In COVID’s Wake is a book written by two political science professors from Princeton, who attempt to analyze different nations' response to the epidemic and identify practices that worked. I am going to say up front, that the book was frustrating. It felt like a couple of “elites” (I use the term ironically, for these authors throw the same term around a lot in the book) spouting right wing rhetoric that I have read from many different sources over the last five years. They believe that nothing worked until vaccines became available.
I think their underlying message is that we need to consider the economic effects of public health policy, not only the “lives saved.” They are unwilling to quantify this, so I am unclear if they think that 2 percentage point improvement in GDP is worth 500 lives or 50,000, but that is something that they think wasn’t considered when making COVID policies.
They begin with a brief look at what was known ahead of COVID. Most papers written ahead of COVID discounted the idea that masking, border closures, and lock downs would make much of a difference in affecting the transmission rates of a flu epidemic and since they had huge economic costs, they should probably not be attempted. Of course, it is hard to know if you should apply policies designed for a flu outbreak to a novel virus – while the authors of In COVID’s Wake strongly imply that COVID is only slightly worse than influenza (they routinely bring up the fact that for people under 50 it wasn’t too bad), the reality is that people over 50, COVID was four or five times more lethal than flu. Influenza typically has a mortality rate of around 1 to 2 per thousand people infected and so lock downs don’t make sense for it, but whether policies centered around a less lethal disease make sense for a more lethal one, is debatable. Flu is estimated to cause 20 to 30,000 excess deaths per season, while COVID killed a million people in the US over a two-year period of time.
They spend a huge amount of time on Sweden, I guess because Sweden is the poster child for a country that didn’t lock down, close schools, and "stayed open." They make the point that at the end of three years, Sweden’s death rate from COVID was similar to the death rate for other Scandinavian countries. I think there are three things to mention here. First, while Sweden didn’t lock down initially, within a few months of COVID hitting the country, Sweden had a number of policies in place asking people to social distance, restricting the sale of alcohol in restaurants, and requesting people to work from home who could. In practice, these acted similar to government policies in other countries. Second, there is no way to demonstrate that Sweden had significantly better economic results than surrounding countries. All of the Nordic economies contracted in 2020 and began to improve in 2021. Third, statistics show worse results for Sweden than other Nordic countries. Sweden to date has had 2,700 deaths per million population while Norway sits at 1,200 and Denmark at 1,500 deaths per million. Finland ended up with 2,100 deaths per million – mostly because they screwed up their vaccine roll out and used Astra Zeneca’s vaccine, which was less effective and had more side effects than other options.
A lot of paper is devoted to the Great Barrington Declaration (GBD). Lee and Macedo believe that the GBD should have been given more press and that the fact that its authors were castigated for it is shameful. In an open society you should allow people to have differing opinions. I think the challenge with GBD was that it claimed something that it probably couldn’t deliver. It posited (rightly) that young people were at low risk of dying from COVID. Therefore, restrictions on them didn’t make sense. Old people who were at high risk of dying from COVID should isolate until everything blew over – whenever that was. The challenge of course, is that while younger individuals may not die from COVID, they can get pretty sick from it, but more importantly, they also provide care for elderly people who can catch it from them and do die from it. The second thing is that the GBD talks about “herd immunity.” As it turns out, herd immunity is a useless concept in terms of COVID, just as it is in terms of influenza or the common cold. People can and do get COVID multiple times – I know people at the time of writing this who have had COVID five times (bad luck for them). Fortunately, after you get COVID a couple of times, your risk from the illness drops considerably, but your immunity to it is not durable as strains shift. The authors of the GBD gave lip service to protecting the elderly while letting young, healthy people carry on life as usual, but it seems like lip service only. In practice, it is hard to say how this could have happened and in point of fact, there is no society where things were open for the young and the elderly were protected.
The authors of the GBD varied greatly in who they thought were “at risk” from the disease. Many of them seemed to have thought it was isolated to individuals over 65 or 70. The reality is that people over 50 had significantly increased risk of requiring hospitalization, or dying from COVID. Lots of younger individuals had major risk factors, as well. Estimates were that around 170 million Americans were at increased risk for complications of COVID, either due to age or other risk factors.
