There are a lot of lessons to be learned from the pandemic, and there is value to rear-view assessments of actions taken or not taken. But it is easier to comment on actions in hindsight than it often was to make those decisions in the early stages of the pandemic, when we had less information. I think it's too harsh to say that Fauci …
There are a lot of lessons to be learned from the pandemic, and there is value to rear-view assessments of actions taken or not taken. But it is easier to comment on actions in hindsight than it often was to make those decisions in the early stages of the pandemic, when we had less information. I think it's too harsh to say that Fauci "lied" about mask use. The understanding about virus transmission by aerosol was still evolving. Faced with the criminal national PPE shortage, a Trump failure, Fauci was in the difficult position of deciding whether to recommend mask use by the public knowing that this would lead to stockpiling and clearing of the shelves, or preserve mask use for health care workers. I am a university biomedical researcher with several family members who are doctors who worked with covid patients. Even with Fauci's advice, they were placed in the terrible position of having to reuse and sterilize masks as the numbers of covid patients was increasing exponentially. I assisted with covid testing at my university and we had to reuse masks and gloves. Had Fauci recommended public mask use before the aerosal picture became clear, the mask supply for health workers would have been much worse. Each doctor and nurse working on covid wards helps many patients; one mask used by one of them has a greater mask:user benefit than one mask used by the public. Of course the real lesson to be learned was that we should never have had to make these decisions due to an inadequate PPE supply. That is directly the fault of Trump's administration ignoring the warnings they received about pandemic preparedness.
I also wish to comment on "Be Unable to Make Decisions Under Uncertainty." This is really a Monday morning post-game comment. I was in contact with epidemiologists at my university and public health personnel in King county, WA, where the first cases in the US occurred. These people were trying to make informed decisions with inadequate information and in the face of a crisis that exploded with little warning and worsened every day. There wasn't the luxury of time to collect and analyze data before acting. But contrary to Tomas' assertion, these people acted quickly, using whatever information they had available. I agree that the federal public health establishment failed to act quickly enough, but this I largely attribute to Trump placing unqualified political hacks in charge of FDA and CDC, and then imposing obstacles to the efforts of permanent staff to act.
My last point is about not knowing who to trust. I think that one of the negative side effects of the pandemic has been the proliferation of experts without expertise, all of them shouting with certainty about things for which they often had little knowledge. Scott Atlas and Zeynap Tufecki lie on a continuum of experts without expertise, with Atlas at the malevolent end and Tufecki at the well-intentioned end. Combine the proliferation of experts without expertise with the explosion of "pre-reviewed" articles on MedRxiv. I think that this clamor of voices created more confusion than useful knowledge, with a frightened public not knowing who to trust.
Tomas, I say all this as a long time admirer of your amazing ability to bring together disparate data sets and integrate them visually in a clear and compelling way. I have followed all your postings since the start and regard you as someone who has contributed in positive ways.
Your point about not knowing who to trust is obviously a key one with respect to the pandemic, but also one of the central issues of life in the 2020s. There is a such a huge amount of information and opinion available now in this technological world. What is true, what is not? What is a good opinion and what is not? The fact remains, however, that to a large extent the people and institutions set up to deal with a potential pandemic or who were in leadership positions at the time failed miserably (certainly in the UK where I am based). That said, no one is perfect and there were many people who did incredibly well in difficult circumstances as you have detailed above.
I agree. One lesson, which we already knew, is that information and advice should be disseminated by one trusted person or office. During the ebola pandemic, the CDC in the US took the lead and its effective director, Tom Friedan, was the person who held press briefings. This focus was completely lacking during the Trump year of the pandemic, with him, Pence, Atlas, and various voices from CDC, FDA, and NIH all talking at once and often giving contradictory messages. Confusion was inevitable and this undermined public trust. CDC should have taken the lead as with ebola, but its director Redfield was in far over his head, as was FDA director Hahn. Fauci is the director of NIAID at NIH, a research institue, and should not have had to be the voice of public health. But I suspect that he and his boss, Francis Collins director on NIH, saw the train wreck of the Trump administration's handling of the pandemic and decided that Fauci had to step forward. I don't envy him having to deal with this gang that couldn't shoot straight.
