ANS -- Brad Hicks on the pandemic

Brad Hicks posted this on Facebook.  It is a brilliant analysis of what's going on with this pandemic and people's bad reactions to it.  Read it.  

--Kim

I heard an interview with an epidemiologist last week, and the reporter asked him if he was willing to admit that there was even one time in this whole disaster that the politicians or the economists were right and the epidemiologists were wrong.

I hated that question, and wanted to shout "NO" but he was more diplomatic -- and, in hindsight, at least partially right -- when he said something to the effect of, "An epidemiologist is never wrong when we tell you what you have to do to control the disease. But maybe we should have listened more to the politicians and the economists when they told us which of those things actually can be done."

Years from now, when all is said and done with this epidemic, I sincerely hope that the world's schools of public health think seriously about inter-disciplinary projects with professors of art, communications, and advertising. Because I suspect that they're going to have a lot to say about why pandemic fatigue set in so soon, and why people stopped complying with public-health advice when they did, why fatalism about the disease set in when it did.

And given that it's happening roughly simultaneously in most countries, I don't think that they're going to conclude that it's just "orange man bad." As (admittedly) a mere layman, but one who's fanatic about public health and sanitation (as part of my lifelong fascination with disaster prevention and planning), I have a few ideas, a few things I hope that they look into, to see if I'm right that these mistakes contributed and if the field of public health can do better next time. For one ...

Public health needs to do a lot more tooting of their own horn between disasters.

There are always going to be mixed messages out there. Even if (as mostly happened this time) the public health specialists are speaking with one voice, there are always going to be lickspittles for the investor class and deranged conspiracy theorists saying that the public health specialists have it all wrong. Setting aside the conspiracists for a moment, I think there's a reason why so many people listened to spokespeople for the capitalists instead of spokespeople for the public health departments: the public health field places a value on "quiet, dignified service," laboring in silence to keep us all confident and safe. The capitalists, on the other hand, trumpet their every success, even if they have to make things up.

The public hears from the wealthy damned near every day "we are the job creators" and "we are the titans of industry." When epidemiologists stop a potential epidemic, like intercepting tainted romaine lettuce (two years in a row!) or stopping SARS-1 through rapid testing and contact tracing, or stop a measles epidemic from spreading outside of the third world by laboring under war-time conditions to deliver vaccinations? They put out a press release and call the job done.

If the public health field wants to be trusted, wants to be listened to? They need to cultivate their field's reputation. Constantly. Never pass up a chance to not just announce a success, but to keep talking about it for weeks and months afterwards. Make sure that everybody knows how many lives they saved and that it took personal acts of heroism and sacrifice to do it. I mean, I knew that -- but does everybody? "My boss gave me a job when I needed one, what have done for me?" Saved your kid's life or your mom's life. Probably at least twice in the last year. "Well that's a lie, because I never heard about it." Secondly ...

Repetition and consistency matter.

People heard, over and over again, first from the scientists but then from public figures in entertainment and business and even politics, "don't leave your home if you don't have to" and we got 85% compliance. People heard "wash your damned hands" several times a day, including with catchy jingles on every TV, radio, streaming platform, and social media. People seem to be washing their hands more than ever. Signs in all public places, newscasters on every platform, and (again) ubiquitous jingles said "six feet away" and everybody knows six feet away.

But the communication on masks has been a jumbled fucking mess. First, the straight-up lie "the public shouldn't be wearing masks." Which meant that when they admitted the lie, they lost all credibility; nobody wanted to hear why they lied. Even if it was for a good reason; it wasn't worth it.

Then, when the amateur sector stepped in and rescued the cloth face-mask supply, they came out with the (true) message "it's to save the people around you" -- a message that only resonates with a few people, for reasons I'll address in a minute. You know what would have been better? Stopping at "wear your damned mask, over you nose AND mouth, every time you leave the house" period. "Wear it so you don't make other people sick if you have it and don't know it" is a loser message, I think. "Wear it because if you all don't, the lockdown will stretch on through Christmas" is a message that would have reached people. Thirdly ...

