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Sunday, June 28, 2020

Public Health has failed us all 

Over the last week, I have come to understand that the COVID 19 pandemic will be known as the worst North American public health failure ever. 
Here's why:
Remember five months ago, way back in February, when COVID cases first began showing up in North America?  
That is also when doctors in Europe, who were already dealing with dozens of cases, started reporting that, unlike other recent viruses,  transmission of COVID 19 appeared to be happening from people who didn't know they were sick and who did not display any symptoms.
It is impossible to find and quarantine such people, because nobody knows who they are. They themselves don't even know they are carrying the virus.
The only way that someone without symptoms can be stopped from transmitting a respiratory infection is for everyone to wear a mask, so that the infected people are prevented from spraying infectious droplets every time they speak, cough, sneeze, etc. 
So if, back in February, we had all been told to wear homemade masks whenever we were out and about (like many people already do in Asia, by the way) this simple act would have protected the friends and families and coworkers and clients of the hundreds of people across North America who were already infected but didn't know it - the dentists, the doctors, the choir members, the conference attendees, the nursing home staff, the teachers, the social workers, the waitresses, etc etc
And thus, COVID 19 virus would not have infected hundreds of thousands.  And thousands of the people who died would have lived instead.
But what happened when, back in February, European doctors started reporting that symptom-less people were infectious? 
Well, nothing.
Faced with these early reports of symptom-less transmission, public health authorities like the World Health Organization, and the CDC and Canada Public Health did not leap into action. 
They squabbled. They denied the evidence. They quibbled about terminology. The New York Times report goes on:
Interviews with doctors and public health officials in more than a dozen countries show that for two crucial months — and in the face of mounting genetic evidence — Western health officials and political leaders played down or denied the risk of symptomless spreading. 
Leading health agencies including the World Health Organization and the European Center for Disease Prevention and Control provided contradictory and sometimes misleading advice. A crucial public health discussion devolved into a semantic debate over what to call infected people without clear symptoms. 
The two-month delay was a product of faulty scientific assumptions, academic rivalries and, perhaps most important, a reluctance to accept that containing the virus would take drastic measures. 
The resistance to emerging evidence was one part of the world’s sluggish response to the virus. It is impossible to calculate the human toll of that delay, but models suggest that earlier, aggressive action might have saved tens of thousands of lives. 
Countries like Singapore and Australia, which used testing and contact-tracing and moved swiftly to quarantine seemingly healthy travelers, fared far better than those that did not.
And another thing happened too, at the same time. 
Even without a lot of evidence, even without contract tracing and quarantining travelers and other government measures, there was one crucial step that everyone could have taken without any government program at all - wearing a homemade mask. 
It seems like at least some of those who work in public health in North America also believed that the situation with COVID 19 was so urgent that wearing masks couldn't hurt and might help.  
But they decided not tell us. 
While public health officials hesitated, some doctors acted. At a conference in Seattle in mid-February, Jeffrey Shaman, a Columbia University professor, said his research suggested that Covid-19’s rapid spread could only be explained if there were infectious patients with unremarkable symptoms or no symptoms at all. 
In the audience that day was Steven Chu, the Nobel-winning physicist and former U.S. energy secretary. “If left to its own devices, this disease will spread through the whole population,” he remembers Professor Shaman warning. 
 Afterward, Dr. Chu began insisting that healthy colleagues at his Stanford University laboratory wear masks. 
Doctors in Cambridge, England, concluded that asymptomatic transmission was a big source of infection and advised local health workers and patients to wear masks, well before the British government acknowledged the risk of silent spreaders.
But back in February, there wasn't enough PPE to go around and all the medical masks we had were desperately needed by medical staff. 
So Public Health authorities had a choice -- they could have been truthful, and told us that masks might help but the general public had to use homemade masks to save the medical ones for the health profession. 
But this message was too complicated and people were already hoarding toilet paper, and homemade masks might "give us a false sense of security" because we're all just so stupid that we wouldn't stay home anymore and besides, we likely wouldn't wear then correctly anyway. So it was just so much easier to us not to bother with masks at all, that they weren't necessary for anyone who wasn't already sick.  
The American authorities, faced with a shortage, actively discouraged the public from buying masks. “Seriously people — STOP BUYING MASKS!” Surgeon General Jerome M. Adams tweeted on Feb. 29.
In other words, they lied to us.
And the politicians those public health authorities were advising -- the governors and premiers and presidents and prime ministers - ended up passing on those lies because they didn't know any better.  
So now here we are in June.
And now the public health authorities say, "Oopsie!!  Hey, you guys, we tell you now that you really should wear masks after all, because everyone would be just so much safer."
Only its too late. Hundreds of thousands have already died. And millions are confused by the changing stories and the untruths and the squabbling and now they don't believe anything that public health authorities are telling them. And the people who own stores and manage events and work in offices and teach in schools are just as confused. So they don't know whether to require masks or not.
Back during the Spanish Flu, public health failed because they just didn't know how to organize public health administration and do the scientific studies and analyze policy options and communicate widely with the public.
Now, we have all that. We have a huge public health infrastructure with thousands of experts worldwide whose whole purpose in life is to keep people safe. 
But in North America, they failed us.
So first they didn't recognize the truth, and then they didn't trust us enough to tell us the truth when we needed it.  
[CDC head] Azar also pushed back on the idea that the new surge in cases is a result of reopening the country too fast, arguing, "That's not so much about what the law says on the reopening than what our behaviors are within that. If we act irresponsibly, if we don't social distance, if we don't use face coverings ... we're going to see spread of disease."

