on January 13, 2024 [3 favorites]
Also a longer look, Dan Werb's Invisible Siege.
posted by gingerbeer at 11:43 AM on January 13, 2024 [3 favorites]
I don't have any books to recommend, but a number of individual topics come to mind.
Early media and popular opinion was harsh on people who recognized covid's risk early. Real Clear Politics had a roundup of bad takes from the first months of 2020. Of particular note is Zeynep Tüfekçi's crucial NYT piece pointing out the nonsensicality of anti-mask advice from the US surgeon general, the WHO, and other major health authorities. This came up on mefi.
People like Tüfekçi wrote contemporaneously about senseless anti-covid measures. I haven't seen any retrospective surveys on e.g. wearing masks while hiking alone or wiping down food delivery boxes; to me it seems like a rich vein. It's also tough now to defend many overly-broad lockdown measures, such as closing beaches or forbidding solo travel to go hike (as in Ireland's 5km travel limit, or stay-at-home orders as seen in France and Italy). Of course there's much to criticize on the flip side, in our inability to implement e.g. rapid contact tracing or to recognize the basic truth that covid is airborne — putting the lie to the idea that keeping a couple meters distance would prevent transmission. We wasted a lot of attention and money on that "short-range droplets" misconception.
The NYT's The Startling Evidence on Learning Loss Is In highlights the enormous damage done by closing schools and remote schooling. (Strictly speaking, whether this was an error depends on how one values the trade-offs.)
I'd say most countries bungled distribution of vaccine resources. Patrick McKenzie's story about VaccinateCA gets into this in the American context. I don't have links but I think most people agree that the UK's single-doses-first strategy has been clearly vindicated in comparison to, say, Germany's "save second jabs in the fridge" method. (Again, people can disagree...if they value saving lives less than other priorities.)
Our failure to comprehend covid risk early in the pandemic is mirrored by our inability to understand risk on the other end, as we ramp down pandemic measures in the era of widespread vaccination and prior infection. I don't see a ton of great writing about this; all I have at hand is a thread about the cult of zero-covid.
posted by daveliepmann at 11:54 AM on January 13, 2024 [3 favorites]
Early media and popular opinion was harsh on people who recognized covid's risk early. Real Clear Politics had a roundup of bad takes from the first months of 2020. Of particular note is Zeynep Tüfekçi's crucial NYT piece pointing out the nonsensicality of anti-mask advice from the US surgeon general, the WHO, and other major health authorities. This came up on mefi.
People like Tüfekçi wrote contemporaneously about senseless anti-covid measures. I haven't seen any retrospective surveys on e.g. wearing masks while hiking alone or wiping down food delivery boxes; to me it seems like a rich vein. It's also tough now to defend many overly-broad lockdown measures, such as closing beaches or forbidding solo travel to go hike (as in Ireland's 5km travel limit, or stay-at-home orders as seen in France and Italy). Of course there's much to criticize on the flip side, in our inability to implement e.g. rapid contact tracing or to recognize the basic truth that covid is airborne — putting the lie to the idea that keeping a couple meters distance would prevent transmission. We wasted a lot of attention and money on that "short-range droplets" misconception.
The NYT's The Startling Evidence on Learning Loss Is In highlights the enormous damage done by closing schools and remote schooling. (Strictly speaking, whether this was an error depends on how one values the trade-offs.)
I'd say most countries bungled distribution of vaccine resources. Patrick McKenzie's story about VaccinateCA gets into this in the American context. I don't have links but I think most people agree that the UK's single-doses-first strategy has been clearly vindicated in comparison to, say, Germany's "save second jabs in the fridge" method. (Again, people can disagree...if they value saving lives less than other priorities.)
Our failure to comprehend covid risk early in the pandemic is mirrored by our inability to understand risk on the other end, as we ramp down pandemic measures in the era of widespread vaccination and prior infection. I don't see a ton of great writing about this; all I have at hand is a thread about the cult of zero-covid.
posted by daveliepmann at 11:54 AM on January 13, 2024 [3 favorites]
I am a historian of science who has studied past pandemics, and for my money the Death Panel podcast is doing absolutely the best work analyzing the pandemic. They recently released a massive summary of the past year, Covid Year Four (link contains a transcript), and have done annual summaries for every year of the pandemic so far. You might also be interested in their episode from last May, The Sociological Production of the End of the Pandemic (sadly no transcript available).
The hosts do an excellent job breaking down the motivations and consequences of the major pandemic actors in government, and are clear-eyed about both the current situation and the history that got us here.
posted by CtrlAltDelete at 12:22 PM on January 13, 2024 [9 favorites]
The hosts do an excellent job breaking down the motivations and consequences of the major pandemic actors in government, and are clear-eyed about both the current situation and the history that got us here.
posted by CtrlAltDelete at 12:22 PM on January 13, 2024 [9 favorites]
I don't see a ton of great writing about this; all I have at hand is a thread about the cult of zero-covid.
