Terrific. Particularly like this: "I am not linking to all those who argued against the facts, because focusing on individuals is not correct."
But I also have a question. What motivated the reasoning of those who opposed the pretty clear thesis of aerosol borne transmission? Why?
And, though I generally agree with the idea of not naming namse. I will name two: President Trump, who said to Bob Woodward in early February 2020: “It goes through air, Bob. That’s always tougher than the touch." It has to be said that Woodward held that information to himself for 7 months!! (before his book publication).
It's a very good question. Multiple things? One version was people who really, really believed hand-washing was important (a point that is generally true) and somehow decided that aerosol transmission would detract from that (weird, yeah but I've heard this argued from highest echelons of expertise in WHO). Some of it is that some people aren't that good at this kind of evidentiary sifting, and they stuck to... guidelines and what turns out to be medical dogma (droplets playing a major role) despite the, yes, obviousness of what was right in front of all of us? Scientific/institutional inertia? These fields do not encourage this kind of rapid response to emerging evidence. Kuhnian dynamics in which paradigms simply do not quickly shift despite evidence? It's one of the most fascinating social processes I've ever witnessed!
Yes, I also came to ask this - why was there such resistance to admitting aerosol transmission? I think I believed (not having the epistemological understanding Zeynep did) that health authorities couldn’t be so wrong and/or dishonest; it would be very helpful to understand why they were, including to assess future claims.
Also, I suspect that those more focused on the economic impacts really, really wanted it to be fomite-based. It’s easy to ostentatiously wipe down surfaces and tell customers “it’s safe!” Look at the absurd lengths airlines were going with their disinfecting to convince people it was safe to fly. Restaurants were using disposable menus and wiping down tables in front of patrons with the same goal: dramatizing sanitation.
You can’t show people clean air. HEPA and HVAC filters hum away in the background. We evolved to fear dirty surfaces but not “dirty” air, because we can’t see it.
In a response that was so excessively driven by behavioral manipulation and lying (some of it “noble”; much of it not) the “fomite myth” simply was irresistible.
I think in addition to institutional pushback/politics, and the attraction of very tangible solutions like wiping surfaces, the droplets/aerosols dichotomy was a big source of confusion that served to obscure the more relevant problem. It led to this pseudo-airborne middle ground defined by arbitrary distance rather than fluid dynamics, which allowed people to fall back on the old paradigm while still giving the appearance of accounting for much of the transmission. It's easier to provide a magical answer within a framework that otherwise feels intuitive, familiar and logical, than a logical and evidence-based answer within a framework that feels counterintuitive, unfamiliar and magical.
I'd like that investigated too. Of course an investigation will lead to people's self-serving recall as well as to people just being not as good at their job as they thought they were, such as the lab manager who could not imagine that his CDC test-making lab was contaminated because he just hadn't seen that happen in his earlier experience and was so set in his ways he wouldn't take in evidence that coronavirus was different. He reminds me of Edwin Hubble having to have numerous Henrietta Leavitt images that showed that variable stars were not in our Milky Way before he had the "aha" experience and proclaimed that other galaxies were not in the Milky Way (See Miss Leavitt's Stars, a great read).
And then there’s issue that some us, who no matter what Trump said, particularly about the virus, quickly dismissed it. It was coming from Trump after all.
Yeah. In this particular case, Trump had almost certainly heard it from Xi or Chinese authorities who had, finally, woken up to the crisis and were now trying to warn the rest of the world so as not to be in the position of having be the initial cause for a terrible pandemic. So they were trying to warn, for sure, and must have stuck in Trump's head--he does that sometimes, will repeat something he hears.
Me theory, for a bit of it, is that some experts believed emphasizing aerosol transmission was more likely to induce panic. Wiping down surfaces is laborious but possible. We didn't (well, I didn't) know at the time that outdoor air was considerably safer than indoor air. It wasn't until we saw a few infection curves peak and come back down again that curbing virus spread via aerosol transmission was even seen as a tractable problem, rather than as a guarantee that the whole world would be overrun.
This theory is based on my reading between the lines of some interviews, I was not privy to any particularly privileged information.
Early on, I had to remind myself that the virus was not dripping from the trees as I walked the neighborhood. I was good and scared. Fear never super conducive to clear thinking.
I recall walking through the New Orleans airport in early March 2020, wearing an N95 mask and getting all kinds of strange looks. At the same time Mike Pence and Dr. Fauci were on CNN defiantly proclaiming that masks “were not necessary for average Americans.”
A giant problem in our discourse is that the media often engages us in a lively debate, but only within certain parameters. In this case it was Trump vs. Fauci, and everybody took a side. Since neither provided a comprehensive analysis of aerosol spread, it didn’t resonate with the public or even many public health experts.
