Sunday, January 23, 2022

The Pandemic Public-Health Disaster

By James B. Meigs

Friday, January 23, 2022

 

In late February  2020, we could see the COVID-19 tsunami coming, but it hadn’t yet hit U.S. shores with full force. Like any father, I wanted to make sure my family was safe. Since all three of my sons were living away from home, we started trading emails about the latest research and recommendations. President Trump’s chaotic management style was one concern: Would state, local, and federal governments be able to focus on fighting the pandemic in an atmosphere of political drama? I tried to reassure everyone: “Despite alarmist stories to the contrary, we have really good public-health officials and infrastructure in the U.S.,” I wrote in a family email on March 2, 2020. “They’ll do their jobs regardless of who is president.”

 

Oh, was I wrong.

 

Over the coming months I realized I had wildly overestimated the competence of our public-health bureaucracy. At a time when we needed our officials to respond nimbly to a rapidly evolving threat, our health agencies proved slow and inflexible. When it came to providing workable tests for the virus, speeding up deliveries of protective equipment, or simply communicating clearly and honestly with the nation, our public-health establishment failed. It wasn’t just a matter of moving too slowly. At times, our health bureaucrats actively obstructed doctors, researchers, private companies, and others trying to fight the pandemic. They even tried to limit the range of permissible scientific discussions about COVID-19, shutting down inquiries into the origins of the virus and debates about how it spreads.

 

The problem wasn’t that they lacked professionalism or empathy; as individuals, most are dedicated and conscientious. The problem is in the nature of the health bureaucracy itself. Its rules and traditions demanded they follow a cautious, plodding approach even in the middle of a galloping crisis. A hard-driving president can sometimes push the bureaucracy to move faster than normal, as Trump did with Operation Warp Speed. And federal agencies are more likely to remain stuck in their ruts under a passive leader, as the Food and Drug Administration and the Centers for Disease Control have mostly done during the Biden administration. But the limitations of our federal bureaucracies are pretty well baked in. Moreover, they haven’t been the only obstacles to fighting COVID. Our leadership class as a whole has proved poorly equipped to deal with the pandemic, in part because it holds such a low opinion of the public it serves.

 

Early in the pandemic, I wrote an article for Commentary about lessons from the 1964 Alaska earthquake. My piece described how, in the hours after the quake, Anchorage officials deputized teams of patrolmen to control the panicked mobs and looters they assumed would soon rampage through the city. “At the time,” I wrote, “most experts believed any major disaster would cause ‘a mass outbreak of hysterical neurosis among the civilian population,’ as social scientist Richard M. Titmuss had put it…. Only firm control by powerful authorities could keep the lid on such dangerous situations.” In the end, those mobs and looters never materialized. Instead, Anchorage civilians immediately started working together to search damaged buildings, clear rubble, and care for survivors.

 

Such calm and cooperative responses to disasters are common—the norm, in fact. Think of the stalwart way Londoners carried on through German bombing attacks in World War II. But people in positions of authority—police, government officials, the media—generally expect the worst from their fellow citizens when trouble strikes. As a result, they tend to see themselves as a bulwark against a dangerous and irresponsible populace. Disaster researchers call this phenomenon “elite panic.” It’s a slightly melodramatic term, but it captures the way people in authority often focus more on controlling the public than on fighting the catastrophe. In disasters ranging from Hurricane Katrina to Fukushima, I wrote, officials have tended to “clamp down on information, restrict freedom of movement, and devote unnecessary energy to enforcing laws they assume are about to be broken.”

 

Does this sound familiar? As we’ve all seen, the COVID-19 pandemic has been one long case study in elite panic. From Day One, the CDC, the FDA, and other agencies have tried to maintain the tightest possible control over how Americans behave in the crisis. Case in point: On February 4, 2020, the FDA issued an emergency authorization allowing the use of a COVID-19 test kit developed by the CDC. Various independent laboratories and health organizations had developed their own tests, but none of those were approved. In fact, organizations that wanted to use their own tests simply to research the spread of COVID were threatened with legal action. Thousands of laboratories capable of processing millions of tests were sidelined.

