Thursday, December 10, 2020

The Failure of the Public Health Establishment

 Matt Yglesias has an excellent retrospective on the absurd reversals over mask usage that arose in the early stages of the pandemic.  You will recall that the public health establishment, amplified by mainstream media outlets like the New York Times, told us all to ditch our masks and concentrate instead on frequent, vigorous hand-washing.  This was transparently absurd at the time, since from the beginning it appeared that coronavirus transmission had something to do with airborne virus exposure.

We were told masking didn’t protect us.

We were told only N95 masks worked, and only if they were taken on and off just so, in a complex procedure us untrained mortals could never execute.

And we were told we had to save these precious masks so health care workers could protect themselves, even though that was in direct contradiction to argument #1.  (Later, Anthony Fauci told us that conserving the inadequate supply of N95's was the underlying motivation, and the rest was mostly persuasion.)

By mid-spring the story had changed, and now we were all supposed to wear masks at least some of the time, although the WHO and the CDC were reluctant to go the full distance and admit that aerosol transmission was widespread and justified routine use of masks in social settings.  Today we have arrived at the point where reluctance to wear a mask is cause for shaming and shunning—as if the initial mask guidance and its repetition in the media had never happened.

But the mask fiasco was only a part of it.  Yglesias also mentions the shifting and contradictory policies regarding distancing: the immediate shutdown of outdoor activities even though indoors was more dangerous and the “hygiene theater” of deep cleaning while air filtration languished.  He says we should have a serious, critical examination of America’s response to the virus once the worst of the pandemic is over.

I agree, but I want to add a further observation and hypothesis.  Every failure of guidance and regulation had a common theme, protection of the health care system.  We should abjure masks because the health care workers needed them.  We can’t base messaging or policy on aerosol transmission because that would require expensive retrofitting of health care facilities.  We can’t restrict travel because medical supply chains and the movement of health care resources can’t be disrupted.  The objective is to “flatten the curve”, not eradicate the virus, because the important thing is to not run out of ventilators or ICU capacity—even though flattening has no visible endgame and itself contradicts the messaging about how awful it is to get covid.  Put it all together, and it’s hard to avoid the conclusion that the mission of public health had quietly morphed from protecting the health of the public to protecting the resources and operations of the health care system.

This is how it looks to me, but it’s still a hypothesis.  We could benefit from scrutiny of public health schools in universities, not least their funding, and public health agencies at the state and federal levels—and also the WHO.  Has public health been redefined this way in practice and even in theory?  If so, what would it take to redirect it so the health status of the public and not the burden on health service providers is their guiding concern?

32 comments:

The Sophist said...

Your thesis is echoed (in the UK) by Richard North over at eureferendum.com, where he basically said the same thing, in detail, over a number of posts that detail-by-detail dissected the UK response.

nobody said...

The dynamics at play here seem somewhat similar to those involved in non-corrupt regulatory capture. Governing bodies eventually adopt the perspectives of, and eventually focus on protecting the interests of, those entities with which they have the strongest relationships.

Public health bodies have very strong relationships with health delivery organizations, which would predispose them to protecting the interests of health delivery entities over those of the general public.

Anonymous said...

The point is that from the beginning efforts that Chinese specialists made to treat and protect against and contain the coronavirus were literally ridiculed in the New York Times. Masks were unnecessary, quarantine was a "dirty" tradition, self-defeating and abusive, building special hospitals was simply for show, and on and on. Where the Chinese realized that older men and women were especially vulnerable and needed special protection, health authorities in New York "directed" nursing homes to take coronavirus patients from hospitals:

https://www.nytimes.com/2020/07/08/nyregion/nursing-homes-deaths-coronavirus.html

July 8, 2020

Does Cuomo Share Blame for 6,200 Virus Deaths in N.Y. Nursing Homes?
A state directive sent thousands of Covid-19 patients into nursing homes, but the Cuomo administration has given other reasons for the virus’s spread.

https://www.nytimes.com/2020/05/13/nyregion/nursing-homes-coronavirus-new-york.html

May 13, 2020

Buried in N.Y. Budget: Legal Shield for Nursing Homes Rife With Virus
In New York, 5,300 nursing home residents have died of Covid-19. The nursing home lobby pressed for a provision that makes it hard for their families to sue.

Anonymous said...

