A century of error, a year of delay and finally, a day of progress
Your work has been invaluable to me and my team at the local public health level. I have referred to your articles and references 100x more than I have referred to the CDC when trying to make decisions and explain things to others. However, the lack of information on aerosols and ventilation from the CDC and WHO has done great harm to us at the local level, when we know and understand these things, but cannot put it into practice because we don't have the backing of the CDC and are required to follow and implement their guidelines and practices. We have not been able to compel quarantine or testing for people who have not been within 6 feet of a case for more than 15 minutes, even if they were 7 feet apart for 2 hours in a poorly ventilated space. We have gotten sued several different times, and doing anything that strays from what CDC says puts us in a precarious and vulnerable position. We have tried to implement some form of backwards contact tracing with absolutely no assistance or learning community opportunities from the CDC or our state health department but instead have had to reach out to other public health workers and academics we've found via Twitter or other random forums. We had to cobble together information from lots of different sources to come up with various metrics and thresholds for reopening (and reclosing) businesses and activities in our county since CDC and our state health department have been slow to respond and make changes based on the latest findings and have had a considerable lack of bold stances and forceful recommendations and requirements. With all of this conflicting information floating around everywhere we have lost the trust of some in our community and get taken less seriously. I had hoped that the Biden administration would improve the situation at CDC, and perhaps it has, but the "recommendations" they put out continue to be confusing, somewhat outdated, and not very helpful to us at a local level when we have to move much more quickly than the pace that they release information. I hope there is some intense and thoughtful after action review at all levels to prevent this mess from happening again (I know we have been engaging in after action review for a while now already). And I hope we actually fund public health infrastructure, data systems, technology, and staff to the appropriate level, but that's probably wishful thinking.
The metaepistemological "tell" to the article is "Why did it take so long to accept that SARS-CoV-2 was being transmitted through aerosols, respiratory particles that are small enough to remain suspended in the air, rather than through short-range respiratory droplets that could not travel more than a few feet because of their (bigger) size?" And it leaves me scratching my head.
I'm just a lay person when it comes to things medical, and I rely on those with training and insider knowledge to keep me informed.
I was out for a beer with a radiologist friend when it first became clear that the virus had reached the States. He told me I should stop at the hardware store on my way home to pick up an N95 or KN95 mask, which would be in the painting section, because there would soon be a run on them and they'd be scarce commodities. Given the known patterns of infection from the cruise ships and from other sources, it was clear to him that aerosols were involved, and that only an N95 mask would be protective against them.
My thought at the time was that this was overkill. There were no other recommendations to get masks from any public health authorities, let alone N95 masks (a term that was new to me). And the stories that were coming out from people who had had Covid-19 were that it was like a bad flu, and would affect most people who were infected with little consequence.
Clearly the possibility of aerosol delivery of the infection was not a secret, or the dream child of a radiologist with a glass of beer. Equally clearly, rather than trusting my friend, I was swayed by the lack of corresponding recommendations from authorities. But what's not clear to me is why, if it was obvious to a radiologist, aerosols were not the first line of inquiry among public health researchers. He cannot have been the only one who recognized that aerosols were the main risk. Why was the opinion you've ascribed to Dr Chapin so much more compelling? And why did "measurements concerned with the size of infectious particles and where they could reach in the respiratory tract got conflated with size at which the particle could float." There's a disconnect here that's correctly fodder for the sociology of science, but to a lay person is just bizarre.
Read your NYT op-ed (or "guest essay" nowadays) as well. I agree with everything you say, but I wonder if we need a more fundamental change to how we elevate people to "respectability" in these fields.
The flaws of men like John Conly aren't intellectual, nor are they environmental. They're characterological—an insatiable arrogance, an ego that cannot admit ever to having been wrong, a resistance to disagreement, and an authoritarian mindset that revolts against questioning. These are traits fundamentally at odds with the scientific method, but they can be advantageous in achieving power in institutions. Shouting down and belittling challengers is, actually, pretty effective in a lot of situations.
To stay with the Conly example for a moment, it is pretty obvious that he's known that he is wrong for at least some time. In early April, under fire from other scientists, he justified his opposition to N95s (for healthcare workers!) by citing risk of acne, eczema, and fearmongering about pregnant women, citing a comically flawed and almost fraudulent study that's been widely debunked. This is the behavior of a man backed into a corner and frantically justifying his past arguments, not a scientist. It is the behavior of a profoundly amoral person who is willing to allow thousands to die simply to win an argument.
Watch the video here: https://twitter.com/davidelfstrom/status/1380896468131848196. Note Kim Prather's stunned reaction starting at about 0:40. It is absolutely incredible.
And it's not just Conly. In _Destiny of the Republic_, the author notes that much of the resistance to Lister's theories in the 19th century stemmed from doctors' not wanting to wash their aprons, because the presence of dried blood on them was considered a status symbol.
