Doctor Do-Little
January 27, 2021 11:42 PM   Subscribe

 
What is the point of this? Deifying Fauci was absurd but making him a villain in the previous administration is nonsensical as well.
posted by 41swans at 12:12 AM on January 28, 2021 [65 favorites]


The more aberrant Trump’s behavior, the more he diverged from the medically prudent course of action, the greater Fauci’s responsibility to leave and blow the whistle.

Nope. Trump was not telling complex lies. Everybody knew he was lying. There's nothing to be gained by resigning and telling the truth. Americans had no interest in the truth. At most Fauci resigning would have been a week long blip before the next shit storm errupted. Also, Fauci is a civil servant, not a political appointee. There's an argument that appointees should resign. Civil Servants has no such duty.

The responsibility for the horrible response to the pandemic falls on Trump and the American public.Trump because he's a sociopath that could not have run a competent response if he'd wanted to and the American public because they were more interested in watching the grifter show than in solving a problem.
posted by rdr at 12:25 AM on January 28, 2021 [176 favorites]


This feels like an overblown list of cherry-picked moments in need of a good frisking. For example, early effectiveness of masks quotes represented preliminary evidence that COVID was not aerosolized, and academic confusion about what the infection rate an aerosolized Coronavirus would have. It wasn't a talking point to keep people happy, it was a legitimate debate in medical research.

All the while governments around the world were struggling with incomplete information. If the virus spread only in droplet form and infections were highly symptomatic, general population mask orders don't make sense. But then we learned COVID acts otherwise. From that consensus, we get our current guidelines on mask issues.

Dismissing this change in guidance as a mere "flip-flop" does a massive disservice to the scientific community and public health officials who try to give the best advice they can based on what they know to be true at the time.
posted by lock robster at 12:40 AM on January 28, 2021 [118 favorites]


I'm going to withhold my judgement until the job is finished. As should any responsible journalist, given the zeitgeist. Their conclusion:

Perhaps, like the American people, he came to believe his own mythology, his own noble lie: that science and politics can be separated.

Bullshit, the politicization of science is the lie. The truth is that science DGAF about politics. Lying is the politician's job. Besides which, Fauci walked a line between doing his job and having a job, he was not deluded about that at all. He was well aware of the politics.

Incidentally, Fauci is the highest paid employee in the US government (forbes) at 417,608 in 2019. He makes more than the president. I'm fine with that. A senior doctor with decades of experience at the highest level is cheap at that rate, he could be making more elsewhere. He's certainly owed a higher rate than some reality show bozo. I'd supplement that with hazard pay considering the brainless mob calling for his blood.

the American public because they were more interested in watching the grifter show than in solving a problem.

The great revelation of 2020 is that half of America is gullible, cruel and idiotic.
posted by adept256 at 12:40 AM on January 28, 2021 [75 favorites]


At some point I learned that many of the highest-paid people in California's government are prison doctors: people with particular expertise filling a completely abhorrent set of needs. Maybe some are pure profiteers, but presumably many are doing their best to provide some good in a terrible place.

Fauci figures heavily in the recent Radiolab episode, 'Ashes on the Lawn,' which focuses on Fauci's role in the government response to the AIDS crisis in the 80's and 90's. It's one of the better radiolab episodes in the last couple-few years, I think, and well worth a listen.
posted by kaibutsu at 1:01 AM on January 28, 2021 [8 favorites]


The main argument seems to be that Fauci didn't take a pessimistic/hard enough stance in January, February, and March. He didn't hit the alarm bells (not that anyone was listening, and he may have done so for SARS-1, swine flu, etc. that didn't become global pandemics), and repeated some very political talking points. The article is pretty clear on the fact that Fauci has no specific authority - he can't call for lockdowns, invoke the Defense Production Act, or give people unemployment money. He can advise Trump but Trump was never the listening type.

By mid-April he was already on Trump's bad side. Trump wasn't listening to him and people were already calling for his termination and/or death. I don't think every misstep since then is somehow Fauci's fault, especially the vaccine distribution that took place nine months later. The United States is uniquely structured to handle a pandemic poorly with its private health care systems and weak social welfare system.

The idea that Fauci quitting would have made a difference is lunacy. People that leave the Trump administration are replaced with less competent people more willing to repeat the administration's lies.
posted by meowzilla at 1:05 AM on January 28, 2021 [58 favorites]


Dismissing this change in guidance as a mere "flip-flop" does a massive disservice to the scientific community and public health officials who try to give the best advice they can based on what they know to be true at the time.

A “flip-flop” in science often indicates you know more today than you did yesterday and can now act more wisely. For some, this prospect is terrifying.
posted by ricochet biscuit at 1:09 AM on January 28, 2021 [107 favorites]


The truth is that science DGAF about politics.

Science might not be political, but the people who carry out the research darn sure are, with the Tuskegee syphilis studies as the standard example.

I don’t know whether Fauci quitting would have mattered, but I do think it’s interesting that while many folks (myself included) raged at officials who kept their positions in order to vainly stabilize a madman instead of virtuously resigning and saying that the emperor had no clothes, Fauci hasn’t really been the target of similar ire. Why that distinction exists is worth exploring. (That isn’t to say that such a distinction shouldn’t be made.)
posted by Going To Maine at 1:19 AM on January 28, 2021 [4 favorites]


Yeah, scientists can read and interpret the research and thereby advise but do not typically have much power. It is up to leaders ie politicians and governments whether to heed and whether to implement that advice.
posted by lulu68 at 1:31 AM on January 28, 2021 [2 favorites]


A “flip-flop” in science often indicates you know more today than you did yesterday and can now act more wisely. For some, this prospect is terrifying.

For others, it's a club with which to bludgeon to death the public's trust in science and it's practitioners.
posted by Thorzdad at 1:51 AM on January 28, 2021 [16 favorites]


I think he makes some thoughtful points, especially about Fauci being a political operator as well as a scientist. But some of this is overstated:
By the same token, if Fauci had publicly denounced the White House’s approach, he would have united the entire medical and scientific community behind him. The effect of such a collective action is difficult to predict, but it’s not unthinkable Trump could’ve been removed from office, especially if Fauci had sufficiently damning evidence to share.
It's not unthinkable, but it's pretty unlikely and he doesn't seem to provide any mechanism for "removing" Trump given the blind, slavish obedience of his cabinet and Republican senators.
posted by TheophileEscargot at 2:56 AM on January 28, 2021 [22 favorites]


From a recent interview of Fauci where he described his relationship with Trump:

The other thing that made me really concerned was, it was clear that he was getting input from people who were calling him up, I don’t know who, people he knew from business, saying, “Hey, I heard about this drug, isn’t it great?” or, “Boy, this convalescent plasma is really phenomenal.” And I would try to, you know, calmly explain that you find out if something works by doing an appropriate clinical trial; you get the information, you give it a peer review. And he’d say, “Oh, no, no, no, no, no, no, no, this stuff really works.”

He would take just as seriously their opinion—based on no data, just anecdote—that something might really be important. It wasn’t just hydroxychloroquine, it was a variety of alternative-medicine-type approaches. It was always, “A guy called me up, a friend of mine from blah, blah, blah.” That’s when my anxiety started to escalate.


This is fundamentally why he stayed, despite direct threats against him and his family. If he had quit, he would have been replaced by the MyPillow Guy, the space alien DNA lady, or some other snake-oil peddler, not just by some corrupt and incompetent Trump crony. "Vertuously resigning" was not an option here.
posted by elgilito at 3:50 AM on January 28, 2021 [94 favorites]


Here in Ontario, alarmingly, the Conservatives seem to be launching attacks at those speaking out now - a right-wing media hit piece on Dr. Fisman and an ER doctor may have been removed for similar.

While we can argue and/or despair about it, I think one thing that’s increasingly clear is that models of governance have depended on part on elected officials wanting to govern at least with a basic regard for human life (see also: Flint Michigan). People, especially marginalized people, have known this isn’t always or in some areas even often the case. The career bureaucrats at their best mitigate and inform the gap. While the public-facing part is important there’s also a lot of the job below the surface. I think we can talk about the responsibilities on both sides of that but I’m not sure I’m ok blaming Fauci wholesale for the system.