I learned on December 30-31, 2019 of a seemingly different type of pneumonia that had been detected in a very few patients in Wuhan. The report was in the Chinese and international press, and from that day on I have followed events in China in the Chinese press and kept records.

By December 30-31, 2019, the cases of pneumonia detected in Wuhan had been reported to regional and national health authorities and news of the pneumonia cases was written about in an international Reuters article:

https://www.reuters.com/article/us-china-health-pneumonia/chinese-officials-investigate-cause-of-pneumonia-outbreak-in-wuhan-idUSKBN1YZ0GP

December 31, 2019
2:55 AM

Chinese officials investigate cause of pneumonia outbreak in Wuhan
By Reuters

The WHO was informed by China, the US was informed by China.  The WHO in turn informed all countries about the pneumonia outbreak from early January.  China updated and made public information on the outbreak every single day from the beginning of January.

By January 7, China had sequenced the genetic code of the novel coronavirus responsible for the pneumonia outbreak.

Anonymous said...

December 10, 2020

Coronavirus

US

Cases   ( 16,039,393)
Deaths   ( 299,692)

India

Cases   ( 9,796,992)
Deaths   ( 142,222)

France

Cases   ( 2,337,966)
Deaths   ( 56,940)

UK

Cases   ( 1,787,783)
Deaths   ( 63,082)

Germany

Cases   ( 1,270,432)
Deaths   ( 21,233)

Mexico

Cases   ( 1,205,229)
Deaths   ( 111,655)

Canada

Cases   ( 442,069)
Deaths   ( 13,109)

China

Cases   ( 86,673)
Deaths   ( 4,634)

Anonymous said...

December 10, 2020

Coronavirus   (Deaths per million)

UK   ( 927)
US   ( 903)
France   ( 867)
Mexico   ( 856)

Canada   ( 346)
Germany   ( 253)
India   ( 103)
China   ( 3)

Notice the ratios of deaths to coronavirus cases are 9.3%, 3.5% and 2.4% for Mexico, the United Kingdom and France respectively.

Anonymous said...

https://news.cgtn.com/news/2020-12-11/Chinese-mainland-reports-15-new-COVID-19-cases-W7T8POzdf2/index.html

December 11, 2020

Chinese mainland reports 15 new COVID-19 cases

The Chinese mainland recorded 15 new COVID-19 cases on Thursday, including 6 locally transmitted cases and 9 from overseas, the National Health Commission announced on Friday.

Seven new asymptomatic COVID-19 cases were recorded, while 200 asymptomatic patients remain under medical observation. No COVID-19 deaths were reported on Thursday, while 8 patients were discharged from hospitals.

The total number of confirmed COVID-19 cases reached 86,688, with 4,634 deaths as of Thursday.

Chinese mainland new imported cases

https://news.cgtn.com/news/2020-12-11/Chinese-mainland-reports-15-new-COVID-19-cases-W7T8POzdf2/img/cc7140aed1b548fca6270e267596636c/cc7140aed1b548fca6270e267596636c.jpeg

Chinese mainland new asymptomatic cases

https://news.cgtn.com/news/2020-12-11/Chinese-mainland-reports-15-new-COVID-19-cases-W7T8POzdf2/img/9594ef8262f54d10b7f4bef23cbe7ac7/9594ef8262f54d10b7f4bef23cbe7ac7.jpeg

Anonymous said...

There has been no coronavirus death on the Chinese mainland since the beginning of May. Since the beginning of June there have been 7 limited community clusters of infections, each of which was an immediate focus of mass testing, contact tracing and quarantine, with each outbreak having been contained. Symptomatic and asymptomatic cases are all contact traced and quarantined.

Imported coronavirus cases are caught at entry points with required testing and immediate quarantine. Cold-chain imported food products are all checked and tracked through distribution. The flow of imported cases to China is low, but has been persistent.

There are now 292 active coronavirus cases in all on the Chinese mainland, 5 of which cases are classed as serious or critical.

ken melvin said...

A real government would have handed out mask, sanitizer and food from the beginning.

Anonymous said...

December 10, 2020

Coronavirus

Massachusetts

Cases   ( 274,781)
Deaths   ( 11,209)

Deaths per million   ( 1,626)

Anonymous said...

December 10, 2020

Coronavirus

New York

Cases   ( 782,680)
Deaths   ( 35,326)

Deaths per million   ( 1,816)

Anonymous said...