 

Across the U.S., researchers and health organizations were desperate to get in the fight against COVID. But the CDC and the FDA essentially told them: Leave the job to the experts. To the bureaucratic mind, an ad hoc and decentralized approach to testing was unthinkable. In the end, the CDC’s test didn’t even work. The experts had bungled the job while simultaneously forbidding others from trying different approaches. At the time, many observers hoped that this testing debacle was a temporary misstep. Sadly, it was a template.

 

When the FDA finally moved to start approving independently developed tests, the laboratories seeking authorization ran straight into a bureaucratic maze. The virus was spreading by the day, but the FDA’s complex procedures couldn’t be streamlined. Instead of submitting applications online, for example, labs were required to encode their data on CD-ROM disks and send those in by mail. (Note to younger readers: CD-ROM is a largely obsolete data-storage format. Big in the 1990s.) By the time other tests were approved, it was too late to help track the initial spread of the disease.

 

The fight against COVID would require “an immediate intervention to break America free from its bureaucratic addiction,” warned good-government advocate Philip K. Howard in an April 2020 City Journal article. That never happened. If anything, our public health bureaucracies became more entrenched, while their power over everyday life expanded exponentially. Even the simplest initiatives got bogged down. Everyone remembers that masks and other types of personal protective equipment were in desperately short supply during the early months. But fewer people know that manufacturers were standing by, clamoring to deliver perfectly acceptable substitutes for the approved brands of PPE. Hold on, the CDC told them. First they’d have to go through the agency’s laborious approval process—which could take as long as three months.

 

The health bureaucracy’s check-every-box mentality isn’t just inertia. (And, of course, during normal times we want these officials to be meticulous.) It’s part of the culture. The CDC and the FDA exhibit a tendency I called the precautionary paradox in another 2020 Commentary column. The precautionary paradox is literally an excess of caution: Many safety-conscious organizations develop elaborate rules and procedures to limit risk, and any proposed changes to those rules must be justified by mountains of data. Normally, that focus on rules really does enhance safety. But in an emergency, an organization needs to move quickly—there isn’t time to conduct endless studies. In those cases, being too rule-bound makes us less safe. Simple, commonsense decisions get delayed. Common sense would say that a mask that’s almost as effective as the CDC-approved version is better than nothing. But that wasn’t good enough for the CDC regulators. As a result, those almost-as-good masks were held up for months. The agency’s misplaced caution meant hospital workers had to go to war against COVID wearing homemade masks and drugstore shower caps. 

 

In any disaster, one of the government’s most critical tasks is clear, honest communication. Here too, our leaders stumbled, and our news media compounded the damage. Even today, the messages from U.S. politicians, health officials, and media outlets reflect a weird combination of the precautionary paradox and elite panic. If this unspoken ethos could be summed up in a motto, it would be: You can’t be too careful, and you can’t trust the public. Since these leaders don’t think people will act responsibly on their own, they feel justified in shading the truth in ways meant to nudge us toward proper behavior. In the early weeks of the pandemic, that meant downplaying the potential severity of the disease. Politicians worried that pandemic panic might tank the stock market or set off spasms of anti-Asian xenophobia. So leaders ranging from Trump to New York Mayor de Blasio all urged the public to “go about your business” or to “come to Chinatown!” as Senator Nancy Pelosi famously urged in February 2020.

 

But once authorities pivoted to lockdowns as the universal COVID strategy, it became more common for officials and the press to exaggerate the risks of various activities. Even early on, it was clear that people were safer outdoors than indoors. Nonetheless, local governments closed playgrounds, and newspapers ran endless pictures of “crowded” Florida beaches as if to shame the reckless Floridians who dared venture into the sunlight. Experts knew these fears were excessive, but most went along with the charade. I suspect they thought pumping up the paranoia might help keep the public in line in other settings as well.

