In Covid’s Wake

Before the covid-19 outbreak, public health officials around the world largely agreed that containment of a flu pandemic is largely futile so better to focus on the most at risk populations: speak honestly, encourage healthy behaviors and work fast on a vaccine.

It didn’t all go to plan. In the United States, the Trump administration successfully oversaw a historic vaccine development, while injecting hostile politics into the system. Meanwhile, left-leaning states over-relied on non-pharmaceutical interventions (NPIs), such as widespread masking and extended school closures, that had limited gains for considerable cost. Right-leaning states contributed to vaccine skepticism, which led to hundreds of thousands of excess deaths.

The new book In Covid’s Wake: How Our Politics Failed Us, written by Princeton University political scientists Stephen Macedo and Frances Lee, attempts to put forward an unimpassioned assessment of the American-led public health response. I simplified their assessment of a handful of the most prominent public health measures into the chart below, and in a social video here.

It’s one of my favorite nonfiction books of the year. Below I share my notes for future reference.

My notes:

• “The light which experience gives is a lantern on the stern, which shines only on the waves behind us” -Samuel Taylor Coleridge
• Like other pandemics, the early mortality rate was too high because only the very sick were diagnosed
• “The greatest mobilization of emergency powers in human history”
• In April 2020, 3.9 billion or half the world’s population was under lockdown
• In summer 2023, a federal judge called efforts by government officials to shadow ban social media accounts that were challenging Covid recommendations the biggest campaign of government censorship in U.S. history (“”most massive attack against free speech in United States’ history”
• William James: “moral equivalent of war” that could rally residents without war itself
• “Follow the science” was misleading because there were always value judgments
• Red and blue states mostly did follow public opinion initially but became one sided in each place
• “Intensely moralized loathing”
• Spinner-Halev and Theiss-Morse: “withholding civic respect”
• Intolerance of one’s opponents means refusing one’s own shortcomings
• Audi alteram partem: listen to other side
• “In Covid policy, it is worth considering the intergenerational debt incurred as the young bore burdens for the sake of the old”
• Francis Collins (Physician, director of the National Institutes of Health until December 2021 and former Director of the National Human Genome Research Institute) to his credit did admit mistakes
• Lab leak, masking and school closures deserved more open debate than they got
• The vaccine pursuit was appropriately pursed
• Truth seeking of journalism, science and universities were taken over by partisan rancor
• John Stuart Mill: best test of truth is openness to criticism
• There is no relationship between NPI (non pharmaceutical intervention like school lockdowns) and COVID mortality
• It was China style suppressive NPIs in January 2020 that shaped the west, though pre COVID research took a dim view of NPIs
• The WHO (World Health Organization) in Nov 2019 review recommended against many NPIs for respiratory pandemic — only for “flattening the curve” in an initial burst
• Mecher-Hazlett Bush-era pandemics guidance faded but came back and mathematical model pushed NPIs
• We took the wrong Spanish flu lesson: compared Philadelphia and St. Louis using NPIs but really the lesson was that more aggressive NPIs did not help
• DA Henderson in 2006: “Communities faced with epidemics or other adverse events respond best and with least anxiety when the normal social functioning of the community is least disrupted”
• Italy showed a western liberal democracy could do a shut down — WHO director Tedros complimented China response on January 23

• WHO trip to China seen as naive and highly controlled — executing a strategy we didn’t need
• On March 3 Tedros tweeted that 3.4% of global COVID cases died — but we know early cases are highly skewed by only most severe cases
• Friday March 13, the CDC was initially advised against closing schools — but March 16 “bombshell” report by mathematical modeler Dr Ferguson of imperial college predicted “the collapse of national health care systems” if layered NPIs weren’t put on
• Sweden’s Johan Giescke: no study has ever “had such a big impact on the world” as report 9 from Ferguson and imperial College, London, shifting policy
• The Trump task force and Fauci swung to recommending state closures
• Failure to distinguish between flattening the curve (short term to reduce hospital strain), to isolate and eliminate it, to reducing across the whole pandemic
• Deborah Birx wanted shutdowns
• March 3, 2020 Rachel Maddow on Fallon tonight show gave a nuanced advice on limited face marks and the inevitable virus spread
• Other public health officials also wrote in support of limited NPIs
• War metaphors are wrong: there is no victory
• The Sweden case study showed lower NPIs, investment in public health and at-risk populations and vaccinations worked
• Gambia closed to WHO guidance and its crop collapsed in 2020
• Great Barrington declaration of October 2020 was good faith but put into toxic world (Recommended “focused protection” but criticized as “herd immunity “)
• Email thread with Fauci, Frances Collins and Gonsalves critical of the Barrington as herd immunity “pseudoscience “
• Gregg Gonsalves wrote on x Oct 12, 2020 “I’m in my mid 50s. I have HIV. I saw my friends die in droves in the 80s, 90s. I have no more fucks left to give… those peddling pseudoscience, bankrolled by right-wing, libertarian assholes can kiss my queer ass. I know you’re kind. We beat you once. [We] will again… This fucking Great Barrington declaration is like a bad rash that just won’t go away.”
• John Snow memorandum: to create “an illusion consensus”
• Washington Post, Wired, Atlantic, NYT stories cited as being used to make barrington case seen as fringe by Collins, gonsalves and Fauci (“it’s a massacre” Gonsalves tweeted tho later deleted)
• Smerconish hosted a debate on focused protection that did gave balance Jay bhattacharya and John Barry (critic of barrington)
• Thomas Frieden op Ed: “the path to herd immunity would be lined with half a million dead Americans” October 2020