Don't need to caveat it at the end, respectful and thoughtful dissent is the key to improvement. Thanks!
On "Be Unable to Make Decisions Under Uncertainty", I don't mean anybody was able to. I mean it was a common failure. The US government was one, but definitely not the only one.
On the expertise, here's a more detailed perspective on this. You'll see the definition of "experts" is not as clear cut.
Thanks Tomas. Not a caveat, I meant the positive comments about your contributions. We agree that it is difficult to know who to trust when there are so many voices clamoring. I confer trust on those with experience in relevant fields, solid records of training and accomplishment in those fields, and most importantly communicate clearly that their knowledge and recommendations are provisional, based on the best current information but subject to revision as new information is obtained. I avoid anyone who speaks with certainty in loud authoritative voices. Nationally I trust sources such as Medscape and Brief 19, and individuals like Rasmussen, Offit, Osterholm, Marr, and Fauci.
I read your twitter thread! As a PhD who has trained PhDs, I have to respectfully disagree with your statement that one earns a PhD by taking a test made up by other PhDs. At least at my institution, the University of Washington, a graduate student in biomedical sciences must produce a substantial body of original research that is deemed to be rigorous by a committee of four or more PhDs and that passes peer review. If only it were as easy as taking a test!
Thanks again for your contributions and for starting this interesting discussion.
Just to clarify your last point: the claim that your body of research was deemed rigorous was made by a committee of four more PhDs. So it's only as good as those 4 PhDs, is that right? And that is recursively true. Those PhDs are such because other PhDs thought so.
I don't want to take away from the hard work of a PhD, and I'm definitely not saying a PhD should be disregarded. Far from that. I am just saying that a PhD is no a universal title that vouches for any holder. A PhD is only as good as the PhDs who vouch for him/her.
And thank you. Seems like this discussion is drifting away from the original issue of who to trust on covid information. I suppose you could say that awarding the PhD only has as much credibility as the individual examiners. Seems like any professional accreditation is subject to the same critique. But earning the PhD degree is really just the ticket that gets you in the door, and the credibility/trust invested in a newly minted PhD over time is only as good as a much larger community of fellow PhDs deems it to be, based on the body of scholarship produced through peer review of publications and a tough process of review of federal grant proposals in the sciences. You could say that a PhD's reputation is crowd sourced. In the biomedical sciences reputation is continually updated by the crowd's assessment of one's most recent research, and can rise or fall quickly. In my 30 years as a professor I never felt that earning the piece of paper that bestowed the PhD was something I could coast on for the rest of my career. There is nothing like a harsh review of a paper to deflate one's ego.
Having said this, I don't think that trust should be conferred (or denied) on anyone just because they have letters after their name. As I said earlier in this conversation, I confer trust based on training, a record of accomplishment, and an honest acknowledgement that their knowledge is provisional and subject to revision. For an excellent example of this latter point, I recommend listening to a conversation between Drs. Michael Osterholm, a widely recognized authority on infectious disease, and Eric Topol, an expert in cardiology and editor in chief of Medscape (https://www.medscape.com/viewarticle/951101?src=mkm_covid_update_210517_MSCPEDIT&uac=369548FV&impID=3380802&faf=1#vp_1). Osterholm shows admirable frankness in acknowledging that there are many aspects of SARS-CoV2 that he still doesn't understand. It's this type of honesty about what he doesn't know that makes Osterholm someone whose information and recommendations on covid-19 I trust.
Tying it back to the original dissent, I reacted specifically to the comment of "experts without expertise", naming Atlas and Tufekci.
I would argue that Tufekci is an expert with plenty of expertise. She might not have the paper with the letters for epidemiology, but she's better than many. That aligns with what you say: Sure, the PhD is one signal, only as strong as the PhDs who vouched for the new one, but what matters most is the track record overall. And Tufekci has a pretty good one I'd reckon. Hence I wouldn't call her an expert without expertise.
Yes, we're close enough to agreement to call it good. Tufecki has done good work, as have you. CDC isn't looking as good, the more we learn about what went on there last year. It used to be the model for the rest of the world's public health agencies. Sad to see its decline when we most needed it to lead the way.