That's really a thread about someone's mental health issues- certainly exacerbated by the pandemic, but it is not even a remotely scientific or unbiased evaluation of successes/failures.
posted by oneirodynia at 1:07 PM on January 13, 2024 [2 favorites]
That's really a thread about someone's mental health issues- certainly exacerbated by the pandemic, but it is not even a remotely scientific or unbiased evaluation of successes/failures.
posted by oneirodynia at 1:07 PM on January 13, 2024 [2 favorites]
[that zero-covid thread] is not even a remotely scientific or unbiased evaluation of successes/failures.
No it's not, which is why I caveated my linking to it. My point is that just like antivaxx sentiment is at least partially preventable by public health action, the conspiracy theories swirling around in the zero-covid world are at least partially the result of public health errors. There was a big push to tell everyone that society was in grave danger; it shouldn't be surprising that (absent targeted outreach) a lot of people have trouble standing down after that threat has passed.
I notice that it's challenging to talk about this phenomenon because mild forms of these conspiracy theories are popular in certain segments of especially American culture. For instance, they need mod intervention with fair frequency on mefi (e.g. this misinformation dump, or "very little has changed in our ability to treat this illness since it started"). They often arise with the explicit admission that the disordered beliefs cause great suffering to the person thinking it and those around them.
If you have a better source to explore my point I'm eager for it. Let's not turn this into a derail.
posted by daveliepmann at 12:05 AM on January 14, 2024 [1 favorite]
No it's not, which is why I caveated my linking to it. My point is that just like antivaxx sentiment is at least partially preventable by public health action, the conspiracy theories swirling around in the zero-covid world are at least partially the result of public health errors. There was a big push to tell everyone that society was in grave danger; it shouldn't be surprising that (absent targeted outreach) a lot of people have trouble standing down after that threat has passed.
I notice that it's challenging to talk about this phenomenon because mild forms of these conspiracy theories are popular in certain segments of especially American culture. For instance, they need mod intervention with fair frequency on mefi (e.g. this misinformation dump, or "very little has changed in our ability to treat this illness since it started"). They often arise with the explicit admission that the disordered beliefs cause great suffering to the person thinking it and those around them.
If you have a better source to explore my point I'm eager for it. Let's not turn this into a derail.
posted by daveliepmann at 12:05 AM on January 14, 2024 [1 favorite]
Oh, I totally forgot to include the lab leak hypothesis! Our cultural response there was definitely a failure.
It got wrapped up in the culture war, international relations, and American race politics, to the extent that many people still consider its mention beyond the pale. Facebook and Twitter censored the idea for a long while. By now it's clear that whether or not it can be proven either way, it was never absurd, impossible, or even particularly unlikely, and our suppression of the hypothesis was excessive. The NYT has a pretty evenhanded summary from spring 2023: Lab Leak or Not? How Politics Shaped the Battle Over Covid’s Origin.
See also Thomas Frank's 2021 opinion in The Guardian:
It got wrapped up in the culture war, international relations, and American race politics, to the extent that many people still consider its mention beyond the pale. Facebook and Twitter censored the idea for a long while. By now it's clear that whether or not it can be proven either way, it was never absurd, impossible, or even particularly unlikely, and our suppression of the hypothesis was excessive. The NYT has a pretty evenhanded summary from spring 2023: Lab Leak or Not? How Politics Shaped the Battle Over Covid’s Origin.
See also Thomas Frank's 2021 opinion in The Guardian:
I am no expert on epidemics. Like everyone else I know, I spent the pandemic doing as I was told. A few months ago I even tried to talk a Fox News viewer out of believing in the lab-leak theory of Covid’s origins. The reason I did that is because the newspapers I read and the TV shows I watched had assured me on many occasions that the lab-leak theory wasn’t true, that it was a racist conspiracy theory, that only deluded Trumpists believed it, that it got infinite pants-on-fire ratings from the fact-checkers, and because (despite all my cynicism) I am the sort who has always trusted the mainstream news media.posted by daveliepmann at 1:32 AM on January 14, 2024 [1 favorite]
My own complacency on the matter was dynamited by the lab-leak essay that ran in the Bulletin of the Atomic Scientists earlier this month; a few weeks later everyone from Doctor Fauci to President Biden is acknowledging that the lab-accident hypothesis might have some merit.
