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The News: Follow the Science, Into Confusion?
Wednesday's Child Is Full of Woe
It’s March 2023. It has been or is right now spring break on lots of college campuses.
This was the moment three years ago where many classes were switching over to Zoom, where many of us were staying at home as much as possible, when we were poring over expert analyses of coronaviruses, of epidemics, of vaccine development.
Three years ago on this date, the CDC was still adamantly telling people not to wear masks. I can remember professors in my Facebook feed (none of them epidemiologists, biologists, or doctors) telling people officiously that masks were ineffective because ordinary people don’t know how to wear them properly, because most of them didn’t really screen viruses anyway, and because the disease certainly wasn’t aerosolized—that was obvious! SARS spread by coughing and sneezing! Big globules of infectious spit and mucus, maybe on surfaces.
It wasn’t until April of 2020 that the fact of asymptomatic spread was confirmed by major public health institutions and mask-wearing was advised. We now know that at least some of the earlier reluctance to advise mask-wearing was to prevent hoarding of N95 masks that were in short supply.
It also wasn’t until April or so that really severe divisions in the American body politic (echoed in some other national publics but by no means all) started to become the major story of the pandemic from that point onward. That in turn has created an environment where clear analysis of the effectiveness of expert responses to the pandemic is nearly impossible.
I was very skeptical of “pandemic forgiveness” recently because the person advocating it seemed to be using the concept just to carry on claiming that she was right and everyone else was wrong. But something like “pandemic re-evaluation” is a reasonable thing to ask of everybody. Not so much to heal our divides and so on, but just to understand that almost everybody was both wrong about some things and had no business being as certain as they were about other things. Which also means that the bitterness and anger we had towards one another were at least attached to practices and factual interpretations that couldn’t bear the weight of what we put on them.
I’m still willing to be bitter and angry towards many skeptics because if nothing else so many of them were dismissive of one of the few absolutely certain facts in all this, which is that to date almost seven million people have died of covid-19 and many other people have suffered serious and debilitating cases of it—and because the skeptics started from a point that it was better to not even try to do anything to manage the disease, whether because they fundamentally mistrust the entire idea of government or expertise or because they operate from a kind of theological or philosophical fatalism. If that’s what we were all fighting about, then the fight will go on and ought to go on.
But on the more particular things, three years on, it’s not very clear that we should have any great confidence in some of the particular battlegrounds of that fight. I keep thinking back to the statistical pornography that so many of looked at with rapt attention: this study on masks proves they’re effective! this study on lockdowns shows how helpful they were! this study on ivermectin shows that it actually has a positive effect! this study and that study.
Whenever I crossed out of my own cultural-epistemological spaces, I’d trip across people who were either dishonest or unequipped to interpret quantitative analyses or unaware of the difference between a small preliminary study with limited data and a robust comparative study built on a large body of data flinging citations into discussions. Checking the citation was always a disappointment: the studies didn’t say what they were said to say, or they did but they were themselves careless or dishonest in how they came to say that. But traverse back into my own spaces and I’d see a fair amount of that going on there too. Perhaps some over-interpretation of the latest study showing masking had a positive impact, perhaps some over-optimistic reading of the impact of vaccination. More often I think a refusal to seriously evaluate some of the major policy choices as having trade-offs—a discounting of the economic damage from closure of services and institutions; a dismissal of the possibility that masking and social distancing were creating suspicion or new forms of psychological distances; an underweighting of the mental health consequences of pandemic isolation.
I started thinking about this today when someone at my lunch table asked “Do you think we’ll do better with the next pandemic?” My first response is that it will depend a little on what the disease itself is: covid-19 seems almost tailor-made to cause some of the divisions and uncertainties of this pandemic, whereas something as physically awful as a hemorrhagic fever with high mortality I suspect would intrinsically unfold differently. But more of it depends on whether we really know or understand what we did poorly, and I don’t think we do.
When you look at the global mortality statistics for covid-19 by country—a division that seems to be useful if you want to understand whether policy choices made a difference and what kind of difference they made—you can see some really huge variations. Peru and Mexico versus South Korea and Australia at two ends of the scale, for example. But as you dive into detailed analyses of those differences, so many contending factors emerge: the pre-existing state of public health in those countries, the quality and character of the public health system, the degree of practical authority the state has over its territory and its cities in particular, the capacity of the state to procure needed supplies, the degree of income inequality, the racial or ethnic heterogeneity of the population, the average age of the national population, and so on. Then there’s the difference in the quality of the data: how often did a given country test, how reliable were its tests, how well were the results of tests recorded, how consistently was a given country able to test across its entire territory.
Out of all that, are we ever going to have clarity about highly granular policies and the difference they made or didn’t make? There’s already a significant body of scholarship debating a highly specific and relatively controlled comparison between Sweden, Finland, Norway and Denmark, a comparison which also featured heavily in the kinds of debates that non-experts had on Facebook or in op-ed pages around the U.S., full of unjustified certainty and bombast. The use of these countries as illustrative for the favored approach of various ideologues continues unabated, from what I can see, but what leaps out at me is mostly that the differences seem to have amounted to less overall than many would claim. Sweden performed the worst, and at least some of that seems to have been a consequence of its failure to protect vulnerable people in elder care or in multi-generational households. So if the lesson is “Don’t be Sweden”, that seems reasonable enough, though maybe not as huge or dramatic as many liked to claim (in all directions) during the height of the pandemic. But that’s within a particular competitive league of “strong Northern European social democracies”: it doesn’t feel as if “be more like Denmark” is available as a singular policy response to pandemic management, because being like Denmark is much more than “test in this way, isolate in that way”.
To me, that’s the thing that none of us are really grappling with because it’s not tractable to policy formation and implementation in the usual sense. In short, you go to pandemic management with the country you have, not the country you wish you had. You don’t look to a country rife with partisan division and steeped in paranoia about governmental power and think that the first thing you do is decide about compulsory masking. In any public health crisis in the United States—and many other countries around the world—the first problem is to get people to care at all about living more and dying less. Which might not be a problem that “science” is particularly well-equipped to address.
If Americans “followed the science”—including and especially the kinds of Americans who put signs on their lawns saying that we ought to do that—covid-19 management would be the least of the things we would urgently follow to a new destination. The science—both natural and social science—offers massive evidence that a single-payer health care system is possible and that the American alternative form of private health care with limited governmental subsidies is both vastly more expensive and provides vastly worse health outcomes than the public health systems of many wealthy nation-states, both liberal democracies and otherwise.
American workplaces that had no trouble at all mandating vaccination for their employees would steadfastly refuse to take a position on building the kind of health care system that many other countries benefit from. That, they would say, is not following the sciences, it is trafficking in politics. At least some workplaces wouldn’t even go so far as to offer good healthcare plans to employees on the grounds that living more and dying less is good for their workforce and good for society.
That’s what you can see if you look back: that many nations don’t work for the health of their citizens. Sometimes because they’re poor or lack capacity. But sometimes because they don’t especially care about living more and dying less, and perhaps because that lack of concern is shared by some citizens as well as those governments. We can’t follow the science if the moral premise of the science isn’t agreed upon in the first place, and we’ll never get clarity about the specific measures that really could have worked and the ones that did or didn’t work unless we understand better what a constrained space we’re working in when it comes to societies that have worked hard to kill off any idea of the public good.