Note: this article will be updated as more failures get highlighted by subscribers There have been 3 million deaths so far and tens of millions of people with long COVID. As I explained last week, we could have had a few thousands instead. We need to learn the lessons so that these widespread governmental failures don’t happen again. Here are the top 25 mistakes of COVID management I see so far, from least important to most.
Good analysis but I don't agree with items 24 and 23. My understanding is that past infection does not stop you from catching covid again (and passing it on to others). The idea of quarantined infection parties is highly impractical (people would have to be quarantined for the entire incubation and infectious period with leaks extremely difficult and expensive to avoid - eg via cleaners, hotel staff). My guess is that this would just lead to more infection in the broader community (as well as long covid if not death for a portion of participants - have you included lifelong medical costs and reduced earnings of long covid sufferers in your cost/benefit analysis?). Society has an obligation to help those who are too stupid to help themselves (eg mandatory seatbelts as you mention). And surely the people who are most concerned about their individual freedoms would not agree to be locked up in a hotel for 14+ days.
I think the biggest mistake was governments failing to realise that elimination of the virus was achievable, particularly with early action and strong fences, and failing to set this as the policy goal from the outset.
I think you missed a big thing - personalizing/politicizing decisions. Statements like "Fauci lied" lead to more such statements - "a Trump failure". These diverted and continue to divert the focus from the disease to the persons/politics. Many disastrous decisions (eg. early celebration of victory in many places) arose from political needs and such statements create more political needs. Whether the statements are true or false does not matter as much as the fact that their use makes it harder to do the thing that needs to be done - focus on the disease. Anyone who mentions an individual and attaches an emotive term to them is being human in a way that is not helpful at the moment.
As a Canadian I am particularly interested in how different the Atlantic experience was. I have heard that closing the borders was easier for them, (not being on major transport routes, relatively few crossing points), that they had better test and trace, .... I do not know how significant each of those factors was.
A consequence of disease overdispersion is that some places, especially ones with low population density, can just get lucky. If we are the lucky ones, we are sure it is due to our superiority (personalizing again). Manitoba had no first wave to speak of. They lead the country now.
We need to focus. We've had 3 pandemics in 20 years. The next one may not be so mild and a vaccine may not be so quickly forthcoming. I doubt we're even half-way through this one.
The exaggerated recommendations by health care experts for more respirators leading to unnecessary and miserable deaths. The sequela of the over use of respirators has been ignored and a lesson slowly learned. Millions of dollars wasted on an unnecessary and misused technology. The early use actually caused lung damage. More needs to be acknowledged regarding this horrible error of medical judgement.
As always, a very thought provoking article, and, unless I've missed one, your first "listicle".
I wish here in France the government had followed your advice, your point about everything looking like a nail for those with a hammer applies so well. It's so frustrating the number of useless measures when the test, trace and isolate dance has barely been tried. And the vaccination ramp up has been painfully slow, but as you note, that's not only here.
So, here is my quibble: your points 24 and 10 seem to me short-sighted and not particularly well argued.
Of course, point 24 out of 25 implies that you're less invested in it, but it's linked to your point 10 "Making Privacy Sacred" so I want to make the counter argument.
This pandemic, as you know, is not the end of the world, and there will certainly be others. But which ones will need to be managed on an "Immunity Passport" ?
This isn't an easy question, and while vaccination records have long been necessary for travel (across borders), though decreasingly so, I'm much more leery about their use in "everyday life".
Again, this links back to privacy, which does not preclude paying taxes (your favorite example), since your personal information is legally protected from prying eyes. Trump's tax info was not leaked by the IRS, but by journalists who got access via a family member who had the records for other reasons.
Even after we defeat this pandemic, Facebook and other abusers of privacy will be amongst us.
I do hope that governments can be trusted to keep our important data safe, but I prefer to minimize the risk, as we have seen that governments can be more or less competent.
I hope this is cogent, despite being drafted on my phone, and I'd be interested in your reaction.