I think the article raises some interesting questions but where it falls apart for me is the insistence that Fauci should absolutely have resigned. I think there’s a mythology there that is very American, the idea that a single act by a brave man would have changed everything or was the sole moral choice. It’s an interesting opinion. It strikes me as speculative.
posted by warriorqueen at 4:03 AM on January 28, 2021 [22 favorites]


This article feels like it was written by the high school quarterback who is trying to be "edgy" and "controversial" by attacking a nerdy scientist who actually SPOKE TO THE PEOPLE.

Dr. Fauci's persona -- and his heavy Brooklyn accent -- went a long way toward making people, including doctors, feel like someone understood what was happening. I cannot overstate how important it is for health care professionals to see another health care professional, rather than a politician, leading these briefings. Fauci quitting would have improved exactly nothing; Fauci's power lies in his platform. The idea that health professionals would have risen up in protest and removed Trump from office (did this guy pass 8th grade civics? more to the point, has he been paying attention to how hard it's been for health professionals to unionize and strike over concrete issues like PPE, let alone an abstract "who's head of NIAID?" hypothetical?)

I stopped reading when the writer started on about the "flip-flop" on masking. Hey, buddy, re-evaluating your conclusions in the face of new data is called "doing science." The "flip-flop" term is also, of course, what the right used to smear John Kerry in the 2004 campaign. This smells like both-sides-ism, and I'm not here for it.
posted by basalganglia at 4:15 AM on January 28, 2021 [70 favorites]


Jesus, what a crap hit-piece that is. "Thank you for being the only adult in the room and doing what you could to stem the insanity. But, you should have resigned because ideals." WTF? I'll never understand the liberal habit of, with perfect hindsight, shitting on anyone not 101% living up to some highly-polished set of moral ideals. People do what they can. Good people do the best they can. Fauci was, and is, undeniably a good person.

Does the writer really believe Fauci should have quit? Somehow, I think if Fauci had resigned, we be reading a similar hit piece on how he disregarded his moral duty and threw America under the bus.
posted by Thorzdad at 4:18 AM on January 28, 2021 [74 favorites]


This article feels like it was written by the high school quarterback who is trying to be "edgy" and "controversial" by attacking a nerdy scientist who actually SPOKE TO THE PEOPLE.

Very much this. He tweets 'Here's my piece, look how controversial it is', and then takes a swipe at 'Marxists', even though his piece got into what is supposed to be a left-wing publication. He's trying too hard to be Taylor Lorenz and is instead ending up Jan Moir.
posted by Cardinal Fang at 4:36 AM on January 28, 2021 [5 favorites]


This piece is very much punching who you can reach, not who deserves it. The idea that Fauci would have unified opposition to Trump enough to have him impeached by resigning is arrant nonsense; James Mattis was a similarly venerated character in his administration who left some time ago. When was the last time you heard from or about Mattis? Right.
posted by Halloween Jack at 4:41 AM on January 28, 2021 [30 favorites]


Science might not be political, but the people who carry out the research darn sure are, with the Tuskegee syphilis studies as the standard example.

It’s a real stretch to categorize scientists as political based on the actions of a few , although the gravity of lacking ethics in designing a study is devastating.
posted by waving at 4:55 AM on January 28, 2021 [1 favorite]


I think this is a dumb article but there is a larger point about separating service to the people / the nation and serving "in" a fundamentally bad administration. That is especially true when you disagree about methods and not about principle. Clearly if you believe ICE should be abolished and the whole US system of immigration is rotten to the core in terms of its aims, you cannot work for ICE with the aim of changing it from the inside. This however was not about resigning from an administration trying to do evil (in this particular area) but from an administration that was incompetent, floundering, poorly led, and had poor priorities. Resigning in the latter case is really a very different matter because you actually can do a lot of good by staying.

There is not an easy answer. The article points out that Dr Birx got a lot less deferential treatment but wasn't she in basically the same position? She also had to choose between continuing to be inside a tent with bad people and trying to fix what she could vs resigning demonstratively. Contrary to the way they have been treated by the media, Drs. Fauci and Birx did not make fundamentally different choices but only slightly different choices of tone and style. Logically then they should also be treated as people who made slightly different decisions and it is not fair to treat Tony Fauci as a resistance hero and Deborah Birx as some kind of Trump retainer and denialist stooge.

By the same token, if Fauci had publicly denounced the White House’s approach, he would have united the entire medical and scientific community behind him. The effect of such a collective action is difficult to predict, but it’s not unthinkable Trump could’ve been removed from office, especially if Fauci had sufficiently damning evidence to share.

The contempt for the administration's handling of this crisis, even among lifelong Republicans I know who voted for Trump in 2016 was already substantial. If you look at the number of split ballots, it probably swung the election to Biden. Among scientists and doctors, the attitude (again, even among political conservatives which is not unusual among doctors) was often one of white hot fury. How many people does this guy think would have been convinced?
posted by atrazine at 4:59 AM on January 28, 2021 [7 favorites]


It's not unthinkable, [Re: removing Trump from office]
It's completely unthinkable. He order a hit mob on Congress itself and they still wouldn't do it. A few righteously pissed off scientists wouldn't have budged the needle.
posted by stevis23 at 5:20 AM on January 28, 2021 [70 favorites]


The article's mask derail was completely unnecessary and detracts from the greater question of why the Faustian bargain Fauci obviously made remains both unexamined and even absolved to a certain extent.

Fauci made the kind of complicated ethical compromise usually reserved for scientists working on the Manhattan Project. At various points, he shared the stage and quietly smiled while Trump spread dangerous, made-up bullshit. He lavished praised on Trump's policies when it was required of him, and when journalists pressed him on whether Trump's distorted reality was harmful, he always declined to "get political" and could only offer the most passive-voiced criticism possible. Even if we assume he was working behind the scenes to influence policy for the better, we still ended up with eleven months of uncontrolled pandemic and over 400,000 lives lost which is a fucking horrible outcome, and it seems like every day brings to light how much worse the Trump administration's response plan was than previously thought.

Honestly, I don't know what Fauci could have done better, but I do think that defending him with hypotheticals about how much worse his replacement would have been is just as nonsensical as writing fanfic about about what he should have done. I do think the amount of rehabilitation Fauci has received is premature and it's a little gross that we're celebrating him for being only slightly more straightforward and honest than others like Birx who were in the same ethical bind and made the same decisions.
posted by RonButNotStupid at 5:23 AM on January 28, 2021 [13 favorites]


i got to the false equivalence between Dr Birx, who stayed the face of the lies and whose attempt at redemption included the truly orwellian phrase "parallel data" to describe those lies and Fauci who seems to have survived by going underground and bailed - its hard to imagine any strategy he might have employed to contradict the straight up intentional infliction of this pandemic on the American people that wouldnt have gotten him canned.
posted by Exceptional_Hubris at 5:34 AM on January 28, 2021 [2 favorites]


Bullshit, the politicization of science is the lie. The truth is that science DGAF about politics.

Science is not objective. Science is not apolitical. Even beyond questions of ethics, science is a political process. Science - especially as practiced during a pandemic - is inextricably linked with politics. Scientists in the US rely on governmental funding for the vast majority of our research. This shapes research questions and entire fields of study. SO MANY SCIENTISTS pivoted to COVID-19 research from whatever their area of work was in the past year, and the influx of funding to COVID research across a bunch of fields is truly staggering. By way of example, pubmed lists 96,670 publications with COVID-19 as a keyword, all published since November 2019. By contrast, there are 99,197 publications with malaria as a keyword since 1828. Now, there's a reason scientists in the west pivoted so quickly. There's a reason Operation Warp Speed developed a vaccine quickly and then sped through the manufacturing and clinical trial process, and that reason is political will in wealthy countries that just doesn't exist to comparable amounts of money and time and scientific effort into research on diseases that aren't imminent threats to the global north. There will certainly be consequences of the way funding has been distributed, and it will probably be both higher mortality in the global south as a result of less research attention and less funding for public health initiatives that aren't COVID related, and longer times to develop therapeutic interventions/vaccines/other measures to manage diseases that largely affect the global south.

