I’ve had the covid-19 pandemic on my mind this week for a simple reason: almost exactly four years since students were sent home at spring break and asked not to return to their campuses and we all descended into a swirl of advice and arguments about washing groceries, masking, staying six feet away from other human beings, vaccinating, taking medicine for deworming livestock, closing businesses and perfecting our online pedagogy to the mediocre heights allowed by the technology, I have caught my first case of covid.
That is not a result of my being particularly careful. Since the masks (mostly) came off and the distancing stopped, I’ve taken no special precautions other than getting the maximum number of vaccine boosters that have been offered and recommended. I haven’t travelled as much as I did a decade ago, but that’s less about covid and more about finding air travel more and more unpleasant as well as questioning the wisdom of it in environmental terms. I’m maybe less out in public than I have been too, but I’ve never been someone prone to going to concerts or crowded venues.
So really, I’ve just been lucky, I think, and sooner or later, luck runs out. While I’ve felt pretty awful for the past week, it’s mostly just been a bad cold, easing with each successive day. (Worst symptom: constantly watering and itching eyes for three days solid.) The main distinction from a bad cold for me has just been that vague haunting thought about the worst-case scenarios associated with covid: what if my sense of taste disappears for months? what if I develop breathing difficulties? what if I get the “brain fog” that many people report? what if this curdles into “long covid”? But even those questions are less terrifying than they were in late 2020, when we knew so little.
So here I am at home. I have ginger ale, but I don’t feel like watching game shows on TV. My eyes aren’t watering for the moment and my brain is not fogged. And yet I am stuck in a rut, extending from some of the other reflections I’ve had about the history of the pandemic. It’s becoming clear at this point that the pandemic as an event has had in some ways far more dramatic and lasting effects on everybody than the disease itself may have, except for those who are suffering from long-term chronic effects and those who died (and their families). In some ways, it may turn out to inflect into culture and everyday life as much as the Great Depression did into the 1960s in many countries.
So far in this particular U.S. election, the political trauma of the pandemic has been less prominent than 2021-22 might have led us all to believe it would be. I don’t think that’s a result of anybody reconsidering their basic advocacy from that time in a fundamental way, and it’s certainly not due to a general decline in partisan rancor. I think it’s more a confusion within the leadership of both political parties about whether the issue sorts out to their advantage at all at this point, which I think in turn calls to some mixed feelings within most of the factions that developed during the pandemic.
Looking back, it seems plain that there were more than two factions. There were at least two separate groups who acknowledged the reality and potential gravity of the pandemic but who disagreed over the extent and intensity of specific measures taken to slow or inhibit the transmission of the disease, generally over the move to remote instruction in public schools and over the closure of some businesses. I think there were also some skirmishes between epidemiologists about whether some of the arbitrary standards borrowed from previous epidemic management, such as using six feet as the standard distance for “social distancing”, were in any way based on meaningful research findings. Some of that skirmishing continues to play out in the scholarly literature—did masking work? under what circumstances and by what standards of “work”? was distancing relatively irrelevant compared to attention to air quality and filtration within structures? just how much difference did vaccination make in lessening the severity of outcomes for people infected by any given strain, and how much of that lessening was instead a result of the virus adapting to human hosts?
Those disagreements got smothered underneath a highly politicized overlay that prompted many people who fundamentally rejected most or all concerns about the pandemic, either doubting that it existed, doubting that it was serious, or doubting that people advising various countermeasures had pandemic management as their major objective. The more that the pandemic became a proxy for mobilization around Trumpism more generally, the more that intramural disagreements within any given side seemed to matter less. And yet I think it’s the more subtle differences of opinion that may matter most as the years wear on. Trumpism can map onto anything at any moment and yet often leave behind what seemed like deeply-felt commitments too in favor of some new focal point.
The lasting consequence of Trumpism’s stamp on the pandemic, unfortunately, is that the conversations we should be able to have about lessons learned become acrimonious because they seem to provide aid and comfort to the unmistakably malicious forces swirling around Trump’s actions during the pandemic and the deep hostility that all the key signifiers of “respectable pandemic management” still provoke amongst the MAGA base.
If we could gently peel off the worries about validating those sentiments, I think there are a couple of propositions that should affect a lot of public policy going forward. Four in particular stand out to me.