Thanks Thomas, this is one of your more interesting articles. For me, what you did and are doing just shows us how insightful have you been and when you add the tremendous revision work you made, capturing it into your articles, we are able to read a brilliant guy. I must congrats you for your bravery, that at the end allowed people to understand better the pandemics. We know that history (and mistakes), repeat over and over again, for the good and for the bad things. We knew from the first moment, at least in January 2020, this disease was caused by a coronavirus and these viruses “traditionally” spreads by aerosols, we had two examples at the beginning of this century, so it was not very difficult to try to think about to use barriers, but you are right, we don’t listen and even we don’t want to. I am just a chilean shoulder orthop. surgeon, but from the same moment we knew with my team about the Covid-19 we started to wear masks (which by the way “clever” and young bussiness men bought earlier in January here...) and face shields, beeing immediately told not to do by our authorities, because we were scaring the rest of the health workers and patients, after 2 months, the use of them was the rule...Chile has made a terrible management of the pandemics, making a lot of the mistakes you mention, even with recent evidence before our eyes. We were said we will be the Korea of Latin America, but TTI never, ever worked, not even today. The borders never were closed really (too many international treaties to abide by...like allowed hundred of trucks and people, coming from Brasil) this was our more important mistake, we knew about what had happened in Europe, we knew about the variants and the goverment was told by many, included its scientific advisory board to close the borders or not “to open them...they suposed to be closed”, that is why we had and still have a terrible second wave. To implement this quite simple policy would save thousand of lives, but there were other more important “things” than lives that make the government to keep the borders opened. We always used just PCR tests, having even the fastest israeli ones here. Quarentines never really worked, too many works and displacement permits (and we knew they did not were the solution). The genetic survelliance we are doing is a joke and the privacy rights over the health of the people were a good excuse to keep the mess, which at the end maybe benefited some.
Chile should act like Australia, that was the advice from the start of the pandemic, beside the use of the hammer. Last year we didn’t have a first wave as a whole country because the geography of Chile, we had different peaks at different times, in our case if we would act as a kind of federal nation, perhaps we would had a different outcome. By the way, like you did, all these advices were given to the government before the chaos come. This is such a true, that right now many people want to “wash their hands”, because truth is being exposing but “they didn’t know in off about this virus”.
Concerning points 24 and 25, I thing like others who wrote here, maybe re-infection rate is understimated, I was actually twice infected, second one last 2 days and we had the Manaus recent and terrible history. I know not less people re-infected after 2 and 4 weeks from the second shot of the inert virus vaccine we are using, again, Manaus fate was before our eyes, there were some warnings about the efficacy (in vitro), of the vaccine on P.1 variant, but people was not informed at all. Amongs some other mistakes, that just showed the profound lack of solidity of our institucions, seeing the chilean whole picture of the pandemic management, one can rightly think that the government bet on immunity, without and with vaccines. They thought vaccines will save us quickly but they didn’t count on mutations and variants, because maybe and here is a point for uncertainty we never see a coronavirus pandemic before and we believed they don’t mutate that fast, now we know that.
First of all, thank you. I took what you wrote about this last year in March, shared with my students/colleagues/family, and tried to live life accordingly. My wife and I are now vaccinated. So are her grandparents, and our parents. Her grandparents were all v. high risk. I am still a little concerned about our youngest, who was hospitalized for pneumonia at both the ages of 3 and 4, but she's 6 now and hopefully could weather this storm... we remain cautious. And indeed, watching our daughters, 6 and 11, walk out of our car with masks (not asked) in places where many do/did not wear them has become a bit unnerving: we still mask up indoors so the kids do it, and if we are the only family somewhere, they have not questioned us about this since August or September... if they can adjust and just "deal with it", why couldn't others?!
We also teach at private schools, me at the college level, her at the HS level. Us and our kids have been in person all year. They don't wear masks at at my wife's school. We had ours until march or april at mine. We have not seen major spread or cases at these places because of mask mandates, and frankly, probably some luck. My University paid students to be tested once a week in the Spring still. My best student got Covid in late march, no symptoms, but did not infect anyone else that we know of either.
