When I read COVID retrospectives, my hopes for humanity die a little bit. Today, I want to zero in on the most crucial lessons people have not learned. Later this week in the premium article, I will do a retrospective on my own performance: What did I get right and wrong? I’ll look back at some articles I’ve written, with a special focus on the big predictions. Subscribe to read it!
It was quite the eye opener to watch my fellow citizens reactions to Covid. It was horrifying to see the leadership not let the right agencies be the leading voice. I was not very understanding of those who rejected the best known protocols from people who spend their careers working with viruses. It was obvious they had the closest thing to a good plan than the rantings on Twitter 'experts' or political gaslighting. So why is it so many people rejected the life raft handed to them, which may have not been perfect but would keep them and those around them alive? It felt insane.
Interesting. Mostly correct, but you join just about everyone in media, left, right, or center, in missing the point on masking. What we knew, fairly quickly, and know still today, is that well fitting N95 masks, or similar, work. Others are much less effective, and when worn by someone who doesn't want to be wearing it (for whatever reason), are just this side of useless. Better than nothing, but not a major factor toward safety. Mandating N95s early on, during a hopeless shortage of N95s, would not have been good policy. Mandating "any mask" was almost equally poor policy, especially later along, though for very different reasons.
Also, as anyone who has ever worked in a job that required N95 masking, for safety reasons, can attest, "fitting" is not a matter of guessing at size oneself, or even of trying several sizes. A professional does it for you. Masking with an ill fitting N95 is just another way of "playing at masking" without actually getting the benefit.
I get it - It's really HARD to give those who opposed masking MANDATES their due, but unless a given critic was also agitating against masking itself (not mandating, but even voluntarily wearing them) give him his due we should. Those who opposed the actual mandates that were actually issued were correct, and still are.
So at the time, it would have made sense to move towards a policy that pushed for any mask while we were ramping up production. N95 was better than anything else (that was clear) but others were still useful on certain circumstances.
Those circumstances included mixing types of cloth and properly fitting the masks. What we’ve learned since goes further (people have a hard time wearing them properly), but that also includes N95s (which most ppl don’t fit properly).
I explore the meta-analysis that seemed to conclude that they don’t. In fact, the only thing the scientists could conclude is “the mere possession of a mask doesn’t protect you”. I lambasted the authors for that.
Specifically, that meta-analysis includes a very good paper showing that masks + EDUCATION did work to reduce COVID incidence. So it is possible.
Of course, the empirical evidence of Japan and Taiwan was another huge clue. So this falls in the “look at reality” type of insight in that regard. It also falls in “a better leadership is possible” type of insight, because better leadership would indeed have pushed for that (and succeeded).
More importantly, those against mask mandates didn’t push back because “the cost-benefit suggests this is a negative-ROI initiative, since the cost of education outstrips the reduction in R”. If I had seen a single such comment, I would agree with you.
The argument was “DON’T TAKE MY FREEDOM AWAY!!”, which is not good thinking.
I follow you. Again, though, there is a difference between saying masks work / sorta work, and concluding that a MANDATE was a good idea. Once a policymaker introduces the idea of a mandate or ban (of anything), we are in the territory where individual IRRATIONALITY matters greatly. Mandating something that you can't prove, or at least convincingly demonstrate, will achieve your stated goal, only serves to undermine confidence of at least a segment of the public in the decision-maker(s), and encourages (psychologically and emotionally) non-compliance, thus undermining rule of law and societal well-being. Which is the most important result that mask mandates achieved.
There never was, and still isn't, evidence that anything but a well-fitted N95 or foreign equivalent provided really strong protection to the wearer. And there was a lot of posturing about "you're wearing it for the others around you", which was, to be blunt, just untrue. The layering and combining was a creative touch, but it completely ignored that the vast majority of the aerosol that passes from the wearer into the room is what escapes AROUND the mask(s) due to lack of a good face-seal, not what passes THROUGH the mask. There were a number of good videos and photos, taken with special lighting, that showed this well. Especially if someone sneezed or shouted or sang. Or you can just put on a mask, or a layering of two, and hold your hand an inch or two from the sides of the mouth, the sides of the nose etc. You can FEEL your normal exhalation escape AROUND not through.