While speedy and decisive responses to public health crises are plainly very important in some cases, there is a serious danger to structuring those responses around a conjecture about the pathogen’s likely behavior that are based on early evidence about its characteristics, its similarities to other pathogens, and what is known about its initial spread. Even with highly-known, familiar diseases, sometimes a cluster outbreak can have some surprising variations. In the case of covid-19, it seems clear now that at least some experts expected it to have some of the characteristics of SARS and MERS and reacted to it as if it had that threat profile and as if it were containable or controllable in the way that they turned out to be. This is a general problem with modern crisis management of disasters and emergencies that call upon vast scales of nested complex systems—the leadership at the top essentially ‘trains the system’ to react on the model of the last crisis, using hindsight about those events to prime the next actions. Sometimes that works. Sometimes it only amplifies the catastrophe because it takes so long to recover from an original error in assessment.
The slowness of that recovery often is intensified by a ten-car pile-up of professionals trying to deflect responsibility for a miscall, politicians trying to seem decisive and not wanting to seem to waffle, and risk managers trying to dodge liability on behalf of their various clients. All of which, when it becomes visible to a wider public, badly conflicts with the declared presumption that cool, objective, factual and scientific decision-making that is also swift and direct should win the day. As soon as “saving lives in a pandemic” seems even modestly subordinate to public relations or professional ambition, it will become nearly impossible to claim the kind of trust needed to make dramatic moves or ask for general sacrifices. First responders have got to become better at politics—and they need to acquire expertise in navigating governmental systems and in talking to wider publics effectively. (Which means stop listening to crisis consultants and their ilk, who are entirely about redistributing blame and protecting their clients.)
Speaking of sacrifices, I know that I hammer on this point a lot, but if there’s anything that public health officials and similar policy experts need to do in preparation for the inevitable next epidemic, whatever it might be, is to not underestimate the material and emotional costs of various measures intended to control the spread and severity of disease. I’m still seeing plenty of people in my social world being completely cavalier about continuous masking in public, as if it’s absolutely no big deal and anybody who doesn’t do it is a selfish monster and emotional infant. I personally don’t mind masking that much, and I certainly expect people who are sick to do so—that would be a great change in public life, to have people who know they have a cold or other respiratory illness mask up for the duration. But I understand that for some people I might be asking a lot of them—the mask may make them very uncomfortable, but also human beings have a non-trivial cognitive/emotional interest in the facial expression of other human beings. There is something different about talking to a person who is masked and something different about being masked while talking to a masked person. It’s fine to talk about how you feel—that it’s not a big deal—but show some humility about assuming that your feelings represent a broad norm or simple expectation. And masking is the least of these issues. It’s pretty obvious at this point that even a short period of being stuck in their own households had a dramatic impact on a lot of individual and familial wellbeing.
And speaking of things I hammer on a lot from this soap box, the failing public health system of the United States is still receiving little to no attention from national or state policymakers despite being a clear cause of a lot of problems during the pandemic. If I’m feeling relatively at ease with my covid case this week, it’s partly because I finally escaped my local health care system that has been nearly annihilated by a private equity firm and I’m rediscovering what a basically competent, responsive primary care practice is like. They can’t wave their hands and make me feel better, but they can answer questions efficiently and I do have some sense that if I had an emergency, I’d have somewhere to go. If, on the other hand, I turned out to develop more complicated “long covid” symptoms, I’m not so sanguine about whether any U.S.-based health system is going to do right by me. The reason can be found in almost any “medical mystery” column in our major newspapers, those essays where a person has a long-term ailment that baffles multiple doctors and takes years and years to solve. In almost any of those stories I’ve read, it turns out that the ailment itself is not necessarily so mysterious, it’s instead that no medical practitioner took a holistic view of their patient or looked over the entirety of their record. They just look at the diagnosis that might arise from their own specialization. It’s a painful trope in the genre—the person at the heart of it, after years of suffering and serious financial losses, ends up saying “Nobody really seemed to be listening to me”. Effective advice about public health rests first and foremost on having a health system that people are happy to turn to when they’re sick—or afraid of becoming sick.
I am still angered by public health officials' advice in the early days of the pandemic when they stated that masks were not necessary and would not help -- which clearly made no sense given that masking is a fundamental way to stem the spread of disease (even if we were unsure at the time if COVID was an airborne disease). It was a clear attempt to ensure there would not be a "run" on masks. I would have rathered the truth with an appeal to reason not to hoard masks. The loss in trust (which as long term) was not worth the initial gain in securing the mask supply (which was short term).
Not good to read it caught you Tim. Hope it’s mild and brief. I sometimes imagine that we have a public health structure that does not need to be re-thought every 3-5 years…one solid and steady at ground level. Indeed, we haven’t really solved tensions between state and federal responsibilities.