The Dishonor System

There was an excellent op-ed in today's newspaper on mask-wearing as the COVID pandemic starts to wind down.  I say it's excellent, of course, because it largely agrees with me, especially this bit:

I am astonished that the CDC and local and state health departments are explicitly depending on the honor system for unvaccinated people to continue mask wearing. When did personal responsibility become an effective public health strategy? Public health officials have never relied on people to act responsibly or prudently. That’s why we have public health regulations.

The people most eager to get rid of masks and to attack vaccination requirements are people without honor: people who produce fake vaccination cards, people who make fake legal arguments about discrimination, people who harass and even assault workers in businesses that require masks, people who tried to force the country to re-open even at the peak of cases last year, people who wanted to force others back to work without safety requirements in jobs that were heavily hit by the pandemic.  In my state, Indiana, they included Republican legislators who tried -- ultimately successfully -- to hobble public health measures, and who now want to cut short extra unemployment benefits in order to force (or so they hope) reluctant workers back to low-paid, unsafe jobs.  And, of course, there's considerable overlap between this stance and the claim that Donald Trump won the 2020 election.

Many people, including me, drew analogies to other public health measures, such as the regulation and inspection of food establishments.  As it happens, a South Bend restaurant was recently closed by the board of health after longstanding multiple violations of the health code, culminating in two cases of food poisoning.  It emerged, however, that over the past couple of years the board of health had cut back on inspections and largely stopped public hearings on businesses with major violations.  The rationale was that they wanted not to subject the offenders to bad publicity that might hurt their business - which is, of course, the whole point of public hearings.  Despite all their fine talk of "choice," this policy had the effect of preventing the public from making informed choices.  It might have been defensible if the board quietly brought the offenders to compliance, but as this case showed, they quietly let the offenders continue to disregard the health of their customers.  It's not certain whether this case, emblazoned on the front page of the paper, will produce a return to transparency.  What is certain is that the push to eliminate public health protections isn't limited to infectious diseases.

As low as my opinion is of such people, I admit that I find their positions baffling.  We know that many of them remained steadfast in their denial of the seriousness of COVID-19 even when they got sick themselves -- even when they died of it, or when people close to them died.  But no matter.  Those who claim that they're entitled to disregard the health of others are wrong, both morally and legally.  They don't have the right to lie about their vaccination status.  They don't have the right to spread infection.

Myself, I still put on a mask when I enter businesses and other enclosed spaces, even though I've been vaccinated.  The more infectious, more virulent Delta variant of COVID-19 has been found in 37 states so far.  If we don't get another big wave of infections, wearing a mask won't hurt me and it won't hurt other people either.  As other people have observed, wearing a mask will probably also protect against the routine illnesses -- colds, flu -- that tend to spread in the fall and winter; it's why many people in East Asia have routinely worn masks for years.  The pandemic isn't over yet, but it's not all we have to worry about: the right-wing attacks on the public health system are partly meant to ensure unpreparedness for the next pandemic, but they aren't just about COVID,

How I Spent My Friday Morning

There aren't many advantages to turning 70, as I did three weeks ago, but one is that I am now eligible to try to get the coronavirus vaccine in the state of Indiana, and I did today.  I say "try" because it wasn't as easy as it should have been.  I spent most of the past week beating my head against the reservation website, which was simple enough but didn't work: I would find a nearby location (there are two in my small town), find what the site said was an available date, type in the requested information, click on "confirm reservation" -- and get an error message telling me that there were no openings on that date.  I called the 211 information and referral number and talked to two very nice and helpful workers, but all they could do was enter my information on the same website -- it didn't work for them either -- and then suggest I try again early the next day.

Then this morning I noticed some differences on the local page.  The county department of health, which had offered reservations starting in mid-February, suddenly reported that no reservations were available. The local hospital, which previously had no open reservations, suddenly had them today.  I grabbed one, the site confirmed it, I rode my bicycle over (about two miles - the department of health was much nearer), walked in, answered some basic questions, got jabbed with the Pfizer vaccine, made an appointment for a second dose in mid-February, waited fifteen minutes to make sure I had no immediate adverse reactions, and walked out again.