And therefore, what I've lived here in the U.S. and what others have lived is a completely different experience. Our youngest got sent home from school once when her class pod had to quarantine for ten days because the mom of one of the students had covid. Beyond that, I have lived life since September with few disruptions, figured out how to teach to inperson/remote students simultaneously. Sure, I grew nervous when our surrounding community numbers started growing, and remained that way well after the peak in November... but no deaths in our area under age 16 and very few since february, with much of the older part of the population no vaccinated... (that vaccination has "stalled" among those under the age of 60 is most disappointing)... will be cautious this summer still, but looking forward to next school year at this point.
So your tone when you talk about our failures doesn't fully resonate with me... it seems possible that people/communities can make their own choices and still come out of something like this ok. Maybe it's because I didn't lose much freedom/privacy and still, for the most part, our immediate communities got through this. (Our surrounding area faired better than others in this country too, probably enabling our measures to be sufficient.) And yet... we did things. We tried to teach the students to be responsible, pointing out that being in person was a privilege and such and was a privilege that could be lost again. We educated ourselves about this. I watched the infection numbers, and got upset when the numbers in our surrounding area started going up in July and they did little besides cancel large gatherings. And literally, the day the mask mandate was issued here (Midish November) is the peak of cases in our surrounding area.
Also, do not underestimate the impact of election 2020! Our governor 'could not' issue a mask mandate until he won reelection because his opponent was advocating for one in October.
So I think what I'm trying to say is, as my libertarian instincts wrestle with my practical ones, choices made by governments do not fully guarantee/prevent success. There is something deeper here about cultural cohesion that I think is relevant: the people of taiwan/s.Korea/Japan succeeded, not just their governments.
Contact tracing takes cooperation. I'm not convinced we can do something like that right now in the U.S. because we seem incapable of depoliticizing any significant issue. Some areas tried to contact trace, but it doesn't work well, as you've said so many times, without getting everyone involved. How do you do that here? ... If Covid was truly the reason Trump lost re-election, millions of people in this country would say that covid worth the cost, might even go so far to say intentional mismanagement to lower his chances of reelection, all worth it. ... So maybe if you had three differently named contact tracing apps? ... But mandates have to be listened to, enforced, etc. Our national/state government are losing that level of authority/respect, or better, do have strong enough institutions to effectively implement such laws: places in the U.S. tried, after all.
At the end of the day, this has proven that knowledge WITH wisdom is power. Now trust has been broken because the people empowered to share/act on the knowledge failed: they lacked the wisdom to make the right choices and recommendations. This isn't just about voting people out of office (so many are unelected positions), or moving (which not only solves nothing in the big picture, it isn't realistic for many [teaching a private schools is even less "lucrative" than public, for example], nor tolerable for those who don't want to leave family). This is about the "greater good" actually being, you know, a concept that people can agree exists. And that our officials and people in general actually strive for. I'm worried for the future of the world when even a pandemic is not a serious enough crisis for the U.S. and many other democracies to lessen political tension.
Agree with some/most points, however as some other commenters already pointed out privacy and individual freedom are subjects people get very worried about if the infringement comes from governments. Rightly so in my opinion.
Furthermore, it is true a lot of people died of Covid/Corona but every year around 9 million die from starvation among which there are 3 million children (according to the worldscounts.com), although there is even in practical terms enough food for everyone. Why does it still happen? Because a lot of people do not care about other people enough. The same happens with Covid/Corona. So I think you overestimate point 22.
Another example in relation to the amount of deaths is more polemic (I obviously do not agree that that course of action below should have been taken, but it illustrates that individual freedom, privacy etc have always been important). Covid will probably turn out to be less serious and deadly than HIV against which less action was taken than against Covid. Why for example were condoms not made obligatory (condoms probably work better against HIV than masks against Covid in preventing getting infected), why were non-monogamous relationships not forbidden, why were HIV positive people not quarantined (remember a few suffer so that the rest can go on with their lives)? Testing, tracing and isolation never happened in the case of HIV in the same way it happens against Covid.