Consider an adjacent problem these days: police brutality. I read an interview in WSJ recently with a former NYPD police chief in which he said that he wished they could begin to psychologically screen officers before hiring them. Traits that lead to verbal and physical abuse emerge early in troubled officers' careers, but it is difficult to terminate officers for these early and relatively minor outbursts.
In addition to the "publish or perish" path to fame, could we implement some kind of process that works to encourage good character traits? Is there a way to weed out the peremptory and the pontifical before elevating them to positions of authority? If anything, accomplishing that feat would be almost as revolutionary as the invention of the scientific method itself. At a minimum, the ideal of the imperious Department Head demolishing his critics with brutal ripostes needs to be done away with.
I know Zeynep is dead-set against naming-and-blaming (and for totally understandable reasons). But I disagree; I think the careers of men like Conly need to be destroyed. Institutions need to ask themselves how such people came to power and what they can do to prevent it in the future.
I would add a couple of insights if I may. We have all kinds of useful data now on public masking and its benefits, but back in late Feb 2020 I researched whatever I could find on the subject with the resources available to me. I found one lonely little study that found masks were useless for self-protection and provided only something like 2% efficacy for prevention of transmission. As a nurse we were schooled rigorously on mask protocol for maintaining sterile field. It wasn't difficult to take the medical view of my training plus lack of data, to arrive at a pretty good assumption that public masking would be a fiasco. People uneducated in sterile field protocol would don masks with noses sticking out, constantly touching and adjusting their contaminated masks thus contaminating everything they touched subsequently (fomite transmission was still a "thing"). I can honestly understand why top public health officials, trained to make evidence-based decisions, were reluctant to mandate masks back at the beginning. Secondly, regarding reluctance to react quickly to current evidence, have you ever encountered simple human inertia? I spent a vast amount of time pushing for changes in our clinic that the older, experienced physicians were reluctant to adopt. Not for lack of evidence, but for their cost-benefits analysis of maintaining the comfortable status-quo (which always provided a patsy to blame if things went wrong) vs taking an educated and forward-thinking risk that could potentially backfire and reflect badly on them.
Zeynep, perhaps you can tag on your Twitter post the CDC's latest update too that happened today. https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/sars-cov-2-transmission.html
Great article. Minor historical addendum: Snow's pump handle wasn't his strongest evidence, due to the usual issues with time-dependent effects. He really made the case by looking at a neighborhood with houses more or less randomly supplied by two different water companies. One had intake upstream of the sewer outlets, one downstream, with the predictable results.
Thank you for being on the front lines of a Kuhnian revolution, with implications for science and policy beyond public health. I wonder if there's a deep evolutionary psych resistance here, since indoor ventilation is a relatively new thing, big picture. Science is supposed to overcome such biases, but it might help explain the stubbornness of the resistance. Either way, the fight is necessary and appreciated.
I wonder when shops and businesses will proudly show their CO2 level on visible displays. I would like to know the CO2 level of my hairdresser, the restaurant I vist, my workplace, just as I know the CO2 level in my home. At my university it is about 650 - which is great. However, so far I only know very few people who would know how to interpret it. Hopefully this changes soon.
But does this explain the greater failure to focus on interrupting the spread by testing and isolating asymptomatic people? That would d have been "public health" strategy. Social distancing, (later) masks, hand hygiene, were communicated as ways to protect the actor, not how they should act to protect others. That is not public health; that is attenuated primary care.
Excellent as always! I wonder if the Kumbh Mela event is the first outdoor super spreading in event then? That said, very extreme circumstances were involved.
One objection to a tangential sentence in a brilliant and depressing essay:
"The superspreading was driving the pandemic, with a small percent of people responsible for more than 70 percent or more of infections, in clusters."
While it is relatively easy to contact trace outward from a superspreading cluster or individual to those infected, it is very difficult to take enough samples of cases and trace them (possibly through intermediate infected contacts) to an originating event. One can make a convincing case that Covid is spread predominantly by "superspreading" but asserting a specific percentage will require a lot more evidence.
TRIPS Waiver important for us to thinking about. I found this useful: https://citationsneeded.libsyn.com/news-brief-on-bidens-trips-waiver-support-substance-matters-more-than-headlines
Well, at least we know Science is Real!
Snickering aside, while I wish conspiracy theories were not so easy for people to fall for, I do think that that meme is supercilious, simplistic and probably polarizing. This article illustrates why we need to take even science with a grain of salt.
I read the OpEd earlier today, and I've been trying to organize my thoughts.
My first question is why didn't you phrase this as science upending a (well, old) standard (if generally accepted) model? Isn't that a success for science?
In other words, isn't the sentence "A few sentences have shaken a century of science" the opposite of what just happened?
Also you can reach out to Kim Prather on a letter that they (Milton, Marr and a couple others) are sending to the CDC in response. She might like your help with that.