Recommend this Post at Progressive Bloggers | 8 comments

8 Comments:

I'm one who is not convinced on the opinion that cloth masks prevent viral spread. To say that if Canadians had started wearing masks back in January or February that we would have seen fewer identified cases and deaths cannot be proven....

I know many people will point to countries like Japan and Taiwan where masks are ubiquitous and point to the incredibly low numbers in those countries...the problem is that both Japan and Taiwan are hardly doing any testing. When an 85 year old with heart disease dies but no Covid test is done, then the death is listed as due to heart disease.

In Canada we've tested over 70,000 people per million of population, Japan has only done 3,572 tests per million, Taiwan just 3,200. It's a well known truism that if you want to manage something you have to have measurements in place, and Japan and Taiwan aren't doing the measurements. Even South Korea, another country touted as an example of how to manage the pandemic is testing at less than half of the rate we're at in Canada.

There's been no scientific study done to suggest that cloth masks are effective in stopping viral spread. As with so much of the advice we've been given it's filled with words like "may" and "could". Anyone saying that cloth masks are effective is expressing an opinion (which is fine) but it is not scientific fact, for that you need a controlled study with blinded protocols.

From what I have seen I believe wearing a cloth mask for many people "could" increase their risk of contracting the virus. This is an opinion based on my observation of people frequently adjusting their masks and then inadvertently wiping their eyes without even being aware of it...

I've been shopping twice in the last 5 days and on both occassions not one employee in the grocery store was wearing a mask, and maybe 25% of the customers (totally unscientific guess based on my observations).

I do share your view that public health officials have horribly botched their response to the pandemic, but I put it down to them stating things as FACT, when it's actually an opinion.....only now do I find they're starting to admit that they simply don't know, the most recent example being the question of asymptomatic spread....they don't know if those who never develop symptoms spread the virus or not, or maybe that some do and others don't.

I fear that a lot of people have just simply tossed in the towel and are basically just tuning everything out. Remember how cholesterol was going to kill everyone back in the 1980s? Then it was 2 types of cholesterol, hdl and ldl....LDL being bad and HDL being good....but then it was that our bodies needed both to varying degrees, then it was genetic. Ugh.

We got lucky with Covid....its not widely deadly, but there will be another Spanish Flu type virus I'm sure at some point....and people might just ignore health officials when it happens because of how badly they botched things this time.

Peace

By Blogger Gordie Canuk, at 10:39 pm  

Thanks for the comment.
There actually have been a number of studies that prove the value of cloth masks - McMaster just finished one, and Sanford advised the WHO on their mask guideline changes in June, based on their research findings. They are not, of course, as effective as the N95 masks, but the researchers think they are at least somewhat effective in reducing transmission.

By Blogger Cathie from Canada, at 11:01 pm  

Cathie, do you see the contradiction in what you just posted in response?