Until now around 30 million people have died from HIV/Aids, my polemic point is that if people would just have given up on their privacy and individual freedoms those deaths could have been prevented as well. (I obviously do not agree that that course of action should have been taken, but it illustrates that individual freedom, privacy etc have always been important). I did read that the US border was closed for HIV positive people for a long time. However, I do not think testing before entering was obligatory (https://pubmed.ncbi.nlm.nih.gov/12286989/), although at the moment there are still countries that require a test if you stay for an extended period apparently (https://www.aidsmap.com/about-hiv/travel-restrictions-people-hiv). This is generally considered a wrong and stigmatizing course of action.
My opinion is that constitutional rights are important in particular during emergencies.
My thoughts are that learning from mistakes and successes are imperative. This is where we start to share. Unfortunately the Federal Government will look for scapegoats. Oh yes, there are many that played a role in how the US response was negligent!! There will be those that want to take credit for "how well we are doing" and those that will go on defense to save their credibility.
I found this source the best source for laying it all out on the table. Please continue!!
I would add Politicians' relentless focus on the short term - specifically the next day's headlines or, best case, the next election. Something like Covid required long-term visionary decision making, together with the humility for politicians to listen to experts. Few national leaders have a background in science, medicine, maths or another technical discipline. And few of them have much humility!
Thank you Tomás. Great food for thought as always.
Items 16 and 4, 3 and 2 are SO IMPORTANT STILL TODAY, I think they deserve to appear somewhere in the non subscription environment...
Regarding low income areas, I think (did not try to access the data but interpreted the accounts from health personnel and some of the press) that this might be one of the few areas where efficient measures were taken in Argentina (Buenos Aires) amongst a generally disastrous pandemics management... Essentially, the DetectAR program. Teaching and isolation with heavy social support.
Great article as usual and great insights. Your analysis is always very clear and straight to the point. Wise. It is very important what you say about freedom and the respect for the others. Thanks for sharing your thoughts!
I agree with the opening points regarding infection parties and this is perhaps the #1 missed opportunity: Why was the same fervor to track the vaccinated not applied to those who have recovered from viral infection? If that were in place your list could likely collapse down to perhaps 6-10 points as the others becomes somewhat meaningless. One (not so small) quibble: I'd be a bit circumspect about the "you can do what you want so long as it does not negatively affect anyone else..." First order logic on that is fairly easy, but what about the 2nd order logic of obesity and a host of metabolically driven co-morbidities? Either put the same level of scrutiny to those topics or perhaps finger wag a bit less about our relative "moral responsibility" to our fellow citizens. That last bit may sound nuts, but takes on a whole other layer of significance when we we consider the hypothesis Dr. Gert Vanden Bossche has put forward: that mass vaccination AMIDST a pandemic may create a remarkable evolutionary selection pressure for the virus, initiating an arms race we cannot win. It is unclear if his hypothesis will stand the test of time, but its mere existence should temper the more virtue signally elements that seem to find fertile ground in the age of Covid.
One thing missing: the ridiculous time, effort and money spent on "hygiene theater" even though fomites aren't the issue. It's taken a looooong time for revision in the surface cleaning recommendations that have cost businesses and, especially, schools, a lot of money for very scant benefit.
I am a doctor in the UK. I have been wondering for over 12 months whether it was SAGE or the government of the UK who made those incredibly bad decisions last year. Looks like the rumour that it was Dominic Cummings who pushed for the lockdown may well be correct! I couldn't watch more than 5 minutes of the debate, it was too upsetting.
Thank you for keeping me sane over the last year and restoring my faith in the intellectual capability of humanity Tomas. I had no idea whatsoever of your background until I subscribed to your new project, because I never felt any need to check whether you were an "expert". Your clear-headed thinking and rational arguments spoke for themselves.
You forgot one mistake: allowing high levels of transmission without considering the increased risk of dangerous mutations. I recall someone raising that as another good reason to suppress Covid-19 over 12 months ago.