 

From the start, some officials have indulged in what they probably believe to be noble lies. In March 2020, when Dr. Anthony Fauci told 60 Minutes, “There’s no reason to be walking around with a mask,” he wasn’t giving his scientific opinion about the efficacy of mask-wearing. As he later admitted, he was trying to discourage the public from buying masks in order to preserve supplies for health-care workers. Why didn’t he just say that in the first place? Because he didn’t trust the public to do the right thing. When the CDC reversed course a few weeks later and began touting the scientific rationale for mask-wearing, many Americans realized they’d been lied to.

 

That was the start of a continuing string of half-truths, factual manipulations, and telling omissions on the part of our public health elite. In particular, officials are willing to bend the truth if they think it will cajole the public into getting vaccinated. Fauci several times changed his estimate of how many people would need to be vaccinated in order to reach herd immunity. He later admitted that he revised the numbers not because the science had changed but in order to persuade more people. “I thought, I can nudge this up a bit,” he said. 

 

During the Omicron surge in late 2021, New York’s Department of Health announced a scary spike in the number of children hospitalized with COVID. It made headlines. Later, the state’s health commissioner had to admit that those children were generally admitted with COVID, rather than because of COVID, and that the overall numbers were small. But the department had a legitimate reason to frighten the public, she said: “It really is to motivate pediatricians and families to seek the protection of vaccination.” As the radiologist and public-health advocate Pradheep Shanker responded on Twitter, “These clowns are undermining faith in the health care system for a generation.”

 

Under Biden-appointed director Rochelle Walensky, the CDC has shown an unseemly deference to the concerns of teachers’ unions. In interviews and briefings, she often cites an Arizona study that found schools without mask mandates were 3.5 times more likely to have COVID outbreaks than schools where children are masked. But, as the Atlantic’s David Zweig showed, the study Walensky likes to reference is a wild outlier, one whose methodology was so sloppy one researcher called it “ridiculous.” In fact, evidence that children need to be masked in schools is dubious at best.

 

This steady drip-drip-drip of misleading or politically motivated statements has taken its toll, especially since they come from officials who claim to represent objective science. And if the statements aren’t accurate, what are we to make of the policies based on them? At the start of the pandemic, polls showed most Americans—including conservatives—were generally willing to accept business lockdowns, masks, school closures, and similar measures, at least for the short term. “Trust the science,” we were relentlessly admonished, and most people did—at first. But as the months rolled on, we learned that the science behind these measures was surprisingly tenuous. Many COVID policies turned out to be based less on science than on a general fear of allowing citizens to move about freely or make their own decisions.

 

But that didn’t stop officials from enforcing arbitrary COVID restrictions with zeal. Governors, mayors, and local officials almost seemed to relish micromanaging people’s daily lives. Michigan Governor Gretchen Whitmer issued rules dictating which hardware-store aisles could remain open and which had to close. Louisville mayor Greg Fisher moved to ban drive-in Easter church services in his Kentucky city and threatened to record the license plates of violators. Police in Encinitas, California, ticketed people for “watching the sunset” on a local beach. Because you can’t be too careful.

 

In New York State, Governor Andrew Cuomo mandated that bars could stay open only if they served plates of food along with beverages. Bars without kitchens began serving plates of “Cuomo chips” alongside glasses of beer. That measure at least had a humorous side. Cuomo’s signature COVID policy—forcing nursing homes to accept COVID patients discharged from hospitals—is believed to have contributed to perhaps 1,000 or more fatalities. We now know that just as Cuomo was basking in media plaudits for his supposedly masterful handling of the pandemic, his administration was busy concealing the data on nursing-home deaths. This wouldn’t be the last time that scientific data was distorted or misused for political ends during the pandemic.

 

At the federal level, the CDC assumed unprecedented new powers. In addition to issuing sweeping “recommendations” that states and cities were expected to follow, the agency claimed direct authority over matters that would normally be the province of Congress or state governments. As part of the March 2020 CARES Act, Congress included a limited moratorium on evicting nonpaying tenants. When that moratorium expired in July 2020, the CDC stepped in and issued a much broader eviction ban, one that covered properties nationwide and included criminal penalties for landlords.