You and some other commenters have noted that any mask is better than nothing, combos better than one, N95s better still, professionally fitted N95s best, invoked "load", etc. All true, but beside the point if we are discussing whether MANDATES for the use of "any mask" were good POLICY. I wore a mask early on most everywhere and religiously, and probably longer than most people, and to this day I carry one and will mask anywhere, if asked. But saying I was convinced it was better for me than doing nothing is very different from saying that mandates were good policy choices. I read your earlier piece on the meta-analysis at the time you published it, and had issues with it then. Again, most in media, and you, missed somehow that the authors of the meta-study, and the more careful interpreters of it, were not saying that MASKING doesn't work, they were saying that MANDATING masking didn't work. I think the meta-analysis showed that that conclusion is sound. Individuals who chose to mask enjoyed some protection. More if they N95'd, less for layered combos, less for surgical, less for cloth, etc. etc. But populations that experienced mandates did not do better than ones that did not have mandates, to the extent that we can suss that out from the available studies.
Bottom line - You and I are not disagreeing on any of the science. We are disagreeing on the relative importance of taking into account social psychology when making policy decisions, and as someone with a foot in both worlds (recently retired from a long career as a Ph.D. R&D scientist, AND still active as a decades long hobbyist political campaign manager and strategist at up to the State Legislator level), I wish we could all get to a place where we can agree that of those things matter, and good policy takes them BOTH into account. For a policy-maker, it should not matter if opponents of a policy are engaging in "not good thinking". That kind of thinking will always exist, and it should matter to me as a policy-maker whether I am GOADING those individuals into embracing "not good thinking". And there was too much of that.
Thank you for your comments, which succinctly and comprehensively address my own objections to mask mandates. It was clear early on that the type of masks permitted under the spectrum of mandates were of limited effectiveness (ill-fitting cloth and paper). To participate in state-mandated kabuki theatre undermines one confidence in and support of governmental policy, and directly contributed to the polarization within the US.
This is by far the best attempt at quantifying this, and showed it worked AS A POLICY, because it was 300k ppl just with training and mask accessibility, and it did reduce COVID infections. Despite the very poor intervention!
Other masks - assuming they cover the nose and mouth - reduce the viral load sent out when people exhale, sneeze, cough etc, and so definitely have a positive benefit. It's the defiant non-maskers and chin-breathers who we should be calling out.
I think you’re assuming that a reduction in the expired viral load=reduction in the spread of Covid (or at least that’s how I read the “definitely have a positive benefit”). I’m not sure there is evidence for that given the variance in places where people masked vs. didn’t mask. It may be the case that the reduction in viral particles just doesn’t matter given the fact that plenty of virus still gets expired.
I've been following you since early COVID, and I have loved everything you've written on the subject. It's such beautiful perspective, and it was comforting at a time when the United States had such poor leadership. Actually, I bought Dave Pell's "Please Scream Inside of Your Heart" which is based on the news stories of the time and I can only get through half of it... Me, a person who is hardly ever triggered.
I love the objective of "think better." And yet, I realized through our COVID experience that so many people function on emotion, and not logic. I function in the latter- I equate data with security... Probably why I love your writing. Yet, when I'd share it with my network to help them better understand a framework of logic, a lot of eyes glazed over.
I think as a "reactive culture" in love with pill panaceas, it's very difficult for Americans to calmly and rationally deal with any sort of mass historic event without allowing their unresolved festering shit boil to the surface, and I don't think governmental leadership was any different. Might also play a part in the low emotional intelligence baked into "we should have."
I appreciate the Calibration game. I'm not sure I'm smart enough to play it. How's that for confidence? ✨
Thank you Andee for your comment. It feels like a little piece of yourself.
My articles are for a certain type of people—like you and me, it sounds. People who are trying to keep themselves honest and base their decisions on data, all the while they know that emotions play a bigger part in the stage of public life.
Reaching a wider audience does require a more emotional communication style. Anybody must know how to use it, but use it sparingly. Only when the data supports the decision. Sometimes I use it (like in Why You Must Act Now), but it a not what Uncharted Territories is generally about.
The fact that people react to this more emotional type of communication is just the way life is. Something to accept and adapt to.
Oh! And you should definitely play the game. If it makes you feel better, I answer 1% and “asdf” or something equivalent to about 1/3 of questions (for which I have no f clue of the answer!)
Two things I’d like to see you address. First the persistence of school closures even after the evidence came in that they weren’t necessary and the continuing covid protocols after vaccination. Those two things change my entire view of government. It was really damaging.
And I agree on the closures post-vaccination criticism: once everybody has had the opportunity to get 2 shots, now it should be up to people to fend for themselves, provided that the healthcare system doesn’t collapse. Which means most lockdowns after mid-2021 were unacceptable.
As humans are often slaves to their entrenched beliefs, and often without any real prospects of “changing their minds”, I expect the next very serious pandemic has the potential to cull a great many inflexible pundit believers. It seems to be another permutation of evolutionary dynamics. Learn, adapt and live. Or not.