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.
Good analysis but I don't agree with items 24 and 23. My understanding is that past infection does not stop you from catching covid again (and passing it on to others). The idea of quarantined infection parties is highly impractical (people would have to be quarantined for the entire incubation and infectious period with leaks extremely difficult and expensive to avoid - eg via cleaners, hotel staff). My guess is that this would just lead to more infection in the broader community (as well as long covid if not death for a portion of participants - have you included lifelong medical costs and reduced earnings of long covid sufferers in your cost/benefit analysis?). Society has an obligation to help those who are too stupid to help themselves (eg mandatory seatbelts as you mention). And surely the people who are most concerned about their individual freedoms would not agree to be locked up in a hotel for 14+ days.
I think the biggest mistake was governments failing to realise that elimination of the virus was achievable, particularly with early action and strong fences, and failing to set this as the policy goal from the outset.
I think you missed a big thing - personalizing/politicizing decisions. Statements like "Fauci lied" lead to more such statements - "a Trump failure". These diverted and continue to divert the focus from the disease to the persons/politics. Many disastrous decisions (eg. early celebration of victory in many places) arose from political needs and such statements create more political needs. Whether the statements are true or false does not matter as much as the fact that their use makes it harder to do the thing that needs to be done - focus on the disease. Anyone who mentions an individual and attaches an emotive term to them is being human in a way that is not helpful at the moment.
As a Canadian I am particularly interested in how different the Atlantic experience was. I have heard that closing the borders was easier for them, (not being on major transport routes, relatively few crossing points), that they had better test and trace, .... I do not know how significant each of those factors was.
A consequence of disease overdispersion is that some places, especially ones with low population density, can just get lucky. If we are the lucky ones, we are sure it is due to our superiority (personalizing again). Manitoba had no first wave to speak of. They lead the country now.
We need to focus. We've had 3 pandemics in 20 years. The next one may not be so mild and a vaccine may not be so quickly forthcoming. I doubt we're even half-way through this one.
The exaggerated recommendations by health care experts for more respirators leading to unnecessary and miserable deaths. The sequela of the over use of respirators has been ignored and a lesson slowly learned. Millions of dollars wasted on an unnecessary and misused technology. The early use actually caused lung damage. More needs to be acknowledged regarding this horrible error of medical judgement.
As always, a very thought provoking article, and, unless I've missed one, your first "listicle".
I wish here in France the government had followed your advice, your point about everything looking like a nail for those with a hammer applies so well. It's so frustrating the number of useless measures when the test, trace and isolate dance has barely been tried. And the vaccination ramp up has been painfully slow, but as you note, that's not only here.
So, here is my quibble: your points 24 and 10 seem to me short-sighted and not particularly well argued.
Of course, point 24 out of 25 implies that you're less invested in it, but it's linked to your point 10 "Making Privacy Sacred" so I want to make the counter argument.
This pandemic, as you know, is not the end of the world, and there will certainly be others. But which ones will need to be managed on an "Immunity Passport" ?
This isn't an easy question, and while vaccination records have long been necessary for travel (across borders), though decreasingly so, I'm much more leery about their use in "everyday life".
Again, this links back to privacy, which does not preclude paying taxes (your favorite example), since your personal information is legally protected from prying eyes. Trump's tax info was not leaked by the IRS, but by journalists who got access via a family member who had the records for other reasons.
Even after we defeat this pandemic, Facebook and other abusers of privacy will be amongst us.
I do hope that governments can be trusted to keep our important data safe, but I prefer to minimize the risk, as we have seen that governments can be more or less competent.
I hope this is cogent, despite being drafted on my phone, and I'd be interested in your reaction.
