More Thoughts on the Loss of Trust
My response to the feedback on my article with Katelyn Jetelina
Last week, Dr. Katelyn Jetelina, aka “Your Local Epidemiologist”, published an article we co-wrote about our conversation on the loss of trust in public health. We got a big response, and I wanted to take some time to address some of the feedback we received, both positive and negative. Katelyn had the same idea, and though we wrote our responses independently, we identified many of the same themes in the feedback. My response is below, and you can read Katelyn’s response here.
A lot of the feedback was positive, with comments like this:
Wonderful! We need more respectful dialogue between people who disagree.
Absolutely, and that’s why I reached out to Katelyn in the first place. I also reached out to others throughout the pandemic, in hopes of engaging in some healthy dialogue about Covid and our response because I wanted to actually make an impact. With tensions high during the pandemic, many people weren’t willing to listen to any dissenting voices, but I’m hopeful that we’re at a place now where there’s a little more willingness now to look back at the past four years and discuss what happened.
On the other hand, there was also some of this…
Kelley is a minimizer, how dare you platform her! / Katelyn is bad, don’t trust her!
Honestly, I was nervous we’d see a lot more of this from both sides, but it wasn’t as bad as I anticipated, which was a relief. There’s a tendency to unfairly malign people who weren’t on your “side” during Covid. I admit, I got pretty frustrated with people at times, but I tried to focus my criticisms at ideas, not people, to keep it productive. And I was always honest about the data. Reasonable people can disagree on the interpretation of the data, or the value judgments people make based on it, but I think honesty about what we know and don’t know is critical.
When I posted our article on Twitter, I saw a lot of comments along these lines:
I still don’t trust public health. Where’s the accountability and apologies?
I get this. I really do. I started tweeting in May 2020 about school reopening, and the New York Times finally published an article this week acknowledging much of what many of us have been saying for years. And some people are still pushing back and defending school closures!
This conversation with Katelyn wasn’t meant to suggest that we’ve mended all the fences and public trust has been restored. But I think an important first step is to open up the dialogue and help the public health community understand that people who fought against things like school closures, mask mandates, and vaccine mandates, include thoughtful, data-driven people. We aren’t evil people who don’t care about the health of children and grandmas — we just think many aspects of health and well-being other than avoiding Covid weren’t given enough weight in the pandemic response.
To truly regain our trust, public health needs to acknowledge things they got wrong, admit areas where there is uncertainty, and rely more on data-driven risk/benefit analysis in future recommendations.
Meanwhile, Katelyn’s Substack comments included the flip side of those complaints:
I don’t trust public health because they gave up fighting Covid.
To these folks, I’m not sure what to say, other than I am sorry that public health spent the past four years terrifying you about a virus that was never going to be stopped and that we are all going to get at some point, likely many times throughout our lives. Anthony LaMesa refers to the US approach in many respects as “Zero Covid-lite” — public health gave false promises of containment or near eradication that were overly optimistic and that ignored the enormous societal costs it would take to try and achieve.
I think many people in public health are now in the precarious position of trying to carefully back down from some of their earlier rhetoric without losing credibility among those who they spent years stirring up into a panic. The CDC has faced harsh criticism by the Covid cautious for some of their updated guidance, when in reality, the CDC is 1-2 years behind many other countries at acknowledging the reality of Covid as an endemic respiratory virus.
Another comment I saw a lot in Katelyn’s Substack comments…
The problem is that everything was politicized!
This is a common complaint among those on the left, who want to blame Trump and his influence on the CDC for every bad thing that happened in the pandemic. Honestly, I don’t think it would have made much difference who was president. No country had a magical solution that saved people from Covid. Any country that people pointed to as a success at some point — from the Czech Republic to New Zealand to China all had a huge wave of Covid later on. The level of restrictions required to control Covid while waiting for vaccines was massive, and frankly, not compatible with American values and freedoms.
And things were certainly politicized in the other direction as well. The Biden campaign pushed hard on the message that schools weren’t safe, and that they couldn’t be reopened without a huge infusion of government money (much of which wasn’t ever used to help reopen schools). And once Biden took office, his administration did everything they could in an effort to prove that “they took Covid seriously,” but there’s no solid data that their approach was any more effective.
