Public health and tradition | The Healthiest Goldfish

As we prepare for Thanksgiving this week, I have been reflecting on the importance of tradition, and how we can weave together the past with the future. Public health is, by nature, forward-looking. We aspire to a progressive vision of the future, one that supports health through a radical reimagining of the status quo. This calls on us to envision new ways of structuring our world, with an eye towards optimizing it for health. Our pursuit of this vision leads us to explore novel approaches to supporting health, to innovate, and to embrace new ways of thinking about, and living in, the world. The most high-profile recent example of this is the emergence of mRNA vaccines, which have done so much to help address the COVID-19 pandemic. And it is worth recalling that public health tools and interventions we now take for granted—like hand-washing, public sanitation, and designing urban spaces with an eye toward health—were once new, radical even. Their success speaks to the importance of a public health that is moving ever-forward, eyes fixed on the possibilities of the future. I have written previously on why we need to keep evolving as a field, to continually hone our focus on what matters most for health. This emphasis on progress supported by collective forward momentum is close to the bone of public health, part of our field’s DNA, and rightly so.

Having established that this vision of progress matters, we can then ask—is it all that matters? Is a relentless focus on the future both necessary and sufficient for getting us to a healthier world? It strikes me that such a focus is not, in fact, enough. For public health to be most effective, it should balance a focus on the future with a respect for—and willingness to learn from—what has served us well in the past. We should pay special attention to what has been handed down to us through the generations—namely, tradition. A focus on tradition also aligns with the themes of the Thanksgiving season, as we pause to reflect, with gratitude, on all we have. This reflection can inform an appreciation of the best of our traditions and how tradition has helped shape a healthier world. Some thoughts on why tradition matters, and how thoughtful engagement with tradition can help us create a better future.

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Mismanaging Messages | The Turning Point

There was never going to be flawless public communication around Covid-19, a new illness that raised an array of novel scientific and sociological issues. Even with this lens, communication about the pandemic has been particularly fraught. The Trump presidency was characterized by repeated lies, and more recently the Biden presidency has demonstrated premature optimism, offering first a “freedom summer” when we were to be largely over Covid-19, only to see the delta wave sweep the nation, and in the fall of 2021, sweeping and premature scientific statements about booster vaccines.

In August, President Biden announced that a Covid-19 vaccine booster should be administered to all Americans already vaccinated. “Just remember as a simple rule, eight months after your second shot, get a booster shot,” Biden said, promising a booster roll-out in a month. Federal health agencies then weighed in, and their opinions had to be shoehorned into the basic shape Biden had offered so as not to contradict his original statement. Yet a month later, when the vaccine was to be available “to all,” only one type of booster had been approved, and only for the elderly, persons with workplace exposure to Covid-19, nursing home residents and immunocompromised people who had received that type of vaccine originally.

The confusion about whether boosters should be taken, and by whom, reflects what happens when policy makers jump to too simple conclusions from still unsettled science. When Biden made his announcement no one really knew the connection between antibody responses (which the booster promised to increase) and duration of human protection. Whether boosters would actually protect against infection, or re-infection, was simply not clear. This then complicated our thinking around boosters, why we may need boosters to begin with. Was the aim of a booster to reduce ongoing viral spread by curbing, at least temporarily, milder infections? After all, the initial vaccinations were continuing to limit the worst effects of Covid-19 in the United States. Would a booster, urgently delivered, save lives? And should we have been focusing on additional vaccinations for Americans before the elderly and health workers in many low-income countries could receive a single dose?

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A populist public health | The Healthiest Goldfish

Ever since roughly 2015, much has been written about populism. The catalyst for this was three political events, all occurring within months of each other. First, there was the rise of Donald Trump and Bernie Sanders in the presidential primaries of 2015—2016. Each in his own way seemed to speak—one from the political left and one from the political right—to the concerns of working-class Americans who felt marginalized by globalization and what they perceived as the misrule of social and economic elites. Sanders addressed this by calling for an ambitious program of redistributive economic policies to level a playing field which had long been uneven. Trump’s argument, too, was partially economic, embracing protectionist trade policies and hostility to NAFTA. He was also—rhetorically, at least (his policies in office would prove another matter) more sympathetic to the existing welfare state than many Republican candidates of the past. But his populism was tinged with racist and xenophobic overtones, which both fueled his political ascent and arguably poisoned the well of our public discourse in ways from which we have not yet recovered. Largely because of Trump, much of the discourse around populism was primed to view the phenomenon as, on the whole, a negative influence—crude, anti-intellectual, and even racist. This view was seemingly confirmed in the months before the presidential election, when voters in the UK chose to leave the European Union. This move was seen by many as motivated by reaction to high levels of immigration and by hostility towards the bureaucratic elite running the EU. Widespread fear of the potential economic and political ramifications of the Brexit vote meant that it, too, would do no favors for populism’s reputation, at least among those not part of the demographic which had already proven receptive to a populist message. Then there was the rise in populist far-right parties throughout Europe, reflected in the figure below. This, too, has cast populism in a negative light, and helped it become, for many, synonymous with far-right politics in general.

