“We lack the courage to take even the smallest step unless we can calculate its effect into the smallest detail.”
What an unappealing hash—Covid 19 in an age where too many seek glory in polemics and social media networks facilitate the spread of hearsay, rumor, buzz, gossip—well noise.
Public health agencies, to successfully shoulder their burden, must cause the public to understand their limitations without dismissing their findings. Science is the tool of curiosity which must be continuous. At any given point science provides insights, but rarely certainty—“here is what we know but our studies will continue.”
We have all been paying some attention to scientific conclusions. This is not a foreign war about which most have long since lost interest. This is personal—death maybe. And this is a subject of opportunity; public health agencies and health care companies get to prove their mettle. The media gets to prove its usefulness. Obscure public health officials are suddenly given a star turn.
Unfortunately at the beginning of the viral illness was politics. For Donald Trump it was the “Chinese flu” and the need to be front and center daily. He did, however, push a race to a vaccine—science. While the public health people were buffeted by what they couldn’t know and the rip-tide of media-motivated politics, geneticists were leveraging what America does best—create, invest, adapt, make— swiftly.
The goal, simply stated, was a return to normalcy while saving the vulnerable along the way. If normalcy had been polled, it would have drawn only dissent from the people who make a living dissenting.
America’s preening politicians at times made the autocrats in Asia look good. And their camp followers found new microphones in social media. In seconds you could go from watching a news conference by the Center for Disease Control to posting your own opinion on Twitter or Facebook.
As we learned, America, indeed the globe, needs more granular measurement. What is an individual’s risk of death or near-death? What circumstances raise or lower that risk? What public interventions in the high risk categories can move the dial in the right direction? In short, how can we live with the reality of a mutating coronavirus?
This is, of course, complicated stuff. As they say “way above my pay grade”, but the technology exists if the will and capability exist to do a lot better in public health.
Many are now predicting the public health policy will evolve to endemic not pandemic rules. Where, we will all want to know, will we be most likely to become infected? And who, at the personal level, is most likely to suffer a fatal or near fatal case? How can we live with it?
I have a close friend who is in his 90’s. Last January before going to a family gathering he got tested and discovered he had an asymptomatic case. Telling everybody from 65 years of age and up that they better avoid family gatherings undermines public confidence.
And how should the media deal with outlier events? We are told young people are very unlikely to have fatal or near-fatal reactions. Then a young person dies of Covid and the headlines make it seem as if you need to pull your child out of school.
We need the tools of risk assessment and discretion. Intuitively we know that immune-compromised persons are at greater risk, but what about people whose medical history is good? Should they shelter in place or go to school or a family gathering or to a concert? Education, families and the arts have often been pandemic fatalities.
And what about being in an interior space with other people who have been vaccinated? Are those circumstances that lead to so-called “breakthrough cases”? And, how dangerous are those cases?
Let me step back. My questions are the tip of the iceberg. But what I think we all know is that scaring the public with generalized data is a losing strategy and one that undermines the progress that we have made. Today there is a dramatic gap between what public health officials say we should be doing and what we are doing. Watch a sporting event, for example, with people packed into stadiums yelling and screaming their enthusiasm.
Michael Lewis’ new book Premonition features a lively and alarming view of public health. Essentially Lewis finds his heroes outside or on the periphery of government agencies. The outliers he featured used science as a tool to probe ceaselessly and act quickly.
Broadly speaking, the public health mission needs to become more urgent and present. It is hard to attract leaders into a career if adrenalin only pumps once every generation. It’s like guarding a building in a low crime neighborhood.
So here is a thought starter on a more diverse and urgent set of missions. Is crime a public health issue? What about advertising that preys on our weaknesses while undermining our health? What about more personal environmental conditions that lead to a lowering of life expectancy?
Yes, I know, other agencies will fight any incursion on their turf but if violent deaths and debilitating environments persist, and they do, it seems to me we need some competition.
It is clear that co-morbidities are the hubs of vulnerability. Should public health agencies have a more active role in reducing human inflicted circumstances that weaken resistance?
Finally, there are and will always be stubborn people who seem to relish the opportunity to say “hell no, I’m not going there.” America allows stubbornness; our Constitution guarantees it. Public health and its private partners need to be stars so that the “hell no” crowd is outmuscled at the ballot box.
Headlines in the last couple of weeks have featured recipients of Nobel Prizes. We celebrate creativity; that is a good thing. But, why aren’t we celebrating the scientific teams that in record time created vaccines.
When a sports team wins it all they come to the White House and are toasted by the President. President Biden, lead America in celebrating the extraordinary accomplishments of a handful of scientists and their historic accomplishment.
Al Sikes is the former Chair of the Federal Communications Commission under George H.W. Bush. Al writes on themes from his book, Culture Leads Leaders Follow published by Koehler Books.