Science isn't only political in medicine. How do you think research on global warming fared during the Trump administration? And, scientific output is a direct reflection of who is in the room doing science. When you have a diverse team of scientists, you get better and more interesting science that can challenge orthodoxies. For instance, women working on sociality in baboons realized that there were all sorts of important dynamics - social structures, decision making, reproductive choices - driven by female baboons that previous male researchers hadn't paid much attention to because they were so caught up in the inter-male politics. Who chooses to, and is chosen to, and even thinks they can, become a scientist is inherently political. Who is welcome, and where, is also political. When ostensibly international meetings are held in the United States, up until about a week ago Nigerian scientists, Iranian scientists, Sudanese scientists, were automatically excluded because they couldn't get visas. The folks I work closely with in Cote d'Ivoire can't afford to come here. I do research in Indonesia; LGBT scientists in my lab have to either stay closeted or work elsewhere.

EVEN THE PROCESS OF SCIENCE, our much beloved scientific method, is embedded in politics. Empiricism is just one way of understanding and studying the world. It's not necessarily the best way, but it's the one that we have chosen and so indigenous sciences and knowledge systems are discounted and ignored. Science is embedded politics and insisting otherwise helps nobody. We have to be honest about our limitations and constraints.
posted by ChuraChura at 5:41 AM on January 28, 2021 [109 favorites]


only slightly different choices of tone and style

Birx claimed that Trump "has been so attentive to the scientific literature and the details and the data, I think his ability to analyze and integrate data that comes out of his long history in business has really been a real benefit during these discussions about medical issues."

Refusing to criticize your political bosses is not the same thing as performatively going to bat for them. The first one is standard civil-servant stuff, whether we like it or not. The second one makes you look like a toady, and torches your credibility with ~half the country.
posted by BungaDunga at 5:46 AM on January 28, 2021 [22 favorites]


I keep reading articles where people seem to propose one weird trick to solve our present problems and the weird trick is usually some kind of moral suasion - some person or other should "exert pressure on" the government, presumably by going on talk shows and tweeting. I think this is a huge misunderstanding of how power works.

Going on TV and tweeting work when reputation and publicity are at stake for an entity with a mass base/audience, if that audience is very online and very swayable. That's why you can get neo-nazis fired from Bank of America or something but you can't always get them fired from Rich Dad's Brokerage For The Very Rich. Bank of America doesn't want the mass of people feeling hinky about them; Rich Dad's doesn't care.

Fauci would have no more power than any other high-profile doctor if he resigned. There are a number of high-profile virologists, epidemiologists and doctors who have been shaping the discourse, but they don't set policy and they only reach the people who are paying attention. It seems unlikely to me that some kind of popular movement would spring up around Fauci once he were outside of the government. How would such a popular movement compel change? Were people going to surround the White House? What mechanism would actually be used?

A lot of the vaguely left stuff I've been seeing doesn't seem to describe how change is compelled. Like, you can use existing bureaucratic mechanisms, you can leverage your connections, you can win elections, you can be backed by strikers and protesters, you can create parallel structures, etc etc. But you can't just say "I think this good change should happen, please like my tweet". That isn't useless in the long term since ideas have to be seeded somehow, but it's not movement-building.

Don't get me wrong; it's very clear that Americans are much more organized now than they were four or eight years ago - that there are far more popular movements and ways to mobilize people, whether for good or for bad. But popular movements are only going to get changes about covid if they leverage existing popular power - strikes, boycotts, sustained mass protest. The bigger the change, the bigger the actions needed, so a phone zap isn't going to get you a nationwide policy change.

~
I also think people underestimate how broken everything is. The covid response is fucked up partly because of Trump, but also because our public health system is broken, states don't have the political will or the political apparatus to act, Congress is made of up rich people who in general don't give a shit and who are no longer indebted to unions or popular movements, we no longer make anything in the US to speak of....I mean, we've been tearing up society with both hands since the Reagan administration and that isn't going to be fixed by one resignation. If Fauci resigned, very little would change except the Trump administration would get incrementally worse.

Government by celebrity itself is bad but Fauci's high profile doesn't really seem like an egregious example. People like to have a recognizable face delivering health information, not just the civil servant of the week.

I guess my feeling is that while the failed covid response and the appalling Trump administration are/were too big for Fauci to really make a dent, things would have been marginally worse had he resigned.
posted by Frowner at 5:47 AM on January 28, 2021 [49 favorites]


Also. I thought that the lesson of the AIDS crisis is that popular power comes from popular organizing and it takes a long time - it was a decade more or less before AIDS organizing really got popular traction.
posted by Frowner at 5:49 AM on January 28, 2021 [2 favorites]


ChuraChura, your comment flagged as fantastic.
posted by Bella Donna at 5:54 AM on January 28, 2021 [2 favorites]


At some point I learned that many of the highest-paid people in California's government are prison doctors: people with particular expertise filling a completely abhorrent set of needs.

There's nothing abhorrent about medical care for people who are incarcerated.
posted by tiny frying pan at 6:00 AM on January 28, 2021 [9 favorites]


His face — elven and expressive — is the face of the medical establishment’s response to the novel coronavirus.

That's one of the weirdest sentences I've recently read.
posted by Brandon Blatcher at 6:09 AM on January 28, 2021 [12 favorites]


Birx claimed that Trump "has been so attentive to the scientific literature and the details and the data, I think his ability to analyze and integrate data that comes out of his long history in business has really been a real benefit during these discussions about medical issues."

That's a disgusting thing to say, but isn't Birx also covered by the "had to play nice with the administration in order to keep from being being replaced with someone worse" excuse that applies to Fauci?
posted by RonButNotStupid at 6:22 AM on January 28, 2021 [2 favorites]


I actually had an unopened box of N-95 masks I had gotten from Home Depot for a project a couple of years ago and started rotating through them once the lockdown started; why not, right??

The 'don't bother with a mask when out in public' messaging in early March was quite hinky -- "Severe Acute Respiratory Syndrome" sounds like something you'd want to wear a mask to prevent spread and/or catching it.

If they were lying to prevent a run on supplies . . . that was . . . wrong??
posted by Heywood Mogroot III at 6:25 AM on January 28, 2021 [5 favorites]


We got here as the result of opinionated white guys with zero qualifications shouting down experts like Dr. Fauci, instead of listening. The problem isn't Dr. Fauci, its guys like Sam Adler-Bell. Maybe we should stop amplifying these asshole Joe Rogan wannabes with their contrarian takes grounded in nothing more than their white privilege expectations of how important their opinions are.
posted by interogative mood at 6:43 AM on January 28, 2021 [28 favorites]


Heywood Mogroot III: If they were lying to prevent a run on supplies . . . that was . . . wrong??

There was a similar pattern here in the Netherlands. Our government started by saying that there was no need to wear masks. It took them months to walk that back. Later on, we started hearing that masks were not encouraged earlier because there was a shortage. Now non-medical masks must be worn in supermarkets and on public transport.

If it makes all y'all feel better, our governments make mistakes too.
posted by Too-Ticky at 6:49 AM on January 28, 2021 [2 favorites]


Our government started by saying that there was no need to wear masks. It took them months to walk that back.

Can confirm something similar here in Germany, though I think they may have been quicker with the U-turn. However, we're now at the point where we need to wear either OP masks or FPP2 masks (more or less N95 equivalent, N94?) in shops/public transport. (Only FPP2 masks are allowed in Bavaria.)
posted by scorbet at 6:58 AM on January 28, 2021 [1 favorite]


Dismissing this change in guidance as a mere "flip-flop" does a massive disservice to the scientific community and public health officials who try to give the best advice they can based on what they know to be true at the time.

I'd go so far as to say this argument either indicates someone who has the shallowest understanding of what was happening in March and April or is deliberately making a bad-faith statement for propaganda reasons.

