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).
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.
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.
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?
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.
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".
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.
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 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?
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.
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.
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. ;-)
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).
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.
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.
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?
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.
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".
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.
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 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?
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.
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.
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. ;-)
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.