December 10, 2020

Coronavirus   (Deaths per million)

Belgium   ( 1,516)
Italy   ( 1,036)
Spain   ( 1,012)
UK   ( 927)

US   ( 903)
France   ( 871)
Mexico   ( 862)
Sweden   ( 726)

Switzerland   ( 671)
Luxembourg   ( 609)
Netherlands   ( 577)
Portugal   ( 518)

Austria   ( 461)
Ireland   ( 427)
Canada   ( 346)
Greece   ( 324)

Germany   ( 253)
Denmark   ( 158)
India   ( 103)
Finland   ( 80)

Norway   ( 70)
Australia   ( 35)
Japan   ( 20)
Korea   ( 11)

China   ( 3)

Anonymous said...

December 11, 2020

Coronavirus

US

Cases   ( 16,295,458)
Deaths   ( 302,750)

India

Cases   ( 9,826,031)
Deaths   ( 142,618)

France

Cases   ( 2,351,372)
Deaths   ( 57,567)

UK

Cases   ( 1,809,455)
Deaths   ( 63,506)

Germany

Cases   ( 1,298,776)
Deaths   ( 21,820)

Mexico

Cases   ( 1,217,126)
Deaths   ( 112,326)

Canada

Cases   ( 448,841)
Deaths   ( 13,251)

China

Cases   ( 86,688)
Deaths   ( 4,634)

Anonymous said...

December 11, 2020

Coronavirus   (Deaths per million)

UK   ( 933)
US   ( 912)
France   ( 881)
Mexico   ( 867)

Canada   ( 350)
Germany   ( 260)
India   ( 103)
China   ( 3)

Notice the ratios of deaths to coronavirus cases are 9.2%, 3.5% and 2.4% for Mexico, the United Kingdom and France respectively.

Anonymous said...

https://news.cgtn.com/news/2020-12-12/Chinese-mainland-reports-13-new-COVID-19-cases-all-from-overseas-W9wt6fAxG0/index.html

December 12, 2020

Chinese mainland reports 15 new COVID-19 cases

The Chinese mainland recorded 13 new COVID-19 cases on Friday, all from overseas, the National Health Commission announced on Saturday.

Seventeen new asymptomatic COVID-19 cases were recorded, while 196 asymptomatic patients remain under medical observation. No COVID-19 deaths were reported on Friday, while 12 patients were discharged from hospitals.

The total number of confirmed COVID-19 cases reached 86,701, with 4,634 deaths as of Friday.

Chinese mainland new imported cases

https://news.cgtn.com/news/2020-12-12/Chinese-mainland-reports-13-new-COVID-19-cases-all-from-overseas-W9wt6fAxG0/img/ca7ab92018e745568132ed8e0e3cd873/ca7ab92018e745568132ed8e0e3cd873.jpeg

Chinese mainland new asymptomatic cases

https://news.cgtn.com/news/2020-12-12/Chinese-mainland-reports-13-new-COVID-19-cases-all-from-overseas-W9wt6fAxG0/img/7e99f89aab064dbfa54e6aa870266944/7e99f89aab064dbfa54e6aa870266944.jpeg

Anonymous said...

There has been no coronavirus death on the Chinese mainland since the beginning of May. Since the beginning of June there have been 7 limited community clusters of infections, each of which was an immediate focus of mass testing, contact tracing and quarantine, with each outbreak having been contained. Symptomatic and asymptomatic cases are all contact traced and quarantined.

Imported coronavirus cases are caught at entry points with required testing and immediate quarantine. Cold-chain imported food products are all checked and tracked through distribution. The flow of imported cases to China is low, but has been persistent.

There are now 293 active coronavirus cases in all on the Chinese mainland, 5 of which cases are classed as serious or critical.

Anonymous said...

https://www.nytimes.com/2020/12/12/nyregion/new-york-hospitalizations-restrictions.html

December 12, 2020

Cuomo Tries to Jolt Public by Warning of Overwhelmed Hospitals
The governor makes a sharp strategic shift to persuade New Yorkers to take the coronavirus seriously as infections surge across the state.
By J. David Goodman and Jesse McKinley

With coronavirus cases surging, Gov. Andrew M. Cuomo of New York has shifted his strategy sharply away from tackling local clusters and toward protecting the state’s health system in a bid to avoid a return to the worst days of spring, when hospitals were stretched to the limit....