A major point that they bring up multiple times is the idea that the “laptop class” was able to sequester themselves away and avoid infections, while the essential workers (many of them in poorer socioeconomic groups) had to continue working. I am not certain what the point here is. If the best policy was to let people do their thing without restriction, then those who went to work like normal, rather than working from home, were the ones in the best situation. If non-medical interventions (masking, social distancing, and school closures) were ineffective, then the laptop class was ridiculous -- doing a bunch of stuff that made no difference, except to make them feel like they were in control of an uncontrollable virus. On the other hand, if that was risky, then the rest of the book falls apart.
Government policy in the United States was extremely fragmented. The feds did almost nothing. States mostly locked down for the first month and then gradually opened up. Even within states, differences varied greatly -- Florida might have no restrictions, but local municipalities might have very tight restrictions on activities that were allowable. Whether or not schools opened and how quickly they moved to in person learning was mostly a local school board decision. The fact that teachers' unions were opposed to in person learning before vaccines were widely available is disparaged in the book. Public school teachers aren’t paid that well and about a third of them are over 50 – it is understandable that they believe their role was to instruct students, not to risk their lives.
Whether or not lock downs work is uncertain. In anything, except an authoritarian state, they probably have limited usefulness. Few people were locked up or fined due to violations of COVID policy and the end result is that most people did what they did. I think this is a point that is important. Most people would have avoided a lot of social contact in the spring of 2020, regardless of whether the government told them they had to isolate or not. As the year wore on, this resolve tended to wane and even the most ardent followers of restrictions tended to gather with other people that they believed were safe. The focus on decreased economic activity during 2020 is foolish. The economies of most countries turned down and then bounced back in 2021.
Most of what individuals experienced had more to do with employer policies and local government restrictions. My employer had employees wear masks for two years. Employees who tested positive were furloughed without pay for five days after a positive COVID test. This had nothing to do with state or federal mandates.
A huge amount of ink is wasted on the lab leak hypothesis. Much is made of Dr. Fauci’s initial response which basically instructed the scientist who brought it up to get together a group of evolutionary biologists to pursue the question of whether this virus was made or naturally occurring in nature and if there was a smoking gun to refer the question to the FBI. It takes a pretty weird mind to see something nefarious in this response – to me it seems appropriate – but the authors here see Dr. Fauci as covering his tracks and trying to make the scientists prove something “beyond a reasonable doubt.” The authors of this book spend a lot of time trying to prove that there is a smoking gun here, but in my own investigation, I don’t see anything particularly nefarious. There is little evidence that the Wuhan Lab was doing gene editing and the out break really didn’t start with workers at the Lab, but in a completely different part of the city, closer to the live animal market – the two are 12 kilometers apart and it is certainly odd that we don’t see an indication of the epicenter of the outbreak being in the area near the lab, rather than near this market. Regardless, I don’t think we will ever know and the majority of Americans believe in the lab leak hypothesis, so whether Francis Collins and Anthony Fauci tried to shut down dissent from the zoonosis hypothesis, they weren’t successful.
I don’t have energy to break down everything else in the book. I think these political scientists are above their head when it comes analyzing scientific studies. At the end of the day, how well policy worked had more to do with what the people in a population did than with the policies themselves. Asian countries fared really well – they are used to wearing masks and are willing to consider the social good of others and do what they think is indicated to help, while Americans push back hard on any kind of impingement of their freedom. I do think that they have forgotten how horrific the beginnings of COVID were and how terrible the Delta variant was as well. In our local community, during COVID waves, the local hospital was completely overwhelmed. Wait times in the ER exceeded twenty hours and all non-elective procedures were cancelled. This was not due to state policy, but simply a lack of resources to deal with the number of COVID patients in the hospital and ICU. The big thing that changed that was the availability of vaccines and that really did bring the level of hospitalization from COVID down to manageable levels.
At the conclusion, the authors seem to say that in the future when we have an epidemic, we should not only gather a panel of experts, but we should also gather a panel of “non-expert dissenters” who are people who disagree with the policies of the experts. By listening to the dissenters, we will gain knowledge on how to proceed with policy.
This seems like an odd way to make policy. I have no idea how this would work. Get RFK Jr., Andrew Wakefield, and Dr. Atlas on a committee and have them turn in recommendations along with a separate committee composed of Dr. Fauci and Dr. Collins and then draw recommendations out of a hat? Experts aren’t perfect, but someone whose main qualification is dissenting status, seems even less likely to bring helpful recommendations to the table.
I wouldn’t recommend this book unless you want a summation of all of the right-wing conspiracies and discreditation of things like government lock downs, masking, and castigation of Dr. Fauci.