I have no tolerance for this "Fake News!" reading of recent history. It's easily examined with only a few minutes of searching.
posted by bonehead at 7:02 AM on January 28, 2021 [2 favorites]


I'm curious to know what people in the medical community think of Dr. Fauci.
posted by Chrysopoeia at 7:30 AM on January 28, 2021 [1 favorite]


I came here to post the same quote that same quote that TheophileEscargot did above:
By the same token, if Fauci had publicly denounced the White House’s approach, he would have united the entire medical and scientific community behind him. The effect of such a collective action is difficult to predict, but it’s not unthinkable Trump could’ve been removed from office, especially if Fauci had sufficiently damning evidence to share.
Which is an absurd hypothetical to make today, given one failed attempt already and another failure in the making. What I found pervasively frustrating throughout the entire article is that it continually describes sins of perceptions: that Fauci, doing one thing, caused others to think the wrong thing. It simultaneously decries Fauci having political saavy and making decisions in light of it, while blaming him for the politics of the situation and his failure to master the politics and beat Trump at his own game or take him down.

It is unthinkable, in hindsight, that Fauci could have rallied the medical community to get Trump removed. At best, stripping the contrarianism from the article, it describes someone in a damned-if-you-do, damned-if-you-don't situation who chose not to give up or go professionally terminal in pursuit of clean conscience.
posted by fatbird at 7:35 AM on January 28, 2021 [4 favorites]


The blame for the US failure in the pandemic should fall mostly on the Trump admin and the Republican party (the failure of our public health system overall to provide medical care to everyone is more bipartisan, though), but lionizing officials that made some mistakes like Fauci, or Cuomo, does not help us understand what happened. One of the main arguments of the piece is that Fauci quitting and/or being more negative in his initial assessments would have changed things, something that has been said of many people who ended up working for the Trump administration at various times. It's also impossible to prove or disprove since those things didn't happen, so while it might be silly to speculate (is it though?), it's not fair to say that's an obviously stupid thing to think about. "Flip-flop" is a bad term but it's not also not a simple case of the science revealing truth after time, Fauci himself said one reason he dismissed masks was to guard the supply, not their efficacy. Maybe Fauci did the best he could, but it's worth considering what else he could have done.

As other commenters have pointed out science is always political in it operation and that is certainly true in the medical research world (I work with medical researchers). Not many people here are mentioning Fauci's more ignominious place in HIV/AIDS history, perhaps because it is mentioned later in the piece, but everyone should watch How to Survive a Plague to see how important it is to recognize the politics inherent to scientific research.
posted by futurescamp at 7:39 AM on January 28, 2021 [4 favorites]


I've gone back and forth on Fauci. I am much more sympathetic to him since his recent interview tour. Not for his explanations but because he talks himself about realizing there was a risk he was doing more harm than good in working with the Trump people. Still not sure he made the right choice but I appreciate that he did make an explicit choice.

My ire is reserved more for Deborah Birx, who's done her own attempt at redemptive interviews.

My fantasy alternate history begins April 23 when Donald Trump famously proposed injecting disinfectant as one of his fantasy treatments for Covid. We all saw her facial reaction in that moment.

In my fantasy Birx doesn't just sit there looking appalled. She stands up, and walks to the microphone, and takes it from Trump. Or maybe just shouts into it loud enough to be heard. And she denounces Trump then and there as obviously insane and ignorant. It's an Emperor's New Clothes moment.

In my fantasy Birx's impromptu demonstration breaks Trump's spell, the way he held half the country in thrall. Everyone stops pretending Trump is even vaguely capable of leading anything related to Covid-19. Americans universally acknowledges his insanity and ignorance. Birx' career blows up, of course, there's no coming back from an outburst like that. But she becomes a folk hero. And her sacrifice moves the discussion far enough that we take a different course, one free of the deranged former presidenet.

It's a nice fantasy. No idea if it would have worked. Instead she just sat quiet as a mouse and kept having little meetings in the background that accomplished nothing visible. She got fully sidelined a month or two later.
posted by Nelson at 7:48 AM on January 28, 2021 [3 favorites]


It's a nice fantasy. No idea if it would have worked.

Do you really not? Personally I try to limit the amount ire I feel for dedicated public servants purely based on my own fantasy world.
posted by atrazine at 7:54 AM on January 28, 2021 [8 favorites]


It’s an interesting opinion. It strikes me as speculative.

Off topic, but this may be the most fantastic pair of sentences that I have read this month.

posted by eviemath at 7:55 AM on January 28, 2021 [3 favorites]


but lionizing officials that made some mistakes like Fauci, or Cuomo

The beatification of Cuomo is absolutely maddening, especially the support it gets among Democrats. Thousands of people, maybe even tens of thousands, have died due to awful decisions he's made since pretty much day 1 of the virus hitting NY. Even the NY AG is getting tired of his shit, and yet the consensus among liberals and the press is that he deserves to be showered with awards, not criticism. The man should be jail for mass manslaughter, not running one of the most powerful states in the country.
posted by Glegrinof the Pig-Man at 7:58 AM on January 28, 2021 [10 favorites]


Oh I can give you a bunch of more mundane reasons to be mad at Birx. The key difference between her and Fauci is that as she says herself, she was the "only full-time person in the White House working on the coronavirus response". It's Trump's fault she was the only full-timer, and it's probably Trump's fault that her expertise was ignored. But she stuck it out and gave false respectability to Trump's lies. She collaborated.

Fauci by contrast was an outside advisor. He has a real day job where he was still doing good. Also as he says in his interviews he did try to correct the record with Trump in limited ways. I wish he did more of that, but at least he did something.

The real story here is that Trump corrupted everything he touched. He corrupted Fauci, he corrupted Birx. They're both victims of his corruption. But they were also both participants.
posted by Nelson at 8:00 AM on January 28, 2021 [6 favorites]


didn't take a pessimistic/hard enough stance in January, February

... In January, if you were following the rumor's and news from China about this - you were treated like a conspiracy nutbar... So, given all of the other things that were happening (like nearly averting a war due to assassination and a commercial flight being shot down), and China's less than forthright behavior, I am not going to put any blame on Fauci about "not" taking a hardline stance in January or even February .

Last year in February, it wasn't even a blip on the medical radar in Canada - my partner and her family and myself spent nearly a week in a hospital, visiting with her aunt before she passed away. There were no safety warnings, precautions, masking, etc.
posted by rozcakj at 8:07 AM on January 28, 2021 [3 favorites]


A year ago the messaging was that the public should not adopt mask-wearing because masks were in limited supply. Anyone paying attention understood that they were not saying masks are ineffective, they were saying that there weren't enough to go around. Of course, vast numbers of people weren't really paying attention and somehow that messaging has retroactively turned into "they said not to wear masks, then they said to wear them, the government is flip-flopping" which -- no, they didn't really, except in the stupidest possible terms.
posted by axiom at 8:07 AM on January 28, 2021 [15 favorites]


Fauci by contrast was an outside advisor. He has a real day job where he was still doing good.

This is what I think lots and lots of people don't get. His involvement with the Trump Admin was his "nights and weekend" gig. He is now more directly involved with the Biden Administration, but he did not work for Trump.

Trump could not fire him, and I guess he could have just refused to show to press events, but not sure that abandoning his patients that he saw (and sees) during his daily rotations would help anything.
posted by sideshow at 8:08 AM on January 28, 2021 [3 favorites]


Friendly reminder that criticizing people Trump doens't like doesn't equate to support for Trump.
posted by MisantropicPainforest at 8:13 AM on January 28, 2021 [2 favorites]


This is a terrible post, sorry: one hit-piece article that is obviously political astro-turfing, with no context? Pot-stirring, indeed.
posted by LooseFilter at 8:18 AM on January 28, 2021 [4 favorites]


Anyone paying attention understood that they were not saying masks are ineffective, they were saying that there weren't enough to go around.

thats a terrible justification. mask dont help, because we need all the mask for medical personel... what?

they could have just said that cloth masks are more than enough for the general population in combination with distancing etc. instead of saying mask dont help and putting yourselve into a position to have to walk that back later.
posted by Megustalations at 8:33 AM on January 28, 2021 [6 favorites]


they could have just said that cloth masks are more than enough for the general population in combination with distancing etc. instead of saying mask dont help and putting yourselve into a position to have to walk that back later.

