When I read the CMOs report from ~1919 I was struck in the run up to the 2009 outbreaks, how remarkably similar the thinking then was to UK PH thinking in 2009. It seems in the intervening 10 years we read, marked and inwardly digested nothing. Despite the Hine report on the outbreak.
One feature from 1918 that I reminded me of the BSE outbreak, which was recent at that time, was that viruses such as Flu viruses and Corona viruses were unknown, though there was speculation that filterable agents were responsible. Similar arguments about prions were prevalent at that time.
The lesson I took away from the response to 'plagues of pestilences' was that controlling communicable diseases is much more about treating both individuals and populations clinically, but instead we pivoted ever more firmly towards treating labs results, or in this latest case self administered and evaluated tests performed in uncontroled conditions.
But the understanding of understanding and admission of ignorance, and uncertainty is almost absent from public discourse. Though individuals if challenged will admit to a degree of uncertainty, their actions exclude any possible uncertainty.
The abuse of statistical analysis is part of this fools certainty.
It costs lives every year, and only in epidemics do we notice the price of false certainty.
“The lesson I took away from the response to 'plagues of pestilences' was that controlling communicable diseases is much more about treating both individuals and populations clinically, but instead we pivoted ever more firmly towards treating labs results, or in this latest case self administered and evaluated tests performed in uncontroled conditions.”
This summarizes a significant failing of not just the pandemic response but in a number of ways how US medicine has evolved both due to the commercialization (and corporate hegemony) of medical practice, but also thanks to a trend to emphasize the biochemical aspects of disease while losing the nuance of PATIENT care.
Public health lost its voice, in some ways because of information overload and in others because we were reluctant to face the online harassment when we made a pronouncement that wasn’t;t favored by some pundits, with or without knowledge and discipline training. I, for one, was so overloaded that my attempts to communicate often sounded much more like how I’d write a critical review of a journal article, or for that matter, a journal article. To that point, my organization essentially assigned a proof-reader to translate my missives for non-medical consumption, and that was who my target audience really was. The sad part is, one-on-one with a patient and/or patient family, I usually do pretty well. Before COVID, I did pretty well in mass communication.
Bush (Jr) established a working group to look at pandemics and preparation for future outbreaks. Obama, to the amazement of that working group, kept the core essentially in tact. The Trump administration essentially shredded the playbook n 2017, and scattered the team to a variety of agencies or lost them to academia and industry. In 2020, the long-term NIH, FDA and CDC personnel had knowledge of the earlier planning, and articulated parts of the plan as best they could, but a lot of what was lost was the background and basis for the recommendations, including historical perspective and numerical modeling (including ensembles of different initial conditions to demonstrate spread of various mitigations). That left a hole that MIGHT have helped explain where we were coming from. We also suffered from the fact that SARS-CoV-2 and COVID-19 was the most studied and documented outbreak ever. We had most of the science, messy as it really is, directly observed and criticized (as opposed to critiqued) thanks to the Internet. By the lay public who never has trained in the nuance of infectious disease, or epidemiology. Yet, we’ve seen said lay public want to debate findings by experts as peers, and taking exception when we identified flaws in their debating logic. To date, I’ve had professional disagreements with others trained in the fields, but the most direct attacks I’ve had have been from non-medical people. Not all my online profiles define my background, so perhaps they could be forgiven if they thought my only expertise was in, say, the Global Positioning System and its uses in geodesy (or even systems design), but one should understand that not everyone’s as simple, nor as linear as others.
For the record, George W’s creating of the pandemic planning panel was a master-stroke and was as apolitical as we could hope, and they were allowed to find and employ some of the finest, of not necessarily conformist, minds out there.
We haven’t learned, as a society, too many of the lessons from the 1918 influenza pandemic. We have decided that our own perceptions of individual rights and freedoms supersede public health laws and scientific recommendations based on known facts at the time, even if they could be revised or superseded as we learned more about the clinical manifestations of the disease process, infection, therapeutics, and clinical procedures. I can recall a discussion in the summer of 2020 where our group chat decided we’d start thinking of COVID as a vascular actor rather than purely a respiratory actor. Now we know many/most organ systems are affected including the cellular immune system.
