POV: In the Midst of the Pandemic, a “Massive Public Health Failure”
POV: In the Midst of the Pandemic, a “Massive Public Health Failure”
The biggest mistake? An intentional unwillingness to articulate a public health goal
With the United States having reached well over a half million deaths from COVID-19 and more than a half million cases and 16,000 deaths in Massachusetts alone, it is clear that there has been a massive public health failure. While the Trump administration is partly responsible, it would be a mistake to ignore the role that states played, and that public health played in general.
There are many specific failures that could be cited, but the chief reason why state governments and public health departments failed is much more basic and overarching, yet it is something that I have not heard mentioned anywhere.
Our biggest failure in public health was the failure to articulate a goal. In every other public health issue or campaign we have worked on, we’ve always had a goal. Here, we intentionally failed to articulate a goal. This is the number one reason for our failure.
Why didn’t we articulate a goal? It was because the decision was made early on that public opinion and perceived economic strength would be the primary policy drivers, not public health protection. You only have to look to the fact that casinos, restaurants, and gyms were open during the absolute peak of the pandemic, while many elementary schools were closed, to appreciate the priorities of Massachusetts Governor Charlie Baker’s administration. The only time there was even a hint of a goal was very early in the pandemic when we were trying to “flatten the curve.” From then on, the Baker administration set no goals, except to try to open businesses as quickly as possible. But for the public, there was no goal. You can’t expect people to act when there isn’t a clear goal. They have to know why we’re telling them what to do.
This failure even occurred at many colleges and universities, which in their own desire to remain open so as not to lose tuition dollars, never advocated for any particular public health goal. In fact, the primary goals for many colleges and universities were not health-related: their chief aims were to avoid the loss of student tuition dollars by appeasing students who “preferred” to attend classes in person. At our own university, students were asked to indicate their preferences without being told that if even one student in the class expressed a preference for in-person classes, the faculty and teaching staff would be required to come into campus and teach in person, even if they believed they were being put at substantial risk. We didn’t even have a goal in terms of the health of our own community. We never articulated how many student or employee COVID-19 cases would be acceptable in order to justify forcing teachers and staff into the classroom. The reason for not articulating a threshold for the number of cases that would be acceptable is clear: because we might actually hit the threshold and force classes to move online, risking the loss of students to deferrals.
As a professor of public health, it was particularly striking to me that even my own school failed to advocate for any articulated goal. We never expressed a commitment to an effort to try to minimize the morbidity and mortality from the pandemic. For example, not once did we promote nonessential worker stay-at-home policies. We couldn’t because we eschewed such a policy. If a school of public health can’t make the right decision, how can we expect policymakers to? If a school of public health doesn’t lead, then where do we expect public health leadership to come from?
The reason for public health agencies not setting a goal was simply to avoid having to pay people to stay home, which would have been unpopular and expensive. But the resulting loss in human life, suffering, and individual economic disaster far outweigh what it would have cost to do this. And ironically, the economy would have recovered much more quickly.
People will do almost anything when there is a clear goal. Look at what the government got people to do during World War I. Not to defend President Woodrow Wilson’s goal of “making the world safe for democracy,” but history demonstrates that you can get people to take quite drastic actions if they know why they are doing so and feel that they are contributing to a well-articulated national or statewide goal.
Even now, as vaccines roll out, the Baker administration still has failed to articulate a public health goal. The state, and our own Department of Public Health, have never stated that we should make an attempt to minimize the amount of health damage and loss of life that occurs between now and when we are able to get the public vaccinated. Instead, the governor loosened social distancing restrictions even further last week, allowing indoor arenas to open their doors and enabling indoor gatherings of up to 100 people, complete with packed dance floors. This is the last thing we should be doing if our goal is to minimize the number of deaths that will occur before we are able to complete vaccination. The state’s policy decisions have opened the door to a possible third surge in cases, as more infectious variants are expected to predominate just as the dance floors are opening up. Clearly, our goal is not to save lives and protect health, but to get back to “normal” as quickly as possible.