Anonymous said...

https://www.nytimes.com/interactive/2020/us/covid-college-cases-tracker.html

December 11, 2020

Tracking the Coronavirus at U.S. Colleges and Universities
By The New York Times

The New York Times is tracking coronavirus cases on campuses through a rolling survey. This page will be updated periodically and was last updated Dec. 11.

Tens of thousands of new coronavirus cases continue to emerge on college campuses. A New York Times survey of more than 1,900 American colleges and universities — including every four-year public institution and every private college that competes in N.C.A.A. sports — has revealed more than 397,000 cases and at least 90 deaths since the pandemic began.

More than 6,600 cases were identified in the athletic departments of the 130 universities that compete at the highest level of Division I football. Those numbers, which are an undercount because dozens of universities provided little or no data, emerged as schools forged ahead with football season amid the pandemic....

Anonymous said...

Latin American countries have recorded 4 of the 13 highest and 6 of the 24 highest number of coronavirus cases among all countries. Brazil, Argentina, Colombia, Mexico, Peru and Chile. Mexico, with more than 1 million cases recorded, has the 4th highest number of cases among Latin American countries and the 13th highest number of cases among all countries. Mexico is now the 4th among all countries to have recorded more than 100,000 coronavirus deaths.

December 11, 2020

Coronavirus (Deaths per million)

US ( 912) *

Brazil ( 846)
Argentina ( 895)
Colombia ( 756)

Mexico ( 867)
Peru ( 1,102)
Chile ( 822)

Ecuador ( 780)
Bolivia ( 767)

* Descending number of cases

Anonymous said...

December 12, 2020

Coronavirus

US

Cases   ( 16,549,366)
Deaths   ( 305,082)

India

Cases   ( 9,857,380)
Deaths   ( 143,055)

France

Cases   ( 2,365,319)
Deaths   ( 57,761)

UK

Cases   ( 1,830,956)
Deaths   ( 64,026)

Germany

Cases   ( 1,320,592)
Deaths   ( 22,171)

Mexico

Cases   ( 1,229,379)
Deaths   ( 113,019)

Canada

Cases   ( 454,852)
Deaths   ( 13,350)

China

Cases   ( 86,701)
Deaths   ( 4,634)

Anonymous said...

December 12, 2020

Coronavirus   (Deaths per million)

UK   ( 941)
US   ( 919)
France   ( 884)
Mexico   ( 872)

Canada   ( 352)
Germany   ( 264)
India   ( 103)
China   ( 3)

Notice the ratios of deaths to coronavirus cases are 9.2%, 3.5% and 2.4% for Mexico, the United Kingdom and France respectively.

Anonymous said...

https://news.cgtn.com/news/2020-12-13/Chinese-mainland-reports-24-new-COVID-19-cases-WbepxxzjLW/index.html

December 13, 2020

Chinese mainland reports 24 new COVID-19 cases

The Chinese mainland recorded 24 new COVID-19 cases on Saturday, including 5 locally transmitted cases, the National Health Commission announced on Sunday.

The local transmissions included 4 cases reported in Heilongjiang Province and 1 in Sichuan Province.

Fourteen new asymptomatic COVID-19 cases were recorded, while 195 asymptomatic patients remain under medical observation. No COVID-19 deaths were reported on Saturday, while 11 patients were discharged from hospitals.

The total number of confirmed COVID-19 cases reached 86,725, with 4,634 deaths as of Saturday.

Chinese mainland new imported cases

https://news.cgtn.com/news/2020-12-13/Chinese-mainland-reports-24-new-COVID-19-cases-WbepxxzjLW/img/0c759c8a71734aa48964b81047983e5c/0c759c8a71734aa48964b81047983e5c.jpeg

Chinese mainland new asymptomatic cases

https://news.cgtn.com/news/2020-12-13/Chinese-mainland-reports-24-new-COVID-19-cases-WbepxxzjLW/img/5d544c22c6ad45fd90ae96f7c295b255/5d544c22c6ad45fd90ae96f7c295b255.jpeg

Anonymous said...

There has been no coronavirus death on the Chinese mainland since the beginning of May.  Since the beginning of June there have been 7 limited community clusters of infections, each of which was an immediate focus of mass testing, contact tracing and quarantine, with each outbreak having been contained.  Symptomatic and asymptomatic cases are all contact traced and quarantined.

Imported coronavirus cases are caught at entry points with required testing and immediate quarantine.  Cold-chain imported food products are all checked and tracked through distribution.  The flow of imported cases to China is low, but has been persistent.