I've been wanting to read We Want Them Infected: How the Failed Quest for Herd Immunity Led Doctors to Embrace the Anti-vaccine Movement and Blinded Americans to the Threat of COVID. The online reviews of it that I saw were good. What I recall hearing is that it brings a lot of receipts to the table.
posted by slidell at 2:30 AM on January 14, 2024 [3 favorites]
posted by slidell at 2:30 AM on January 14, 2024 [3 favorites]
What a minute: there are two possibilities of “lab leak” - one that it was created in a lab and second that someone studying sars viruses working in that lab was the first to get it. #1 is complete nonsense and that’s the one censored. We had several threads here on meta filter prior about the dangers of viruses in this area- and that’s why the lab was located where it was. #2 is the potential scenario but doesn’t help us do anything about COVID or viruses if it is true and no solid evidence has been found.
IMO: go look at the data in the US - COVID danger was extremely race-based and we never did anything to acknowledge that- not build hospitals or clinics in low income areas, not hand out window AC’s or something in areas where people experience crowded living conditions and rely on only windows or fans. Not build housing to alleviate crowding.
Another failure was to communicate important information directly through doctors like Fauci and not via actual communication experts via vetted risk management strategies. Just because he’s a brilliant epidemiologist doesn’t mean he’s good at communicating actionable information back to lay people.
posted by The_Vegetables at 6:05 AM on January 14, 2024
IMO: go look at the data in the US - COVID danger was extremely race-based and we never did anything to acknowledge that- not build hospitals or clinics in low income areas, not hand out window AC’s or something in areas where people experience crowded living conditions and rely on only windows or fans. Not build housing to alleviate crowding.
Another failure was to communicate important information directly through doctors like Fauci and not via actual communication experts via vetted risk management strategies. Just because he’s a brilliant epidemiologist doesn’t mean he’s good at communicating actionable information back to lay people.
posted by The_Vegetables at 6:05 AM on January 14, 2024
Faucci actually reminds me of Allan Greenspan who was head of The Fed for a while in the 1990s and economists would analyze his every nonsense word like tea leaves to discern future Fed action. Now we have better heads in Yellen and Powell who are more open and better communications and all that went away.
posted by The_Vegetables at 6:11 AM on January 14, 2024
posted by The_Vegetables at 6:11 AM on January 14, 2024
Allan Greenspan who was head of The Fed for a while in the 1990s
Say what will about Greenspan's syntax destruction, under his leadership the Fed did engineer our archetypical (er, possibly, only) soft landing in 1994-5.
posted by pullayup at 6:40 AM on January 15, 2024
Say what will about Greenspan's syntax destruction, under his leadership the Fed did engineer our archetypical (er, possibly, only) soft landing in 1994-5.
posted by pullayup at 6:40 AM on January 15, 2024
Some of the problems that I saw with the initial COVID-19 response in the US were availability of testing. It was a totally uncharted situation, so I hold no judgement or resentment and am grateful for the hard work of government agencies to do the best they could. It is certainly something we could learn from.
One thing we did wrong was not accept the initial WHO tests for COVID. Instead, the FDA wanted to create its own test, which was standard practice. However, the tests did not get off the ground fast enough to track, trace, and contain the disease.
This is an article with a good timeline of how this played out: https://www.businessinsider.com/us-coronavirus-testing-problems-timeline-2020-3
More information here: https://www.newyorker.com/news/news-desk/what-went-wrong-with-coronavirus-testing-in-the-us
We could have learned from the response of places like South Korea. I remember being impressed by, even envious of, their early pandemic response. Right away, the government instituted free and extensive drive-through testing. Results were delivered within 24 hours by text message. The rapid response helped with tracing as well as containment. By contrast, in the US, we had scattered drive-through testing, cost was unclear (testing was free as far as I remember, but some facilities were charging for the associated exam), and results took several days, making the decision to quarantine difficult. These variables discouraged people from getting tested unless they really, really, really needed to, which made tracing and containment much more challenging.
posted by aquamvidam at 11:18 AM on January 26, 2024 [2 favorites]
One thing we did wrong was not accept the initial WHO tests for COVID. Instead, the FDA wanted to create its own test, which was standard practice. However, the tests did not get off the ground fast enough to track, trace, and contain the disease.
This is an article with a good timeline of how this played out: https://www.businessinsider.com/us-coronavirus-testing-problems-timeline-2020-3
More information here: https://www.newyorker.com/news/news-desk/what-went-wrong-with-coronavirus-testing-in-the-us
We could have learned from the response of places like South Korea. I remember being impressed by, even envious of, their early pandemic response. Right away, the government instituted free and extensive drive-through testing. Results were delivered within 24 hours by text message. The rapid response helped with tracing as well as containment. By contrast, in the US, we had scattered drive-through testing, cost was unclear (testing was free as far as I remember, but some facilities were charging for the associated exam), and results took several days, making the decision to quarantine difficult. These variables discouraged people from getting tested unless they really, really, really needed to, which made tracing and containment much more challenging.
posted by aquamvidam at 11:18 AM on January 26, 2024 [2 favorites]
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posted by wenestvedt at 6:52 AM on January 13, 2024 [1 favorite]