(C) Daily Kos This story was originally published by Daily Kos and is unaltered. . . . . . . . . . . ICYMI: The NY Times has both-sided the next pandemic [1] ['This Content Is Not Subject To Review Daily Kos Staff Prior To Publication.', 'Backgroundurl Avatar_Large', 'Nickname', 'Joined', 'Created_At', 'Story Count', 'N_Stories', 'Comment Count', 'N_Comments', 'Popular Tags'] Date: 2023-03-16 To paraphrase Dirty Harry "Do you feel lucky?" We know there are threats lurking out there. What happens when they appear - and experts are giving conflicting advice? As part of a series on getting ready for the next pandemic, The NY Times ran an opinion piece a few days ago: (The link should allow passage through the Times pay wall) It’s been three years since the Covid-19 pandemic began, and yet many aspects of how to best respond to a novel virus remain unsettled or fiercely debated. The next currently unknown virus that could cause a pandemic — what the World Health Organization calls “Disease X” — may be different from Covid, requiring a different set of tools and a different level of response. As Dr. Tom Inglesby, director of the Johns Hopkins Center for Health Security, outlines in a guest essay, public health leaders sometimes participate in simulations where they are asked to make decisions based on limited information about Disease X, as they would at the beginning of any pandemic.We asked a group of experts to take part in a scaled-down Disease X simulation to show readers the diversity in views on how to best respond to pandemic threats — quickly, with little detail, as they would likely have to in a real-world situation. We gave the experts a few parameters, and asked them to briefly address specific questions they may be asked by local leaders if such a virus were to emerge and spread in their communities. emphasis added Okay — that’s straightforward enough. Something new pops up, there is little if any information on how it spreads, there’s no experience to judge which treatments will prove effective, and no consensus on how best to control it. Experts will asked to come up with answers by politicians, officials, and the media. Here’s where the opinion piece goes off the rails IMHO: As you’ll see, not everyone agrees. We hope to show that experts with policy-making experience and similar goals can come to different conclusions and advise different strategies. emphasis added Hope to show? They HOPE to show that experts will disagree? How about something like: In the initial stages of a new pandemic, experts will offer the best advice their past experience and training gives them — which means experts may and will disagree because they have different experiences and training to draw on. They may assess potential risks differently, and weigh preventive measures differently. They may have a different understanding of what resources are available and how to prioritize them. While they may agree on some basic measures, there will still be disagreements in the face of a completely new disease. What will happen is that as experts gain more information about the new disease, how it spreads, and what treatments are effective, they can and will change their advice. This is how science works: as more evidence accumulates, better decisions can be made based on that knowledge. It takes time and there will be errors along the way. But — there will also be corrections as those errors are recognized. Consensus will grow from experience. The challenge for those asking for this advice — knowing initially that there are going to be high levels of uncertainty — will be deciding how best to evaluate it, assign priorities based on it, and determine how to put it into practice — while being prepared to modify those decisions as knowledge accumulates AND effectively communicating all this to the public. Game On: The Challenge Here’s the scenario The NY Times came up with to throw at a panel of experts to see what advice they’d come up with: Parameters: A respiratory virus starts spreading tomorrow in the United States. It appears more transmissible and more deadly than SARS-CoV-2, the virus that causes Covid-19, and it is equally risky for children and adults, based on the rapid spread and number of deaths in another country. There's no available vaccine, though one is under investigation. There are only 10 reported cases in the United States, but five are in the jurisdiction you are advising. This is all the information available. They then presented a series of measures to be taken, and chose two experts for each — deliberately presenting opposing views and the reasoning behind those views. There’s a summary for each (with a link to a more detailed response for each answer) at the article). Should schools close? Yes, but only briefly. Prolonged school closures during the Covid-19 pandemic caused substantial harms that will likely be felt for decades. Dr. Jay Varma, former Covid-19 adviser to Mayor Bill de Blasio of New York No, at least not yet. The decision to close schools must be based on the best current understanding of risks and benefits. Dr. Tom Frieden, former director of the Centers for Disease Control and Prevention Should there be a mask mandate? Yes, it will help. The virus is most likely already spreading undetected in our community. Dr. Nicole Lurie, former assistant secretary for preparedness and response at the U.S. Department of Health and Human Services No, this isn’t the time. There are other effective interventions to focus on first. Dr. Anders Tegnell, the former state epidemiologist in Sweden Should there be an international travel ban? Yes, if done properly. Travel bans can be an effective public health tool. Dr. Jerome Adams, the 20th U.S. surgeon general No, the impact will be low. Travel bans have rarely stopped the spread of new pathogens. Dr. Jennifer B. Nuzzo, director of the Pandemic Center at Brown University School of Public Health If a safe and effective vaccine becomes available, should it be mandated? Possibly, even though they’re unpopular. Mandates can be helpful in a pandemic. Wendy Parmet, director of the Center for Health Policy and Law at Northeastern Not without exemptions. Mandates work, but they come with side