Yeah, the current mode of polarization really does not help. Now it's become hard to talk about what happened back then because the prevailing explanation seems to be it was all Trump's fault, which is of course *also* true, but clearly, that is not the only thing that was going on, and still is to some degree, especially at the global level where Trump isn't a factor.
Man me too! Except it was in a grocery store. I had a bunch of N95s before the pandemic and started wearing them (and, admittedly for a few weeks early on, nitrile gloves).
I have rarely felt so uncomfortable (I acknowledge that this means I’ve had a pretty incredible life so far). It was a crazy sensation, feeling quite embarrassed around a bunch of people I’d never see again and being literally the only person in the store wearing a mask, knowing I had good reasons but still feeling like a goofball.
Gave me some empathy for how hard it is to do the “right thing” in any situation in which you’re a major outlier and don’t have any “tribe” that makes you feel welcome.
It was such a stunning failure at two distinct levels: certainly you had the political one which seemed to be a combination of “too tough to be taken down by a virus” and “die for the Dow”, which I’d characterize as ignorant bluster on a stick.
However, there was also the non-bluster scientific one which, in retrospect, appeared to be a combination of dismissing data from East Asia because of the assumption that they were acting out of habit, e.g., “they always wear masks no matter what”, and falling back on the most comfortable (“time proven”) heuristics “sure, a naive view would think aerosols, but if you study the problem more deeply you realize that it’s usually fomites”
It can take a while for the data to move you to a new position, when your model is wrong, but the data is noisy. During the pandemic I’ve been struck by how often it’s claimed that decisions are “data driven” as if that removes biased decision making from the process, while the full process is that data feeds into your model which then produces the decision. People generally have difficulty dropping the model(s) that no longer apply but have worked for them in the past, especially in fast moving situations.
Very much this, yes. There were frameworks and we fit emerging evidence into them, even when it became increasingly uncomfortable. East Asians? They are into masks. I read, in the Washington Post if I recall correctly, an article claiming that masks were superstition, and that's why they wore them in Asia.
Exactly that with the heuristics: "the default is that our prior guidelines were correct therefore this must be.. fomites."
And yes, especially if you are willing to stretch what it means to be "data-driven" you can keep stretching your interpretation of your model to fit a lot of data even beyond any level of face-value credulity. Hence you got people arguing, with a straight-face, that 53 out of 61 people getting infected in a single evening *despite taking a ton of precautions* must still be... that they all touched the same thing and then touched their face and inhaled enough virus that way and somehow this was enough? It happened when they folded the chairs?
It's baffling, and if I hadn't lived through all this, I'd think one was caricaturing the debate or one side of it. But having lived through it, I am both flabbergasted and also amazed at how powerful the social processes are.
This was a good, thoughtful analysis to read. I have to admit I’m trying to put myself in the life of anyone living in America since Trump became president who hadn’t already looked up “gaslighting” at some point. That’s not a criticism; I’m just thinking about people’s different experiences.
I have been puzzled by Fauci's slow response to the evidence of spread by aerosols. I remember back a year ago wearing masks that a friend made and was giving to all of her friends while we were being told not to wear them. Can you address the resistance to telling us all to mask up? Does aerosol transmission just seem harder to deal with than fomites and therefore there was a subconscious desire to think fomites? Why is Trump telling Woodward in early February that the issue is air- and yet, even those we trusted in the health system are telling us not to mask?
Replied a bit in earlier comments too, but inertia, prior medical guidance (that turned out to be dogmatic and not evidence-based in the West, at least), not moving fast enough... It is among the biggest puzzles of this pandemic.
Was it you, in an earlier post, who said that the US was following an "influenza pandemic" playbook when the coronavirus is not influenza? Maybe they're mindset is "stick to the playbook"?
Do you think the bias here was toward easier mitigation strategies, and not crying wolf? Like, "Combating asymptomatic aerosol transmission is really hard and requires a lot of coordination and careful messaging, so let's not even go there unless we're forced to?"
Can this be a part of how science works? It's all centered on people, after all. Perhaps people who have status and power have lower need to adjust to new evidence. Certainly if their status derives from a theory at odds with the new evidence, but also possible in general. That stability of outlook implies gravitas and is also a barrier to whipsaw changes due to reacting to each new study. Also communicating changing advice to millions has overhead, so fewer changes is better.
As a counterweight, it would be nice to have a description of scenarios in which rapidly modifying stance and advice is important, vs when it is a mistake. And who to charge with this.
It isn't the way it's supposed to work, I'd say. And lots of countries got it right! Their scientists were not similarly blocked/rejected by their own scientific establishments.
But that is a huge issue in this country. maybe 2 or 3 times a year I read that scientists were rejected for grants because they had new or offbeat ideas. Of course I usually only see this because the investigator persisted and succeeded, so I do not have any idea how many useful ideas were blocked this way.
