Ars Technica and Public Health Experts Earn a Lazy

Technically, Beth Mole’s (Senior Health Reporter for Ars) write-up of her short panel with two public health experts on learnings from Covid doesn’t really qualify for a LAZY. It’s a perfectly reasonable overview of what was discussed. This LAZY really goes to the panel discussion, to lazy answers, and lazier follow-ups. Small kudos to Ken Fisher (the Editor in Chief) for his post-interview questions which were much less lazy than everything that preceded.

The panelists were Dr. Jennifer Nuzzo (Director of the Pandemic Center at Brown University) and Dr. Caitlin Rivers (Senior Scholar at the Johns Hopkins Center for Health Security). These are true public health experts who really ought to have interesting things to say about what we could or should learn from the response to Covid. Which makes the general tenor of their answers doubly disappointing.

After all, it’s hard to see how the U.S. response to Covid could be considered anything other than a disaster (though we are hardly alone in this regard). The facts on the ground are straightforward and dismal:

  • Massive death toll (per capita and in total)
  • Enormous expenditures of public money
  • Unprecedented social costs especially in education
  • The near complete failure of public interventions and a total absence of measurement around those interventions
  • Dramatic decline in the public trust of health care experts

Against this the only notable success was the rapid design and development of safe and effective vaccines (a success in which most of the public health care system played no part) and a credible if uninspired job in rolling them out.

Given this abysmal performance, coming up with lessons ought to be like asking the Captain of the Titanic for what he would have done differently on his last voyage. Unfortunately, if the Ars’ panelists are representative, what public health experts have “learned” from our disastrous covid response was to go faster and look for icebergs. The Ars panel is notable for its lack of self-reflection, honest criticism, or interesting thoughts about what to do better layered in a heavy sauce of mealy-mouthed, “we need to bring everybody on-board” boosterism.

You can ask any petty bureaucrat how to make things better and you’re sure to hear the same sad refrain Ars’ experts were singing, “we need more money and more people.” More money and people usually do help, but, as our Covid response proved, there is no amount of human and financial capital that a bad system can’t find ways to waste. Neither expert presented one scrap of evidence that the massive expenditure on Covid for anything other than vaccines produced any results. There’s no evidence that effective Covid outcomes that minimized total social cost were to be found in areas with the highest health-care spending or the most health-care workers per capita. Indeed, many of the stupidest and most damaging public interventions (extended school closures, beach and playground closures, convoluted vaccine rollout plans, mask requirements, etc.) came from wealthy states that bought wholeheartedly into the public health complex.

Based on total performance, one might think we need less public health experts not more.

This lack of honest reflection and myopia to actual results extends into every aspect of what the experts seem to believe. Both lamented the sad state of health reporting, the fractured system we use here in the U.S., and lauded the real-time data and dashboards that become de rigueur during Covid. Funding for such programs is going away, and they found plenty to lament. And it’s true, our reporting system is absurd.

Sadly, however, there isn’t evidence that all that real-time reporting added value to anybody. Opinion research deep into the pandemic showed that elite consumers of sources like the New York Times had huge and fundamental misunderstandings about Covid mortality rates and the effectiveness of public interventions. This notwithstanding their very fine dashboards. It’s not true to suggest that the most educated were the least knowledgeable since no one could outdo those who picked up their medical advice from QAnon – but there’s no just reason to believe that public dashboards educated the population or provided actionable value.

In fact, so consistently misguided were the metrics and KPIs presented in public dashboards that it’s fair to wonder why public health experts think they are useful. But not word one did the panel speak regarding effective KPIs in a pandemic or how to measure the actual impact of reporting. The concept of measuring the effectiveness of measurement has not, apparently, crossed these expert’s minds.

Measuring the effectiveness of anything doesn’t seem to be much of a topic in public health.

They lamented that people still use faxes to send in data and cheered funding to improve IT resources. And sure, getting faxes is a nightmare for data integration. But, honestly, is the implication that the people sending the reports hand-write them on paper and then fax them? Or are they, you know, preparing them in Excel or Epic on a computer, printing them, and then faxing them? It’s a little a hard to believe that there are health care providers in the U.S. that can’t afford a desktop computer or laptop.  In which case, it might make more sense to just turn off the fax machines.

I’ve written before that the single biggest failure of public health experts in the United States during Covid was to learn anything about the actual effectiveness of personal and public interventions and convince ANY politician at any level of government anywhere in the United States of the value of this kind learning. At no point was there any effort to create controlled experiments and take advantage of the massive public attention and dollars flowing into the area to prove what worked and what didn’t. Nor has there, apparently, been any post hoc reckoning with this failure. Experts seem perfectly content not to have the faintest idea which public interventions (if any) did any good and are clearly happy to roll them out again, unchanged, for the next go round.

Nor was there any admission that public health experts were routinely dishonest and far too often tailored their messaging under the assumption that “you (the public) can’t handle the truth”. Indeed, the panelists and the moderator seemed continually to court the same disastrous arrogance – “we can’t scare people”, “we need to create trust at the community level”, and “the people who were most distrustful of public health experts don’t have a personal physician they ask”.

This is all bad thinking – the continuing sense of public health leaders that they must baby-feed their message to the public instead of telling the truth (what you know, what you don’t, what you strongly recommend, and what you maybe recommend) underscores just how little has been learned and how unwilling public health experts are to own that people distrust them not because people “don’t have access to a primary physician” but because public health experts were regularly untrustworthy.

Nor does the mealy-mouthed way these experts tiptoe around the vast political stupidities during Covid make them more palatable and it certainly doesn’t make them more believable. Pretending that the big problem with Covid information was that people don’t have a doctor they trust for medical advice is both pointless and misleading. Pandemic experts aren’t somehow going to create a health-care system in which everyone has a trusted physician – that model is gone and if it ever returns it will be in some fundamentally different guise. The conspiracy theorists who hawked anti-vax jabberisms and the politicians who gave them service can and should be excoriated. They did a lot of damage.

Everyone knows that public health experts have contempt for these factions (as they should), so their failure to voice that contempt is just more dishonesty and makes them less trustworthy not more. Yes, public health experts should stay out of politics (and stop dragging their political agendas into their health-care advice during national emergencies), but forthright speech about anti-vaxxers isn’t political, its health care. The problem is that most public health experts don’t seem to understand how or where to draw the line.

No fair-minded person envies the problems that public-health experts in the government faced during Covid. Dealing with the pandemic was a unique and massive challenge made harder because the big boss was an idiot. But neither of these experts have an organizational imperative to dance around the obvious, and the intellectual paucity of their reflections on a generational health disaster is sad and disturbing.

I know, it’s not fair to blame Ars for the banality and laziness of experts. You can bring a fool to a microphone, but you can’t make them say something interesting. But if you’re moderating a panel and your panelists are spewing lazy cliches, you owe it to your audience to push a little harder.

If you don’t, you earn a LAZY.