Now that we’ve hit the two-year anniversary of the lockdowns from the beginning of the COVID-19 pandemic in California, it is time to take stock of hard-won lessons. With all-cause mortality at 18.4% above historical norms, a figure worse than the national average, no one should say that our response was a success. The lessons then should focus on what went wrong so we do not repeat them.
When the disease first arrived in the United States on Jan. 23, 2020, the attitude conveyed by public health officials was one of relative calm. In mid-March, in response to the release of questionable disease-modeling forecasts that predicted 2 million Americans would die within the next two months, President Trump declared a state of emergency. States around the country issued extraordinary orders, shutting schools and businesses, and quarantining the population.
The reasoning behind this panicked order was that there was much unknown about the virus at the time — how it spreads, how many people were already infected, how deadly it is — that prudence demanded assuming the worst and acting accordingly. While this makes some sense, this precautionary principle also requires that we do not assume that the interventions we adopt are harmless to address the risk.
The harms of those policies have been devastating to the physical and mental health of the population. School is vital to the health and future well-being of our children.
Across the country, only Washington D.C. kids had fewer in-person school days during the pandemic than California kids, with poor kids particularly harmed. Basic care, known to save lives, was halted to flatten the curve, including cancer screening and even treatment for heart attacks.
In July 2020, the Centers for Disease Control reported that one in four young adults seriously considered suicide the previous month. And none of this counts the costs of the American lockdown on the well-being of the poor living in countries that depend on American trade.
Lesson No. 1: The precautionary principle permits us to assume the worst about the threat we face until we learn more, but it does not allow us to assume without evidence that all possible interventions we adopt are worthwhile. We still need to count the costs.
The now infamous public justification given for the lockdown order was “two weeks to flatten the curve,” with avoidance of hospital system overcrowding with dying COVID patients as the policy’s primary goal. As two weeks stretched into months, the state established metrics for a return to normalcy that still has not arrived two years later. The justification for the order transformed without explicit acknowledgment into an implied promise that if Californians sacrificed hard enough, we could be rid of this disease forever.
But COVID meets none of the criteria of an eradicable disease. We have no technology to completely stop the disease, not lockdowns, masks, plexiglass, not even the vaccines. At best, these technologies postpone the inevitable, as Australia, New Zealand and Hong Kong, once touted as zero-COVID success stories, have learned with enormous case surges in recent months. Animal reservoirs include dogs, cats, bats and pangolin. One USDA survey found white-tailed deer in the U.S. have COVID antibodies.
The assumption of an impossible utopian goal blinded public health policymakers to what was and is possible — protecting the vulnerable. The great weakness of this virus is that, while it poses an enormous mortality risk to our elderly population and younger people with certain chronic health conditions, it leaves the rest of the population, including children, relatively unscathed. So the right strategy is one of focused protection of the vulnerable rather than universal suppression. It is a strategy made much easier by the availability of a vaccine that sharply reduces the risk of hospitalization and death if infected.
Because public health pushed the wrong strategy, many died. For instance, former New York Gov. Andrew Cuomo sent COVID-infected patients into unprepared nursing homes in part because of the advice he received to protect hospital systems rather than the vulnerable.
Lesson No. 2: Public health should adopt realistic goals that take advantage of the threat’s biology and aim at protecting the vulnerable, rather than utopian ones that inevitably lead to worse outcomes.
Throughout the epidemic, public health officials have repeatedly lied to the public to induce compliance with public health orders.
Dr. Anthony Fauci, the architect of the failed pandemic strategy, has admitted to dissembling about the efficacy of masks in the early days of the pandemic.
Many public health officials ignored the overwhelming evidence going into the pandemic that cloth masks are ineffective at stopping the spread of a respiratory virus.
Prominent figures, including the current CDC director, have downplayed that COVID-recovery provides strong immunity; you can get infected again, but the second infection is very likely to be less severe than the first.
All these lies served a purpose.
Fauci’s early lie about masks aimed to preserve masks for hospital staff. Public health’s quasi-religious commitment to masking has been motivated in part by a desire to provide the public a sense of agency and control over infection risk. The denial of immunity after recovery was perhaps inspired by a desire not to undercut vaccine demand.
As worthy as these goals may be, each lie undercuts the confidence in the public in public health, and fewer and fewer people will obey or trust when the next order comes around.
Lesson No. 3: A noble lie is still a lie. The public’s trust in public health is a precious commodity that should be preserved with an ironclad commitment to truth-telling.
Two years on and the virus continues to circulate in countries around the globe.
The pandemic, however, is drawing to a close as government after government has accepted the fact that the virus is here to stay forever, joining the 200 or so other pathogens that cause diseases in humans and the other circulating human coronaviruses. That is the bad news.
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The good news is that much of the world’s population has protection against severe disease and death if infected either via vaccination or immunity conferred by recovery. The virus is no longer meeting the immune-naïve population that it met in early 2020, so there is no reason to reimpose that panic.
If public health learns the lessons of the last two years well, schools and businesses will return to normal, and scientists will continue working on better treatments and better vaccines.
Meanwhile, public health should take steps to ensure that the remaining vulnerable people be strongly encouraged — but not coerced — to receive a vaccine for their own protection no matter where on Earth they live.
Jay Bhattacharya is a professor of health policy at Stanford University and a research associate at the National Bureau of Economics Research. He holds an MD and PhD in economics, both earned at Stanford University.