It all went very smoothly.  I've been to the hospital a few times since I moved up here, for lab work and other diagnostics, and the staff have always been great -- professional in the best sense of the word.  I wouldn't have guessed, to observe them today, that they'd been dealing with a major pandemic for the past year.  One of them explained that they'd starting out using both Pfizer and Moderna vaccines, but had decided to phase out the Moderna except for second doses because they had the facilities to handle the ultra-cold storage the Pfizer vaccine needs -- not bad for a hospital in a town of about ten thousand people; supplies of the Moderna are now going to smaller, more rural locations.

I also wouldn't have supposed, from the numbers of people they were processing, that there's any great resistance to the vaccine around here.  Maybe there isn't, but this is Trump country.  As Jake Bacharach tweeted a few days ago, though, "I'm sure there will be some genuine refusals, but as with abortion, many of the loudest moral and political opponents will rush to the clinic the minute they need one for themselves or their families."  If every spot on the schedule hadn't been filled, it was probably because of the flaws in the website, not lack of demand.

Twelve hours later I have a slight ache in my upper arm where I got the injection; it's no worse than the flu shot I got in November.  But then I've always been lucky with shots -- never had an allergic reaction, for example, or significant side issues other than a sore arm.

I'm writing about this partly for the same reason I write most of my posts: to process what is happening to me and around me.  But it's also because I wrote a post at the end of December posing some questions and expressing concerns about the vaccines.  I said explicitly that I am not anti-vaccine, and that I would probably get vaccinated when it became available.  At the time I didn't think that would be before spring or summer.  When I learned that I could get it now, I decided to go with it for two main reasons: it takes time to build full immunity, so the sooner I begin the process, the better; I hope I might be able to visit friends this summer with less worry.  The other is that the sooner we all start building immunity, the sooner we can see what result it will have on the advance of the virus.

Recently I got a daily New York Times e-mail newsletter dealing with the vaccine, and to my surprise and pleasure it backed up many of my concerns.  Here's hoping the link works.  The writer argues that the lack of honesty about the virus has not only hindered the struggle against it, but contributed to people's skepticism about all authoritative pronouncements (except those of the authorities they like, of course).

Early in the pandemic, many health experts — in the U.S. and around the world — decided that the public could not be trusted to hear the truth about masks. Instead, the experts spread a misleading message, discouraging the use of masks.

Their motivation was mostly good. It sprung from a concern that people would rush to buy high-grade medical masks, leaving too few for doctors and nurses. The experts were also unsure how much ordinary masks would help.

But the message was still a mistake.

It confused people. (If masks weren’t effective, why did doctors and nurses need them?) It delayed the widespread use of masks (even though there was good reason to believe they could help). And it damaged the credibility of public health experts.

This is basically what I wrote in December, as well as in previous posts about science, expertise, and the myth of meritocracy.  You can't really complain that the public doesn't trust you if you've been lying to them, but that's what experts in many fields have been doing all along.

Right now, public discussion of the vaccines is full of warnings about their limitations: They’re not 100 percent effective. Even vaccinated people may be able to spread the virus. And people shouldn’t change their behavior once they get their shots.

These warnings have a basis in truth, just as it’s true that masks are imperfect. But the sum total of the warnings is misleading, as I heard from multiple doctors and epidemiologists last week.

The uptake is that our guiding experts should be upbeat, and accentuate the positives about the vaccine.  Which I agree with, as long as the positives are true.  So, the writer goes on to explain that the 95% protection rate is "on par with the vaccines for chickenpox and measles. And a vaccine doesn’t even need to be so effective to reduce cases sharply and crush a pandemic."  As it happens, it's very unlikely that vaccinated people will spread the virus.  And so on: read the rest of the article.  The comparison to other vaccines was something I'd been wondering about, and now I wonder why it hasn't been stressed more.  It seems to me that the same public health experts whom we're supposed to rely on to inform and guide us are mostly not very good communicators, and that they don't trust their audience with accurate information.  But communication and accuracy are their job, and if they aren't going to do their job, what use are they?  I'm reminded of the days when doctors routinely lied to patients with cancer or other serious illnesses, which made those conditions even scarier than they needed to be.  Some of them, like Anthony Fauci (remember his fairy tale about vaccinating Santa Claus?), seem to enjoy lying to the public because it makes them feel powerful.  That's an occupational hazard of experts.