Thanks Thomas, this is one of your more interesting articles. For me, what you did and are doing just shows us how insightful have you been and when you add the tremendous revision work you made, capturing it into your articles, we are able to read a brilliant guy. I must congrats you for your bravery, that at the end allowed people to understand better the pandemics. We know that history (and mistakes), repeat over and over again, for the good and for the bad things. We knew from the first moment, at least in January 2020, this disease was caused by a coronavirus and these viruses “traditionally” spreads by aerosols, we had two examples at the beginning of this century, so it was not very difficult to try to think about to use barriers, but you are right, we don’t listen and even we don’t want to. I am just a chilean shoulder orthop. surgeon, but from the same moment we knew with my team about the Covid-19 we started to wear masks (which by the way “clever” and young bussiness men bought earlier in January here...) and face shields, beeing immediately told not to do by our authorities, because we were scaring the rest of the health workers and patients, after 2 months, the use of them was the rule...Chile has made a terrible management of the pandemics, making a lot of the mistakes you mention, even with recent evidence before our eyes. We were said we will be the Korea of Latin America, but TTI never, ever worked, not even today. The borders never were closed really (too many international treaties to abide by...like allowed hundred of trucks and people, coming from Brasil) this was our more important mistake, we knew about what had happened in Europe, we knew about the variants and the goverment was told by many, included its scientific advisory board to close the borders or not “to open them...they suposed to be closed”, that is why we had and still have a terrible second wave. To implement this quite simple policy would save thousand of lives, but there were other more important “things” than lives that make the government to keep the borders opened. We always used just PCR tests, having even the fastest israeli ones here. Quarentines never really worked, too many works and displacement permits (and we knew they did not were the solution). The genetic survelliance we are doing is a joke and the privacy rights over the health of the people were a good excuse to keep the mess, which at the end maybe benefited some.
Chile should act like Australia, that was the advice from the start of the pandemic, beside the use of the hammer. Last year we didn’t have a first wave as a whole country because the geography of Chile, we had different peaks at different times, in our case if we would act as a kind of federal nation, perhaps we would had a different outcome. By the way, like you did, all these advices were given to the government before the chaos come. This is such a true, that right now many people want to “wash their hands”, because truth is being exposing but “they didn’t know in off about this virus”.
Concerning points 24 and 25, I thing like others who wrote here, maybe re-infection rate is understimated, I was actually twice infected, second one last 2 days and we had the Manaus recent and terrible history. I know not less people re-infected after 2 and 4 weeks from the second shot of the inert virus vaccine we are using, again, Manaus fate was before our eyes, there were some warnings about the efficacy (in vitro), of the vaccine on P.1 variant, but people was not informed at all. Amongs some other mistakes, that just showed the profound lack of solidity of our institucions, seeing the chilean whole picture of the pandemic management, one can rightly think that the government bet on immunity, without and with vaccines. They thought vaccines will save us quickly but they didn’t count on mutations and variants, because maybe and here is a point for uncertainty we never see a coronavirus pandemic before and we believed they don’t mutate that fast, now we know that.
First of all, thank you. I took what you wrote about this last year in March, shared with my students/colleagues/family, and tried to live life accordingly. My wife and I are now vaccinated. So are her grandparents, and our parents. Her grandparents were all v. high risk. I am still a little concerned about our youngest, who was hospitalized for pneumonia at both the ages of 3 and 4, but she's 6 now and hopefully could weather this storm... we remain cautious. And indeed, watching our daughters, 6 and 11, walk out of our car with masks (not asked) in places where many do/did not wear them has become a bit unnerving: we still mask up indoors so the kids do it, and if we are the only family somewhere, they have not questioned us about this since August or September... if they can adjust and just "deal with it", why couldn't others?!
We also teach at private schools, me at the college level, her at the HS level. Us and our kids have been in person all year. They don't wear masks at at my wife's school. We had ours until march or april at mine. We have not seen major spread or cases at these places because of mask mandates, and frankly, probably some luck. My University paid students to be tested once a week in the Spring still. My best student got Covid in late march, no symptoms, but did not infect anyone else that we know of either.