I saw that story in STAT! One of the great examples. It is disappointing to me because Dr. Karikó was clearly making progress in her research, in that she was learning about mRNA and working toward medical uses for it. Her students must have been learning valuable lessons in research methods and lab techniques. Funding agencies did support her work toward basic understanding for a few years, but this was unusual. Federal and other agencies consider whether the research is "succeeding" in producing medical breakthroughs or income-generating findings.
I think funding agencies use your definition of "pan out." In the beginning (of science) there was room for science just to advance knowledge. As Science moved in to and was supported by universities that opened the door for people who could not fund their own research to be scientists. For awhile universities supported research as a means of both investigation and teaching. Much of early genetics advanced this way. No one was trying to breed a better fruit fly. But dozens of young researchers learned in each of several of the early labs and we are still citing their work today.
Now universities provide minuscule support for labs, except startup costs. You can argue that research is more expensive and you would be right. But , to take one example, because agriculture product producers have taken over almost all of the research in that field, we only know about things that will make them products and money. We do not know why the soil in our fields is not "live." Is it climate change? Did the Crazy Ants eat all of the edible matter or did the microbes die for some reason? No one is asking. No one is looking.
Insightful, convincing and depressing. If science and institutions are too conservative to react quickly, then what else can we rely on.
One objection though, there is no need to bring in "gaslighting" when (a subtler version) Hanlon's razor suffices, "Misunderstandings and lethargy perhaps produce more wrong in the world than deceit and malice do. At least the latter two are certainly rarer".
Right, though you'd be surprised by the vehemence by which the folks arguing that this was clearly airborne were treated with. In some circles, including some highest level of global authorities like the WHO, it goes on to this day on that particular question. Baffling.
In an article in this week's New Yorker, Sweden's Anders Tegnell is quoted as saying, this December, regarding wearing masks: “Due to the developments we see, we need to use even measures where evidence and effect is low”.
Baffling indeed. The ancient Romans, during the triumphal entry of a victorious general, would require that a slave whisper in his ear "remember, thou art mortal". Perhaps we can have a plaque in the offices of highest global authorities quoting Cromwell, "I beseech you, in the bowels of Christ, think it possible that you may be mistaken."
I’m not an aerosol scientist, so I didn’t experience any of the gaslighting you refer to. But it seems like the mainstream guidance did not entirely ignore aerosols: we were told to avoid crowded indoor spaces and hospitals used negative pressure for Covid wards. Yes, we were also told to wash hands (which I’m not convinced is unhelpful) and to not be within 6 feet of others. But I think there’s still a lot of evidence that close contact is a major cause of spreading.
I don’t think that there was ever a blanket denial that it *can* spread via aerosols, only that the primary cause seems to be droplet. It’s clearly different from extreme aerosol diseases, like measles. Also different from fomite diseases, like norovirus.
I think a problem is that many in the public (and some officials) don’t want complexity. They want simple rules that don’t change. But nature is complex and knowledge evolves. Even if the virus primarily transmits via droplets, sometimes (especially for high-viral-load people) spread a lot by aerosols. For example, the choir washed hands and yet still met in person, disregarding the possibility that the virus might evade those interventions.
One problem is close contact was also likely aerosols... Which is a subtle point (not covered here) but I am co-author on a paper on this coming out soon and will come back to this. But yes, wanting simple rigid rules is clearly part of this.
I saw the news reports on the choir and subsequently read the CDC report on the choir, and asymptomatic spread did not occur to me, but spread by exhalations as aerosols did. It was an ideal circumstance and a very high level of transmission. Adding the (Korean? Chinese?) restaurant was convincing enough to me to incorporate distance into my guidelines.
A detail I read earlier is that the chorus member who had the virus reported felt no symptoms before the rehearsal, thus implying asymptomatic transmission. Yet we're still checking everyone's temperature with those handheld gizmos.
In the reporting on the choir case, I’ve been struck that more attention hasn’t been paid to the fact that singing is a vigorous aerobic activity, involving drawing air deeply into the lungs. More generally I’m curious if there is any link between how deeply a person is breathing when they are exposed (because they are singing, or exercising, or- in the case of the cruise ship- sleeping, etc) and the likelihood of infection and/or severity of illness?
It puzzles me that the lessons from “Legionnaires Disease” in Philadelphia in 1976 were lost. True, that was bacterial, but it invaded through the air ducts. It’s not like we’ve never seen the likes in the States.
I think the big mental block is not so much being able to get some disease through the air (after all, mold), as this occurring directly person-to-person via breathing alone which for Legionnaires is apparently very rare. But that's a great reminder because their symptomology looks similar and their rates may converge eventually assuming vaccination is effective, so there's a growing risk of mistaking Legionnaires for COVID.
when the stories about the cruise ships first broke, my immediate reaction was “Is this like Legionnaire’s disease?” I decided that since I’m an acknowledged epidemiological ignoramus, the parallels had been drawn and quickly rejected. from Zeynep’s critique, I’m now dubious the parallels had surfaced at the time.