 

How did this happen? The CDC’s authority derived from the 1944 Public Health Services Act, which gives federal officials license to perform functions such as “inspection, fumigation, disinfection, sanitation, pest extermination,” and so on. Nowhere does it mention the wholesale negation of private property rights. Of course, the argument that evicting delinquent tenants would inevitably spread COVID was tenuous at best. Nonetheless, the CDC repeatedly extended the order for over a year. In the end, the Supreme Court had to swat down the agency’s unconstitutional overreach.

 

Other agencies also expanded their remits. In September 2021, Biden ordered the Occupational Safety and Health Administration to issue an “emergency” policy forcing companies with 100 or more workers to require their employees be vaccinated. George Mason University law professor Ilya Somin writes that the OSHA mandate “effectively gives presidential administrations a blank check to control nearly every aspect of every workplace in the country.” This measure was also blocked by the Supreme Court (although the court upheld a vaccine mandate for federally funded healthcare institutions). During oral arguments, some justices still managed to rattle observers by repeating wild misinformation about COVID-19. Justice Sonia Sotomayor asserted that 100,000 children are hospitalized, “many on ventilators.” In truth, fewer than 5,000 coronavirus-positive children were in hospitals at the time, most for other conditions. 

 

At every level of government, the precautionary paradox ruled. Once a particular order was in place, the burden of proof shifted: Public health officials didn’t have to show that lockdowns and other measures were worth their enormous costs; instead, it was up to lockdown opponents to prove that reopening would be safe. At the same time, our definition of safety shifted. What began as “two weeks to stop the spread” turned into an effort to eradicate COVID entirely. That gave teachers’ unions, for example, the clout to argue that if reopening schools would lead to even a handful of new cases, that was reason enough to keep them closed.

 

It will take years to assess the widespread economic, psychological, and social damage caused by these excessive restrictions. But we already know that poor children in particular have fallen far behind because of school closures. Michael Petrilli of the Thomas B. Fordham Institute told Politico, “We haven’t seen this kind of academic achievement crisis in living memory.” And the emotional fallout is growing. The American Academy of Pediatrics recently warned of “soaring rates of mental health challenges among children, adolescents, and their families.” The CDC says attempted suicides among young teenage girls are up sharply. It’s particularly heartbreaking given that children have never been at much risk from COVID. As the New York Times’ David Leonhardt notes, American society “accepted more harm to children in exchange for less harm to adults.” With the explosion in Omicron cases, teachers’ unions again began pushing for school shutdowns. As I write this, Chicago schools are closed thanks to a teachers’ strike. Because you just can’t be too careful.

 

Perhaps the biggest blow to elite credibility on COVID came after the George Floyd killing in May 2020. While protestors flooded the streets in defiance of COVID guidelines, public health officials were mostly silent—or cheering from the sidelines. A group of 1,288 self-described health experts and “community stakeholders” signed a letter encouraging the protests because “White supremacy is a lethal public health issue.” We now know that outdoor gatherings are not major spreaders of COVID-19. But at that time, virtually all outdoor events—music festivals, sporting events, weddings, funerals—were suspended. Previously, group singing had been implicated as a key element in super-spreader events. Now suddenly, Americans were being encouraged to pack the streets, singing, chanting, and shouting for hours on end.

 

“At least for me, the sudden change in views of the danger of mass gatherings has been disorienting,” former Harvard Medical School dean Jeffrey Flier told Politico, “and I suspect it has been for many Americans.” It wasn’t just disorienting; for many—and not just for conservatives—the flip-flop revealed a maddening hypocrisy. “That episode single-handedly destroyed trust in public health officials, proving they’d politicize their expertise when convenient,” wrote left-wing gadfly Glenn Greenwald.