And therefore, what I've lived here in the U.S. and what others have lived is a completely different experience. Our youngest got sent home from school once when her class pod had to quarantine for ten days because the mom of one of the students had covid. Beyond that, I have lived life since September with few disruptions, figured out how to teach to inperson/remote students simultaneously. Sure, I grew nervous when our surrounding community numbers started growing, and remained that way well after the peak in November... but no deaths in our area under age 16 and very few since february, with much of the older part of the population no vaccinated... (that vaccination has "stalled" among those under the age of 60 is most disappointing)... will be cautious this summer still, but looking forward to next school year at this point.
So your tone when you talk about our failures doesn't fully resonate with me... it seems possible that people/communities can make their own choices and still come out of something like this ok. Maybe it's because I didn't lose much freedom/privacy and still, for the most part, our immediate communities got through this. (Our surrounding area faired better than others in this country too, probably enabling our measures to be sufficient.) And yet... we did things. We tried to teach the students to be responsible, pointing out that being in person was a privilege and such and was a privilege that could be lost again. We educated ourselves about this. I watched the infection numbers, and got upset when the numbers in our surrounding area started going up in July and they did little besides cancel large gatherings. And literally, the day the mask mandate was issued here (Midish November) is the peak of cases in our surrounding area.
Also, do not underestimate the impact of election 2020! Our governor 'could not' issue a mask mandate until he won reelection because his opponent was advocating for one in October.
So I think what I'm trying to say is, as my libertarian instincts wrestle with my practical ones, choices made by governments do not fully guarantee/prevent success. There is something deeper here about cultural cohesion that I think is relevant: the people of taiwan/s.Korea/Japan succeeded, not just their governments.
Contact tracing takes cooperation. I'm not convinced we can do something like that right now in the U.S. because we seem incapable of depoliticizing any significant issue. Some areas tried to contact trace, but it doesn't work well, as you've said so many times, without getting everyone involved. How do you do that here? ... If Covid was truly the reason Trump lost re-election, millions of people in this country would say that covid worth the cost, might even go so far to say intentional mismanagement to lower his chances of reelection, all worth it. ... So maybe if you had three differently named contact tracing apps? ... But mandates have to be listened to, enforced, etc. Our national/state government are losing that level of authority/respect, or better, do have strong enough institutions to effectively implement such laws: places in the U.S. tried, after all.
At the end of the day, this has proven that knowledge WITH wisdom is power. Now trust has been broken because the people empowered to share/act on the knowledge failed: they lacked the wisdom to make the right choices and recommendations. This isn't just about voting people out of office (so many are unelected positions), or moving (which not only solves nothing in the big picture, it isn't realistic for many [teaching a private schools is even less "lucrative" than public, for example], nor tolerable for those who don't want to leave family). This is about the "greater good" actually being, you know, a concept that people can agree exists. And that our officials and people in general actually strive for. I'm worried for the future of the world when even a pandemic is not a serious enough crisis for the U.S. and many other democracies to lessen political tension.
Agree with some/most points, however as some other commenters already pointed out privacy and individual freedom are subjects people get very worried about if the infringement comes from governments. Rightly so in my opinion.
Furthermore, it is true a lot of people died of Covid/Corona but every year around 9 million die from starvation among which there are 3 million children (according to the worldscounts.com), although there is even in practical terms enough food for everyone. Why does it still happen? Because a lot of people do not care about other people enough. The same happens with Covid/Corona. So I think you overestimate point 22.
Another example in relation to the amount of deaths is more polemic (I obviously do not agree that that course of action below should have been taken, but it illustrates that individual freedom, privacy etc have always been important). Covid will probably turn out to be less serious and deadly than HIV against which less action was taken than against Covid. Why for example were condoms not made obligatory (condoms probably work better against HIV than masks against Covid in preventing getting infected), why were non-monogamous relationships not forbidden, why were HIV positive people not quarantined (remember a few suffer so that the rest can go on with their lives)? Testing, tracing and isolation never happened in the case of HIV in the same way it happens against Covid.
