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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."

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