Masking is, and was, a good idea. The policy was poorly implemented in most/all countries. In my country, New Zealand, the messaging was poor early on. This was likely due to a shortage of masks but the message should have been, if you can get a mask, wear one indoors (away from home). Later, it became obvious that poor masks and poorly worn masks were next to useless, so the masking policy was updated to specify the masks that can be worn in places where they were then mandated. However, there was next to no follow up messaging to push the correct way of wearing them. Consequently, I rarely saw people wearing masks properly or wearing well fitting masks. So a masking policy may have been right but if people don't follow it, it is next to useless.
Regarding vaccine effectiveness, I thought they were reasonably effective, at first. But, I've followed the data here, almost from the start, and it's now clear that the effectiveness is poor. Unvaccinated people are only about 1.5 times as likely to die of COVID as those with a booster, though about 4 times as likely to die as those with just the primary course of vaccinations. With hospitalisations, there is almost no difference between the unvaccinated and the boosted, with the unvaccinated/boosted about twice as likely as those who've had the primary course only to be hospitalised. Sadly, the published data is sadly lacking to do a deep dive into nuances due to age and co-morbidities. I'm a little disappointed that I had a booster, now.
No papers. I've simply added the data, as they came out of our health service, to a spreadsheet and analysed those data (simply dividing the number by the appropriate population size). It seemed to start changing after delta became prevalent and has remained the way I mentioned for the last year and a half, though I don't have good recent death data as I have to keep requesting the data, with a breakdown by vaccination status (it's not published). The last data I have on that is about 6 months ago but the hospitalisation data is updated regularly and vaccinated populations aren't changing much (those data are infrequently updated, so exact per 100k figures are estimates). The published data is disappointing in what and how they publish it, almost as though they don't want you to know the true picture. Age related data would be even better but that's not forthcoming. If the story was as you indicated, I feel sure the authorities would be only too keen to show that in the data they provide.
I think using Jacinda Ardern as an example of leadership done right overlooks how she was ousted from her job as soon as the pandemic started to wane: https://www.bbc.com/news/world-asia-64328433
Leaders who want to stay in power will look at this and conclude they should have done the opposite.
My understanding was that she was super popular during and after COVID, and that her popularity waned afterwards (inflation etc), and that despite that she was still more popular than most western COVID leaders.
(I'm Australian, so grain of salt) I think she was not voted out, because she jumped before being pushed.
I agree inflation etc was a cause too, but then where did the inflation come from? At least partially from Covid response.
I think the general vibe these days is that everyone went a bit too far, and people are a bit soured on leaders that were more popular in the heat of the moment.
It was easy to use against particular political leaders, and in democracies people get very enamored of ‘change.’ Everyone wants what is in the mystery box.
It’s a mixture of both but in Australia and New Zealand party vote is strongly correlated to popularity of leader, and it doesn’t react quickly to changes in leader.
Good artlcle - one thing I think you touch on, but with insufficient attention, is trust in leaders. Ardern succeeded in New Zealand because she had built trust with the population - not just among her supporters - and so when it came to a crisis they trusted her, the US was the opposite - a failure to trust government anyway, and with parties pulling in different directions led to a failure to believe anyone not aligned with your politics. Australia was somewhat in between - political parties were mostly aligned in fighting the pandemic, but there was poor trust in government after the appalling response to the previous summer's fires.
A good question to ask is "how likely are people to trust a politician/leader of the party other than the one they voted for, in a crisis".
Hypothesis: trust before and during was highly correlated, not because of the situation, but because of the leader. A good leader forma trusts in peacetime and wartime.
Thank you for this. It’s like breathing fresh air after sitting in a dank basement. You have such an excellent way of cutting through the crap. Intuitively, I think I have come to the conclusions you come to but was never able to articulate them this well.
🙏And some of the best lessons can also be found here: The Great Influenza” by Dr John Barry, the best history written about the 1918-1920 Pandemic. Not enough leaders have read it, and we made the same old mistakes in 2020-23.
I give us a 4 for both. I’m not optimistic for the next one. Cooperation with the origin country is key. 20-25% of doctors-nurses switching professions leaving the field. Lack of budget for Public Health initiatives, a political movement/environment set on deconstructing the federal agencies that serve the common good and a starving the CDC Budget. Another good read is the editorial by former CDC director Foegi, very critical of Evangelical Dr Redfields total failures and lack of respiratory virus basics.