There are a lot of lessons to be learned from the pandemic, and there is value to rear-view assessments of actions taken or not taken. But it is easier to comment on actions in hindsight than it often was to make those decisions in the early stages of the pandemic, when we had less information. I think it's too harsh to say that Fauci "lied" about mask use. The understanding about virus transmission by aerosol was still evolving. Faced with the criminal national PPE shortage, a Trump failure, Fauci was in the difficult position of deciding whether to recommend mask use by the public knowing that this would lead to stockpiling and clearing of the shelves, or preserve mask use for health care workers. I am a university biomedical researcher with several family members who are doctors who worked with covid patients. Even with Fauci's advice, they were placed in the terrible position of having to reuse and sterilize masks as the numbers of covid patients was increasing exponentially. I assisted with covid testing at my university and we had to reuse masks and gloves. Had Fauci recommended public mask use before the aerosal picture became clear, the mask supply for health workers would have been much worse. Each doctor and nurse working on covid wards helps many patients; one mask used by one of them has a greater mask:user benefit than one mask used by the public. Of course the real lesson to be learned was that we should never have had to make these decisions due to an inadequate PPE supply. That is directly the fault of Trump's administration ignoring the warnings they received about pandemic preparedness.
I also wish to comment on "Be Unable to Make Decisions Under Uncertainty." This is really a Monday morning post-game comment. I was in contact with epidemiologists at my university and public health personnel in King county, WA, where the first cases in the US occurred. These people were trying to make informed decisions with inadequate information and in the face of a crisis that exploded with little warning and worsened every day. There wasn't the luxury of time to collect and analyze data before acting. But contrary to Tomas' assertion, these people acted quickly, using whatever information they had available. I agree that the federal public health establishment failed to act quickly enough, but this I largely attribute to Trump placing unqualified political hacks in charge of FDA and CDC, and then imposing obstacles to the efforts of permanent staff to act.
My last point is about not knowing who to trust. I think that one of the negative side effects of the pandemic has been the proliferation of experts without expertise, all of them shouting with certainty about things for which they often had little knowledge. Scott Atlas and Zeynap Tufecki lie on a continuum of experts without expertise, with Atlas at the malevolent end and Tufecki at the well-intentioned end. Combine the proliferation of experts without expertise with the explosion of "pre-reviewed" articles on MedRxiv. I think that this clamor of voices created more confusion than useful knowledge, with a frightened public not knowing who to trust.
Tomas, I say all this as a long time admirer of your amazing ability to bring together disparate data sets and integrate them visually in a clear and compelling way. I have followed all your postings since the start and regard you as someone who has contributed in positive ways.
Your point about not knowing who to trust is obviously a key one with respect to the pandemic, but also one of the central issues of life in the 2020s. There is a such a huge amount of information and opinion available now in this technological world. What is true, what is not? What is a good opinion and what is not? The fact remains, however, that to a large extent the people and institutions set up to deal with a potential pandemic or who were in leadership positions at the time failed miserably (certainly in the UK where I am based). That said, no one is perfect and there were many people who did incredibly well in difficult circumstances as you have detailed above.
I agree. One lesson, which we already knew, is that information and advice should be disseminated by one trusted person or office. During the ebola pandemic, the CDC in the US took the lead and its effective director, Tom Friedan, was the person who held press briefings. This focus was completely lacking during the Trump year of the pandemic, with him, Pence, Atlas, and various voices from CDC, FDA, and NIH all talking at once and often giving contradictory messages. Confusion was inevitable and this undermined public trust. CDC should have taken the lead as with ebola, but its director Redfield was in far over his head, as was FDA director Hahn. Fauci is the director of NIAID at NIH, a research institue, and should not have had to be the voice of public health. But I suspect that he and his boss, Francis Collins director on NIH, saw the train wreck of the Trump administration's handling of the pandemic and decided that Fauci had to step forward. I don't envy him having to deal with this gang that couldn't shoot straight.
Don't need to caveat it at the end, respectful and thoughtful dissent is the key to improvement. Thanks!
