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?