Authoritarian public health as a consequence of human action, but not the execution of any human design

I am slowly making my way through the stacks of books in my office in a relatively vain attempt to bring some order to the chaos of my books.  In doing so, I come across In the Wake of the Plague: the Black Death and the World It Made by Norman F. Cantor, published in 2001.  

Obviously pre-pandemic but boy, does it start off with prescience unexpected in a book about history.

In the sixth month of the new millennium and new century, the American Medical Association held a conference on infectious diseases. Pronouncements by scientists and heads of medical organizations at the conference were scary in tone. Infectious disease was the leading cause of death worldwide and the third leading cause in the U.S.A., it was stressed. The situation could soon become much worse.

As the world becomes more of a global village, said one expert, infectious disease could by natural transmission become more threatening in the United States. Here monitoring is lax because of a mistaken belief that the threat of infectious disease has been almost wiped out by antibiotics.

Bioterrorism presented a further and much greater possibility of terrible outbreaks of pandemic in the United States. The New York Times reported: “A speaker at the meeting warned that the healthcare system in the United States was not prepared for a bioterrorist attack, in which hundreds or thousands of people might flood hospitals, needing treatment for diseases: anthrax, plague, or smallpox, which most hospitals, needing treatment for diseases: anthrax, plague, or smallpox, which most doctors in this country have never seen.”

 

In 2001, Cantor was making the case for what happened nearly twenty years later.  The CDC, FDA, and public health infrastructure in the US was unprepared for an infectious disease.  And that unpreparedness had been identified and discussed continuously for the prior twenty years.  

That's not quite correct.  We actually were prepared in the sense that we had prepared in advance distillations of all that we could learn from history, science and experience.  Drafts and proposals for response plans had been prepared and circulated broadly, both nationally and internationally, for comment over a number of years and were finalized and in place when Covid-19 struck.

Those plans were researched, reviewed and in place and our public health governance chose to ignore the entire game plan.  Travel restrictions, track and trace for highly infectious and fast evolving viruses, lock downs, school closures, mask wearing, social distancing, vaccine mandates, etc. were all researched and rejected in the plans that had been developed.  Those tactics either did not work at all, worked only at too high a cost, or worked under only very limited circumstances.  None were deemed effective for a highly infectious low mortality novel zoonotic virus such as Covid-19.

We were prepared and knew what to do (and what not to do) and yet the CDC and the FDA and the constellation of public health agencies, for reasons still not clear, chose to ignore the prepared plans, went off script, implemented strategies and tactics which had failed in the past and which failed once again.  

And this time, it was all done in a fashion which crushed rule of law, transgressed the rules of science, crushed the economy, and which trashed the reputation of public health professionals.  Countries which did not implement these rejected and failed strategies have empirically ended up with lower all causes mortalities.  The public health failure has been comprehensive.

Why did it happen that way when we knew not to do what was done?

We don't know yet and won't know for a long time.  All the public health institutions which submitted to the seat of the pants approach now regret their actions.  They are working hard to disavow their participation or are claiming that they did not do what they clearly did do.  In a world that is completely digital and captured, it is a strikingly naive belief that mere denial could cause people to forget.

Especially when there are those dedicated to truth and or seeking vengeance for the professional harm that was done to them by the Covidians.  Recently, it emerged that Pfizer had never tested their vaccine for its effectiveness in preventing transmission, despite they, and all their public health allies claiming at the time that getting the vaccine injection would prevent transmission.  

Anyone who said otherwise was condemned, deplatformed, professionally threatened, etc.  Now that it is clear that the claim was never true and had no data to support it, Pfizer, CDC, FDA, Fauci, et al are all claiming that they had not stated that taking the vaccine would prevent transmission.  And all those victims of their authoritarian wrath are now compiling the documentation that puts the lie to the claim that they never said it would stop transmission.  Especially effective, are the 2-3 minute video compilations in which every public health leader is shown on video claiming multiple times over three years that all you needed to do was get vaccinated to stop transmission.