You're probably right - this was just post facto analysis! But you raise a good point since that parallel is still suggestive enough that you might expect it to help generate the correct alternative hypothesis for this new situation, even if it doesn't technically carry over.
I read the book in the 1980s; so forgive me if I'm off base. And I don't buy into the most deconstructionist/relativistic versions of the his account. But isn't this just a miniature version of Thomas Kuhn's The Structure of Scientific Revolutions - a bunch of scientists seeing things within an existing paradigm and fiercely protecting the paradigm, until it collapses?
I have come to see Kuhn as having described a basic human trait. Paradigm shift is an unexpected event for all of us every day. We expect today to be much like an earlier day, unless we know we are doing something different (going on vacation, moving, etc.)The part that may be built in to science is the effort that has to go in to building the initial hypothesis, (these days in order to get funding, in early days just to keep the experiment on the rails instead of turning in to naturalist observation). Then the person is committed to this belief, has a sunk cost in it, and we know how hard it is for humans to give up on a sunk cost. It causes a scientist to not see what is under his nose. It causes him to lose face. It causes him to lose his future grants, etc.
So yes, Kuhn, as you describe him, is real. But I see it as one example of human life.
Of course, science as a concept wasn't supposed to be this way. It was supposed to be rational or true, or something I don't have great language for.
it seems like science means doing studies or gathering more evidence, while talking about it on Twitter is something more like scientific communication, even when the scientists themselves are doing it? And this seems to be where the trouble is? When scientists argue on Twitter, it may be a more informed debate than the rest of us can have, but this disagreement of experts isn’t the same as doing more studies.
What can be done to improve the speed and accuracy of scientific consensus-making in public health? I guess having leaders in charge? But the leaders we had moved quite slowly.
There has been hundreds of studies, if not thousands, though, on all this. The scientists working on all these points have been publishing non-stop. It's really baffling.
These contortionist explanations probably just added to the virus's mystique (they did everything right and it STILL magically got in, like the villain in a horror movie!). One would assume that the airborne scenario feels inherently more scary than the fomite/droplets transmission one, and thus less easy to accept - either by policymakers who don't want to "scare" people, or by regular folks who don't want to be scared. But maybe sometimes we're more drawn to the scary explanations than the conventional ones? And there's something uniquely scary about surfaces as well: you can see them everywhere and you're aware of touching them constantly. I wonder how much the relative scariness of one explanation over the other figured into all this resistance to evidence (in addition to rigidity and institutional resistance which clearly played a big role as well). And, how these respectively scary scenarios tended to influence people and in which ways this operated.
BTW, Masha Gessen's article today is an eye-opener - https://www.newyorker.com/news/our-columnists/the-mystery-of-breakthrough-covid-19-infections - I would like to think we can celebrate these vaccines' miraculous effectiveness while continuing to revise our understandings in light of emerging evidence, just as you advocate here. At a certain point there may be an epistemological question of what it means exactly to know you "have" COVID post-vaccine, if the implications are so much less serious.
Yeah, I don't know. The current thing is the mutantninjainvincible various discourse around variants (which should be watched, and responded to, but not the media coverage/concern has been.. often quite misleading, to be honest).
I recalled reading that Buzzfeed interview when it came out and had a moment of "OF COURSE it's airborne". I'm no specialist, but something that rocked some of us in the EU back in the 80s is that old hospitals were more likely to kill you because their ventilation systems were not adequate. I mean, it was either that, or fomites, or fecal-oral... that last one being quite less likely. ;-)
Isn't it blaringly obvious? Just that ship? What else could be happening with hundreds of passengers quarantined in their rooms? Yes, of course, fomite transmission occurs in ships, too, but in this case, there was this extraordinary set-up in which people were simply not allowed to move (though the crew was).
Hi Zeynep! You said "... infected in a rapidly growing outbreak despite all the passengers being entirely quarantined in their rooms".
The graph you show of the timeline of infection shows a big drop in new infections 4 days after the quarantine started, and a complete drop off a few days after that. Isn't that just consistent with the incubation period of the virus, and that the quarantine worked as expected?
The article quoted mentions that spread between rooms was inevitable unless the ships had a ventilation system that they could not have had. Viking cruises is saying that every cabin on its ocean ships has its own independent air system, no shared air. This sounds like someone is confused.
Terrific. Particularly like this: "I am not linking to all those who argued against the facts, because focusing on individuals is not correct."
But I also have a question. What motivated the reasoning of those who opposed the pretty clear thesis of aerosol borne transmission? Why?
And, though I generally agree with the idea of not naming namse. I will name two: President Trump, who said to Bob Woodward in early February 2020: “It goes through air, Bob. That’s always tougher than the touch." It has to be said that Woodward held that information to himself for 7 months!! (before his book publication).
