This thread is worth reading in its entirety. The basic message is what I have claimed for 18 months: "We still don't know what is going on with Covid-19." All the confident proclamations have turned to dust. All the forecasts? Dust in the wind. I have been astonished that there is not much commentary on the fact that the vaccines were supposed to confer reasonable immunity and stop the spread and yet now turn out to have an effective life of only 8 months. 8 month is not the problem. The fact that we did not know that it would only be good for 8 months is the problem.
Wanted to say a few things about this story trying to suss out the knowns and the unknowns at this weird, tough point in the pandemic: https://t.co/0eYiTFn9M6
— Alexis C. Madrigal (@alexismadrigal) August 15, 2021
Click through to see the full thread.
Some of Madrigal's points
Very high levels of vaccination (70-90%) alone will probably not protect communities from having outbreaks.
It's very very likely that (some) vaccinated people with breakthrough infection are transmitting the virus, even asymptomatic people.
The different vaccines' effectiveness against any kind of infection is not fully known.
We can't do tracking at this late date in the pandemic.
The federal government is still not following through on its promises to improve the data available to the public.
The CDC decision not to track breakthrough infections is inexplicable.
CDC communication has been strikingly bad.
No one has been held accountable for bad forecasts and bad public health decisions?
Johns Hopkins epidemiologist in Montgomery Co. Maryland, *not* ‘an area of high transmission’ attended a 15-person gathering where all were vaccinated and eleven contracted Covid-19.
Vaccination is necessary but not sufficient for containing the virus.
CDC has been dramatically inconsistent between its recommendations, its own research, and the replicated research of others.
Delays due to poor coordination between the CDC and FDA have caused many deaths.
CDC seems to have suffered regulatory capture by the pharmaceutical industry.
Madrigal is a man of the Mandarin Class statist left. This list of criticisms, though, would be substantially or completely agreed to by most on the right. There is a common basis of shared criticism to begin reforming the CDC and FDA so that we are not caught so flatfooted by a future infectious disease.
But there are some pretty critical differences remaining.
Mystifyingly, Madrigal remains fully committed to the effectiveness of masks in reducing transmission despite the worldwide studies indicating that cloth masks are not effective. If you are still considering wearing masks as an appropriate response, it would seem you are not following the data. Japan was hailed at the beginning of the pandemic for its cultural disposition towards mask wearing and that was identified as a reason why they had so few Covid-19 cases. As with so many places, it really had nothing to do with masks or lockdowns. The waves eventually came. The Japanese have remained highly adherent to mask wearing and yet the Covid waves continue.
Similarly, there is no mention by Madrigal about the importance of assembling the full range of Covid-19 treatments. It appears all his eggs are in the vaccination basket even as vaccination seems increasingly unlikely to be effective as a strategy owing to citizen choices (lost trust in CDC and vaccinations), limited life of the vaccines, and the possibly accelerating variant cycle. We have a plethora of treatments now but there has been little CDC effort to collate and share the successes of these treatments which do reduce deaths.
There is also an almost studied incapacity to see that the serial failures of the CDC has been a major driver in vaccine hesitancy. It is not improbable that the final public accommodation of Covid will be controlled natural immunity acquisition rather than mass vaccination. In other words, those seeking to avoid the risks associated with novel vaccines which are proving to perform differently than anticipated will have made the better choice. The people who the Mandarin Class are currently condemning in strident, vitriolic and authoritarian fashion (vaccine passports, denial of treatment to the unvaccinated, increase in taxes on the unvaccinated, etc.) seem likely to eventually be judged as the ones to have made the best risk:reward balanced decision.
CDC has one primary mission which is to protect the nation from infectious diseases and has been unable to fulfill that role. A specific failing has been the stunning incapacity to design and execute effective data collection, tracking, analysis, and forecasting capabilities to fulfill that mission.
The CDC Mission is:
The agency's main goal is the protection of public health and safety through the control and prevention of disease, injury, and disability in the US and worldwide.
The control and prevention of infectious diseases is predicated on good data collection, tracking, analysis and forecasting capabilities. That is the core of the job and they were completely without capability and capacity. They were not structured or managed to perform their most critical mission on a prospective basis.
Madrigal appears hostage to the error of looking at cases of infection (a function of testing) rather than deaths. Delta variant is more infectious and driving higher cases but it appears to have been decidedly less lethal with lower mortality. Infections are important for anticipating hospital capacity needs but the ultimate measure of success is reduction in deaths. Delta lends itself to panic based on cases but has been good news in terms of reduced deaths. The focus on cases misses this critical development.
This is especially egregious because it is a general pattern of new infections that they generally become more infectious (more cases) but less lethal (fewer deaths) over time. This is a good trend.
There is no discussion or reference at all to the gold standard of response to novel diseases - excess deaths as the measure of overall pandemic impact. As we have come to see, some/many deaths are not due to Covid-19 itself but to our response to Covid-19. The exact numbers are still unreported but it seems clear from our and other nations's experiences that severe lockdowns are not only economically destructive but also are leading to excess drug overdose deaths, lost lives due to postponed surgeries, mental health impacts and possibly suicides. Excess deaths by cause capture those nuances.
A further undiscussed issue which remains a mystery is that no one foresaw the asynchronous waves of infection resulting in adjacent areas having distinctly different temporal distributions and number of waves. Seasonality is clearly a factor in some areas but for not obvious reasons, less or not at all in others.
Finally, absent a demonstrated percipience about infectious diseases and how to respond effectively to Covid-19, CDC has resorted to threats, arguments from authority (argumentum ab auctoritate), ad hominem attacks,
Argumentum ab auctoritate does not work when the crux of the issue is that you are now widely seen as no longer having demonstrated expertise or authority.
CDC, needing voluntary compliance, is doing everything to undermine the public confidence in them as an institution and decrease compliance based on that reduced trust. Coercion merely exacerbates the problem but that is their go to solution to their own ineffectiveness. This is not a recipe for success. Radical reform and restructuring needs to occur. And given that personnel are policy, we need accountability and better personnel than we have right now.
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