In my opinion, this is why you need an actual team, including a professional communicator, and not just a doctor making vague medical statements on the fly. Faucci handling briefings should never be done. Making policy - heck yes, but explaining policy decisions? No. Being good at one thing doesn't make you a master at everything.
posted by The_Vegetables at 8:45 AM on January 28, 2021 [8 favorites]


instead of virtuously resigning and saying that the emperor had no clothes, Fauci hasn’t really been the target of similar ire. Why that distinction exists is worth exploring

I don't think it's that confusing. I mean, he was pretty much saying that without resigning. He was pretty blunt and immediate in correcting many the president's factual incorrect statements. And he never went down the path of Trump sycophant.

Fauci's famous Science interview definitely soft-peddled criticism but there's nothing gratuitously nice about Trump. In contrast here's Birx: "He’s been so attentive to the scientific literature and the details and the data. I think his ability to analyze and integrate data that comes out of his long history in business has really been a real benefit during these discussions about medical issues."

Similarly, CDC head Redfield and FDA head Hahn, while also respected non-Trumpist professionals, made embarrassing missteps. Dig up Hahn's representation of the data at the convalescent plasma press conference for example, or the timing of CDC statements on various well-known issues such as aerosol transmission. (I know someone who knows Redfield professionally, really respects him overall, and is just nonplused about Redfield's inability to protect the CDC and its reputation from Trump.)

Fauci didn't cave on policy and was clear enough that he certainly could have been fired. Everyone could tell he was contradicting his boss on things his boss cared about. He pissed off Trump, according to plenty of reports. I think for the professional class especially, he found the right line to stand up to an idiot boss and keep doing his job honestly. (Which I recognize isn't a great reason for him to get so much praise, but it's still a big contrast from just about everyone else.)

There's certainly stuff to criticize (especially early in the response, and especially in hindsight) but the article, which focuses on the theater and performance aspects of the job, also misses various various accomplishments.
posted by mark k at 8:48 AM on January 28, 2021 [4 favorites]


¨..but isn't Birx also covered by the "had to play nice with the administration in order to keep from being being replaced with someone worse" excuse that applies to Fauci?¨

My biggest irritation with Birx was watching her smile and nod while Trump peddled his BS. I never got the impression Fauci agreed with Trump, just that he was choosing his words carefully.

And I wish we could all fight the evil idea, that is somehow out in the world, that Science is this static settled thing. People learn more and old ways of doing things change, etc.etc. I know many people who think that means scientists are lying, or changing what they say for personal benefit.
posted by olykate at 8:53 AM on January 28, 2021 [3 favorites]


What this article is 'about' that interests me is the limitations of cloaking yourself in the illusion of being apolitical.

In the story that is now being constructed (in the sense that all history is constructed as we make meaning of it later) about Fauci and AIDS, as movingly told in the above mentioned recent Radiolab episode, Fauci becomes heroic by succumbing to political pressure from radical activists. If he had continued to use his power (which he indeed has through policy and budget setting mechanisms) to just uphold the status quo, many more people would have died. Instead, he responded to activists who were burning effigies of him on his office lawn by inviting their participation into research and policy making. He did not 'remain neutral'; he allowed himself to be 'politicized'.

In the Trump context, there were forces much more powerful than ACT-UP exerting pressure against saving lives, and Fauci's 'neutrality' did little or nothing to reduce this loss of life, and may have played a harmful role in mildly legitimating Trump at his news conferences.

He as a person is not important to me (I guess Adler-Bell has a bone to pick with the hagiography aspect, which I agree with on principle, not caring for the whole benevolent patriarch theory of how good things happen). But thinking about how change happens is important to me. And this article argues that Fauci's commitment to simply remaining in the room, in the context of COVID, did nothing to make change or save lives.

There's another, less central point about the tension between the value of institutional stability vs the potential limitations of having one dude running the same set of agencies for 40 years that's important to think about too.
posted by latkes at 8:57 AM on January 28, 2021 [5 favorites]


And this article argues that Fauci's commitment to simply remaining in the room, in the context of COVID, did nothing to make change or save lives.

We could still have hydroxychloroquine approved by the FDA and recommended as a use for front line therapy. States and counties with mask mandates could be fighting with a federal government that unequivocally says they aren't necessary. Biden could be walking into office with a federal agencies completely stripped of qualified personnel and not at all ready to pivot to a science based response.

2020 was such a horrible year, and the King Lear bit (never say 'this is the worst') still applies.

Also, I struggle to see how Fauci contradicting the president and throwing his head in his hands at mis-statements legitimized the response. There was a reason that Trump loyalists online--or in the administration like Novarro--hated him and tried to undercut him.
posted by mark k at 9:09 AM on January 28, 2021 [2 favorites]


The Case Against Fauci

I'd go so far as to say this argument either indicates someone who has the shallowest understanding of what was happening in March and April or is deliberately making a bad-faith statement for propaganda reasons.


I notice that the author of the piece Sam Adler-Bell co-hosts a podcast that bills itself as a leftist's guide to the conservative movement. The word that triggers me there is "leftist" because I've been unable to ignore similar sentiments to Adler-Bell's from some pretty strident leftists in my own network -- people I'd thought of as friends but now, I'm not so sure.

I could go deep into it but let's just say their loud and unrelenting criticism of the (too-little-too-late-driven-by-vile-neoliberal-economics-they-have-blood-on-their-hands) medical officers who've been directing the covid fight in my particular region (which has actually done pretty well comparably) amounts to a demand for perfection. Which at best lands as immature given the complexity of covid-19, not just the virus but also the historical and cultural factors that have informed any given province-state-nation-region's response to it (ie: an autocratic culture like China did a comparatively effective job of containing things once they understood what they were dealing with, or more democratic cultures like South Korea and Taiwan handled it well because the reality of SARS was still vivid in their memory).

I guess what really annoys is that these kind of out-loud leftists present themselves as fierce students of history (they certainly know a lot of facts and relevant theory) yet seem incapable of realizing just how messed up we (humans) are, historically, in our response to crises. Always. Even if it's not an actual violent war, the war analogy is a good one. Because nobody who finds themselves in a war survives it unsullied, pure. To argue otherwise is bluntly foolish and wrong and (perhaps more relevant in the context of the now) just more childish noise.

Grow the fuck up, Sam Adler-Bell. And when I say that, I'm really saying it to a few other people who I know personally, but I'm trying to avoid saying it to their faces because well, I guess I'm hoping we may still find a way to be friends again once this enormously complex weather system has passed ... he said, mixing in yet another metaphor.
posted by philip-random at 9:16 AM on January 28, 2021 [14 favorites]


I guess there's a case against Fauci if either you couldn't pay close attention to what he was doing or you deliberately didn't so that later you could write a shittyshitty hit piece and get a ton of yummy clicks.

Every news conference I'd watch Birx do her craven scarf dance and shudder with horror and grief. Then I'd watch Fauci skip up and hop onto the line, perfectly. Never dishonest yet never actionably contradictory in a way that would get him booted offstage. Always, if you were listening, helpful. I'd be whispering and hope he could somehow hear me, "watch out Fauci, watch out!" and he always did watch out. He stayed out of Trump's reach and onstage longer than I thought humanly possible and in this he steeled the resolve of his audience and made us know that all was not lost. By remaining where he was and continuing to speak to us honestly as long as he possibly could when we desperately needed to hear the truth and NOBODY ELSE WAS TELLING THE TRUTH, Fauci kept us sane and out of despair. Sorry whoever wrote that crap lacks reading comprehension or something and failed to benefit.
posted by Don Pepino at 9:42 AM on January 28, 2021 [18 favorites]


I can't help thinking that the COVID-19 crisis is a giant trolley problem, except that the front window is made of frosted glass, the number of tracks keeps changing, the number of tied up people keeps changing, and there a whole forest of levers available. And that's the normal situation, where the driver is at least aware that there are people tied up on the tracks. In the situation Fauci found himself trapped in, the driver was sure that he could make the trolley fly because "he knew more about trolleys than anybody".
posted by elgilito at 9:49 AM on January 28, 2021 [5 favorites]


If it's a trolly problem the biggest danger to all of us tied to the tracks wasn't the driver (Trump?) but that the tracks haven't been maintained in 40 years and someone removed the train's brakes and sold them for scrap. We have no public health infrastructure capable of centralized testing, contact tracing, or vaccine administration. There are a ton of things a functioning federal government could and should have done, from mask mandates to better financial compensation to keep us at home, to the defense production act that would have reduced loss of life, but a smart democrat in office would not have been able in one year to rebuild our systemic starvation of, for only one example, county health departments over decades. The infrastructure literally doesn't exist. California just gave up on vaccine administration and handed the whole project over to a private insurer. And I don't see Biden prioritizing fixing that either.
posted by latkes at 10:05 AM on January 28, 2021 [5 favorites]


Fauci didn't cave on policy and was clear enough that he certainly could have been fired. Everyone could tell he was contradicting his boss on things his boss cared about. He pissed off Trump, according to plenty of reports. I think for the professional class especially, he found the right line to stand up to an idiot boss and keep doing his job honestly.