The whole herd immunity discussion over 18-24 months was predicated on the assumed effectiveness of the vaccine at stopping transmission.

All lies then and now they are lying about the lies they told then.  Astonishing.

But thinking about Cantor's description caused me to reconsider an old argument.

For the past thirty years, conservatives and libertarians have complained that the CDC in particular has ventured far beyond its remit to contain and control infectious diseases.  Most often their argument centered around their concern about the CDC's obsession with gun control as a mechanism for promoting public health.  The concern of those critics was so grave about the authority overreach that the Republicans eventually passed legislation explicitly restricting the CDC from conducting gun violence and gun control research.

And while much of the attention focused on the CDC's interest in gun control, there were other CDC public health initiatives which had nothing to do with infectious diseases.  Obesity for example.  Suicide was another.

In parallel to claiming that the CDC was overreaching their mission by trying to effect gun control through public health policy, conservatives and libertarians also argued that the CDC was not only overreaching but also was no longer effective at their own and original mission - controlling infectious diseases.

The latter argument is now inescapably proven with the CDC's response to Covid-19.  CDC was established to control infectious diseases and they did everything wrong by willfully going against their own research.

On the periphery of the CDC and gun control debate was a fringe group arguing that the CDC was being used as an instrument of authoritarian control and that guns were a mere wedge.  

At the time, I considered that argument logical but ill-supported.  Yes, repressive regimes always use crises, especially security and public health crises, as a means of increasing centralized authority.  It is just the nature of man and governance.  

But I thought it foolish to assume that there was a conscious strategy on the part of individuals within the CDC to enforce greater central government authority over citizens with a corresponding abridgment of civil and natural rights via gun control as public health.  

I still reject that conspiracy theory.  But I wonder more whether it might have been functionally correct.  In other words, no, it wasn't an actual conspiracy.  But yes, the means were still accomplished through emergent, or spontaneous order.  No coordination but the same outcome.  

As Adam Ferguson observed in An Essay on the History of Civil Society published in 1767,

Every step and every movement of the multitude, even in what are termed enlightened ages, are made with equal blindness to the future; and nations stumble upon establishments, which are indeed the result of human action, but not the execution of any human design.

I suspect the evolution of the CDC (and its affiliates) might have been caused by or facilitated by the emergence of network theory and the related idea of social contagion.  

Social contagion involves behaviour, emotions, or conditions spreading spontaneously through a group or network. The phenomenon has been discussed by social scientists since the late 19th century, although much work on the subject was based on unclear or even contradictory conceptions of what social contagion is, so exact definitions vary. Some scholars include the unplanned spread of ideas through a population as social contagion, though others prefer to class that as memetics. Generally social contagion is understood to be separate from the collective behaviour which results from a direct attempt to exert social influence.

Two broad divisions of social contagion are behavioural contagion and emotional contagion. The study of social contagion has intensified in the 21st century. Much recent work involves academics from social psychology, sociology, and network science investigating online social networks. Studies in the 20th century typically focused on negative effects such as violent mob behaviour, whereas those of the 21st century, while sometimes looking at harmful effects, have often focused on relatively neutral contagion such as influence on shopping choices, and even on positive effects like the tendency for people to take action on climate change once a sufficient number of their neighbours do.

Network theory obviously emerged primarily out of the technology and IT revolution of the 1970s but social contagion research is much more recent.  Connected: The Surprising Power of Our Social Networks and How They Shape Our Lives by Nicholas Christakis and James Fowler, published in 2009 is a good example of the argument that social networks and social contagion can drive public health outcomes via a mechanism different from infectious diseases.

If your friend groups are obese, then the probability that you might be obese are much higher.  If there is one suicide in a school, then there is a much higher probability that there will be another within the year.  If your friends are smokers, then the probability that you will be a smoker are much higher.  