You start off by saying: "There actually have been a number of studies that prove the value of cloth masks. (my bolding)

But then you contradict it with:
"...the researchers think they are at least somewhat effective in reducing transmission.

If you could post a link to the studies that would be great, real science follows strict protocols.

By Blogger Gordie Canuk, at 11:34 pm  

I googled the Mac study and came up with this:

https://brighterworld.mcmaster.ca/articles/evidence-shows-cloth-masks-may-help-against-covid-19/

May help, which automatically infers that they also "may not". The concluding quote from the study's first author I think says it all:

" we suggest that the possible benefit of a modest reduction in transmission likely outweighs the possibility of harm...."

This isn't evidence....

By Blogger Gordie Canuk, at 11:51 pm  

Yes, but do not let perfect be the enemy of good. Just because masks aren't perfect doesn't mean they are not useful and effective. The goal of Public Health is to reduce COVID transmission as much as possible, and homemade masks do reduce transmission.

By Blogger Cathie from Canada, at 10:48 am  

I'll pass over Gordie's comments as he's been pushing his single idea for several months on his blog. He's not interested in what anyone else thinks, because he thinks he's correct, and yet even with his four responses, he manages to change from one POV to the opposite.

Hindsight is remarkable, so yes I think we were not ably led by Public Health. Dr Tam was reassuring us that Canada's crack hospitals were fightin' fit after SARS, and 17 years later Canadians had no worries about a mere virus. Then the hospitals checked their stockrooms and SHRIEK! not enough PPE. Prepared all right. Not.

Me, I looked, and saw European civilians wearing masks, but nah, nobody in PH thought them necessary here. My first venture out around April 2 to get groceries was two weeks after our local lockdown. I'd made a mask/bandana from ideas in the Guardian, and also wore latex gloves.

From thence to now, most people don't bother with masks. Both Sobeys and Loblaws employees wore none, and seemed to be entirely ignorant when questioned of even the existence of Public Health. They just followed orders from management, and masks were optional. I regarded that attitude as disrespectful of me and their customers. But people are so ill-educated you might as well be talking to a wall. Factor that in when when we criticize PH.

I'm an engineer, my brother is a doc. You don't have to be a nuclear scientist to observe that Kleenex was invented as a substitute for a handkerchief and you sneeze into them. Wonder of wonders, they work. So it's not an intellectual leap to see that masks do too. But to Public health doctors, this was a step too far. Then they said it was to protect others from you. Anyone with the least modicum of a brain can see it works the other way round as well or all logic disappears. Same with the no wearing of gloves mantra. Horsesh!t!

Now of course we're supposed to wear masks when shopping etc. But here in my province, there are essentially none available at retail. What -- does everyone have an Amazon account? Not round these parts. So where are the free masks after three months, the cost of which is miniscule compared to the millions shovelled down ratholes to support business? I regard the lack of readily available masks locally as a crime, essentially. Public Health seems to operate up in a cloud of nonsense, and that applies to testing as well. Modern math seems to have eluded these folk in the sense of why there hasn't been random testing. I could go on for pages, but will forbear.

Wear a mask, stop objecting to them and do your civic duty. End of story. One virus won't infect you, you need several hundred in a clump, a good mist droplet you can see. A mask will protect from that. Or have the laws of physics been repealed?

Canada has only been middling good on CV-19. We basically abandoned the elderly. The situation is not so lop-sided elsewhere, and the virus kills. Look at Mexicans TFW's in ON. I list here a website that shows deaths per million population by country and lists past flu deaths for comparison. Most big Euro countries are still well worse than the US, except Germany, where they wear masks. QED.

https://www.realclearpolitics.com/coronavirus/

BM

By Anonymous Anonymous, at 3:44 pm  

I did not write the last comment about the perfect being the enemy of the good. And I still have yet to see a single scienfifically proveable study demonstrating that cloth masks are effective in reducing transmission.

But, it is a free country...if you want to wear one fill your boots. It will go well with a tin-foil hat.

By Blogger Gordie Canuk, at 5:38 pm  

Thanks BM, very interesting comment.

By Blogger Cathie from Canada, at 11:45 am  

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