Whatever other armchair quarterbacking happens about 2020, he already gets a lot of praise from other researchers in his field for the groundwork he helped put down for doing clinical studies, which allowed researchers to get rolling quickly on Covid-related data collection. We learned about the disease faster and were able to learn how to treat the disease faster, because of the procedures he helped set up.

I'd rate their professional opinions higher than that of a random Internet writer, particularly as to what they know about his career-long contributions to public health.

I suspect HIV taught him the value of playing the long game. He waited out Trump, keeping his head low while still reaching out to the public in effective ways about the virus, and protecting your family by social distancing and wearing masks. He can now do his job with much less political interference.

On the other hand, Birx claims that she was the victim of "parallel" data streams, which she could have done much to stop early on, with the right sets of conflicting charts quietly sent to the right journalists. She continually and consistently placed the regime's political agenda over public health policy, and even over whatever meagre value she placed on her own medical training. That's the difference that makes her a collaborator, where Fauci was not.
posted by They sucked his brains out! at 10:05 AM on January 28, 2021 [7 favorites]


Personally I've found the deification of media figures like Fauci and Cuomo disturbing, but this piece kind of subtly reinforces that with it's suggestion that Fauci should have quit to rally the "scientific establishment" to ........ do what exactly? I don't think it would have made a difference either way.
posted by eagles123 at 10:11 AM on January 28, 2021 [7 favorites]


Just to keep the elevation of Andrew Cuomo in perspective, from the perspective of a multi-generational Cuomo watcher, is that Andrew Cuomo basically looked good in contrast to the Trump administration's being bad. He did leadership-looking-things at the appropriate times. But beyond that, hey if you want nursing home workers to give a damn about their jobs, how about paying them what they're worth, rather than what you can get away with?
posted by mikelieman at 11:07 AM on January 28, 2021 [6 favorites]


I'm curious to know what people in the medical community think of Dr. Fauci.
posted by Chrysopoeia at 10:30 AM on January 28 [1 favorite +] [!]


To quote my own earlier comment: "Dr. Fauci's persona -- and his heavy Brooklyn accent -- went a long way toward making people, including doctors, feel like someone understood what was happening. I cannot overstate how important it is for health care professionals to see another health care professional, rather than a politician, leading these briefings."

I mean, I can't speak for the several million bedside clinicians in the US, but I have yet to meet one who dislikes or blames Fauci. That includes my friend's mother, a career scientist at NIAID, who when Fauci was named to the coronavirus taskforce, said he was the best boss she could imagine.

The CDC, at one point in mid-March, recommended that clinicians wear scarves and bandannas. Fucking bandannas. That statement alone led to a lot of justified anger among the medical community that we were being treated as cannon fodder by an administration that not only wasn't listening to us, was going out of their way to harm us and our ability to care for others. None of that's new -- we are very aware, thanks to decades of capitalist medicine, that administrators rarely have our backs, but it was egregious in a way that severely damaged not only the public trust in the CDC, but also professionals' trust.

We've been bent to the point of breaking this year. I don't begrudge anyone their St Anthony of Bethesda votive candles.
posted by basalganglia at 11:22 AM on January 28, 2021 [4 favorites]


lock robster: "Dismissing this change in guidance as a mere "flip-flop" does a massive disservice to the scientific community and public health officials who try to give the best advice they can based on what they know to be true at the time."

If new facts don't cause you to change your story, you're selling religion, not science. It's kind of how science works. Review evidence, draw conclusions, when new evidence is found you re-evaluate.
posted by caution live frogs at 11:23 AM on January 28, 2021 [5 favorites]


I have no interest in defending Birx, but I do think she had harder levels of difficulties than Fauci did. She was in the direct line of fire, and a woman. Both of them had to walk a fine fucking line in dealing with a madman in power. Fauci did it better, there's no denying, but also he had two advantages that Birx did not. I'm not super happy with what she did and it was more of being a collaborator, but at the same time...

In my experience in dealing with crazy people, you have to pretend to be on their side if you want to get anywhere, or at least not get attacked yourself. Standing up to them and saying, "no, that is WRONG" and reminding them of the reality we actually live in instead of the one they are in has gone...poorly. The stakes here were super high and being in a position where you can't say "no, that is WRONG" and at the same time ethically you desperately need to say "no, that is WRONG...." Fuck if I know what I would have done.
posted by jenfullmoon at 12:41 PM on January 28, 2021 [3 favorites]


I don't know, I think this article has some good points. It's over the top to think Fauci's resignation would have taken down Trump, sure.

But Fauci is absolutely a politician who pretends he's not a politician. And the long delay before recommending mask-wearing has killed tens of thousands of people, it's completely unconscionable. Encouraging masks early and then backing off later would have been way better than the other way around, which we did. Fauci early on fell into the trap of thinking that absence of evidence is evidence of absence, which is like Scientific Reasoning 101 level stuff. Look back at the threads and news, there were lots of people saying we should be wearing masks early on.
posted by medusa at 12:59 PM on January 28, 2021 [3 favorites]


It is my understanding that public health officials are supposed to present recommendations based on scientific evidence, not "hunches" We didn't have a lot of data on mask usage outside of a clinical setting when Covid hit last spring. We didn't know how effective they would be and it was possible they might actually making things worse if improperly worn and the recommendation would of adversely affected supplies to those we KNEW at the time needed masks.
posted by interogative mood at 1:02 PM on January 28, 2021 [1 favorite]


Anyone paying attention understood that they were not saying masks are ineffective, they were saying that there weren't enough to go around.

That's absolutely not what they were saying, and lots of us were objecting at the time.

It is my understanding that public health officials are supposed to present recommendations based on scientific evidence, not "hunches" We didn't have a lot of data on mask usage outside of a clinical setting when Covid hit last spring.

There weren't data that hand-washing helps prevent infection, but they were recommending hand-washing. And there were data, they were just data from China that US officials decided don't count. I just disagree with the argument that a low-cost, common sense measure should be actively recommended against (it might make things worse!).
posted by medusa at 1:23 PM on January 28, 2021 [1 favorite]


...
posted by y2karl at 2:04 PM on January 28, 2021


It is my understanding that public health officials are supposed to present recommendations based on scientific evidence, not "hunches"

No, they absolutely do hunches. I mean you call them "best available recommendation based on the limited scientific data available" or something but same thing. The public health role is like the scientific management role: You can no longer just describe the science and suggest the next study. You have to recommend actions (or inaction) right now.

I am more forgiving on the early mask mistakes than many people for various reasons. But basically they started to standard advice for cold season (wash hands, stay home if you're sick, mask won't help) because it was standard. Not because they had evidence it was better. (I'd argue the various east Asian officials were giving their opposite advice because it was also standard for them, with limited data as well. They just happened to be right.)
posted by mark k at 2:24 PM on January 28, 2021 [2 favorites]


Trump knew the stakes back in February, and Rick Bright's whistleblowing did fuck all to stem that evil tide. [Biden re-hired Bright.] Fauci would have been sidelined at best for months if he'd spoken up. This article is ridiculous, and its timing is suspect.
posted by Iris Gambol at 2:43 PM on January 28, 2021 [5 favorites]


There weren't data that hand-washing helps prevent infection, but they were recommending hand-washing

That's not a true statement. The CDC has a whole section of their website with data and publications that back up the efficacy of handwashing as a means of controlling the spread of illness. The studies go back years and the results are clear. There is even Global Handwashing Day.
posted by interogative mood at 2:44 PM on January 28, 2021 [2 favorites]


> I have no interest in defending Birx, but I do think she had harder levels of difficulties than Fauci did. She was in the direct line of fire, and a woman. Both of them had to walk a fine fucking line in dealing with a madman in power. Fauci did it better, there's no denying, but also he had two advantages that Birx did not.

