Politics. The saying, “in God we trust, everyone else brings data” rarely crosses the lips of the political class. Darin Gordon, one of the longest serving state Medicaid Directors in the U.S. once declared, “government is into the recreational collection of data,” implying the massive amount of data collected often goes unused.
At its root, resistance to a full embrace of data is due to the way in which it can upset the narrative. Storytelling is the bread and butter of politicians and a good living for the consultants, pollsters and other minders that surround them. Narratives are born on the campaign trail and transformed into campaign promises and political platforms.
In times past, the storytelling and campaign promises were translated by the bureaucracy into action or as Mario Cuomo so succinctly put it “campaign in poetry, govern in prose.” A primary reason for Civil Service protection is to allow the permanent bureaucracy to balance the realities of governing against political pressures. In turn, bureaucrats tended to avoid political brawls to “do their job,” the common refrain to describe applying their expertise in as serious and apolitical a manner as possible.
In recent years, despite unprecedented collection and dissemination of data, bureaucrats have become storytellers themselves. Dr. Micelle Fiscus, head of Tennessee’s immunization program was fired in July for not doing her job well. Tennessee ranks in the lowest decile of states for COVID-19 immunizations, a fact easily accessible by almost everyone.
That track record was ignored for a short while in favor of Dr. Fiscus’ own story which was that she was punished for advising state legislators on the circumstances in which minors can seek medical care, (a retaliation unlikely under most Civil Service rules), thus linking a COVID-19 vaccine campaign targeting youth to abortion and other services deemed controversial by the Tennessee General Assembly. She claimed she was sent a dog muzzle as a “message” to stay quiet.
Her story supported other narratives and political storytelling, none of which included her responsibility for wretched rollout of COVID-19 vaccinations. National media appearances ensued including CNN’s Anderson Cooper 360. She was celebrated for her bravery in speaking out.
That was until Axios reported that Dr. Fiscus had purchased the muzzle herself. All that is lost is the credibility of public health officials at a time when it is needed most.
Policy. Great policy is born out of good information. Early in the pandemic, there was little of that. Many policy choices were made, some of them bad ideas. As time has worn on and data is collected and available, one should expect a significant improvement in the number of available choices as well as the way in which they are applied.
One would be disappointed.
Pediatric admission of patients with COVID has risen significantly in states currently experiencing a wave of the Delta variant infection. The absolute numbers are low, relative to adult admissions. In Louisiana, Mississippi and Tennessee, admissions of pediatric patients with a confirmed COVID-19 infection were 11,3 and 5 on August 17, respectively.
However, those numbers are large enough to generate a public health concern and several questions that could inform a policy response. For example, do these children have underlying conditions? What are the likely areas of transmission that should be avoided? Are there any trends associated with age cohort? And so on.
Despite testing everything with a pulse over the last 18 months, we cannot say. The absence of good information to support sound policy gives us more of what we got; mask wars erupting at school board meetings around the U.S.; dueling letters to the editor; another problem for the White House; exasperated parents and even a little hilarity.
(Mask a 2-yr old? Really? Have you ever met a two-year-old? You know, the little people that stick their fingers in your mouth and up your nose while you carry them into preschool?)
The CDC has surely collected this information (to be fair, they publish somewhat incomplete case line data on a lag) but to date has only managed to spit out a new controversial mask policy that is at odds with international standards.
Is it the slow, plodding and retrospective culture of public health officials that keeps data driven policy from developing quickly? Probably.
Or is it a desire not to disrupt the narrative? Also, likely true. Certain peer group experts have weighed in. The American Academy of Pediatrics, after telling mothers how much babies learn from facial expressions is now on board with masking them. Pediatric Cardiac Pulmonologists have said something similar.
That leaves parents and probably a lot of pediatricians with some common sense or at least a fealty to their training to develop on their own terms and on their own time what they think is best, eroding further the relevance of the medical and scientific establishment.
Power. If all that is important to the federal bureaucracy and their political overlords is a narrative, something that fits into the broader landscape of groupthink, then expertise does not have a home within the much of the government and, arguably several organizational defenders of the establishment.
In that purely American tradition, however, the void is being filled. Early in the pandemic, Johns Hopkins jumped in to provided needed data on case counts around the world. State health departments stepped up their collection and data sharing with almost every one of them offering interactive dashboards by spring 2020. Florida’s Emergency Management Agency produced a 2400 page county level report on everything from lab test results to hospitalizations and deaths
Private citizens have collected public health data and produced easy to understand visuals about the spread of disease within the context of their local community A few mainstream news organizations that have not lost their capacity to ask direct and uncomfortable questions are playing a role in defining public opinion.
As with any disruption of power, not all of it has been benign. For those that fell into the thrall of the wishful thinking that is zero COVID and all the dimensionless numbers provided by something called End Coronavirus Now, several policy errors were probably made. Absent their own data infrastructure and analysis, perhaps exacerbated by political tensions with state level health officials, local leaders sometimes relied on other third parties, like COVID Act Now which provides generalized and often inaccurate data.
As the experience of COVID-19 has unfolded, the value of individual data sources and news organizations has been easier to discern. The efficacy of non-pharmaceutical interventions can now be independently assessed outside the thin air of the scientific community. New York Magazine, hardly a scientific journal, has produced a number of level-headed articles that are having an impact on public opinion.
While certainly painful at times, the beauty of what is unfolding is the U.S. is that those zealous public health leaders that remain and their political enablers who might once again embrace school closures and lockdowns are finding a very cold reception. The same cannot be said for some parts of the world. The difference will separate economies for years to come.
Note: We will not be publishing from Aug. 26th to Sept. 1 to spend a little time with family. Look for Health Policy news back in your inbox On Sept 3rd.
Have a great rest of the weekend.
Emily Evans
Managing Director – Health Policy
Twitter
LinkedIn