Until now around 30 million people have died from HIV/Aids, my polemic point is that if people would just have given up on their privacy and individual freedoms those deaths could have been prevented as well. (I obviously do not agree that that course of action should have been taken, but it illustrates that individual freedom, privacy etc have always been important). I did read that the US border was closed for HIV positive people for a long time. However, I do not think testing before entering was obligatory (https://pubmed.ncbi.nlm.nih.gov/12286989/), although at the moment there are still countries that require a test if you stay for an extended period apparently (https://www.aidsmap.com/about-hiv/travel-restrictions-people-hiv). This is generally considered a wrong and stigmatizing course of action.
My opinion is that constitutional rights are important in particular during emergencies.
My thoughts are that learning from mistakes and successes are imperative. This is where we start to share. Unfortunately the Federal Government will look for scapegoats. Oh yes, there are many that played a role in how the US response was negligent!! There will be those that want to take credit for "how well we are doing" and those that will go on defense to save their credibility.
I found this source the best source for laying it all out on the table. Please continue!!
I would add Politicians' relentless focus on the short term - specifically the next day's headlines or, best case, the next election. Something like Covid required long-term visionary decision making, together with the humility for politicians to listen to experts. Few national leaders have a background in science, medicine, maths or another technical discipline. And few of them have much humility!
Thank you Tomás. Great food for thought as always.
Items 16 and 4, 3 and 2 are SO IMPORTANT STILL TODAY, I think they deserve to appear somewhere in the non subscription environment...
Regarding low income areas, I think (did not try to access the data but interpreted the accounts from health personnel and some of the press) that this might be one of the few areas where efficient measures were taken in Argentina (Buenos Aires) amongst a generally disastrous pandemics management... Essentially, the DetectAR program. Teaching and isolation with heavy social support.
Great article as usual and great insights. Your analysis is always very clear and straight to the point. Wise. It is very important what you say about freedom and the respect for the others. Thanks for sharing your thoughts!
I agree with the opening points regarding infection parties and this is perhaps the #1 missed opportunity: Why was the same fervor to track the vaccinated not applied to those who have recovered from viral infection? If that were in place your list could likely collapse down to perhaps 6-10 points as the others becomes somewhat meaningless. One (not so small) quibble: I'd be a bit circumspect about the "you can do what you want so long as it does not negatively affect anyone else..." First order logic on that is fairly easy, but what about the 2nd order logic of obesity and a host of metabolically driven co-morbidities? Either put the same level of scrutiny to those topics or perhaps finger wag a bit less about our relative "moral responsibility" to our fellow citizens. That last bit may sound nuts, but takes on a whole other layer of significance when we we consider the hypothesis Dr. Gert Vanden Bossche has put forward: that mass vaccination AMIDST a pandemic may create a remarkable evolutionary selection pressure for the virus, initiating an arms race we cannot win. It is unclear if his hypothesis will stand the test of time, but its mere existence should temper the more virtue signally elements that seem to find fertile ground in the age of Covid.
One thing missing: the ridiculous time, effort and money spent on "hygiene theater" even though fomites aren't the issue. It's taken a looooong time for revision in the surface cleaning recommendations that have cost businesses and, especially, schools, a lot of money for very scant benefit.
I am a doctor in the UK. I have been wondering for over 12 months whether it was SAGE or the government of the UK who made those incredibly bad decisions last year. Looks like the rumour that it was Dominic Cummings who pushed for the lockdown may well be correct! I couldn't watch more than 5 minutes of the debate, it was too upsetting.
Thank you for keeping me sane over the last year and restoring my faith in the intellectual capability of humanity Tomas. I had no idea whatsoever of your background until I subscribed to your new project, because I never felt any need to check whether you were an "expert". Your clear-headed thinking and rational arguments spoke for themselves.
You forgot one mistake: allowing high levels of transmission without considering the increased risk of dangerous mutations. I recall someone raising that as another good reason to suppress Covid-19 over 12 months ago.
Felicidades por su trabajo!! Me encantaría conocer su opinión sobre la situación actual, ¿cómo ve el fututo próximo?
Muchas gracias!!
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.