It's a very good question. Multiple things? One version was people who really, really believed hand-washing was important (a point that is generally true) and somehow decided that aerosol transmission would detract from that (weird, yeah but I've heard this argued from highest echelons of expertise in WHO). Some of it is that some people aren't that good at this kind of evidentiary sifting, and they stuck to... guidelines and what turns out to be medical dogma (droplets playing a major role) despite the, yes, obviousness of what was right in front of all of us? Scientific/institutional inertia? These fields do not encourage this kind of rapid response to emerging evidence. Kuhnian dynamics in which paradigms simply do not quickly shift despite evidence? It's one of the most fascinating social processes I've ever witnessed!
Yes, I also came to ask this - why was there such resistance to admitting aerosol transmission? I think I believed (not having the epistemological understanding Zeynep did) that health authorities couldn’t be so wrong and/or dishonest; it would be very helpful to understand why they were, including to assess future claims.
I think the whole topic is worth a huge investigation, if not a few books. (I hope all of those will happen.) Weirdly, it's still happening! Still!
Please write a book on this, Zeynap! I promise to buy it and copies for all of my friends.
It would be both fascinating and a great opportunity to think about the meta-epistemology concepts you’ve been exploring this year.
Also, I suspect that those more focused on the economic impacts really, really wanted it to be fomite-based. It’s easy to ostentatiously wipe down surfaces and tell customers “it’s safe!” Look at the absurd lengths airlines were going with their disinfecting to convince people it was safe to fly. Restaurants were using disposable menus and wiping down tables in front of patrons with the same goal: dramatizing sanitation.
You can’t show people clean air. HEPA and HVAC filters hum away in the background. We evolved to fear dirty surfaces but not “dirty” air, because we can’t see it.
In a response that was so excessively driven by behavioral manipulation and lying (some of it “noble”; much of it not) the “fomite myth” simply was irresistible.
I think in addition to institutional pushback/politics, and the attraction of very tangible solutions like wiping surfaces, the droplets/aerosols dichotomy was a big source of confusion that served to obscure the more relevant problem. It led to this pseudo-airborne middle ground defined by arbitrary distance rather than fluid dynamics, which allowed people to fall back on the old paradigm while still giving the appearance of accounting for much of the transmission. It's easier to provide a magical answer within a framework that otherwise feels intuitive, familiar and logical, than a logical and evidence-based answer within a framework that feels counterintuitive, unfamiliar and magical.
I'd like that investigated too. Of course an investigation will lead to people's self-serving recall as well as to people just being not as good at their job as they thought they were, such as the lab manager who could not imagine that his CDC test-making lab was contaminated because he just hadn't seen that happen in his earlier experience and was so set in his ways he wouldn't take in evidence that coronavirus was different. He reminds me of Edwin Hubble having to have numerous Henrietta Leavitt images that showed that variable stars were not in our Milky Way before he had the "aha" experience and proclaimed that other galaxies were not in the Milky Way (See Miss Leavitt's Stars, a great read).
And then there’s issue that some us, who no matter what Trump said, particularly about the virus, quickly dismissed it. It was coming from Trump after all.
Yeah. In this particular case, Trump had almost certainly heard it from Xi or Chinese authorities who had, finally, woken up to the crisis and were now trying to warn the rest of the world so as not to be in the position of having be the initial cause for a terrible pandemic. So they were trying to warn, for sure, and must have stuck in Trump's head--he does that sometimes, will repeat something he hears.
h/t to reporter David Sirota on this point about Woodward/Trump, btw.
Me theory, for a bit of it, is that some experts believed emphasizing aerosol transmission was more likely to induce panic. Wiping down surfaces is laborious but possible. We didn't (well, I didn't) know at the time that outdoor air was considerably safer than indoor air. It wasn't until we saw a few infection curves peak and come back down again that curbing virus spread via aerosol transmission was even seen as a tractable problem, rather than as a guarantee that the whole world would be overrun.
This theory is based on my reading between the lines of some interviews, I was not privy to any particularly privileged information.
Early on, I had to remind myself that the virus was not dripping from the trees as I walked the neighborhood. I was good and scared. Fear never super conducive to clear thinking.
I recall walking through the New Orleans airport in early March 2020, wearing an N95 mask and getting all kinds of strange looks. At the same time Mike Pence and Dr. Fauci were on CNN defiantly proclaiming that masks “were not necessary for average Americans.”
A giant problem in our discourse is that the media often engages us in a lively debate, but only within certain parameters. In this case it was Trump vs. Fauci, and everybody took a side. Since neither provided a comprehensive analysis of aerosol spread, it didn’t resonate with the public or even many public health experts.