The greatest disappointment to me is that no public health agency stated very simply that our goal is to minimize the number of deaths from COVID-19 or at least set any quantitative goal. The bottom line is that deep down, we really didn’t mind all these deaths occurring. To the Baker administration and most other government agencies, public health departments, and institutions, it was the loss of economic activity that was the big tragedy of the pandemic, not the loss of human life. Sadly, I’m not sure it was any different for most universities.
Is BU tracking the ongoing health status of students, faculty and staff who it knows were infected with COVID? Studies suggest about 10% of even people who suffer mild initial effects go on to suffer medium to longer term impairment (“long haulers”, “long COVID”). How are these members of our community doing?
The biggest mistake might actually be public health’s inability to diagnose its own myopia.
Dr. Siegel, for instance, has insisted on marching to the beat of his own drum since the pandemic began. Never mind the fact that esteemed colleagues such as Davidson Hamer sit on Boston University’s own Medical Advisory Group or that Dean Sandro Galea chaired a statewide emergency task force of the Massachusetts Public Health Association. Why is it that Siegel doesn’t account for others’ public health opinions on this pandemic?
The fact of the matter is that leaders of the University and the Commonwealth balanced numerous factors and devised an effective solution given the crushingly difficult circumstances. For example, Siegel ignores the fact that, had BU shuttered its doors to in-person learning, budgetary models projected that BU would have had to lay off or furlough over 1,000 employees on top of the other drastic cuts that BU already made. At the outset, there was no assurance of a financial backstop with a divided Congress. Could it be that Siegel, who carries the antibodies that come with the luxury of a tenured academic position, is simply immune to economic disease? Thousands of employees of BU (many of us from disadvantaged backgrounds) don’t carry that immunity, not to mention the scores of small business owners that surround our campus!
Siegel also ignores the numerous mitigation measures that the University has taken to stay open. The result: Zero in-class transmission of the virus.
And, Siegel glosses over the fact that, had BU closed, it would have forestalled the educational progress for thousands of students. Instead of failing kids like many of our public lower schools have done, BU’s faculty, students, and staff persisted and, though the conditions are not optimal, deep learning is taking place.
Strangely, Siegel prefers to pin the blame on others. Say what you want about Governor Baker, but it wasn’t the governor who time and again sought to shutter schools (even in the face of overwhelming evidence that they were safe). Apparently, teachers unions also suffer from this myopia.
By theatrically acting as if he’s the only voice crying in the wilderness, Siegel fails to account for the possibility that, like the boy who cried wolf, one day no one may no longer want to listen to the important and critical role that public health plays in society. The worrisome failure at play here is unilateralism, and it goes well beyond the public health sector in today’s world. Instead of dogmatically insisting that their voice is the only one in the room, it would be more helpful if individuals like Siegel sat down, pulled a chair to the table, conferred broadly with other stakeholders, and put their noses to the grindstone until they produced a nuanced, multifaceted, albeit complicated, solution to both the pandemic of today and the problems of tomorrow.
Gotta love the hypocrisy of this argument that only a sheltered academic could make! Talking about the tuition dollars that pay their hefty salary while they sit tucked away at home pontificating from their high horse and telling students they’re not public health material if they choose to come to class in person. Talk about white male privilege!
Ms. Trotwood’s response, viz.;” Say what you want about Governor Baker, but it wasn’t the governor who time and again sought to shutter schools (even in the face of overwhelming evidence that they were safe). Apparently, teachers unions also suffer from this myopia.”
My wife is an instructional aid in a public school. She is in her 60s and so am I. The issue to go back to school or not was agonizing for her, for many reason that involved the whole family, not just her. She finally got hired part time to work by Zoom with her class. It worked out great – for both her and the kids. You see, the kids love multi-media on teh internet. And my wife felt safe, and that made my family feel safe that she stayed home. So it was a WIN-WIN solution. The teachers union helped out, her class did fine, and the school was none the worse. In fact, they have already used the lesson learned by starting a “remote academy” [ZOOM] to work with students at home, who are staying home for whatever reason, or just need help after school work in general. So lots of positivity came out of it. But it took a whole “eco-system” of effort to figure it out.