I'd already figured out on my own that it will still be necessary to wear masks and continue other existing precautions when I heard a doctor reluctantly say it on NPR a couple of weeks ago.  My heart sank at first, but it was important to know.  Reading this article made me feel better, almost hopeful for the first time since the outbreak of the pandemic.  Sometimes the truth hurts, sometimes it helps.  So I'm writing here about why I got the vaccine, and how I'm getting along afterwards.  I'll follow up later if there's anything to tell.  Other people's stories have always fascinated and helped me; here's mine.

The Call of Science

I added an important update and reconsideration below.

In October Scientific American endorsed Joe Biden for the presidency, the first time it had endorsed a candidate in its 175-year-history.  No wonder he's been saying "Trust the Science."

The trouble is that Science is a lot like God, in that we laypeople have no direct access to Its truths.  We have to rely on human intermediaries, and even they admit that they are flawed, imperfect vessels.  Yet we must hearken and obey.

First we have the scientists themselves, but they rarely pollute themselves by speaking to us directly.  So we must also rely on science coverage in the corporate media, despite the fact that scientists constantly attack science news for incompetently or maliciously misrepresenting True Science.  And they're not entirely wrong about that.  Like politicians, though, scientists are apt to claim they've been misquoted even when they have been quoted accurately.

Think again of last week's Great Conjunction, commonly called "the Christmas Star" in even nominally secular news media.  I still don't know why they got the facts -- the Science -- so wrong so persistently, but they did.  Even the scientists they quoted directly mostly bollixed it up.  And this was an event of no worldly importance at all, so there could hardly have been outside pressure from interest groups or sponsors to make them distort the science.  Nor was it highly advanced science on the order of quantum or string theory.

So take something like the novel coronavirus and the new vaccines currently being distributed.  That's very important to people's lives and livelihood, so the scientists and the media would try much harder to get it right, wouldn't they?  No.  There are billions of dollars at stake, and the Science is being filtered through pharmaceutical companies who have an interest in beefing up their prestige and making a return on their investments.  The news media could, in principle, scrutinize their claims, but in practice they rarely do that.  Even 'educational' media like our public broadcasting systems, despite their devout Scientism, identify Science with corporate-branded research and production.  Look for BiDil in this post, a drug marketed (unsuccessfully, as it turned out) as an African-American-specific treatment for high blood pressure: even after it had been discredited and taken off the market, an NPR science program endorsed it to promote a scientific-racist agenda.

This post from Naked Capitalism makes some important criticisms of the promotion of the Pfizer vaccine, and this one shows that Pfizer carefully made important information almost inaccessible in the published report on it.  Does that mean that Pfizer's vaccine is bad?  No, it means that we don't and can't know things we need to know about it to try to decide whether it's good or not.  By "we," I mean not only you and I but medical and other scientific professionals who couldn't get at the data.

[UPDATE: A reader sent me a link to this post by Marcus Ranum, which is a good critique of the Naked Capitalism post I linked above.  The writer doesn't address the question of data exclusion (though one of his commenters does), but his arguments against the post are good.  He shows that the anonymous doctor who wrote the NC post misrepresents some of his examples, notably the Cutter Incident of 1955 in which a batch of defective polio vaccine caused 40,000 cases of the disease; "within a month the first mass vaccination programme against polio had to be abandoned."  This was, as the blogger stresses, a production failure, not the result of inadequate testing of the vaccine as Doctor Anonymous claimed.  Other errors and disingenuous takes in the NC post pretty much discredit it, it seems.

[Rather than revise this post to eliminate mention of Doctor A, I'm leaving him in.  If I hadn't linked it, I wouldn't have learned about Ranum's critique; so I, and I hope readers, will be better informed as a result.  The reader who sent it to me accused me of too much skepticism; it should be obvious that I wasn't skeptical enough. Ranum begins by noting, "It’s hard to tell contrarianism from disinformation or just ignorance and usually my approach is to try to detect the signs of dishonest or motivated reasoning."  I agree, though I feel that at times Ranum skates close to authoritarianism with his references to "heroes" and the like. Reliance on experts is often a necessity, because there's too much we need to know, but it's an unfortunate one. I think that one warning signal of what Ranum calls "contrarianism" is a refusal to question one's own authority.  As Nietzsche wrote, the important thing is having the courage for an attack on one's convictions.  Anti-maskers, anti-vaxxers, Trump cultists aren't really skeptics in that sense, and don't really reject authority.]