One of the major issues we saw was that the science itself was often politicized — many studies were published that seemed to push a predetermined narrative rather than test a hypothesis and then come to an objective conclusion. I’ve spent a lot of time on Twitter and my Substack exposing flaws in some of these studies, and the state of “the science” has been frustrating to say the least.
Even if the science were politically neutral, it’s still up to politicians to make decisions for the country/state/locality about how to respond, given what the data shows. There’s more to navigating through a pandemic than just “following the science” as the following study, by famed epidemiologist D. A. Henderson and colleagues, so aptly described in this “overriding principle” below:
Finally, a few comments were more specific, and I want to touch on those as well. The one thing I wrote about that several people reacted strongly to is this:
Kelley didn’t know people who were hospitalized or died?!?
To be clear, I wasn’t denying that people were hospitalized or died from Covid, but I was trying to relay to Katelyn and others that much of the public health messaging didn’t come across as believable to people who didn’t know a lot of older or other high-risk people. Senior citizens and people living in NYC in Spring 2020 certainly had different experiences, but the messaging could have been better if it acknowledged that the risks were not being experienced evenly across all communities. It seemed like public health was committed to pushing a message that Covid was as big of a threat to a family with young kids as it was to an elderly cancer patient.
And some specific items I left out that people mentioned in my Twitter replies…
Other public health actions that caused people to lose trust:
Sudden embrace of lockdowns in March 2020 based on data from China
Efforts to cover up the origin of SARS-CoV-2
Promotion of ineffective cloth masks based on weak studies when it was obvious that they weren’t effective in the real-world
Acceptance of the George Floyd protests while other in-person gatherings were restricted
Denial of post-infection protection, aka “natural immunity”
Refusal to seriously acknowledge (or compensate people for) adverse events from vaccines
College vaccine mandates (mandating vaccination among young people at low risk of disease but in the highest risk group for vaccine myocarditis)
Vaccine mandates to get a green card for legal immigration into the US (while others coming into this country are not required to get Covid vaccines)
Long Road Ahead
It will take time to get us out of the mess we’re in now. I plan to keep reaching out and trying to bridge the gap between people who held dissenting views throughout the pandemic. We’ve all been through a difficult time, and it’s clear that there are a lot of raw emotions on both sides still, but I think earnestly listening to each other is an important step in rebuilding trust. I recommend keeping an open mind and trying to give others the benefit of the doubt as we navigate a way forward — you might find that you agree on more than you realize.
One of the biggest issues I had was the outright lying.
To pretend that they knew more than they actually knew, they lied about it. Lied about trade-offs, lied about data, just lied.
But it wasn't just the deceptions, but that they tried to otherize the people who were trying to dig into what was actually going on. In some cases, these other people may have been incorrect, but they were trying their best. In some cases, they turned out to be correct. But no, they wanted grandma to die, you see.
They are going to have a difficult time rebuilding trust if it's not just that they say, "Sorry, we were wrong, we shouldn't have done that" (they're still making excuses -- some won't go that far), but that they say, "We won't do it next time." -- some may say the first, but not the second. We can't trust it won't happen again. They'll lie again if they feel they want to wield that power. It's for our own good, you see.
Even if they're wrong. Again. Because they're the experts.
I continue to really appreciate what you are both doing here but when taking a step back some of the dynamics are really strange, aren't they? For example, the idea that we must show "public health" officialdom that those with dissenting views were data driven and not bent on destruction or whatever (similarly, Dr. Jetelina's statement in the original piece that she was initially surprised she could have a civil and productive dialog with you (!))... I mean, is public health a serious profession and field of study? Or some kind of insular and emotionally fragile club?
Because in most serious professions / fields of study the ability to consider and incorporate alternate views is pretty baseline. As their reflection continues (at its glacial pace) I hope they will consider there might be something fundamentally awry in the epistemological state of either the field itself, or the majority of its contemporary practictioners.