This point is made by Dr. Fauci himself in last month's New Yorker feature, "The Plague Year," a comprehensive evaluation of the pandemic thus far. Also the New Yorker article linked above directly contradicts a number of this author's assertions about Fauci not being criticized.
posted by desuetude at 3:31 PM on January 28, 2021 [4 favorites]


I find the author's breathless assertions incredibly frustrating. There's a pervasive thread of strawmanning throughout.
posted by desuetude at 3:33 PM on January 28, 2021 [1 favorite]


There is quite a bit of daylight between not recommending mask wearing and saying that masks are ineffective. I suspect everyone in a position to make public pronouncements was surprised by people's willingness to make their own cloth masks if need be.
posted by wierdo at 4:03 PM on January 28, 2021 [1 favorite]


To paraphrase John Kerry: "How do you ask someone to be the last person to die before we can finally convince Trump to take virus seriously?"

At some point the whole "not rocking the boat too much so we don't get replaced by someone less competent" plan starts to show diminishing results.
posted by RonButNotStupid at 4:13 PM on January 28, 2021


I have posted this here before, I think, but there was a great episode of The Daily back in July 2020 about the mixed messaging that came out of American and global health agencies circa late February and early March around mask wearing, in the face of what was then a developing situation around the pandemic. I'll leave this quote as kind of a larger indictment of officials associated with Trump and his administration:
Matt Apuzzo
Well, I mean, so I’m in Belgium. And here’s a practical example. Belgium locked down nursing homes and said, you can’t visit if you’re sick. And thousands of people in nursing homes died. And they think that symptomless visitors and symptomless care workers brought the disease in, and they just had no idea that was even a possibility. We had the Diamond Princess cruise off the coast of Japan, where one of the reasons that people were allowed to mix and mingle and go to the buffet, even after a former passenger tested positive, was because, well, we don’t think he was symptomatic when he was on board. And then February 29, we get a tweet from the U.S. surgeon general, all caps: “Seriously, people, stop buying masks. They are not effective in preventing the general public from catching coronavirus.” And it’s hard to imagine the surgeon general weighing in like that if there was kind of a growing acceptance in the medical community that, boy, this might actually be spreading before symptoms.

Michael Barbaro
And of course, now we know that symptomless spread can be curbed, and a primary way to curb it is masks.

Matt Apuzzo
Yeah, and now good luck messaging that when you’ve been telling the public, in all caps, masks don’t help. As you look at these moments, it just cost us time. And that’s kind of the story of Covid right now. We lost time.
I don't think one can reasonably put all of that on Fauci, specifically, although he did initially call for PPE to be reserved for healthcare professionals, as masks provide little to no protection when incorrectly used. His position changed as more information came out on asymptomatic spread of the virus, information which others affiliated with Trump and the GOP denied (and some still do to this day, by their behavior, e.g., Rand Paul).
posted by They sucked his brains out! at 4:13 PM on January 28, 2021 [1 favorite]


This article makes a case (badly) that a doctor has too much power, but then suggests a solution based on a criticism of that doctor's personal actions, rather than proposing to get rid of his position. It s a pretty American thing to do. But you don't get rid of the monarchy by having the perfect king, you have to build a new form of government. Structural problems don't have personal solutions.

It seemed like he was going to end up with, "and that's why we should have Medicare for all, so people can see their doctor, instead of being forced to depend on the doctor on tv". That would be a leftist article.

But the article just devolved into a different kind of fantasy about the TV doctor.
posted by eustatic at 4:44 PM on January 28, 2021 [2 favorites]


Mod note: Couple deleted at poster's request.
posted by Eyebrows McGee (staff) at 4:57 PM on January 28, 2021 [1 favorite]


At some point the whole "not rocking the boat too much so we don't get replaced by someone less competent" plan starts to show diminishing results.

Fauci did concrete good. He also rocked the boat.

You are taking mental shortcuts that are leading to a morally counterproductive suggestion.

Richard Holbrooke stuck with the State Department during Vietnam. He was more more competent (and potentially less malicious) than some replacements, but he was helping implement a policy whose very goals was wrong. And his very position prevented him from saying that publicly. He should have stepped down. But while was impossible to fight the Vietnam War in a good way, fighting coronavirus is laudable. It's kind of a big difference.

Sally Yates stepped down rather than implement illegal and anti-immigrant policies. On the Covid front: Rebekah Jones in Florida should not (and did not!) stay employed because her job became lying about coronavirus. So good for them.

What about Fauci? Well, he contributed to clinical trial work, to protecting scientists from political interference, to pressuring the CDC and FDA for better policy decisions. He had a bigger forum to communicate the seriousness of the disease than if he'd gone private. He could contradict Navarro or Hoover Institute think tank bozos and get covered doing it. How much have you heard from Yates on the immigration debate since 2017?

Or he could have stepped down and let the gutting and corruption of the government's scientific establishment continue, defended by people who'd be less effective doing it. And let the post-Trump president walk into a bigger mess with fewer resources to deal with it.

You're pretty clear that your approach is explicitly modeled on Vietnam protests and is mostly to make you feel better. It have done that but it would have made a lot of people feel worse--and then feel dead.
posted by mark k at 5:00 PM on January 28, 2021 [12 favorites]


>half of America is gullible, cruel and idiotic<

Huh, honestly? I would have bet on more than half...
posted by twidget at 6:13 PM on January 28, 2021 [3 favorites]


By March 20th Seattle was collecting citizens’ still-wrapped shop masks and nitrile gloves for medical and first response workers. Goodwill drivers volunteered and came around and picked them up off the porch. IIRC they recommended that we wear our slightly used ones to necessary outings.
posted by clew at 9:58 PM on January 28, 2021 [1 favorite]


A year ago the messaging was that the public should not adopt mask-wearing because masks were in limited supply. Anyone paying attention understood that they were not saying masks are ineffective, they were saying that there weren't enough to go around. Of course, vast numbers of people weren't really paying attention and somehow that messaging has retroactively turned into "they said not to wear masks, then they said to wear them, the government is flip-flopping" which -- no, they didn't really, except in the stupidest possible terms.

Incorrect. There were a lot of messages early on about masks being ineffective. The Surgeon General tweeted:

"not effective in preventing" COVID-19 in the general public, saying, "Seriously people- STOP BUYING MASKS!

This is partly because the available research on masks was inconclusive. Fauci later stated that the advice against masks was in response to there not being enough masks to go around. People have taken this to mean the messaging about masks being ineffective was a ploy to avoid shortages - if that's what he meant it's a truly disastrous tactic, but I'm not certain that he did mean that versus just defaulting to talking about one of two different reasons people were advised not to buy masks.

In general though there's a lot of stuff like that, where on one hand the state of knowledge of the disease was legitimately in flux, but on the other the people responsible for communicating it to the public, even the non-Trumps, legitimately did a poor job!
posted by atoxyl at 11:03 PM on January 28, 2021 [1 favorite]


Personally I've found the deification of media figures like Fauci and Cuomo disturbing, but this piece kind of subtly reinforces that with it's suggestion that Fauci should have quit to rally the "scientific establishment" to ........ do what exactly? I don't think it would have made a difference either way.

Cuomo just sucks, which is why it sucks to see how much some people love him - though I get that for a while he came off as a steady hand in an uncertain time, even though... he's not, really.

Fauci, I think some of the criticism of his actual work as a public health communicator is warranted. Criticism of his very presence in the Trump administration... I think truly he was damned if he was and damned if he wasn't.
posted by atoxyl at 11:08 PM on January 28, 2021 [1 favorite]


My recollection of the mask about-face is:

- initially there was no strong evidence that showed that anything other than an N95 type mask would significantly protect the wearer from airborne virus IF worn correctly, so the general public hoarding the N95 masks would not be that beneficial, in addition to depriving healthcare workers of them

- when asymptomatic transmission was found to be common, it was clear that a basic mask would help prevent the wearer from infecting others if they were asymptomatically infected but didn't know it. And the only way for that to happen is if everyone wears a mask, even a cheap or homemade one.
posted by Artful Codger at 1:31 PM on January 29, 2021 [7 favorites]


That's a lot of my take too. It wasn't just that the evidence got better, it was how we thought of who masks were supposed to protect changed too. PPE is usually conceptualized as protective to the wearer.