Yeah, the current mode of polarization really does not help. Now it's become hard to talk about what happened back then because the prevailing explanation seems to be it was all Trump's fault, which is of course *also* true, but clearly, that is not the only thing that was going on, and still is to some degree, especially at the global level where Trump isn't a factor.
Man me too! Except it was in a grocery store. I had a bunch of N95s before the pandemic and started wearing them (and, admittedly for a few weeks early on, nitrile gloves).
I have rarely felt so uncomfortable (I acknowledge that this means I’ve had a pretty incredible life so far). It was a crazy sensation, feeling quite embarrassed around a bunch of people I’d never see again and being literally the only person in the store wearing a mask, knowing I had good reasons but still feeling like a goofball.
Gave me some empathy for how hard it is to do the “right thing” in any situation in which you’re a major outlier and don’t have any “tribe” that makes you feel welcome.
It was such a stunning failure at two distinct levels: certainly you had the political one which seemed to be a combination of “too tough to be taken down by a virus” and “die for the Dow”, which I’d characterize as ignorant bluster on a stick.
However, there was also the non-bluster scientific one which, in retrospect, appeared to be a combination of dismissing data from East Asia because of the assumption that they were acting out of habit, e.g., “they always wear masks no matter what”, and falling back on the most comfortable (“time proven”) heuristics “sure, a naive view would think aerosols, but if you study the problem more deeply you realize that it’s usually fomites”
It can take a while for the data to move you to a new position, when your model is wrong, but the data is noisy. During the pandemic I’ve been struck by how often it’s claimed that decisions are “data driven” as if that removes biased decision making from the process, while the full process is that data feeds into your model which then produces the decision. People generally have difficulty dropping the model(s) that no longer apply but have worked for them in the past, especially in fast moving situations.
Very much this, yes. There were frameworks and we fit emerging evidence into them, even when it became increasingly uncomfortable. East Asians? They are into masks. I read, in the Washington Post if I recall correctly, an article claiming that masks were superstition, and that's why they wore them in Asia.
Exactly that with the heuristics: "the default is that our prior guidelines were correct therefore this must be.. fomites."
And yes, especially if you are willing to stretch what it means to be "data-driven" you can keep stretching your interpretation of your model to fit a lot of data even beyond any level of face-value credulity. Hence you got people arguing, with a straight-face, that 53 out of 61 people getting infected in a single evening *despite taking a ton of precautions* must still be... that they all touched the same thing and then touched their face and inhaled enough virus that way and somehow this was enough? It happened when they folded the chairs?
It's baffling, and if I hadn't lived through all this, I'd think one was caricaturing the debate or one side of it. But having lived through it, I am both flabbergasted and also amazed at how powerful the social processes are.
This was a good, thoughtful analysis to read. I have to admit I’m trying to put myself in the life of anyone living in America since Trump became president who hadn’t already looked up “gaslighting” at some point. That’s not a criticism; I’m just thinking about people’s different experiences.
I have been puzzled by Fauci's slow response to the evidence of spread by aerosols. I remember back a year ago wearing masks that a friend made and was giving to all of her friends while we were being told not to wear them. Can you address the resistance to telling us all to mask up? Does aerosol transmission just seem harder to deal with than fomites and therefore there was a subconscious desire to think fomites? Why is Trump telling Woodward in early February that the issue is air- and yet, even those we trusted in the health system are telling us not to mask?
Replied a bit in earlier comments too, but inertia, prior medical guidance (that turned out to be dogmatic and not evidence-based in the West, at least), not moving fast enough... It is among the biggest puzzles of this pandemic.
Was it you, in an earlier post, who said that the US was following an "influenza pandemic" playbook when the coronavirus is not influenza? Maybe they're mindset is "stick to the playbook"?
Do you think the bias here was toward easier mitigation strategies, and not crying wolf? Like, "Combating asymptomatic aerosol transmission is really hard and requires a lot of coordination and careful messaging, so let's not even go there unless we're forced to?"
Probably part of it. Let's not scare people was definitely part of what I heard.
Can this be a part of how science works? It's all centered on people, after all. Perhaps people who have status and power have lower need to adjust to new evidence. Certainly if their status derives from a theory at odds with the new evidence, but also possible in general. That stability of outlook implies gravitas and is also a barrier to whipsaw changes due to reacting to each new study. Also communicating changing advice to millions has overhead, so fewer changes is better.
As a counterweight, it would be nice to have a description of scenarios in which rapidly modifying stance and advice is important, vs when it is a mistake. And who to charge with this.
It isn't the way it's supposed to work, I'd say. And lots of countries got it right! Their scientists were not similarly blocked/rejected by their own scientific establishments.
But that is a huge issue in this country. maybe 2 or 3 times a year I read that scientists were rejected for grants because they had new or offbeat ideas. Of course I usually only see this because the investigator persisted and succeeded, so I do not have any idea how many useful ideas were blocked this way.