Excellent posting. It is important to do this kind of exercise to learn what lessons we can going forward. Too many of the "mistakes were made" analyses forget what the circumstances were at different stages of the pandemic, especially the first year. At the university where I work as a biologist there were weekly online town halls where our health science colleagues reported on their experience treating covid patients. Early on there was an urgent sense of dealing with a largely unknown crisis and making the best decisions based on very incomplete knowledge. The health providers were forthright about what they didn't know, and the provisional nature of treatment and mitigation protocols. They were in daily communication with other providers around the country and with officials in local, state, and federal health agencies. Inevitably there were mistakes, such as the early emphasis on hand hygiene over masking. It is important to understand, however, that at least in my experience these mistakes were made in good faith and were not the result of sinister motives as has been too widely shouted. Another important point to keep in mind is that health authorities had to deal with the inadequacies of America's health delivery systems and the chaotic political situation. The recommendation for hand washing over masking in early 2020 was driven by the gross inadequacy of mask availability in the country, as well as by the early thought that the virus transmitted in droplets rather than as aerosol. There was an urgent call at my university for any of us who had masks and other protective equipment in our labs to donate them to health providers who were re-using masks and wearing plastic garbage bags. I recommend reading "Lessons from the Covid War" by the Covid Crisis Group, for an in depth discussion of the topic raised in Tomas' article.
The idea you should judge a result by the quality of the thinking is a key theme in Think Again: The Power of Knowing What You Don't Know https://a.co/d/hqafnpl
There was zero data on children’s IFR early on, because most countries locked down before many were infected. How much they transmitted COVID was also unknown. These were 2 key data points that were missing to make an early call.
Note that I never called for any school policy because I always found it one of the toughest calls.
It was obvious to anyone around March 2020 that there was a high RISK of kids passing the virus between them and taking it home to their vulnerable relatives.
As Tomas explains, the risk at that state of knowledge means it was a good decision to close schools, even if subsequent learning suggested it wasn't (and actually I'm not aware of anything to suggest it would have been better – even in retrospect – to have not closed schools).
I looked at it in summer of 2020. It was terrible back then. Then on and off since. It didn’t look any better. I saw an article claim it was amazing recently, but after 3 lines it looked biased. I’m happy to read an unbiased look into it.
You can easily view in the published data about mortality, hospitalization, etc that Sweden, at end of covid performed far better than almost all European countries and USA. Also impact on economy and most important on education and wellness of young people were not as bad as in other parts of the world.
A major point missed by this article is that Covid was only a deadly disease to a small cohort of the population and the experts knew, yes knew, who they were from the early stages but ignored it and never utilised this information to define an effective public health policy. That is the direct failure of the public health officials and all political leaders involved.
Perhaps more attention to nursing homes where the elderly and people with less competent immune systems are housed was
an obvious location where more aggressive containment could have been implemented at an early date These areas of population concentration like jails could have been expected as a target for very aggressive action to avoid excess deaths. That is the only policy I might identify
The issue of containment is difficult even in hospitals where hand washing is always mandatory many slip ups occur daily With mask use the issue there is easier as all medical personnel are familiar with need for surgical masking but M95s have not been the type of mask used there traditionally in the OR
This was tried. Notably by Sweden. Miserable failure, because nursing homes are full of young people (aka workers) who, when there’s a massive wave outside, tend to catch it and bring it to the nursing home, where a single escape then quickly infects everybody (indoors, crammed, old ppl).
I don’t know a single region in the world that was able to do this successfully.
For the same reasons that masking is not 100 percent effective. It only takes one or two slip ups and the bug wins. Procreation and expansion is the moving power
Are you aware that the overall covid mortality was estimated to be 0,26% in April 2020, and now it's 0,1% right? Just to make sure you understand what you're talking about.
Hi! You should analyze how that number is reached. A blended, global IFR for a naive population in developed economies (the number that’s relevant for these countries’ judgment of measures) would be closer to 1%.
The number you quote is usually used for a global population (how do you know the infection rate?) and includes post-vaccines and the like.
It was quite the eye opener to watch my fellow citizens reactions to Covid. It was horrifying to see the leadership not let the right agencies be the leading voice. I was not very understanding of those who rejected the best known protocols from people who spend their careers working with viruses. It was obvious they had the closest thing to a good plan than the rantings on Twitter 'experts' or political gaslighting. So why is it so many people rejected the life raft handed to them, which may have not been perfect but would keep them and those around them alive? It felt insane.
I agree.
That said, experts were definitely not always right! Skepticism is always welcome. Ignorance with arrogance, however, is not!
Interesting. Mostly correct, but you join just about everyone in media, left, right, or center, in missing the point on masking. What we knew, fairly quickly, and know still today, is that well fitting N95 masks, or similar, work. Others are much less effective, and when worn by someone who doesn't want to be wearing it (for whatever reason), are just this side of useless. Better than nothing, but not a major factor toward safety. Mandating N95s early on, during a hopeless shortage of N95s, would not have been good policy. Mandating "any mask" was almost equally poor policy, especially later along, though for very different reasons.