Most of the textbooks on it are all about protective factors, time to barrier penetration, that sort of thing. I've never seen a PPE text (looking at a bunch right now in my office) about reducing the risk of the wearer's own exhalation to others. So that was kind of a big change for many people.
posted by bonehead at 1:48 PM on January 29, 2021 [3 favorites]


Having to explain different types of masks providing different types of protection, despite having the same N95 classification, would have certainly complicated messaging. N95 masks with vents provide no protection to those outside the wearer, in terms of asymptomatic spread. Even ignoring that they provide little to no protection at all to the wearer, when incorrectly worn or used.

That doesn't excuse the numerous failures of the Trump administration and the resulting hundreds of thousands of avoidable deaths, but trying to reserve scarce PPE for healthcare professionals at the start of the US wave of the pandemic seems a reasonable ask and a reasonable health policy goal, even if the language at the time was confusing and often contradictory.

In hindsight, when nurses ended up having to do their jobs wearing garbage bags, maybe it only delayed the inevitable. But the ultimate goal was rational.
posted by They sucked his brains out! at 3:19 PM on January 29, 2021 [3 favorites]


This is fundamentally why he stayed, despite direct threats against him and his family. If he had quit, he would have been replaced by the MyPillow Guy, the space alien DNA lady, or some other snake-oil peddler, not just by some corrupt and incompetent Trump crony.

I mean yes, but: he stayed but it was herd-immunity crank Scott Atlas who ended getting Trump's ear with his Wormtongue "what if we just let them all get infected" whispers.
posted by We had a deal, Kyle at 6:35 PM on January 29, 2021


"nurses ended up having to do their jobs wearing garbage bags" dates to March 2020.
posted by Iris Gambol at 6:56 PM on January 29, 2021


initially there was no strong evidence that showed that anything other than an N95 type mask would significantly protect the wearer from airborne virus IF worn correctly, so the general public hoarding the N95 masks would not be that beneficial, in addition to depriving healthcare workers of them

A big problem, as sorta implied elsewhere in the thread, is that the CDC was not treating this as an emergency in their recommendations. In normal times you wait until there is "strong evidence" before making a recommendation. But in an emergency they should have been making recommendations based on what seemed most likely to be beneficial or even what had a decent chance of being beneficial so long as there wasn't a big downside. And it was clear that the evidence for masking was somehwere between "this most likely helps even though we can't prove it right now" and "eh, can't hurt and there's no significant downside". Which should have led to a recommendation for mask wearing as soon as significant community spread started in the USA.

But the CDC and others stuck with, and are still sticking with, waiting for strong or overwhelming evidence before acting even in cases where that doesn't make sense in an emergency.

Part of that is institutional inertia, but part of it is that nobody wants to make recommendations or exercise discretional authority in a way that might turn out to be wrong later even if the negatives from not acting are clear and inevitable. It's basically a giant trolley problem except with at least as many people on the current track as the alternate path. But everybody is super reluctant to be the one to pull the lever because the culpability for that action is direct whereas the culpability for doing nothing is much more attenuated.

When history looks back on the pandemic I think it should be clear to basically everyone that folks in positions of authority at every level from local to the President (who will rightfully get the most blame) did not act aggressively enough out of risk aversion.

Seriously, we are a year into this thing. Have we seen a ton of overreaction or has it been virtually entirely underreaction? I don't think the answer is hard.
posted by Justinian at 8:47 AM on January 30, 2021 [6 favorites]


There were also a number of moral hazard type arguments about masks - will wearing a mask give people a false sense of safety and encourage them to take risks they would not otherwise? - which make a little bit of sense on paper but which seem absurd in retrospect given people’s actual behavior and a year plus timeline.

I also think it’s totally fucked that we are still making people personally responsible for their masks with no testing, standardization or subsidization.
posted by atoxyl at 12:06 PM on January 31, 2021 [2 favorites]


It's also a standard not applied to other actions. Nobody seriously suggests not telling people to wash their hands because they might take more risks if they do so. It's stupid.
posted by Justinian at 1:47 PM on January 31, 2021 [2 favorites]


There were also a number of moral hazard type arguments about masks - will wearing a mask give people a false sense of safety and encourage them to take risks they would not otherwise?

I think there was concern that a strong mask mandate at the outset would override the importance of the messages of isolatiing at home as much as possible, and banning activities etc where people group together. "Hey, if I wear a mask when out, I'll be fine".

I also think it’s totally fucked that we are still making people personally responsible for their masks with no testing, standardization or subsidization.


As far as I know, prevention of the spread FROM infected but asymptomatic people is still the main goal, and there's not yet a mask solution that would significantly protect the wearer. Given how some people wear the things (or won't), I agree with that call. So there's not really a standard to cleave to; a basic disposable or cloth mask blocks virus output sufficiently.
posted by Artful Codger at 1:50 PM on January 31, 2021 [1 favorite]


As far as I know, prevention of the spread FROM infected but asymptomatic people is still the main goal, and there's not yet a mask solution that would significantly protect the wearer.

I don’t think that’s true. Even cloth masks work to some extent in “both directions” - just not necessarily to a large extent. N95 or better masks are very likely to provide greater protection to the wearer, and the non-valve type is likely to provide greater protection to others as well.
posted by atoxyl at 6:51 PM on January 31, 2021


If there wasn’t a difference there wouldn’t be a reason to reserve the better tier of masks for healthcare workers in the first place.
posted by atoxyl at 6:56 PM on January 31, 2021


Right. If there was no mask solution which protected the wearer every health care professional who works in a hospital with covid patients would have been infected very quickly. N95 masks protect the wearer extremely well when worn properly. And no, they don't suddenly become useless if you don't have them professionally fit tested. We're not talking about walking into a level 4 biosafety lab working on SuperEbola where even a 1% loss in efficacy could easily be a death sentence, we're talking about going to a grocery store.

And a multi-layer tight weave cloth mask will provide some protection. How much is still not definitively known but it does seem to be enough to be worthwhile.
posted by Justinian at 6:57 PM on January 31, 2021


N95 masks protect the wearer extremely well when worn properly

... so how many non-medical people have you observed wearing ANY mask properly? or at all? I'm not denying that PERHAPS earlier widespread mask use would have helped, but the extent of aersol transmission was not immediately appreciated, and it's my impression, almost a year down the road, that mask use would have been no substitute for isolation and social distancing.

Anyway, masks are just about mandatory now in most places. Compliance is the remaining issue.
posted by Artful Codger at 7:25 PM on January 31, 2021




One thing the pandemic will provide is a generation of Ph.D. theses for students of the social sciences and historians of science, just on mask wearing recommendations alone. You can get another generation's worth out of the public response.

Those in public health and the life sciences can spend that time figuring out exactly how and how well masks actually worked in the field, because it's really hard to sort out exactly.
posted by mark k at 9:08 PM on January 31, 2021


... so how many non-medical people have you observed wearing ANY mask properly? or at all?

Here in Los Angeles? Virtually universal mask wearing. Mostly properly, which is a bit of a change from early in the pandemic. You still get people whose masks are too loose and keep having to fix dicknose.
posted by Justinian at 9:01 AM on February 1, 2021


Fauci and Birx are both saints compared to Scott Atlas. Why are there not more articles detailing what a piece of shit Atlas is? Yet Atlas is still gainfully employed sucking away at right wing welfare. Despite being an accessory to the murder of easily 250000+ avoidable deaths the man still can practice medicine.
posted by benzenedream at 11:39 PM on February 1, 2021 [2 favorites]


Terry Gross interviewed Fauci on Fresh Air Feb. 4.
posted by theora55 at 9:10 AM on February 5, 2021


« Older Cloris Leachman, 1926-2021   |   “‘I know that one,’ said Vimes. ‘Who watches the... Newer »


This thread has been archived and is closed to new comments