Politics. The former Mayor of Nashville, Bill Purcell, acquired some years ago from his father an antique fire engine. He was and is still prone to pulling it out of storage for a trip around East Nashville during the Hot Chicken Festival. He told me he loved the fire truck because it was a timeless reminder of how much the little things in government matter, like safe streets, good schools and prosperous businesses.
Bill, when presented with a policy challenge that did not go his way, which was rarely, would point out the collective amnesia that often infects politicians who discover late their poor choices. “They will say they didn’t know, but they did. They just didn’t care.”
His point was made in excess when the Nashville School Board was visited by two of the leading pediatric infectious disease specialists in the world. The board was assured by these researcher/physicians that the risk to children was so low, and the damage being done so great, the choice was a simple one. The board was unmoved.
The sequela to poor policy choices driven by a nearly pathological need to avoid being tagged as an outsider by your tribe, however you define it, is just enough more amnesia to deflect blame to others. The explanatory sentence, when faced with the inevitable outcome begins with “they said” followed by a justification embraced mere months ago but now someone else’s fault. Then, the coup de grace: the pivot.
Ever so slowly we approach that inflection point. The New York Times has recognized that children are not so resilient they can, in effect, skip schools for two years without a high cost to themselves, their families and their communities. Comparisons to those previously knuckle dragging luddites that insisted on open schools are not flattering to either the New York Times or the governors and mayors who will say they didn’t know.
What comes next for a political system when a large part of the electorate concludes they might have been misled?
The best analog we have is the Iraqi War, a foreign entanglement in an ancient land, and not down the street in your hometown.
Policy. Last week PFE and MRNA announce EUA submissions for a fourth COVID shot. PFE has requested approval for the over-65 population. MRNA has asked for an all-adult indication. This, despite the increasing loud and credible criticism coming chiefly from the pediatric community, not to mention age restrictions being imposed by European governments.
Dr. Paul Offit, who I have cited many times, does a superb job of explaining why boosters for the young are not necessary. Dr. Vinay Prasad has pointed out the extraordinary low bar of evidence the vaccine manufacturers have thus far had to clear. Something called Public Health and Medical Professionals for Transparency Documents fought for release of PFE's trial data and won. They have a website with links to all the documents required to be released under FOIA.
And then there is the CDC’s data.
I have been a bit obsessed with mortality for the last couple of years, hoping I could explain the massive disruption that did not seem to square with only 5-6 million deaths globally. Indeed, The Lancet published an analysis of excess deaths last week that concludes about 18 million died, which is below the low end of our 20M range but still within a respectable distance.
The CDC WONDER database contains data from death certificates submitted by county public health departments. Death is a very inexact thing, but the data is organized well by cause, primary and secondary, using ICD-10 codes, and by age and geographical region.
There is more work to be done as the data is very granular and the website not easy to work with but an area of concern for policymakers, assuming they start thinking for themselves, are deaths due to “symptoms, signs and abnormal lab results not otherwise classified” (ICD-10 R00-R99) are displaying an anomalous pattern that developed in August 2021 (~Week 34).
There are a host of benign explanations for a massive deviation from the 2018-19 baseline. There may be some external motivation to exclude a COVID diagnosis from the death certificate that remains unexplained. There could be a data error. The CDC has had to make corrections recently especially related to child hospitalization.
The not-so-benign explanation could be that the concerns raised by European regulators and American scientists are valid and that there are certain known and unknown risks to the cardiovascular and other systems that have not been identified in clinical trials. Given the low bar for evidence, especially for expanded age indications, it isn’t the craziest idea.
Also, in the benign-not-so-benign camp is the American health care reality that an immune-response to a COVID-19 vaccine that might be handled well by a large research hospital was beyond the talents of a community medical center.
The data may be telling us about the failure of American health care, or it could be telling us PFE and MRNA are epic shorts. We will wait for the data to mature so for now, pick your own conclusion.
Power. The mistakes made by local, state and federal officials in their COVID-19 responses are legion, beginning with ignoring centuries of public health practice and the well documented response plans freely available on the CDC’s website. As the costs of “not caring” because “they said” accrue and the story is told, it will probably be President Joe Biden’s decision to declare a microscopic virus his political opponent that marked the point of no return. Defeat, as they say, was snatched violently from the jaws of victory.
By January 2021, vaccines were being delivered to the aged and vulnerable to great effect. Excess deaths declined markedly throughout winter and spring. The hoped-for victory stalled, however, when labor, a prime constituency of the Biden administration, refused to join the party, citing risk of infection from unvaccinated children. Into the open and waiting arms of the pharmaceutical industry, Joe Biden fell.
The administration doubled down on vaccinations, got ahead of the health agencies – a message even apolitical scientists could not miss – and declared that vaccinations would be available to all adults in May 2021.
By the time the Delta wave hit Joe Biden’s success as president was inextricable linked to a nearly uncontrollable health hazard. Vaccination status joined the other emblems and icons of the tribe, masks or not; closed or open schools; and social gatherings or isolation. Mandates were justified and documentation required.
As vaccination status was elevated, science was demoted. Low thresholds of evidence have become the standard and risks are generally being ignored by the regulators, the political class and the population at large. According to CDC data, 15.6M people aged 25-39 received 16.5M boosters, no doubt in response to mandates. This cohort is second only to the 50-64 year old cohort which has received 26.4M. As you probably already know, the death rate among the young is less than one per 100k. Among the middle age it is about five per 100k.
In the end, though it will be impossible to correct such a political miscalculation. All the Twitterati, and cable news talking heads cannot alter what individual people experience in their households, their churches and their communities. Knuckle draggers or not, the hesitant and skeptical may prove to be the most powerful constituency in the post-COVID world.
Emily Evans
Managing Director – Health Policy
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