A popular narrative about the COVID-19 pandemic is that President Donald Trump cares little about science and data and that his top public health officials must regularly and valiantly try to restrain him from making foolish decisions or unsound assertions. The narrative gained momentum last week when video of Dr. Deborah Birx, the White House coronavirus response coordinator, went viral showing her reaction to Trump's comments about light and disinfectant.
Widespread acceptance of this narrative has contributed to fawning media attention for Trump's chief medical advisers, such as Birx, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, and (to a lesser extent) Surgeon General Jerome Adams.
Widespread acceptance of this narrative has contributed to fawning media attention for Trump’s chief medical advisers.
In Florida, for example, 62 percent of voters say they rely on public health officials the most for accurate information about the coronavirus. By contrast, only 18 percent say the same for Trump.
Certainly, the president should be held accountable for his policies and actions during the gravest public health and economic crisis the country has faced in decades, but public health professionals should not be immune from tough — but informed — questioning, either. The high level of trust placed in them by the American public should be matched by serious scrutiny.
Alas, Trump's public health advisers are too often viewed as infallible. The change in guidelines on mask-wearing in early April is a great example. With notable exceptions in conservative media, the original guidelines and the subsequent pivot were largely accepted without much second thought or criticism. Yet much is troubling about the instructions issued by the U.S. government on a consequential public health issue.
It was Feb. 25 when a senior official from the Centers for Disease Control and Prevention first loudly rang the alarm about the coronavirus' reaching U.S. shores. But Adams hectored the American people against buying masks.
Adams tweeted: "Seriously, people- STOP BUYING MASKS! They are NOT effective in preventing general public from catching #Coronavirus."
Fauci did not hector, but he conveyed the same message. In interview after interview, Fauci emphasized that only those who were already infected needed to wear masks to avoid exposing others. For ordinary Americans, he said in mid-February, "there is absolutely no reason whatsoever to wear a mask."
CDC guidelines reflected those sentiments.
And yet, experience overseas showed those recommendations to be misleading.
In an interview March 24 with Asian Boss, an Asia-based online media channel, the most prominent coronavirus expert in South Korea, a country hailed for its effective response to the outbreak, disagreed with the surgeon general and said wearing a mask was "definitely effective."
Kim Woo-joo, a professor of infectious diseases at Korea University College of Medicine, said mask-wearing by nearly everyone in South Korea was one of the reasons the country has had a relatively low rate of infection.
"Why else would doctors in hospitals wear masks?" Kim asked rhetorically. "They wear them because they prevent infection."
Similarly, the Czech Republic, which had a significantly lower rate of infection compared to fellow European countries such as Spain and Italy, produced a video advising all other countries to "implement population-wide use of face masks, even homemade ones." Adam Vojtěch, the Czech health minister, stated, "Today we see this was one of the most important decisions we have made, and if it helped here, it can help anywhere."
Why were top U.S. public health officials telling Americans otherwise?
"I did read [the surgeon general's] tweet and you have to understand the context," Kim told Asian Boss. "I think the point was to prevent people from hoarding masks because medical professionals need them more. ... In other words, because masks are in short supply in the U.S., medical professionals should be prioritized."
America's lack of protective equipment is indeed a crisis. But that was not what the public health officials were telling Americans, not really. You had to read between the lines to get to that conclusion. Much more directly, these officials insisted that mask-wearing was not effective for healthy people.
As the pandemic raged on, this advice increasingly made less and less sense.
The White House's Birx was reported to have opposed recommending public mask-wearing for fear that it would create a false sense of confidence to dispense with social distancing. Almost all experts agree that social distancing is vital to flattening the curve. Yet Americans could simply have been advised that mask-wearing would be a complement to, not a replacement for, social distancing.
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Keep in mind that the White House, at the advice of its public health experts, first instructed Americans to practice social distancing on March 16. In other words, Americans were not practicing social distancing and were also being discouraged from wearing masks during those weeks before. Would mask-wearing have slowed the spread of the coronavirus, especially in densely populated areas like New York City? The national media have not really asked.
To be fair, the United States' waffling is not unique. Singapore had originally favored social distancing and instructed its residents against mask-wearing, as well.
To be fair, the United States' waffling is not unique. Singapore, widely lauded for its early success at responding to the coronavirus, had originally favored social distancing and instructed its residents against mask-wearing, as well. It was not until April 14 that it made mask-wearing compulsory.
On April 3, the CDC finally reversed itself and recommended that Americans wear face coverings in public, claiming that new data had revealed many carriers of COVID-19 to be asymptomatic. Fauci estimated that as many as 50 percent of carriers of COVID-19 could be asymptomatic, even though in late January, he himself dismissed concerns that such "silent carriers" could drive transmission in an epidemic.
But here also, U.S. experts were contradicting experts elsewhere in the world. Gabriel Leung, the chair of public health medicine at the University of Hong Kong and a highly respected expert in the city, explained to a Cantonese cable news channel in late March that invisible carriers of COVID-19 were very dangerous transmitters. Indeed, according to Leung, silent carriers could be up to 20 percent or even 30 percent of infected people.
Medical professionals in the U.S. knew about such silent carriers early on, as well. This month, The New York Times published frantic warnings made early this year by a group of public health officials and experts who nicknamed their email exchanges "Red Dawn." The Times blamed Trump for not having heeded this advice earlier.
The "Red Dawn" group had come to the realization by the third week of February that many people in the U.S. were likely to have been infected already, even if they were not showing any symptoms.
So why did the top health experts advising Trump dismiss the dangers posed by such silent carriers until early April? For the most part, the media have not bothered to inquire. In a rare instance when a reporter tried to seek accountability at a White House coronavirus briefing last week, the surgeon general responded that he resented the implication.
That is not an attitude that inspires confidence. The point of asking pointed questions is not to malign public health officials or to undermine their influence. Science must guide health policy, just as science must inform economic policies made during a public health crisis. But even scientists make mistakes, and figuring out how and why can help us better understand this pandemic and our response to it. Just as important, it can help us avoid similar mistakes when a new wave of the coronavirus — or any other epidemic — inevitably occurs.