Also, as anyone who has ever worked in a job that required N95 masking, for safety reasons, can attest, "fitting" is not a matter of guessing at size oneself, or even of trying several sizes. A professional does it for you. Masking with an ill fitting N95 is just another way of "playing at masking" without actually getting the benefit.
I get it - It's really HARD to give those who opposed masking MANDATES their due, but unless a given critic was also agitating against masking itself (not mandating, but even voluntarily wearing them) give him his due we should. Those who opposed the actual mandates that were actually issued were correct, and still are.
Hi! Thank you for your comment. I’m not sure I agree.
I do agree that early on masks should be reserved to healthcare workers, as I mentioned in the hammer and the dance.
The best paper on masking, summarizing the state of the art at the time, was from April 2020 and it suggested that any mask is better than nothing.
https://twitter.com/jeremyphoward/status/1249698787666399235
So at the time, it would have made sense to move towards a policy that pushed for any mask while we were ramping up production. N95 was better than anything else (that was clear) but others were still useful on certain circumstances.
Those circumstances included mixing types of cloth and properly fitting the masks. What we’ve learned since goes further (people have a hard time wearing them properly), but that also includes N95s (which most ppl don’t fit properly).
In Do Masks Work?
https://unchartedterritories.tomaspueyo.com/p/do-masks-work
I explore the meta-analysis that seemed to conclude that they don’t. In fact, the only thing the scientists could conclude is “the mere possession of a mask doesn’t protect you”. I lambasted the authors for that.
Specifically, that meta-analysis includes a very good paper showing that masks + EDUCATION did work to reduce COVID incidence. So it is possible.
Of course, the empirical evidence of Japan and Taiwan was another huge clue. So this falls in the “look at reality” type of insight in that regard. It also falls in “a better leadership is possible” type of insight, because better leadership would indeed have pushed for that (and succeeded).
More importantly, those against mask mandates didn’t push back because “the cost-benefit suggests this is a negative-ROI initiative, since the cost of education outstrips the reduction in R”. If I had seen a single such comment, I would agree with you.
The argument was “DON’T TAKE MY FREEDOM AWAY!!”, which is not good thinking.
Hope that makes sense.
I follow you. Again, though, there is a difference between saying masks work / sorta work, and concluding that a MANDATE was a good idea. Once a policymaker introduces the idea of a mandate or ban (of anything), we are in the territory where individual IRRATIONALITY matters greatly. Mandating something that you can't prove, or at least convincingly demonstrate, will achieve your stated goal, only serves to undermine confidence of at least a segment of the public in the decision-maker(s), and encourages (psychologically and emotionally) non-compliance, thus undermining rule of law and societal well-being. Which is the most important result that mask mandates achieved.
There never was, and still isn't, evidence that anything but a well-fitted N95 or foreign equivalent provided really strong protection to the wearer. And there was a lot of posturing about "you're wearing it for the others around you", which was, to be blunt, just untrue. The layering and combining was a creative touch, but it completely ignored that the vast majority of the aerosol that passes from the wearer into the room is what escapes AROUND the mask(s) due to lack of a good face-seal, not what passes THROUGH the mask. There were a number of good videos and photos, taken with special lighting, that showed this well. Especially if someone sneezed or shouted or sang. Or you can just put on a mask, or a layering of two, and hold your hand an inch or two from the sides of the mouth, the sides of the nose etc. You can FEEL your normal exhalation escape AROUND not through.
You and some other commenters have noted that any mask is better than nothing, combos better than one, N95s better still, professionally fitted N95s best, invoked "load", etc. All true, but beside the point if we are discussing whether MANDATES for the use of "any mask" were good POLICY. I wore a mask early on most everywhere and religiously, and probably longer than most people, and to this day I carry one and will mask anywhere, if asked. But saying I was convinced it was better for me than doing nothing is very different from saying that mandates were good policy choices. I read your earlier piece on the meta-analysis at the time you published it, and had issues with it then. Again, most in media, and you, missed somehow that the authors of the meta-study, and the more careful interpreters of it, were not saying that MASKING doesn't work, they were saying that MANDATING masking didn't work. I think the meta-analysis showed that that conclusion is sound. Individuals who chose to mask enjoyed some protection. More if they N95'd, less for layered combos, less for surgical, less for cloth, etc. etc. But populations that experienced mandates did not do better than ones that did not have mandates, to the extent that we can suss that out from the available studies.