So your notion that to “shutter schools” is bad – is false. Your notion that schools were “overwhelming . . .safe” – is false. Living in a family with a public school educator was hard, because teachers love their students, but teachers needed to be protected and respected, AND their family members like me. So please don’t gloss over the hard conversations with simplistic ideology that we just have to open the schools and all is well.
So when you conclude that teachers unions are obstructionists, and that public schools failed our educational system, you remarks are simply false. Its been a tough year for everyone who has had to deal with making tough decisions. To suggest anything less is real myopia.
The cynical stance Dr. Siegel takes is that the loss of economic activity trumped any loss in human life, and that “we really didn’t mind all these deaths occurring.” In a global pandemic, it’s understood that people will die. Thus, public policy was shaped around preventing exposure to those that are most vulnerable, chiefly in the forms of masks and social distancing. The goal of minimizing deaths and cases is implicit in this policy formation, and it does not need to explicated by the public health agency. Setting a quantitative goal for an unprecedented pandemic is unreasonable; in a world where Trump pushes aside science and inspires an anti-mask movement, how can you reasonably expect agencies to set up a target? It’s inviting failure.
But Dr. Siegel’s insistence of no clear goal being pushed is what baffles me. Firstly, as I mentioned before, the goal was to minimize deaths–to that end, mask mandates and social distancing policies were enforced. Secondly, Dr. Siegel heavily criticizes the economic drivers, but is it not universally understood that quelling economic downturn is a priority? He highlights the closure of schools before restaurants and casinos, but this wasn’t a demonstration of priorities; rather, it was an effort to stop the spread in vulnerable communities while allowing some businesses to remain functional. Lastly, people do not act accordingly when there’s a clear goal. The public was given a clear order to wear masks, and people still don’t follow that order. Of course, this is partially due to the mixed messages that the public received through Trump/Fauci, but the general public will not fall in line like Dr. Siegel suggests. He uses an example from World War I, but that was due to the government working synchronously with propaganda efforts, namely through selling bonds and recruitment. In our current situation with the country ideologically divided and an invisible enemy’s invasion, no clear goal could get us to unite.
To respond to his emotional stake, I empathize with his disappointment. As a healthcare provider the COVID pandemic began almost as if entering foggy waters, with first responders, emergency medicine workers and those on the fringes of society serving as the proverbial guinea pigs for those who bear the privilege of hanging back in safety.
However, while I agree that success is impossible if there is not a goal to strive towards and to use as a metric of “success”, I disagree with Professor Siegel’s expressed connotation of opening back to normal. I think the economic piece of reopening has more implications that simply peoples’ wallets and bank accounts. Rather it is in the ability to do things that were apart of peoples’ routines and livelihoods. Our efforts to socially-distance also resulted in intense social isolation. Whether we like it or not COVID exists, but as we transition back to a new sense of normal I think we are often overstating the implicit danger of the disease. Old people, whether by COVID or not, pass away. While this statement carries intense weight and gravity it must be said. How much of our lives are we giving up to these continued failed attempts at eradicating the disease? Considering the distribution of the vaccine, if enough people are vaccinated to avoid strain on our healthcare infrastructure, then why can’t the Governor continue with re-opening the state?
As a student during the pandemic, I will say that I do understand how frustrating and confusing it can be when it comes to what will happen next. At the beginning of the pandemic there was uncertainty to every aspect of my life. I wish that humans would come to agreement faster, however the reality is that will never happen. Throughout the article Professor Siegel mentions the lack of a goal, however I struggle to understand exactly what the ideal goal would be. Siegel does mention that “You can’t expect people to act when there isn’t a clear goal. They have to know why we’re telling them what to do” which is true, however it’s not as easy to convince people and the definition of a clear goal is vague. What is a tangible differentiator between a clear goal and an unclear one.