Positively Negligent
Positively Negligent
Having COVID gives you time to ponder our public-health failures
It was March 8, 2020. As cases of COVID-19 started popping up in the United States, Americans’ fear of the virus was arguably at its peak. (The irony that this was the case when its prevalence was so much lower than the heights it would later reach might be funny if it weren’t so morbid.) For a fleeting moment there was a (relative) ideological consensus that we should act to keep people safe, and it was a crucial chance to set the tone for our collective response to the incipient pandemic.
It was in this context of an unusual national appetite for scientific expertise that Dr. Anthony Fauci sat down for an interview with Dr. Jon LaPook. Their conversation on 60 Minutes that night would go down in infamy:
LAPOOK: There’s a lot of confusion among people, and misinformation surrounding face masks. Can you discuss that?
FAUCI: The masks are important for someone who’s infected to prevent them from infecting someone else. Now, when you see people, and look at the films in China, or in South Korea, whatever, and everybody’s wearing a mask. Right now, in the United States, people should not be walking around with masks.
LAPOOK: You’re sure of it. Because people are listening really closely to this.
FAUCI: Right now, people should not be walking — there’s no reason to be walking around with a mask.
Fauci went on to condescendingly finger-quote that masks might make people “feel” better as a placebo, and to suggest that the benefits of wearing one were outweighed by the possibility of touching your face to adjust it. He even added a Trumpian xenophobic flourish, implying that masks were for other people.
What haunts me about this moment is not that Fauci was wrong — observing and reevaluating is part of science — but that it was intentionally misleading. As Fauci later conceded, his primary reason for discouraging masks was not that he doubted their effectiveness but that he wanted to preserve the country’s limited supplies of protective equipment for health-care workers. It was an undoubtedly noble motive, but it was nonetheless a dishonest one. (Secondarily, he also claimed his advice predated the knowledge that asymptomatic people could spread the virus, despite the fact that Fauci himself had warned about the phenomenon a month earlier.)
I am both broadly and selfishly grateful that medical workers’ already-dire shortages of protective equipment were not strained even further, and I don’t doubt that Fauci’s intentions were good. Yet I can’t help but wonder how many of the Americans who died in the first phase of the pandemic were infected by people who would have worn masks had Fauci recommended them from the start.
Maybe Fauci’s paternalistic bet was the correct one — the situation might very well have been worse if he had been honest about both the efficacy of masks and the shortage of them from the beginning. But I would ask yourself if there are any other circumstances in which you would accept a Trump administration official spreading misinformation for a purported greater good, and whether Fauci should really be seen as an exception.
However he weighed the short-term effect of his anti-mask messaging, I suspect Fauci did not account for how it would reverberate in the long run. By the time he started advocating for face-coverings, the moment of national unity had largely passed, and requiring or even recommending transmission-control measures had taken on a partisan bent. Beyond the diminished receptiveness to new restrictions in a country that was already aching to get back to normal — oh, how naïve we were, thinking this might be over in a matter of weeks! — Fauci’s flip-flop became grist for the mill of bad-faith reactionaries, who in turn sowed seeds of doubt about masks’ usefulness among even well-meaning people.
Surely some great number of the more-than-a-million Americans who died of COVID-19 would still be here if wearing masks had not become a political statement in our country. Some incalculable further fraction still — a terrible tragedy in human terms, even if proportionally small — can presumably be traced back to Fauci’s initial recommendation against it. Such are the stakes of public-health leadership.
I have COVID. I’m writing this essay between fits of coughing and swigs of tea. (Hopefully if you’re a subscriber this doesn’t get caught in your email provider’s virus filter! Ba dum tss.) I’m lucky in that my symptoms are mild, I have access to medicine and testing, and I have a comfortable place to wait the illness out. Yet even a mild case of COVID sucks. It feels like a bad chest cold, which again is a lot better than it could be, but isn’t fun to deal with. The prospect of being confined to my apartment for several more days has given even this homebody a case of cabin fever. And my potential contagiousness has already cost me the chance to attend two major special events that I’ve been looking forward to for months.
Being stuck at home gives you a lot of time to ponder things. It would be easy to wallow in the frustration that a stranger’s carelessness caused me to cancel a trip, or to beat myself up because the levels of caution that protected for me for two years finally failed a week before my friends’ wedding. Either attitude would be fair. But dwelling on such things is itself a symptom of a broader disease: The delegation of public-health responsibilities from government experts to individual laypeople.
It started with, or at least under, the Trump administration. After the initial COVID panic started to subside, the federal government abdicated its responsibility to help its citizens make informed decisions about the risk. Leading Republicans downplayed the severity of the disease, opposed measures to reduce transmission, and fomented distrust in the miraculous, lifesaving vaccines. Politicians in blue states and major cities have implemented restrictions at various points, and the Biden administration has at least paid lip-service to a more-collectivist approach. Yet most local measures are no longer in effect, and leading Democrats seem checked out of mitigation efforts even as the country is engulfed by yet another big wave. With the admittedly large exception of free vaccinations, the American people have mostly navigated the pandemic on our own.
The average person isn’t equipped to assess their own medical risk or parse scientific data, yet our country’s approach has been unapologetically individualistic. The cautious among us have unfortunately internalized the notion that getting COVID is a moral failing, betraying an insufficient level of caution. We roll our eyes at people who don’t get vaccinated, but don’t consider whether they have accessible ways of doing so. It’s easy to glare at the bare-faced customer at the pharmacy — or stranger yet, the person with the mask strapped below their chin like an amulet — and reflexively judge them for their selfishness. We as individuals surely have an obligation to those around us to act responsibly, but that should not obscure the core failures of public-health communication and regulation that have led people to make such choices.
