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Jan's avatar

I had stopped reading NYT Covid coverage when the Morning/David Leonardt made large factual errors in interpreting data and refused to retract.

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Eric Fish, DVM's avatar

Thanks for highlighting this great interview! I'm curious what you think about Matt Yglesias's recent covid-19 retrospective ("What happened with Covid NPIs?", 11/1/23). It is a paid Substack article, but his thesis essentially goes like this:

Contrary to popular wisdom, there was not much covid mortality difference between "red" and "blue" states pre-vaccines not because NPIs were universally ineffective, but precisely BECAUSE NPIs were actually *quite* successfully implemented across the country, flattening the curve, and preventing a Lombardy or NYC-style horror anywhere else in the US. Obviously there were pronounced differences from 2021 on that trace directly to political rhetoric about vaccines. There was a lot of goalpost-shifting about what the objective was for NPIs. We initially told people it was to "flatten the curve" to buy time to learn more about the disease, ramp up PPE and treatments, prevent hospital overrun etc, and we did that! But then it shifted into a long-term strategy with people claiming we could somehow just prevent infections if everyone just followed NPIs forever with seemingly no time limit. When Delta (and later Omicron) hit and people who were formerly cautious and compliant with restrictions started getting covid a lot of trust and credibility eroded.

Yglesias also argues we could not have done much better than we did, not for any particularly nihilistic reasons, but because the pandemic playbook written by the Bush and Obama administrations in the 2000s in the shadow of bioterrorism directly looked to the Great Influenza of 1918 and we followed the precedent as well or better than a century ago. If you look at the data from that era, most NPIs were in place an average of only 4 weeks across the country, which was a little shorter than even the most aggressive red states were in re-opening; the longest 1918 influenza NPIs were in place for 10 continuous weeks, which was *FAR* shorter than many locations in the US with covid.

In the end, Yglesias argues that the lesson we should take from the pandemic is not "NPIs don't work" but that we should re-think which ones we pick, how they are implemented, and how they're enforced, or not. Masks (high-quality ones worn correctly) clearly DO reduce spread of respiratory viruses. However, the evidence the various mask MANDATES worked is less clear and provoked significant backlash, arguably making masks less effective in aggregate (less people wearing them because of politicization). Closing schools in spring 2020 made a ton of sense and was clearly the right move in the beginning when we didn't know anything. But keeping them closed a year after we opened bars and salons and gyms under lobbying from business interest groups isn't coherent policy and clearly upset a lot of people due to learning loss and mental health concerns to say nothing of the economic disruption. We need to remember that public health is not just the specific policy prescription, but also communication, trust, and real world implementation. Trade-offs and conflicting human behaviors abound. People don't exist as dots in a statistical model.

Maybe we could have improved results on the margins, but I do think coronaviruses are inherently much more contagious and difficult to control than something like the flu (speaking as a vet where many significant and deadly coronaviruses impact animals), and some of what we were up against was biology. The US is definitely different culturally than China/Singapore/Taiwan, etc and I don't think there was ever a world in which we could have made our citizens accept covid zero (outside of maybe a couple coastal cities). The biggest improvements we made was from converting an immunologically naive population to an immunocompetent one through vaccines, and sadly for many, natural infection.

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