Bottom line - You and I are not disagreeing on any of the science. We are disagreeing on the relative importance of taking into account social psychology when making policy decisions, and as someone with a foot in both worlds (recently retired from a long career as a Ph.D. R&D scientist, AND still active as a decades long hobbyist political campaign manager and strategist at up to the State Legislator level), I wish we could all get to a place where we can agree that of those things matter, and good policy takes them BOTH into account. For a policy-maker, it should not matter if opponents of a policy are engaging in "not good thinking". That kind of thinking will always exist, and it should matter to me as a policy-maker whether I am GOADING those individuals into embracing "not good thinking". And there was too much of that.
Thank you for your comments, which succinctly and comprehensively address my own objections to mask mandates. It was clear early on that the type of masks permitted under the spectrum of mandates were of limited effectiveness (ill-fitting cloth and paper). To participate in state-mandated kabuki theatre undermines one confidence in and support of governmental policy, and directly contributed to the polarization within the US.
Let me make it clearer.
https://www.science.org/doi/10.1126/science.abi9069
This is by far the best attempt at quantifying this, and showed it worked AS A POLICY, because it was 300k ppl just with training and mask accessibility, and it did reduce COVID infections. Despite the very poor intervention!
Other masks - assuming they cover the nose and mouth - reduce the viral load sent out when people exhale, sneeze, cough etc, and so definitely have a positive benefit. It's the defiant non-maskers and chin-breathers who we should be calling out.
I think you’re assuming that a reduction in the expired viral load=reduction in the spread of Covid (or at least that’s how I read the “definitely have a positive benefit”). I’m not sure there is evidence for that given the variance in places where people masked vs. didn’t mask. It may be the case that the reduction in viral particles just doesn’t matter given the fact that plenty of virus still gets expired.
The lower viral load usually lowers the gravity and lethality. I have not seen papers discussing this on COVID specifically.
Great comment
I've been following you since early COVID, and I have loved everything you've written on the subject. It's such beautiful perspective, and it was comforting at a time when the United States had such poor leadership. Actually, I bought Dave Pell's "Please Scream Inside of Your Heart" which is based on the news stories of the time and I can only get through half of it... Me, a person who is hardly ever triggered.
I love the objective of "think better." And yet, I realized through our COVID experience that so many people function on emotion, and not logic. I function in the latter- I equate data with security... Probably why I love your writing. Yet, when I'd share it with my network to help them better understand a framework of logic, a lot of eyes glazed over.
I think as a "reactive culture" in love with pill panaceas, it's very difficult for Americans to calmly and rationally deal with any sort of mass historic event without allowing their unresolved festering shit boil to the surface, and I don't think governmental leadership was any different. Might also play a part in the low emotional intelligence baked into "we should have."
I appreciate the Calibration game. I'm not sure I'm smart enough to play it. How's that for confidence? ✨
Thank you Andee for your comment. It feels like a little piece of yourself.
My articles are for a certain type of people—like you and me, it sounds. People who are trying to keep themselves honest and base their decisions on data, all the while they know that emotions play a bigger part in the stage of public life.
Reaching a wider audience does require a more emotional communication style. Anybody must know how to use it, but use it sparingly. Only when the data supports the decision. Sometimes I use it (like in Why You Must Act Now), but it a not what Uncharted Territories is generally about.
The fact that people react to this more emotional type of communication is just the way life is. Something to accept and adapt to.
Oh! And you should definitely play the game. If it makes you feel better, I answer 1% and “asdf” or something equivalent to about 1/3 of questions (for which I have no f clue of the answer!)
Two things I’d like to see you address. First the persistence of school closures even after the evidence came in that they weren’t necessary and the continuing covid protocols after vaccination. Those two things change my entire view of government. It was really damaging.
When was the evidence enough about schools?
And I agree on the closures post-vaccination criticism: once everybody has had the opportunity to get 2 shots, now it should be up to people to fend for themselves, provided that the healthcare system doesn’t collapse. Which means most lockdowns after mid-2021 were unacceptable.
As humans are often slaves to their entrenched beliefs, and often without any real prospects of “changing their minds”, I expect the next very serious pandemic has the potential to cull a great many inflexible pundit believers. It seems to be another permutation of evolutionary dynamics. Learn, adapt and live. Or not.
Very possible, especially if the virus is very different
Masking is, and was, a good idea. The policy was poorly implemented in most/all countries. In my country, New Zealand, the messaging was poor early on. This was likely due to a shortage of masks but the message should have been, if you can get a mask, wear one indoors (away from home). Later, it became obvious that poor masks and poorly worn masks were next to useless, so the masking policy was updated to specify the masks that can be worn in places where they were then mandated. However, there was next to no follow up messaging to push the correct way of wearing them. Consequently, I rarely saw people wearing masks properly or wearing well fitting masks. So a masking policy may have been right but if people don't follow it, it is next to useless.