There’s another story from relatively early in the pandemic that I’ve thought about almost every day since I read it. It’s about a man named Josh, as detailed by The Atlantic’s Amanda Mull. At the start of the 2020-21 winter surge that led to the U.S.’ deadliest phase of the pandemic, Josh considered himself a COVID-cautious person, yet he regularly ate indoors in New York City restaurants when transmission was high and before vaccines were available. The oxymoronic juxtaposition of his self-image and his actions stemmed not from cognitive dissonance or a belief in his own invulnerability, but from a mistaken trust in his state and municipal technocrats: If it weren’t safe to do it, the restaurants would still have been closed. Josh “assumed that local health officials had figured out a patchwork of precautions that would make indoor dining safe,” Mull wrote. “If indoor dining couldn’t be made safe, he wondered, why were people being encouraged to do it?”
Josh’s story is illustrative of two congruent but distinct problems with how the Democratic Party has approached pandemic-mitigation. (Yes, of course the Republicans have been even worse on this, but for the most part the GOP has made no secret of its disinterest in public-health initiatives, whereas the Democrats campaigned on Believing Science and control almost every executive office and legislative body in whose respective jurisdictions I lie — for now.) The first is demonstrating through their (in)actions that they do not see containing COVID as a top priority. At the national level, Joe Biden’s campaign website reads like a ghost town of abandoned ideas, from the ambitious 100,000-person public-health job corps (converted to a much-smaller AmeriCorps project) to the seemingly innocuous National Pandemic Dashboard to make local-transmission information more accessible (disappeared from the conversation so thoroughly that Google has literally two results for it in the last year). The administration considered and decided against sending out tests to preempt last year’s viral surge, and were pressured into doing so only belatedly, after Press Secretary Jen Psaki all-but-laughed at idea of it.
Sometimes there’s nothing implicit about their glib approach to the pandemic. By their own admission, the Biden administration was caught off-guard by the emergences of both Delta and Omicron — there’s an expression that comes to mind about being fooled twice — and ignored pleas to push harder for the vaccine patent waivers that would help prevent new variants from arising. The CDC’s recently loosened thresholds for post-infection quarantine lengths and community-transmission levels both serve to downplay the virus’ severity. Earlier this month, news from the White House concurrently featured two tellingly juxtaposed messages: that the government is running out of money to fight COVID, and also that cities should divert their remaining pandemic-related funds to law-enforcement.
We can see this unseriousness at the local level, too. As Omicron surged here in Philadelphia in December, the city announced that a two-dose vaccine regimen would be required to eat in a restaurant…with a five-week delay before the rule went into effect. Two days later, the health commissioner asked Philadelphians not to gather with other households for the holidays — implying that, in the city’s eyes, visiting your cousins for Christmas was irresponsible, but meeting them at a crowded bar on New Year’s Eve where the other patrons may or may not be vaccinated was safe. (To say nothing of the fact that the mandate did not include boosters, despite the by-then-common understanding that months-old initial doses were not enough to prevent someone from catching and transmitting Omicron.) The city wound up dropping the restaurant requirement after less than a month, meaning the grace period lasted longer than the actual policy. Incredibly, this wasn’t the only time that’s happened here: last month’s brief reimposition of the municipal mask mandate was launched with a week’s warning, then nixed after just four days.
The second issue illustrated in Mull’s essay is less immediately harmful but might be even more insidious in the long run: A loss of credibility. I can’t read Josh’s story and imagine him heeding a politician’s public-health claim ever again. And we’ve seen so many more instances of civic leaders blatantly undermining the urgency of the situation. Relaxing the CDC guidelines for isolation time and prevalence-tolerance despite objections from epidemiologists breeds distrust, especially when it’s presented as about economics, not health. Biden undercut his own administration’s messaging on the importance of face-coverings after the national mask mandate on airplanes and public transportation was struck down last month (a ruling leant more apparent justification by the CDC’s artificially lowered risk levels). For all the talk of how harmful anti-vaccine demagoguery is, no one seems to mind that now-Secretary of Transportation Pete Buttigieg was pandering to its adherents on the campaign trail mere months before COVID emerged. To say nothing of the constant parade of politicians flagrantly ignoring their own safety guidelines.
The last two years have been chock full of public-heath decisions seemingly based more on politics than science — arguably starting with Fauci’s dismissiveness of masks. Fairly or unfairly, sincerely believed or cynically spun, each perceived instance of capricious guideline changes or hypocrisy without accountability abets in eroding the ethos of our institutions. Without remotely condoning the right-wing push to undermine trust in science and medicine, is it any wonder that such skepticism is widespread enough for bad-faith actors to capitalize on?
You can’t be too careful these days. I mean that literally: Unless you lead a fully hermetic lifestyle, the virus is too prevalent and contagious to be confident that you can avoid it. You can mitigate your risk (and the risk you pose to others) of COVID by getting vaccinated, minimizing your time in crowded spaces, wearing a tight-fitting non-cloth mask indoors, and testing when you can. (PSA: You might be eligible for free at-home tests from USPS and/or CVS.) The virus still got me, but that doesn’t mean it wasn’t worth the effort.
I believe we each have an obligation to your community to do at least some combination of those things, and I think it’s fair to judge those who choose not to. But to focus primarily on individual-level morality in navigating COVID is to accept a problematic premise. We should expect our elected leaders to provide honest knowledge, helpful guidance, and medical resources in the midst of a pandemic. It’s not surprising that the absence of such things begets doubt and noncompliance. When those who are tasked with ensuring public health shirk that responsibility — let alone flaunt their disinterest in providing it — it creates the perfect conditions for viral mentalities to spread.