 

But even as they overreached in trying to regulate our daily lives—Don’t go to work! Do go out and protest!—health officials have remained weirdly hesitant to try to learn everything possible about the virus. At times they’ve even lashed out at scientists who raise uncomfortable questions. In the early weeks, several prominent virologists wondered whether COVID-19 might be related to research at the Wuhan Institute of Virology, which is a major center for studying this family of viruses. But in February 2020, a group of eminent virus researchers jointly published a letter in the Lancet, a leading medical journal, denouncing the lab-leak question as a “conspiracy theory.” Top U.S. officials and the World Health Organization echoed the accusation and the news media eagerly doubled down, calling the notion “debunked” despite the lack of any investigation.

 

Why such a backlash? Elite panic was a big part of it: Some members of the public-health establishment openly worried that discussing China’s possible culpability would stir up xenophobia and anti-Asian violence. Mainstream journalists and the social-media giants—always leery of topics they fear will rile up the right—worked hard to deep-six the story. (“Someday we will stop talking about the lab leak theory and maybe even admit its racist roots,” a New York Times science reporter wrote on Twitter. “But alas, that day is not yet here.”) Another factor was the creeping politicization of COVID-19 science: Among the people asking about a possible lab leak were conservatives and Trump supporters. Some scientists later admitted that that fact alone meant they couldn’t discuss the question, even if they thought it had merit. The media quickly concluded that the lab-leak theory had been ginned up by Republicans for political gain. The Atlantic’s David Frum even compared it to the anti-Communist witch hunts of the 1950s. Instead of weighing the evidence, the media framed the debate in Manichean terms: Whose side are you on? It took over a year before independent researchers and a few brave journalists managed to drag the issue into the sunlight.

 

Perhaps the most ominous factor in the suppression of the lab-leak story was institutional self-preservation. We eventually learned that the U.S. National Institutes of Health, along with Dr. Anthony Fauci and several of the scientists involved with the Lancet letter, had been working closely with the Wuhan lab and had funded some controversial research there. Instead of putting their cards on the table, and perhaps facing some tough questions from Congress and the public, these public-health leaders tried to bury the whole topic. Even today, much of the vital information about the origin of COVID and the relationship between U.S. officials and the Wuhan lab remains under wraps. So much for transparent scientific inquiry.

 

* * *

 

The public health elite also showed a profound lack of curiosity about exactly how COVID-19 behaves in the environment. From the start, the WHO, the CDC, and other health agencies were confident that the virus spreads much like other respiratory viruses: through “close contact” with infected people. That would include breathing in the “respiratory droplets” people emit when they breathe, or touching surfaces contaminated by such fluids. “The virus does not spread easily in other ways,” the CDC flatly asserted. Conventional wisdom held that such droplets usually settle to the ground within two meters, hence the advice we heard endlessly repeated: Stay six feet apart and “just wash your hands.” But the CDC’s guidance was based on shoddy science. Worse still, the CDC, the WHO, and other groups were refusing to listen to scientists who knew better.

 

As early as March 2020, experts in airborne disease transmission were marshaling evidence that the conventional wisdom on droplets was wrong. In fact, many of the particles exhaled by infected people were extremely small—tiny enough to be classified as aerosols, these scientists maintained—which meant they could stay aloft longer and infect others at much greater distances. Far from being rare, airborne transmission was “the dominant route for the spread of COVID-19,” one group of researchers concluded. Still, the CDC and the WHO refused to budge, even after an international group of 248 scientists published an open letter begging health agencies to acknowledge the airborne risk. It wasn’t until October 2020 that the CDC admitted COVID might “sometimes” be spread by air.

 

What took so long? Once again, our health bureaucracy was hobbled by a misguided sense of caution. Public health officials were reluctant to change their “close-contact” model without an enormous amount of evidence. Of course by being too cautious about changing its guidance, the CDC put Americans at greater risk. The agency could have told the public early on that airborne transmission was a real possibility even though the data weren’t conclusive. But that would have required asking the public to cope with a bit of nuance—and you can’t trust the public. Instead the CDC strongly downplayed the airborne angle, giving the public a false sense of security. People were washing their groceries when they should have been opening their windows. Even after the agency changed direction, it didn’t actively promote the necessary mitigation measures. Schools, businesses, nursing homes, and other institutions desperately needed advice on how to make their facilities safer. But it took over a year before the CDC began issuing detailed guidance on improving ventilation, upgrading air filters, and the like.