Public health specialists have got to work together with communications specialists and social psychologists to find some way to counter optimism bias.

Because during the early days of an epidemic, when actually affordable intervention could stop it in their tracks, they can say things like "if we don't identify and lock down the few infected areas now, there's a two-thirds chance (or even three-fourths, or even 90%!) that we'll have to lock the whole country down to keep millions of people from dying" and, sadly, way, way too many human beings are going to hear "so you're saying there's a chance we won't have to?"

There's got to be some way to get it through to first policy makers, and then to the general public, that hoping to win against Russian-roulette level odds is not smart. At least, I hope there's a way. But it's unmistakably clear that we don't have it yet.

This also relates, I think, to the messaging about "how long is this going to go on?" Once public health officials saw how tepid the lock-down measures were going to be, it was entirely foreseeable that it was going to have to stretch on through August to get the numbers low enough to deal with via ordinary public health measures. There are two ways you can communicate that, though, and only one of them works. Telling people "we won't know for sure but we're going to tell you in two weeks" is going to be heard as "we're going to open in two weeks."

No, they should have been telling people from the beginning, "Plan around the assumption this is going to stretch into August; if something comes up that makes it possible before then, we'll let you know. And no, we don't expect that." People would have been shocked, and a lot of them angry -- but they would have also been warned, they (and their politicians!) could have made plans.

We told them "we'll tell you how long in two weeks." And then 2 weeks later we told them "we'll tell you in four weeks." And then 4 weeks later we told them "we'll tell you in three weeks." And that, combined with optimism bias, is why they're angry that you haven't lifted the lockdown yet. You never told them you were going to open it a month and a half ago -- but you didn't tell them strongly enough that it wasn't likely. And finally ...

I think that saying "we're all in this together" is bourgie bullshit and we shouldn't have said it if we didn't mean it.

As someone put it on the radio the other day (wish I knew who), we're all on the same storm-tossed sea, but we are not all in the same boat. We are asking a lot of people to make sacrifices for other people, for strangers they don't know and don't even like, and an awful lot of the people we're asking have every reason to say, "What have those people done for me?"

From the lead-poisoned school to prison pipeline to predatory lending to equally predatory slumlords to non-existent routine health care for themselves and their kids to being left to fend for themselves in an opiate epidemic, we're asking people to chip in when nobody has chipped in for them, ever in their lives.

Hell. People absolutely would be more inclined to make sacrifices if we told them "we won't let you fall, we've all got you covered" -- and then did pick them up when they fell because they were sacrificing for the rest of us.

Two months ago, when we promised them help through the CARES Act, people were complying. It's two months later, they're running out of food and medicine, their bill collectors are still hounding them, and at least half of us haven't gotten our first CARES Act payment -- and disproportionately, it's the neediest who are still waiting. So when you keep telling them, "We won't let you fall," they have long since tuned you out.

And this is an area where at least some economists could have helped -- if they'd had enough noisy, unified support from the epidemiologists. And could still help, if the epidemiologists thrown their voices behind two still-controversial arguments in economics right now.

There is a concept of "administrative burden" -- the right says that having a high administrative burden to receive benefits is essential to preventing slacking; the left says that it chokes you when emergencies strike. As experts on how fast emergencies can strike, epidemiologists ought to be weighing in here.

And, closely related, there's an argument about what are called "automatic stabilizers," safety net programs that only kick in when a disaster is detected, but don't have to wait for Congress to pass anything because they're pre-authorized for future disasters. If epidemiologists want infected people to self-isolate, they need to help the economists who are arguing for ways to make it humanly possible to do so.

Otherwise, even if people know that they need to self-isolate? If they also know that they'll become homeless and die waiting for Congress to step in, they're not going to comply, certainly not for long enough if at all.

Anybody got more suggestions?