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False Confidence and Our Covid-19 Failings | The Turning Point

In 2009, President Obama declared a national emergency eleven days after the first case of swine flu was reported. Because recovery from the devastating Great Recession was the priority of the day, President Obama never shut down cities or business or schools. Republican governors and Congress fell in line quickly behind the Obama administration’s health decisions, perhaps because the most vulnerable to infection were children and those under 30 years old.  Funding decisions faced little opposition. Biologically, we got lucky. Swine flu turned out to be far less lethal than Covid-19. Although vaccines arrived late, after most infections had happened, fewer than 15,000 Americans died even as at least 60 million Americans were infected.

We had been lucky before. While in 2003 SARS resulted in the quarantine of thousands in Toronto, its effect was barely felt in the US. Other outbreaks like Ebola have barely touched our shores.

This good fortune perhaps left us with a false sense of confidence about our ability to weather pandemics. That false sense of confidence may have been disastrous in the context of Covid-19.

The Trump administration waited 53 days after the first case of Covid-19 was detected in the US to declare a national emergency. During those weeks, the president himself declared the virus “is going to disappear” like “a miracle.” The administration’s public health arm at the CDC was scared and silenced. The threat was dismissed.

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Reflections on The Contagion Next Time | The Healthiest Goldfish

In last week’s column, I introduced my new book, The Contagion Next Time, in advance of its November 1 release. In that column, I wrote about why I felt compelled to write a book about a pandemic during a pandemic. I have since had a chance to engage with friends and colleagues who are in the process of reading the book and engaging with its ideas. This has long been a favorite part of the writing process. The aim of writing has always been, for me, to sharpen my thinking, with the goal of informing a broader conversation about the issues that matter most for health. Once a piece is out in the world, engaging with readers—in addition to being simply fun—helps sharpen my thinking still further. This has been the case in the days since the launch of The Contagion Next Time. It has been a joy to be able to speak with readers, to hear their reflections.

In a way, these conversations have been consistent with the spirit in which the book was written. While the act of writing is a solitary endeavor, producing a book—shaping its ideas and thinking through its structure—is a collaborative process. The thoughts in The Contagion Next Time emerged from countless conversations with friends and colleagues, from reading the work of authors and journalists I admire, and from the unique academic setting in which I am privileged to work. Academia is a discipline founded on rigorous debate, on the airing of ideas in the public conversation. I was deeply influenced by this context in writing The Contagion Next Time.

A Hard Weight | The Turning Point

Long before Covid-19, obesity was a serious health concern, a major contributor to cardiovascular and cancer deaths. More than one in three adults in the United States are living with obesity, many more are overweight. The arrival of Covid-19 has shed a new light on this longstanding health risk. The pandemic led many Americans—housebound, working fewer hours in the world, exercising less, drinking more, depressed—to gain weight.

At the same time, it became clear that having excess weight worsened Covid-19 outcomes. Obesity tripled the risk of hospitalization, and increased intensive care unit admission and death from Covid-19, particularly for those under 65 in the US. Internationally, nearly 90% of deaths from the pandemic disease have been in countries with high levels of obesity. Only old age is a stronger risk factor for severe illness. Overweight, at least, may be reversible.

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Why write a book about a pandemic during a pandemic? | The Healthiest Goldfish

I have long been inspired by the songs and message of the musical Hamilton. There is a moment in the show when the titular character faces an hour of maximum crisis, when it seems like his world is crumbling. He sings of being in the eye of a hurricane, before declaring “I’ll write my way out,” expressing his intent to use words to both process the chaotic moment and also, hopefully, find some deliverance from it. 

That moment particularly resonated with me. I have long turned to writing to make sense of challenging events, and to try to inform a conversation that helps support a better future. And, in recent years, we have all known what it is to feel like we are in the eye of a storm. The COVID-19 pandemic has been a tempest, turning our world upside down, radically changing how we live. We have all processed the pandemic differently. My way has been writing. During the crisis, I wrote about why we found ourselves in the situation we were in, and what it will take to avoid another, potentially worse, pandemic. Those writings became my new book, The Contagion Next Time, which will be out Monday.

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When Do We Stop Counting? | The Turning Point

All over the country, over the course of a few months, there were about 21,000,000 symptomatic cases, 290,000 hospitalizations, and 37,000 deaths.  More than 25,000 of the deaths were in the 65+ age group. 

It seems likely that this type of case and death count recitation is familiar to the reader, seen through the lens of Covid-19, where we have assiduously documented cases and deaths for the greater part of two years. But these numbers were not Covid-19 numbers. They were cases, and deaths, from flu, during the 2010-2011 influenza season, one of the worst seasons in the past decade. We wonder: how many of us were aware of the daily case and death count during that flu season more than a decade ago?  And, perhaps more importantly, would we have behaved differently as a society if we had beenkeeping track of cases and deaths the way we have been during Covid-19?

In some ways Covid-19 case and death counting, 18 months into the pandemic, has taken on an uncomfortably familiar role, with tallies being reported in all media in much the same way as, say, the weather, which is also reported daily. But what impact does this abundance of reporting have on how we think about the pandemic? 

Read the full post at The Turning Point.