There are now 306 active coronavirus cases in all on the Chinese mainland, 6 of which cases are classed as serious or critical.

Anonymous said...

December 12, 2020

Coronavirus

Massachusetts

Cases   ( 285,725)
Deaths   ( 11,307)

Deaths per million   ( 1,640)

Anonymous said...

December 12, 2020

Coronavirus

New York

Cases   ( 803,912)
Deaths   ( 35,500)

Deaths per million   ( 1,825)

Anonymous said...

Latin American countries have recorded 4 of the 13 highest and 6 of the 24 highest number of coronavirus cases among all countries.  Brazil, Argentina, Colombia, Mexico, Peru and Chile.  Mexico, with more than 1 million cases recorded, has the 4th highest number of cases among Latin American countries and the 13th highest number of cases among all countries.  Mexico is now the 4th among all countries to have recorded more than 100,000 coronavirus deaths.

December 12, 2020

Coronavirus   (Deaths per million)

US   ( 919) *

Brazil   ( 849)
Argentina   ( 896)
Colombia   ( 760)

Mexico   ( 872)
Peru   ( 1,102)
Chile   ( 826)

Ecuador   ( 781)
Bolivia   ( 767)

* Descending number of cases

Anonymous said...

Matt Yglesias is a fucking moron

Anonymous said...

December 13, 2020

Coronavirus

US

Cases   ( 16,737,267)
Deaths   ( 306,459)

India

Cases   ( 9,884,716)
Deaths   ( 143,393)

France

Cases   ( 2,376,852)
Deaths   ( 57,911)

UK

Cases   ( 1,849,403)
Deaths   ( 64,170)

Germany

Cases   ( 1,338,483)
Deaths   ( 22,406)

Mexico

Cases   ( 1,241,436)
Deaths   ( 113,704)

Canada

Cases   ( 460,743)
Deaths   ( 13,431)

China

Cases   ( 86,725)
Deaths   ( 4,634)

Anonymous said...

December 13, 2020

Coronavirus   (Deaths per million)

UK   ( 943)
US   ( 923)
France   ( 886)
Mexico   ( 878)

Canada   ( 354)
Germany   ( 267)
India   ( 103)
China   ( 3)

Notice the ratios of deaths to coronavirus cases are 9.2%, 3.5% and 2.4% for Mexico, the United Kingdom and France respectively.

Anonymous said...

https://news.cgtn.com/news/2020-12-14/Chinese-mainland-reports-16-new-COVID-19-cases-WcTdyWCmVG/index.html

December 14, 2020

Chinese mainland reports 16 new COVID-19 cases

The Chinese mainland recorded 16 new COVID-19 cases on Sunday, including 2 locally transmitted cases in Heilongjiang Province, the National Health Commission announced on Monday.

Nine new asymptomatic COVID-19 cases were recorded, while 197 asymptomatic patients remain under medical observation. No COVID-19 deaths were reported on Sunday, while 9 patients were discharged from hospitals.

The total number of confirmed COVID-19 cases reached 86,741, with 4,634 deaths as of Sunday.

Chinese mainland new imported cases

https://news.cgtn.com/news/2020-12-14/Chinese-mainland-reports-16-new-COVID-19-cases-WcTdyWCmVG/img/119496c9ece14fd8bbd3732f0a8b4276/119496c9ece14fd8bbd3732f0a8b4276.jpeg

Chinese mainland new asymptomatic cases

https://news.cgtn.com/news/2020-12-14/Chinese-mainland-reports-16-new-COVID-19-cases-WcTdyWCmVG/img/fdb8c14855b14bb6bfa95e3cb0814404/fdb8c14855b14bb6bfa95e3cb0814404.jpeg

Anonymous said...

There has been no coronavirus death on the Chinese mainland since the beginning of May.  Since the beginning of June there have been 7 limited community clusters of infections, each of which was an immediate focus of mass testing, contact tracing and quarantine, with each outbreak having been contained.  Symptomatic and asymptomatic cases are all contact traced and quarantined.

Imported coronavirus cases are caught at entry points with required testing and immediate quarantine.  Cold-chain imported food products are all checked and tracked through distribution.  The flow of imported cases to China is low, but has been persistent.

There are now 313 active coronavirus cases in all on the Chinese mainland, 7 of which cases are classed as serious or critical.

Wallfly said...

Not for the first time, I am struck by the crying need to moderate your comment threads.