Regarding vaccine effectiveness, I thought they were reasonably effective, at first. But, I've followed the data here, almost from the start, and it's now clear that the effectiveness is poor. Unvaccinated people are only about 1.5 times as likely to die of COVID as those with a booster, though about 4 times as likely to die as those with just the primary course of vaccinations. With hospitalisations, there is almost no difference between the unvaccinated and the boosted, with the unvaccinated/boosted about twice as likely as those who've had the primary course only to be hospitalised. Sadly, the published data is sadly lacking to do a deep dive into nuances due to age and co-morbidities. I'm a little disappointed that I had a booster, now.
Thx! Agreed on masks.
I stopped following vaccination data in mid 2022. Up till then, vaccines worked really well. What papers illustrate your claims?
No papers. I've simply added the data, as they came out of our health service, to a spreadsheet and analysed those data (simply dividing the number by the appropriate population size). It seemed to start changing after delta became prevalent and has remained the way I mentioned for the last year and a half, though I don't have good recent death data as I have to keep requesting the data, with a breakdown by vaccination status (it's not published). The last data I have on that is about 6 months ago but the hospitalisation data is updated regularly and vaccinated populations aren't changing much (those data are infrequently updated, so exact per 100k figures are estimates). The published data is disappointing in what and how they publish it, almost as though they don't want you to know the true picture. Age related data would be even better but that's not forthcoming. If the story was as you indicated, I feel sure the authorities would be only too keen to show that in the data they provide.
I think using Jacinda Ardern as an example of leadership done right overlooks how she was ousted from her job as soon as the pandemic started to wane: https://www.bbc.com/news/world-asia-64328433
Leaders who want to stay in power will look at this and conclude they should have done the opposite.
Really?
My understanding was that she was super popular during and after COVID, and that her popularity waned afterwards (inflation etc), and that despite that she was still more popular than most western COVID leaders.
Also she was not voted out.
But maybe I’m wrong?
(I'm Australian, so grain of salt) I think she was not voted out, because she jumped before being pushed.
I agree inflation etc was a cause too, but then where did the inflation come from? At least partially from Covid response.
I think the general vibe these days is that everyone went a bit too far, and people are a bit soured on leaders that were more popular in the heat of the moment.
I hear you. I don’t know enough about her post-COVID situation. Inflation was def not unique to NZ though.
It was easy to use against particular political leaders, and in democracies people get very enamored of ‘change.’ Everyone wants what is in the mystery box.
To give you an idea of her waning popularity (of course it’s not a perfect metric), check out yesterdays NZ election results.
Why does that speak of her and not the rest of the party?
It’s a mixture of both but in Australia and New Zealand party vote is strongly correlated to popularity of leader, and it doesn’t react quickly to changes in leader.
Good artlcle - one thing I think you touch on, but with insufficient attention, is trust in leaders. Ardern succeeded in New Zealand because she had built trust with the population - not just among her supporters - and so when it came to a crisis they trusted her, the US was the opposite - a failure to trust government anyway, and with parties pulling in different directions led to a failure to believe anyone not aligned with your politics. Australia was somewhat in between - political parties were mostly aligned in fighting the pandemic, but there was poor trust in government after the appalling response to the previous summer's fires.
A good question to ask is "how likely are people to trust a politician/leader of the party other than the one they voted for, in a crisis".
Hypothesis: trust before and during was highly correlated, not because of the situation, but because of the leader. A good leader forma trusts in peacetime and wartime.
Thank you for this. It’s like breathing fresh air after sitting in a dank basement. You have such an excellent way of cutting through the crap. Intuitively, I think I have come to the conclusions you come to but was never able to articulate them this well.
I'm glad to hear, Ro!
🙏And some of the best lessons can also be found here: The Great Influenza” by Dr John Barry, the best history written about the 1918-1920 Pandemic. Not enough leaders have read it, and we made the same old mistakes in 2020-23.
I read it early on during the pandemic. I concur. For example, the evolution of lethality if the variants was predictable after reading the book.
Sad!
On a scale of 1 to ten, How prepared are we for the next respiratory pandemic?
On the plus side, we now have massive experience at a societal level.
On the down side, afaik few countries have approved good laws to deal with the next one.
So I’d say 6 for a similar respiratory virus and 2 for a virus for which we would need to unlearn a lot of things.
I give us a 4 for both. I’m not optimistic for the next one. Cooperation with the origin country is key. 20-25% of doctors-nurses switching professions leaving the field. Lack of budget for Public Health initiatives, a political movement/environment set on deconstructing the federal agencies that serve the common good and a starving the CDC Budget. Another good read is the editorial by former CDC director Foegi, very critical of Evangelical Dr Redfields total failures and lack of respiratory virus basics.