 

Not everything has gone badly during this pandemic. Even as we criticize some public health leaders, we should recognize the important and thankless work of many unnamed officials at the federal, state, and local levels. Doctors and medical researchers made huge, rapid strides in understanding and treating this confounding disease. And, of course, the development and approval of three vaccines in under a year was an unprecedented achievement. The public-private partnership embodied in Operation Warp Speed should be seen as a model for future emergencies.

 

But even the vaccine success story was tainted by politics. In the fall of 2020, a group of prominent medical experts, led by Scripps Research Institute professor Dr. Eric Topol, feared that Trump was applying untoward pressure on the FDA to approve the Pfizer vaccine before the election. The group publicly lobbied the FDA and Pfizer to push back the authorization process until later in the year, which they ultimately did. Topol celebrated the delay on his popular Twitter feed: “We were on a path for a vaccine emergency authorization (EUA) before November 3rd. Thanks to the FDA, Trump’s plan was disrupted.”

 

Topol and his allies feared that if the public believed that Trump had put his thumb on the FDA’s approval scale, it would undermine public trust in the vaccine. They might have been right about that. But delaying the rollout of a lifesaving vaccine by several weeks—at a time when COVID was killing 600 people each day—seems like an extreme solution to a hypothetical problem. More ominously, perhaps some advocates for slowing the authorization also worried that good news on vaccines might boost Trump’s reelection chances. If so, the authorization delay would count as one of history’s more cynical abuses of scientific authority for political ends.

 

In any event, it wasn’t only Republicans undermining confidence in the vaccines. On the campaign trail, both Biden and Kamala Harris flirted with the idea that any vaccine approved under Trump couldn’t be trusted. Harris told CNN she believed that under his presidency, honest public health experts would “be muzzled, they’ll be suppressed, they’ll be sidelined.”

 

Joe Biden won the presidency partly on the strength of his promise to “shut down the virus.” But he spent his early weeks in office emphasizing performative gestures such as canceling the Keystone XL pipeline. Then came the all-consuming battle to pass the Build Back Better bill. No doubt Biden’s advisers assumed the vaccines would vanquish the pandemic, leaving them free to tackle more momentous goals. They never came up with an adequate plan to cope with follow-on waves of COVID-19 variants, even though experts had warned about that likelihood from the start.

 

A comprehensive pandemic plan would have addressed two realities: There will always be some people who refuse to be vaccinated. And no vaccine will be 100 percent effective. That means doctors still need an arsenal of treatments for the disease. And we need a robust testing capacity, including PCR tests and rapid at-home antigen tests. The Biden administration promised aggressive action on both fronts. But when Omicron hit in late 2021, the White House was caught flat-footed. With the holidays coming on and Omicron spreading, Americans rushed to buy home testing kits—if they could find or afford them. “It’s an outrage that rapid tests aren’t cheap and plentiful on grocery store shelves,” Yale School of Public Health professor David Paltiel told ProPublica. Meanwhile, PCR test centers were overloaded. In many cases, test facilities couldn’t promise to return results in less than three or four days.

 

As the outcry grew, the White House scrambled to address this entirely foreseeable problem. Biden himself seemed bewildered. “I wish I had thought about ordering a half a billion [tests] two months ago,” he told ABC News. In fact, his administration had repeatedly promised to make test kits widely available—and so had his campaign during 2020. (In most of Europe, kits are plentiful, and either free or dirt cheap.) The administration finally cobbled together a plan to make insurance companies reimburse the cost of test kits—if anyone could find them. It was all too little, too late.

 

Why didn’t U.S. public health agencies make home test kits a bigger priority? I think elite panic played a part: Home testing gives people personal control over their health information. The government doesn’t have access to the data from home kits, and it plays less of a role in telling users how to interpret the results. Obviously, people wouldn’t be buying the kits if they didn’t want to use the information to help keep themselves and others safer. (“Let’s all take a test before we go visit Grandma.”) If tests were cheaper and more widely available, those kinds of individual decisions could do a lot to arrest the spread of COVID. But that would mean allowing people to use their own judgment. And you can’t trust the public.