• Sanjay Gupta’s World War C book open with three vignettes: a 22 year old, 41 and 53 — all healthy, two die. This is unusual not representative of the mortality for younger and healthy people
• Public health officials knew those over 75 were 10,000 times more likely than someone under 15 to die from COVID
• Missouri vs Biden court case shows how much Democrats Biden were pushing social media to suppress “disinformation” — which Zuckerberg admitted was a mistake
• They say truth is the first victim of war
• Narrow focus on covid rather than public health taking into account all the many harms (cancer screenings, childhood hunger served school lunches)
• In November 2020, Stanford faculty censured Scott Atlas — who has put forward fact based criticisms
• Louis Brandeis: laboratories of democracy
• Large state partisan variety in outcomes
• Democrats had more school closures and longer lockdowns

• Before vaccines, there was little difference between Republican and democratic state mortality — but then the difference opened with vacc in e (vaccines mattered; NPIs didn’t) but it wasn’t state policy but individual preferences that boosted vaccines
• International airports, age population, obesity and uninsured all had some effects
• Not yet scholarly consensus on all this
• Covid advisory groups did not have anyone other than infectious disease experts and general government reps — no education or economists or psychologists. The focus was on reducing COVID deaths not considering collateral damage.
• Media coverage then, in turn, only focused on whether the government restrictions weren’t strict enough — opening “too early,” putting the economy in front of health (only Covid in mind rather than cancer screenings, etc.
• $5 trillion in COVID relief
• Lab leak theory was suppressed by American officials who wanted Chinese support — even though there really is a lab in Wuhan studying these very coronovirus, and Dr. Anthony Fauci had even funded research there
• Kristian Anderson and Fauci in discussion, and among those who decided to downplay the lab leak theory — it should have been decided by politicians if China’s partnership was necessary. This was not science, argues the authors
• Feb 4, 2020 email among researchers, Kristian Anderson writes “ I think the main thing still in my mind is that the lab escape version of this is so friggin’ likely to have happened because they were already doing this type of work and the molecular data is fully consistent with that scenario.”
• “Proximal origin” paper was used to shape headlines but it was bad science to say they knew it wasn’t a lab leak. But in emails and Slack messages obtained, they argued the lab leak was possible or plausible. Fauci and Collins encouraged the paper and then later trumpeted it without disclosing their involvement — meanwhile Anderson’s lab grant was being approved by Fauci at the same time
• The “furin cleavage site” of the virus fit so neatly in human body it seemed engineered for it
• March 31, 2021 Nature letter defending open inquiry into lab leak and criticizing a WHO report with China
• Angela Rasmussen: lab leak theory was “steeped in racist stereotypes”
• Feb 27, 2023: Energy Dept calls lab leak “most likely”
• Mask debate: May have helped individuals when worn well and slowed but at a cost and limited gains

• Headstart mandated masks through September 2022
• ((Reminds me of this interview I did: Mask mandates don’t work, but masks do)
• But different masks worn in different ways for different reasons. Human coronavirus particles are smaller than what an N-95 mask catches even when worn perfectly — but sure sometimes they ride on larger carrier molecules (blocking from sneezing and talking, not normal breathing)
• Sissela Bok’s 1978 book Lying: lying for public good can lead to groupthink and evade credible pressure
• Can Democracy allow rule for the many that relies on the expertise of the few?
• CDC Director Robert Redfield pushed the lab leak exploration — Collins and Fauci turned on him
• Lewis Anthony Dexter: elites can be right in longterm but tunnel vision (specialized training) and class bias in short term
• Barbara Tuchman’s “rubric of folly,” detailed in her 1984 book The March of Folly, defines folly as governments pursuing policies contrary to their own clear self-interests, despite available alternatives and awareness of negative consequences, exemplified by the Trojan War, Britain’s loss of the American Colonies, and U.S. involvement in Vietnam, highlighting persistent, collective, self-destructive decision-making.
• Elvin T Lim: balancing different priorities
• Paul Offit has criticized Covid boosters for all
• Plato’s legendary Allegory of the Cave, from The Republic, describes prisoners chained in a cave, seeing only shadows on a wall, which they mistake for reality, representing human ignorance and sensory perception. When one prisoner escapes and sees the true world (Forms) illuminated by the sun (the Good), they realize the shadows are illusions
• August 15, 2023 JAMA Network Open published article by Sahana Sule advocating for censorship of medical professionals spreading “disinformation” but the examples included the lab leak theory and that government actors were in contact with Twitter to suppress ideas — but these and other examples we now know are true or open to interpretations
• The Noble Lie is a concept from Plato’s Republic, where rulers tell a foundational myth (a “noble lie”) to citizens to ensure social harmony, stability, and acceptance of their assigned roles for the good of the state, most famously illustrated by the “Myth of the Metals” assigning gold, silver, or bronze souls to different classes. It’s a deliberate, unifying fiction, not a malicious untruth, meant to foster loyalty, unity, and purpose, though its ethics remain debated.
• In covid era, Graham Allison advocated for a Team B to question all recommendations
• George Orwell wrote in 1944 about the worry that honest self criticism plays into the hands of our enemies “if you write anything truthful about the London slums, you were liable to hear it repeated on the Nazi radio a week later. But what, then, are you expected to do? Pretend there are no slums?”

View this post on Instagram