Simply brilliant.
When I read the CMOs report from ~1919 I was struck in the run up to the 2009 outbreaks, how remarkably similar the thinking then was to UK PH thinking in 2009. It seems in the intervening 10 years we read, marked and inwardly digested nothing. Despite the Hine report on the outbreak.
One feature from 1918 that I reminded me of the BSE outbreak, which was recent at that time, was that viruses such as Flu viruses and Corona viruses were unknown, though there was speculation that filterable agents were responsible. Similar arguments about prions were prevalent at that time.
The lesson I took away from the response to 'plagues of pestilences' was that controlling communicable diseases is much more about treating both individuals and populations clinically, but instead we pivoted ever more firmly towards treating labs results, or in this latest case self administered and evaluated tests performed in uncontroled conditions.
But the understanding of understanding and admission of ignorance, and uncertainty is almost absent from public discourse. Though individuals if challenged will admit to a degree of uncertainty, their actions exclude any possible uncertainty.
The abuse of statistical analysis is part of this fools certainty.
It costs lives every year, and only in epidemics do we notice the price of false certainty.
“The lesson I took away from the response to 'plagues of pestilences' was that controlling communicable diseases is much more about treating both individuals and populations clinically, but instead we pivoted ever more firmly towards treating labs results, or in this latest case self administered and evaluated tests performed in uncontroled conditions.”
This summarizes a significant failing of not just the pandemic response but in a number of ways how US medicine has evolved both due to the commercialization (and corporate hegemony) of medical practice, but also thanks to a trend to emphasize the biochemical aspects of disease while losing the nuance of PATIENT care.
Public health lost its voice, in some ways because of information overload and in others because we were reluctant to face the online harassment when we made a pronouncement that wasn’t;t favored by some pundits, with or without knowledge and discipline training. I, for one, was so overloaded that my attempts to communicate often sounded much more like how I’d write a critical review of a journal article, or for that matter, a journal article. To that point, my organization essentially assigned a proof-reader to translate my missives for non-medical consumption, and that was who my target audience really was. The sad part is, one-on-one with a patient and/or patient family, I usually do pretty well. Before COVID, I did pretty well in mass communication.
Bush (Jr) established a working group to look at pandemics and preparation for future outbreaks. Obama, to the amazement of that working group, kept the core essentially in tact. The Trump administration essentially shredded the playbook n 2017, and scattered the team to a variety of agencies or lost them to academia and industry. In 2020, the long-term NIH, FDA and CDC personnel had knowledge of the earlier planning, and articulated parts of the plan as best they could, but a lot of what was lost was the background and basis for the recommendations, including historical perspective and numerical modeling (including ensembles of different initial conditions to demonstrate spread of various mitigations). That left a hole that MIGHT have helped explain where we were coming from. We also suffered from the fact that SARS-CoV-2 and COVID-19 was the most studied and documented outbreak ever. We had most of the science, messy as it really is, directly observed and criticized (as opposed to critiqued) thanks to the Internet. By the lay public who never has trained in the nuance of infectious disease, or epidemiology. Yet, we’ve seen said lay public want to debate findings by experts as peers, and taking exception when we identified flaws in their debating logic. To date, I’ve had professional disagreements with others trained in the fields, but the most direct attacks I’ve had have been from non-medical people. Not all my online profiles define my background, so perhaps they could be forgiven if they thought my only expertise was in, say, the Global Positioning System and its uses in geodesy (or even systems design), but one should understand that not everyone’s as simple, nor as linear as others.
For the record, George W’s creating of the pandemic planning panel was a master-stroke and was as apolitical as we could hope, and they were allowed to find and employ some of the finest, of not necessarily conformist, minds out there.
We haven’t learned, as a society, too many of the lessons from the 1918 influenza pandemic. We have decided that our own perceptions of individual rights and freedoms supersede public health laws and scientific recommendations based on known facts at the time, even if they could be revised or superseded as we learned more about the clinical manifestations of the disease process, infection, therapeutics, and clinical procedures. I can recall a discussion in the summer of 2020 where our group chat decided we’d start thinking of COVID as a vascular actor rather than purely a respiratory actor. Now we know many/most organ systems are affected including the cellular immune system.