This post, which I found in Vagabond Scholar's annual blog roundup, also discusses a question that had been stirring in my mind ever since the first announcements of the Pfizer and Moderna vaccines: Just what does "95 percent effective" mean?  The explanations I heard didn't really add up.  Out of curiosity I looked up the effectiveness of polio vaccine: according to the CDC, "Two doses of inactivated polio vaccine (IPV) are 90% effective or more against polio; three doses are 99% to 100% effective."  That makes me feel a little better, but then we have sixty-five years' experience with polio vaccine.  The flu vaccines now in use are much less effective, though I'm not sure by how much: the CDC fudges by using a different criterion of effectiveness: "recent studies show that flu vaccination reduces the risk of flu illness by between 40% and 60% among the overall population during seasons when most circulating flu viruses are well-matched to the flu vaccine."

Like Thomas Neuberger, who discussed effectiveness in the post I linked to, I'm not saying that people should not get vaccinated when they get access to it.  "This," Neuberger wrote, "is not a recommendation not to be vaccinated against Coronavirus. It’s an encouragement to decide for yourself and your family when to be vaccinated and which vaccine to choose based on the most accurate information available."  The trouble is that Pfizer's and Moderna's promotional material, or media reports that simply repeat it, are not necessarily the most accurate information.  I'm not gloating over the limitations of science, I'm very concerned about them and their ramifications for ordinary people like you or me.

Think again of Doctor Anthony Fauci and his public claims that Santa Claus is immune to COVID-19 (true of the fictional Santa, not true of the human beings who play him during the Christmas system) and that he personally had vaccinated Santa.  The latter is a flat-out lie, but most adults think it's cute to lie to children. I just finished reading the historian Stephen Nissenbaum's book The Battle for Christmas (Knopf, 1996), which traces the development of Christmas in (mostly) the US since the colonial period.  Nissenbaum makes an interesting suggestion about the importance of Santa Claus to adults: although he was a commercial figure, he stood for a pre-commercialized ideal of gift-giving outside time and history.  "In that sense, it was adults who needed to believe in Santa Claus" (175).  Many adults, including Fauci, need to lie to them.  Besides, Fauci thinks of the public as children who must be ordered around by men of Science like him, so he has no compunction about lying to us. See him lying to the naughty children in the clip Krystal Ball plays a few minutes into this commentary; the whole clip is worth watching for its catalog of institutional failure during the pandemic.  As Ball says, Fauci is far from the worst high-level figure in the story, but the adulation liberals are heaping on him has nothing to do with his real virtues.  It's because of his grandfatherly manner and because they see him as an anti-Trump figure.

This isn't just about Fauci, of course.  If we're to trust duly credentialed experts, our government, Science, they must earn our trust.  If the vaccines blow up in our faces, it will detonate trust in them, and they won't be able to blame anyone but themselves - not that they won't try.  Again, though: it's not about them, about their status, about saving face.  Human lives are at stake.  That basic reality keeps getting lost.

P.S.  Because I evidently haven't made it clear, let me stress that I am not against vaccination, not an "anti-vaxxer."  I get a flu shot every year, I've had anti-shingles and anti-pneumonia vaccinations as my doctors have prescribed. I got polio and other shots as a child, and though that wasn't my decision, I have no regrets about it.  I probably haven't stressed enough that I accept the FDA approval of the Pfizer and Moderna vaccines, though as I think I said, I am concerned about the necessary rapidity of the process, and I think everyone should bear in mind the "emergency" nature of the approval.  I thank Marcus Ranum clarifying the precautions being taken against allergic reactions when someone gets the vaccine: someone is standing by with an epipen in case of trouble, since allergic reactions show up show up almost immediately.  I think many people would be reassured if the media pointed this out in their video coverage of people getting the vaccine; so far I have not noticed them doing so.  That would take precious time away from speculation and baseless predictions about What the President Will Do or What Senator McConnell Might Do, however.  What I was ranting about in this post was bad science reporting, and poor communication from medical spokesmen like Fauci.  But just as I find I'm too naive when I'm accused of cynicism, I find I'm not skeptical enough.