Yes! Even mRNA researchers encountered this, I recall. https://billypenn.com/2020/12/29/university-pennsylvania-covid-vaccine-mrna-kariko-demoted-biontech-pfizer/
Of course, I guess there’s no foolproof way to know up front which ideas will pan out and not every researcher can be funded. But still.
I saw that story in STAT! One of the great examples. It is disappointing to me because Dr. Karikó was clearly making progress in her research, in that she was learning about mRNA and working toward medical uses for it. Her students must have been learning valuable lessons in research methods and lab techniques. Funding agencies did support her work toward basic understanding for a few years, but this was unusual. Federal and other agencies consider whether the research is "succeeding" in producing medical breakthroughs or income-generating findings.
I think funding agencies use your definition of "pan out." In the beginning (of science) there was room for science just to advance knowledge. As Science moved in to and was supported by universities that opened the door for people who could not fund their own research to be scientists. For awhile universities supported research as a means of both investigation and teaching. Much of early genetics advanced this way. No one was trying to breed a better fruit fly. But dozens of young researchers learned in each of several of the early labs and we are still citing their work today.
Now universities provide minuscule support for labs, except startup costs. You can argue that research is more expensive and you would be right. But , to take one example, because agriculture product producers have taken over almost all of the research in that field, we only know about things that will make them products and money. We do not know why the soil in our fields is not "live." Is it climate change? Did the Crazy Ants eat all of the edible matter or did the microbes die for some reason? No one is asking. No one is looking.
Insightful, convincing and depressing. If science and institutions are too conservative to react quickly, then what else can we rely on.
One objection though, there is no need to bring in "gaslighting" when (a subtler version) Hanlon's razor suffices, "Misunderstandings and lethargy perhaps produce more wrong in the world than deceit and malice do. At least the latter two are certainly rarer".
Right, though you'd be surprised by the vehemence by which the folks arguing that this was clearly airborne were treated with. In some circles, including some highest level of global authorities like the WHO, it goes on to this day on that particular question. Baffling.
In an article in this week's New Yorker, Sweden's Anders Tegnell is quoted as saying, this December, regarding wearing masks: “Due to the developments we see, we need to use even measures where evidence and effect is low”.
Baffling indeed. The ancient Romans, during the triumphal entry of a victorious general, would require that a slave whisper in his ear "remember, thou art mortal". Perhaps we can have a plaque in the offices of highest global authorities quoting Cromwell, "I beseech you, in the bowels of Christ, think it possible that you may be mistaken."
I’m not an aerosol scientist, so I didn’t experience any of the gaslighting you refer to. But it seems like the mainstream guidance did not entirely ignore aerosols: we were told to avoid crowded indoor spaces and hospitals used negative pressure for Covid wards. Yes, we were also told to wash hands (which I’m not convinced is unhelpful) and to not be within 6 feet of others. But I think there’s still a lot of evidence that close contact is a major cause of spreading.
I don’t think that there was ever a blanket denial that it *can* spread via aerosols, only that the primary cause seems to be droplet. It’s clearly different from extreme aerosol diseases, like measles. Also different from fomite diseases, like norovirus.
I think a problem is that many in the public (and some officials) don’t want complexity. They want simple rules that don’t change. But nature is complex and knowledge evolves. Even if the virus primarily transmits via droplets, sometimes (especially for high-viral-load people) spread a lot by aerosols. For example, the choir washed hands and yet still met in person, disregarding the possibility that the virus might evade those interventions.
One problem is close contact was also likely aerosols... Which is a subtle point (not covered here) but I am co-author on a paper on this coming out soon and will come back to this. But yes, wanting simple rigid rules is clearly part of this.
I saw the news reports on the choir and subsequently read the CDC report on the choir, and asymptomatic spread did not occur to me, but spread by exhalations as aerosols did. It was an ideal circumstance and a very high level of transmission. Adding the (Korean? Chinese?) restaurant was convincing enough to me to incorporate distance into my guidelines.
A detail I read earlier is that the chorus member who had the virus reported felt no symptoms before the rehearsal, thus implying asymptomatic transmission. Yet we're still checking everyone's temperature with those handheld gizmos.
In the reporting on the choir case, I’ve been struck that more attention hasn’t been paid to the fact that singing is a vigorous aerobic activity, involving drawing air deeply into the lungs. More generally I’m curious if there is any link between how deeply a person is breathing when they are exposed (because they are singing, or exercising, or- in the case of the cruise ship- sleeping, etc) and the likelihood of infection and/or severity of illness?
It puzzles me that the lessons from “Legionnaires Disease” in Philadelphia in 1976 were lost. True, that was bacterial, but it invaded through the air ducts. It’s not like we’ve never seen the likes in the States.