On "Be Unable to Make Decisions Under Uncertainty", I don't mean anybody was able to. I mean it was a common failure. The US government was one, but definitely not the only one.
On the expertise, here's a more detailed perspective on this. You'll see the definition of "experts" is not as clear cut.
https://twitter.com/tomaspueyo/status/1369995433406259204
Thanks Tomas. Not a caveat, I meant the positive comments about your contributions. We agree that it is difficult to know who to trust when there are so many voices clamoring. I confer trust on those with experience in relevant fields, solid records of training and accomplishment in those fields, and most importantly communicate clearly that their knowledge and recommendations are provisional, based on the best current information but subject to revision as new information is obtained. I avoid anyone who speaks with certainty in loud authoritative voices. Nationally I trust sources such as Medscape and Brief 19, and individuals like Rasmussen, Offit, Osterholm, Marr, and Fauci.
I read your twitter thread! As a PhD who has trained PhDs, I have to respectfully disagree with your statement that one earns a PhD by taking a test made up by other PhDs. At least at my institution, the University of Washington, a graduate student in biomedical sciences must produce a substantial body of original research that is deemed to be rigorous by a committee of four or more PhDs and that passes peer review. If only it were as easy as taking a test!
Thanks again for your contributions and for starting this interesting discussion.
Thanks for your response!
Just to clarify your last point: the claim that your body of research was deemed rigorous was made by a committee of four more PhDs. So it's only as good as those 4 PhDs, is that right? And that is recursively true. Those PhDs are such because other PhDs thought so.
I don't want to take away from the hard work of a PhD, and I'm definitely not saying a PhD should be disregarded. Far from that. I am just saying that a PhD is no a universal title that vouches for any holder. A PhD is only as good as the PhDs who vouch for him/her.
And thank you. Seems like this discussion is drifting away from the original issue of who to trust on covid information. I suppose you could say that awarding the PhD only has as much credibility as the individual examiners. Seems like any professional accreditation is subject to the same critique. But earning the PhD degree is really just the ticket that gets you in the door, and the credibility/trust invested in a newly minted PhD over time is only as good as a much larger community of fellow PhDs deems it to be, based on the body of scholarship produced through peer review of publications and a tough process of review of federal grant proposals in the sciences. You could say that a PhD's reputation is crowd sourced. In the biomedical sciences reputation is continually updated by the crowd's assessment of one's most recent research, and can rise or fall quickly. In my 30 years as a professor I never felt that earning the piece of paper that bestowed the PhD was something I could coast on for the rest of my career. There is nothing like a harsh review of a paper to deflate one's ego.
Having said this, I don't think that trust should be conferred (or denied) on anyone just because they have letters after their name. As I said earlier in this conversation, I confer trust based on training, a record of accomplishment, and an honest acknowledgement that their knowledge is provisional and subject to revision. For an excellent example of this latter point, I recommend listening to a conversation between Drs. Michael Osterholm, a widely recognized authority on infectious disease, and Eric Topol, an expert in cardiology and editor in chief of Medscape (https://www.medscape.com/viewarticle/951101?src=mkm_covid_update_210517_MSCPEDIT&uac=369548FV&impID=3380802&faf=1#vp_1). Osterholm shows admirable frankness in acknowledging that there are many aspects of SARS-CoV2 that he still doesn't understand. It's this type of honesty about what he doesn't know that makes Osterholm someone whose information and recommendations on covid-19 I trust.
We're in complete agreement!
Tying it back to the original dissent, I reacted specifically to the comment of "experts without expertise", naming Atlas and Tufekci.
I would argue that Tufekci is an expert with plenty of expertise. She might not have the paper with the letters for epidemiology, but she's better than many. That aligns with what you say: Sure, the PhD is one signal, only as strong as the PhDs who vouched for the new one, but what matters most is the track record overall. And Tufekci has a pretty good one I'd reckon. Hence I wouldn't call her an expert without expertise.
Yes, we're close enough to agreement to call it good. Tufecki has done good work, as have you. CDC isn't looking as good, the more we learn about what went on there last year. It used to be the model for the rest of the world's public health agencies. Sad to see its decline when we most needed it to lead the way.