effects. Dr. Saad Omer, director of the Yale Institute for Global Health WTF, Gray Lady? The Yes/No format here is misleading. The arguments behind these summaries for the differing viewpoints are more nuanced and not as diametrically opposed as might be assumed from a casual reading. It’s also curious that each response is from a different expert without explaining how they arrived at their advice. Did they consult with each other, did they ever meet as a group? Did they offer an answer on all four questions or did the Times simply pick and choose answers that gave the clearest disagreement? There’s no authorship on this opinion piece, no way to know how they put it together and some question about what they were trying to prove. If they were simply trying to show that experts could reasonably disagree, well duh. They might have been a bit more careful and transparent in the way they did it. If they were trying to create the impression that there’s no point in listening to experts because they can’t agree on anything, well they succeeded whether or not that was their intent. Given that there is a war on actual expertise out there in this country now, this opinion piece looks remarkably like a subtle attempt to advance that agenda. It certainly gives people ammunition to believe whatever they want to believe. Digby had a post several days ago which looked at how Republican politics work. (It’s all Id) It essentially said Republicans voters decide what/who they like, and then build up a framework of arguments to validate that belief. (Not that such behavior is exclusive to the GOP base, but...) The problem for officials asking public health leaders for advice isn’t just that there will be some level of disagreement — it’s that a certain percentage of the general public whose interests they are trying to protect with that advice will choose to believe what they want to believe, listen to those to whom they want to listen, and go with their gut. Charles P. Pierce put it bluntly in his book “Idiot America: How Stupidity Became a Virtue in the Land of the Free” “Once you’re on television, you become an expert, with or without expertise, because you are speaking to the Gut, and the Gut is a moron, as anyone who’s ever tossed a golf club, or kicked a lawn mower knows. Intellect is pitted against feeling.” Three Great Premises of Idiot America. The First Great Premise: Any theory is valid if it sells books, soaks up ratings, or otherwise moves units. The Second Great Premise: Anything can be true if someone says it loudly enough. The Third Great Premise: Fact is that which enough people believe. Truth is determined by how fervently they believe it. And... “In the new media age, everybody is a historian, or a scientist, or a preacher, or a sage. And if everyone is an expert, then nobody is, and the worst thing you can be in a society where everybody is an expert is, well, an actual expert.” Charles P. Pierce Nobody asked me, but here’s my two cents worth The opinion piece links to a separate newsletter article by Dr. Tom Inglesby, the director of the Johns Hopkins Center for Health Security and an expert in pandemic preparedness. It’s a bit more useful. Rather than focusing on potential disagreements to come, he discusses what we should do now to prepare. To summarize: We need to get vaccines in arms much faster. We need to make it much easier to develop and distribute tests. We need a stronger stockpile of high-quality protective gear. We need to seriously change our approach to indoor air quality. We need stronger research oversight and lab safety. The C.D.C. needs a reset. In the face of what will be confusion and uncertainty with another novel pandemic, we need to recognize that experts may offer contradictory advice — but it’s still likelier to be better than advice from talk show hosts, bible bangers, con men, politicians with an agenda, and self-proclaimed ‘experts’ with conspiracy theories that ‘explain’ what’s really happening. The key will be to follow the science as we learn more about what we are facing, and make changes as justified by new findings. As SquireForYou reminds us, it makes a difference who is in charge, and that we really need to do something about our healthcare institutions that are still in bad shape. There should be no more stonewalling on Medicaid expansion, or a lot of communities will find they have no healthcare facilities left by the time the next pandemic hits. Paid sick leave is another no-brainer. If the new pandemic is going to be as deadly as described, there are some other things that suggest themselves. Advise people to update their wills and funeral plans, designate a healthcare proxy, and decide whether to file a DNR order. Given that Covid had some localities running out of morgue space and body bags, the authorities should plan ahead as well. Stockpile a supply of food and other supplies (toilet paper!) so that if/when someone in a household becomes sick, they can immediately isolate without having to go shopping. Make sure that tools for distance communication (videoconferencing, etc.) work and procedures are in place to deal with the disruptions that will occur. These are all practical steps that don’t really inconvenience people (at least those living above the poverty line - sucks to be them. Which is why more government assistance should be in the toolbox if needed.) One more thing: it may be impossible but... Shut down Fox and the GOP. The last pandemic showed us their only concern is how to exploit any crisis for political gain. They will spread disinformation, attack authorities, and increase division. They are willing to let their base die rather than tell them anything they don’t want to hear. January 6 showed how far they will go. They won’t fund even the most basic health measures. If their base wants to resist impositions on their ‘freedom’ - let them. But… encourage them to wear red trucker hats or some other visible symbol so they can be loud and proud about their defiance. (And the rest of us can know who to avoid.) If they want to hold rallies, let them. If they won’t listen to experts like Fauci, let them argue with Darwin. 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