These negative health outcomes are not due to biological contagion.  They are due to social contagion.

The argument then becomes the foundation for a different perspective on the mission of the CDC.  Whereas it was once to contain and control negative health outcomes from biological contagions (such as viruses), it is likely that the effort to expand the remit emerged by considering all negative health outcomes to be the product of either of two contagions, social contagions or biological contagions.  

There is a logic to that opinion.  But it is not reflected in the authorizing legislation.  The CDC is reasonably clearly tasked with containing and controlling biological contagion.  The ideas behind social contagion are very recent and still largely ill-understood.  The Wikipedia article notes:

The field of social contagion has been repeatedly criticised for lacking a clear and widely accepted definition, and for sometimes involving work that does not distinguish between contagion and other forms of social influence, like command and compliance, or from homophily. In social network analysis and related network science fields, the contagion metaphor has been described as potentially misleading in various ways. For example, an actual virus can affect someone after a single exposure, whereas typically with social contagion, people need several exposures before adopting the new behaviour or emotion. Some scholars (e.g., Ralph H. Turner) have suggested that certain types of collective behaviour are better understood by emergent norm theory or convergence theory, rather than by social contagion.

It is reasonably obvious that one does not "catch" obesity from one's friends as one might catch Covid from them.  The definitional exactitude is not present to make the distinction with any great clarity.

But that does not undermine the spontaneous order explanation for why the CDC went beyond its remit (while simultaneously neglecting to the point of ineffectiveness its primary responsibility.)

The people interested in biological contagion will significantly overlap with those people interested in social contagion and network theory.  The mechanisms of biological contagion are very analogous to the assumed mechanisms of social contagion.  Why would the CDC not expand its remit to all forms of public health impact and not just those originating from biological infection?

The fact that public health professionals overlap with academia and overlap with government institutions and also overlap with membership in either the Democratic Party and/or progressive movements is an entirely separate set of issues.

Yet the consequence is that it can strongly appear that a government agency already noted for partisanship and left leaning ideologies might also take to the notion of both biological and social contagion and then be seen as an explicit conspiracy where in fact, I suspect, it is primarily spontaneous order.

But however it emerges, the operational consequences are pretty severe.  

If we view something as arising from biological origins, it is reasonably more straightforward to address and effectively treat that condition.  You develop vaccines (when pertinent) and/or treatments for the biologically contagious disease and then make those treatments known and available.  If they are demonstrably effective, take-up will generally be high, though not necessarily universal.

This viewpoint is what informed the established pre-Covid protocols which abjured masks, lock-downs, isolation, vaccine mandates, school closures, etc.  It also, in general, precludes civil rights abuses where freedom of speech, freedom of movement, freedom of religion, freedom of association, freedom of physical autonomy, freedom of privacy, rule of law, and equality before the law are overruled and abrogated.  

But the social contagion mindset is predisposed to do all that.  In order to change social contagion, you must control behaviors, information flows, emotions, etc.  And when you seek to control information, emotions, and behaviors in order to stop the spread of contagion, you necessarily have to override freedom of speech, freedom of movement, freedom of religion, freedom of association, freedom of physical autonomy, freedom of privacy, rule of law, and equality before the law.

Suddenly, the institutional concern about misinformation, disinformation, etc. becomes much more explicable.  If you have a social contagion mindset, of course you need to constrain or prevent free speech.  

Was there an explicit conspiracy to achieve totalitarian authority via public health institutions, particularly the CDC?  I very much doubt it.  

Was an expanded conception of contagion to include social contagion with biological contagion sufficient for public health institutions such as the CDC and FDA to suddenly become authoritarian instruments of oppression?  I suspect quite possibly.  

Perhaps the authoritarian, ineffective and frequently illegal CDC response to Covid-19 was merely the current manifestation of Ferguson's long ago observation that outcomes can be the result of human action, but not the execution of any human design.