I think the big mental block is not so much being able to get some disease through the air (after all, mold), as this occurring directly person-to-person via breathing alone which for Legionnaires is apparently very rare. But that's a great reminder because their symptomology looks similar and their rates may converge eventually assuming vaccination is effective, so there's a growing risk of mistaking Legionnaires for COVID.
when the stories about the cruise ships first broke, my immediate reaction was “Is this like Legionnaire’s disease?” I decided that since I’m an acknowledged epidemiological ignoramus, the parallels had been drawn and quickly rejected. from Zeynep’s critique, I’m now dubious the parallels had surfaced at the time.
You're probably right - this was just post facto analysis! But you raise a good point since that parallel is still suggestive enough that you might expect it to help generate the correct alternative hypothesis for this new situation, even if it doesn't technically carry over.
I read the book in the 1980s; so forgive me if I'm off base. And I don't buy into the most deconstructionist/relativistic versions of the his account. But isn't this just a miniature version of Thomas Kuhn's The Structure of Scientific Revolutions - a bunch of scientists seeing things within an existing paradigm and fiercely protecting the paradigm, until it collapses?
I have come to see Kuhn as having described a basic human trait. Paradigm shift is an unexpected event for all of us every day. We expect today to be much like an earlier day, unless we know we are doing something different (going on vacation, moving, etc.)The part that may be built in to science is the effort that has to go in to building the initial hypothesis, (these days in order to get funding, in early days just to keep the experiment on the rails instead of turning in to naturalist observation). Then the person is committed to this belief, has a sunk cost in it, and we know how hard it is for humans to give up on a sunk cost. It causes a scientist to not see what is under his nose. It causes him to lose face. It causes him to lose his future grants, etc.
So yes, Kuhn, as you describe him, is real. But I see it as one example of human life.
Of course, science as a concept wasn't supposed to be this way. It was supposed to be rational or true, or something I don't have great language for.
it seems like science means doing studies or gathering more evidence, while talking about it on Twitter is something more like scientific communication, even when the scientists themselves are doing it? And this seems to be where the trouble is? When scientists argue on Twitter, it may be a more informed debate than the rest of us can have, but this disagreement of experts isn’t the same as doing more studies.
What can be done to improve the speed and accuracy of scientific consensus-making in public health? I guess having leaders in charge? But the leaders we had moved quite slowly.
There has been hundreds of studies, if not thousands, though, on all this. The scientists working on all these points have been publishing non-stop. It's really baffling.
These contortionist explanations probably just added to the virus's mystique (they did everything right and it STILL magically got in, like the villain in a horror movie!). One would assume that the airborne scenario feels inherently more scary than the fomite/droplets transmission one, and thus less easy to accept - either by policymakers who don't want to "scare" people, or by regular folks who don't want to be scared. But maybe sometimes we're more drawn to the scary explanations than the conventional ones? And there's something uniquely scary about surfaces as well: you can see them everywhere and you're aware of touching them constantly. I wonder how much the relative scariness of one explanation over the other figured into all this resistance to evidence (in addition to rigidity and institutional resistance which clearly played a big role as well). And, how these respectively scary scenarios tended to influence people and in which ways this operated.
BTW, Masha Gessen's article today is an eye-opener - https://www.newyorker.com/news/our-columnists/the-mystery-of-breakthrough-covid-19-infections - I would like to think we can celebrate these vaccines' miraculous effectiveness while continuing to revise our understandings in light of emerging evidence, just as you advocate here. At a certain point there may be an epistemological question of what it means exactly to know you "have" COVID post-vaccine, if the implications are so much less serious.
Yeah, I don't know. The current thing is the mutantninjainvincible various discourse around variants (which should be watched, and responded to, but not the media coverage/concern has been.. often quite misleading, to be honest).
I recalled reading that Buzzfeed interview when it came out and had a moment of "OF COURSE it's airborne". I'm no specialist, but something that rocked some of us in the EU back in the 80s is that old hospitals were more likely to kill you because their ventilation systems were not adequate. I mean, it was either that, or fomites, or fecal-oral... that last one being quite less likely. ;-)
Isn't it blaringly obvious? Just that ship? What else could be happening with hundreds of passengers quarantined in their rooms? Yes, of course, fomite transmission occurs in ships, too, but in this case, there was this extraordinary set-up in which people were simply not allowed to move (though the crew was).
Hi Zeynep! You said "... infected in a rapidly growing outbreak despite all the passengers being entirely quarantined in their rooms".
The graph you show of the timeline of infection shows a big drop in new infections 4 days after the quarantine started, and a complete drop off a few days after that. Isn't that just consistent with the incubation period of the virus, and that the quarantine worked as expected?
The article quoted mentions that spread between rooms was inevitable unless the ships had a ventilation system that they could not have had. Viking cruises is saying that every cabin on its ocean ships has its own independent air system, no shared air. This sounds like someone is confused.