Excellent posting. It is important to do this kind of exercise to learn what lessons we can going forward. Too many of the "mistakes were made" analyses forget what the circumstances were at different stages of the pandemic, especially the first year. At the university where I work as a biologist there were weekly online town halls where our health science colleagues reported on their experience treating covid patients. Early on there was an urgent sense of dealing with a largely unknown crisis and making the best decisions based on very incomplete knowledge. The health providers were forthright about what they didn't know, and the provisional nature of treatment and mitigation protocols. They were in daily communication with other providers around the country and with officials in local, state, and federal health agencies. Inevitably there were mistakes, such as the early emphasis on hand hygiene over masking. It is important to understand, however, that at least in my experience these mistakes were made in good faith and were not the result of sinister motives as has been too widely shouted. Another important point to keep in mind is that health authorities had to deal with the inadequacies of America's health delivery systems and the chaotic political situation. The recommendation for hand washing over masking in early 2020 was driven by the gross inadequacy of mask availability in the country, as well as by the early thought that the virus transmitted in droplets rather than as aerosol. There was an urgent call at my university for any of us who had masks and other protective equipment in our labs to donate them to health providers who were re-using masks and wearing plastic garbage bags. I recommend reading "Lessons from the Covid War" by the Covid Crisis Group, for an in depth discussion of the topic raised in Tomas' article.
Nice illustration, thank you!
The idea you should judge a result by the quality of the thinking is a key theme in Think Again: The Power of Knowing What You Don't Know https://a.co/d/hqafnpl
Thanks!
This is complete and utter nonsense. Closing schools was the wrong decision and was readily apparent to anyone with a modicum of common sense.
I don’t think so.
There was zero data on children’s IFR early on, because most countries locked down before many were infected. How much they transmitted COVID was also unknown. These were 2 key data points that were missing to make an early call.
Note that I never called for any school policy because I always found it one of the toughest calls.
That’s ducking the question. Fine we closed schools in March of 2020 but many remained closed well into 2021. That was just criminal.
" readily apparent to anyone with a modicum of common sense"
Perhaps best to detail your reasoning so that epidemiologists can be educated.
Rubbish Marko.
It was obvious to anyone around March 2020 that there was a high RISK of kids passing the virus between them and taking it home to their vulnerable relatives.
As Tomas explains, the risk at that state of knowledge means it was a good decision to close schools, even if subsequent learning suggested it wasn't (and actually I'm not aware of anything to suggest it would have been better – even in retrospect – to have not closed schools).
How about Sweden? It was the best approach if you consider all the facts.
I looked at it in summer of 2020. It was terrible back then. Then on and off since. It didn’t look any better. I saw an article claim it was amazing recently, but after 3 lines it looked biased. I’m happy to read an unbiased look into it.
You can easily view in the published data about mortality, hospitalization, etc that Sweden, at end of covid performed far better than almost all European countries and USA. Also impact on economy and most important on education and wellness of young people were not as bad as in other parts of the world.
A major point missed by this article is that Covid was only a deadly disease to a small cohort of the population and the experts knew, yes knew, who they were from the early stages but ignored it and never utilised this information to define an effective public health policy. That is the direct failure of the public health officials and all political leaders involved.
Please give me one policy that would have used this successfully.
(Note if have seen dozens of them and they’re all bad)
Perhaps more attention to nursing homes where the elderly and people with less competent immune systems are housed was
an obvious location where more aggressive containment could have been implemented at an early date These areas of population concentration like jails could have been expected as a target for very aggressive action to avoid excess deaths. That is the only policy I might identify
The issue of containment is difficult even in hospitals where hand washing is always mandatory many slip ups occur daily With mask use the issue there is easier as all medical personnel are familiar with need for surgical masking but M95s have not been the type of mask used there traditionally in the OR
This was tried. Notably by Sweden. Miserable failure, because nursing homes are full of young people (aka workers) who, when there’s a massive wave outside, tend to catch it and bring it to the nursing home, where a single escape then quickly infects everybody (indoors, crammed, old ppl).
I don’t know a single region in the world that was able to do this successfully.
For the same reasons that masking is not 100 percent effective. It only takes one or two slip ups and the bug wins. Procreation and expansion is the moving power
"the experts knew" . Citations please.
Are you aware that the overall covid mortality was estimated to be 0,26% in April 2020, and now it's 0,1% right? Just to make sure you understand what you're talking about.
Hi! You should analyze how that number is reached. A blended, global IFR for a naive population in developed economies (the number that’s relevant for these countries’ judgment of measures) would be closer to 1%.
The number you quote is usually used for a global population (how do you know the infection rate?) and includes post-vaccines and the like.