 

A similar ambivalence might have undermined efforts to speed up the delivery of COVID-19 treatments. A handful of them, including monoclonal antibodies, were available when Biden came into office. Others were in the approval pipeline. Where was Biden’s version of Operation Warp Speed to move these treatments along? In late December 2021, the FDA authorized two promising oral treatments for COVID-19, Molnupiravir from Merck and Paxlovid from Pfizer. Paxlovid, in particular, seems to be a game-changer; in a 28-day study it reduced COVID-19 patients’ chances of hospitalization and death by 88 percent. But neither pharmaceutical company appears ready to deliver these drugs in the necessary quantities for several months.

 

When Omicron descended, demand for COVID treatments spiked. Although Omicron is milder than previous forms of COVID-19, it is infecting many more people. And some of those infections require aggressive treatment. But the needed drugs—including monoclonal antibodies that had been authorized in late 2020—are in short supply. Just as in the desperate early months of the pandemic, state governors are complaining that the federal government is hoarding vital medical supplies. But it isn’t early 2020; it’s 2022, and COVID-19 has been the central focus of our public-health establishment for two grueling years.

 

Why aren’t they ready for this not-particularly-deadly variant? There are several reasons, but a subtle antipathy toward treatments in general might be one. Earlier in the pandemic, many conservatives latched on to the (much disputed) benefits of treatments such as hydroxychloroquine and ivermectin, and public health officials and the media pushed back with a vengeance. (When podcaster Joe Rogen announced he’d taken ivermectin, an anti-parasitic widely used in both human and veterinary medicine, CNN host Brian Stelter insisted on calling it “a horse deworming medication.”)

 

Some health officials worried that if people believe that COVID-19 can be easily treated with drugs, they’ll be more reluctant to follow distancing and masking guidelines or to get vaccinated. So, like everything else COVID touched, the question of potential treatments became politicized. Conservatives became enamored with the idea of treatment, while the public health establishment and liberal elite wanted to keep the focus on prevention. Is it any wonder, then, why a truly groundbreaking treatment like Paxlovid has been greeted with somewhat muted enthusiasm?

 

Under Trump, skeptics worried he would force the FDA to cut corners on approvals. Under Biden, we seem to have the opposite problem. There has been no detectable sense of urgency in accelerating authorizations of new treatments or ramping up supplies as fast as safely possible. A key part of Operation Warp Speed involved subsidizing the manufacture of vaccines even before they were authorized. It was a gamble that allowed large numbers of doses to be made available almost immediately. The Biden White House did pre-order some doses of Paxlovid, but nowhere near enough to cope with Omicron. Not until January 4, 2022, did Biden announce that his administration would double its Paxlovid order to 20 million doses. They’ll all be here by…September.

 

Trump was justifiably criticized for his premature predictions that the virus would soon “just disappear.” But the Biden administration has proved every bit as over-optimistic as its predecessor. It had no plan to cope with new variant waves because it didn’t think it needed one. That might prove a blessing in disguise. With Omicron running rampant in blue states and elite communities, policymakers are finally accepting that the only real solution is something closer to the red-state approach: Vaccinate the willing, treat the sick, and let everyone carry on with their lives.

 

But this turnabout comes too late to repair the public’s trust in scientific institutions and in our leadership class in general. The American people entered this pandemic prepared to do whatever was necessary to fight the disease. But they’ve witnessed too much fudging and evasion from officials, too much media manipulation of the facts, and too many petty, unnecessary restrictions on daily life. Instead of regarding the public as engaged partners, our leaders treated American citizens as wayward children in constant need of being scolded, nudged, and even deceived into following the rules. Because you can’t be too careful. And you can’t trust the public.

 

When it came to public health, we were continually told to “trust the science.” But the scientists and public officials also needed to have a little trust in us. Our leaders lost faith in the American people long before the people lost faith in them.

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