The odd but oddly satisfying thing about “How the West Lost COVID,” New York Magazine writer David Wallace-Wells’ magisterial and muddled new overview of pandemic response failures in the United States and Europe, is that you’ll probably come away from it far less certain about how “the West lost COVID” than you were going in.
Some of the priors the piece might force you to update:
- Your view of the singularly negative impact of Donald Trump (and positive impact of Anthony Fauci, who comes off badly);
- Your assumptions about culture or policy’s determinism of a country’s pandemic successes; and,
- Perhaps most unsettling of all, your faith in immunologists to ever explain what Wallace-Wells calls the “seemingly random, and still mysterious, dynamics of spread, even beyond stochasticity, which can be at least mathematically modeled.” (To date, it cannot.)
Still, Wallace-Wells advances a thesis: Speed of response was essential to success, and Europe and the United States moved too slowly to contain the pandemic compared with East Asian countries (Japan’s response excepted, and there is always an exception).
“Too slowly” meant, in the case of Italy (the real epicenter of global spread, experts tell Wallace-Wells), taking action after 107 Italians had died. The later the response, historian Adam Tooze tells Wallace-Wells, the more the trajectory of a pandemic hews to
a deterministic line, which is that we are dealing with an exponential or semi-exponential kind of a process … Either you control this early on, in which case the trade-offs are relatively manageable and all sorts of conventional things make sense, or you don’t and you end up in a space which really no advanced polity’s decision-making process is very good at coping with. And so then it’s really a matter of degrees of failure across the board.
What’s really interesting for our purposes: Expertise is at the heart of this theory of fatal slowness — specifically, one dominant model of when expertise is ready to inform and push for interventions.
In the West, the Harvard epidemiologist Michael Mina tells Wallace-Wells, the pandemic has revealed us “medical-centric” — prioritizing individual health over population health and public good. That means not only that we elevate solutions that benefit individual cases but hurt the public good. It also means we wait for the perfect randomized controlled trial over evidence that’s good enough to act on. And this mindset, Mina argues, is exactly the wrong one for a pandemic. “Imagine in World War II,” he tells Wallace-Wells, “if that was how we treated it all — that we couldn’t make a single mistake.”
Epidemiologist Marc Lipsitch, Mina’s Harvard colleague, made a similar case in a piece (“Good Science is Good Science”) he wrote for Boston Review in May. Maybe not surprisingly, Lipsitch was one public health expert who called the trajectory of the pandemic in the United States early. He told The Atlantic’s James Hamblin on Valentine’s Day of last year that the coronavirus “would infect 40 to 70 percent of the U.S. population and likely become endemic.” At that point, Hamblin reports, the United States had 15 confirmed cases of COVID-19.
In a new piece, Hamblin quotes Lipsitch on why he spoke out:
I have no illusion that I had the exact right calibration … But I think as early as I was able to put together the evidence, I said what I thought it meant. And I don’t know how to do any better than that.
Of course, calling it early doesn’t get you rewarded. Ten days later, when The Atlantic published Hamblin’s piece (“You’re Likely to Get the Coronavirus”) containing Lipsitch’s analysis, both Lipsitch and Hamblin took a lot of fire from critics who thought they were too pessimistic and might even cause panic — motivation that seemed to drive most public health officials, including Fauci’s early pronouncements. In May, Lipsitch told Hamblin that he was out of the prediction business — even though, as Hamblin puts it, “if anyone should be in it, it’s him.”
Calling it early shouldn’t be an act of bravery. The war should be with the problem, not with calling out the problem.
Takeaway: Calling it early — and acting early — becomes an act of bravery when your culture actively works against calling it early, when the incentives skew toward hanging back until your call is obviously right, until it’s too late for your call to mean anything.
Here’s one big lesson from the pandemic for science and for public scholarship in general — and for your organization in particular. We — and you — need to align incentives and culture to produce early calls and early interventions. Anything less is a social failure of our authority.