From the federal mask recommendations suspended in May to White House COVID coordinator Jeffrey Zients’s December pronouncement that the unvaccinated are to blame for “the hospitals you may soon overwhelm,” the Biden administration has organized its COVID response around an ethos of personal responsibility.
COVID is spun as a pandemic of the unvaccinated even as the vaccinated can also spread the virus. Vaccines and their boosters, importantly protecting the vaccinated from hospitalization and death, appear nothing of the public health silver bullet they’ve been positioned to be, presently offering only 10 weeks’ protection against symptomatic infection with the now circulating Omicron variant.
Such a campaign against the unvaccinated represents both bad politics and bad public health.
Many of the unvaccinated aren’t ideologically motivated. Skepticism and hesitancy mark as much a failure of vaccine access, including the absence of a national door-to-door campaign to convince the 84 million Americans walking around without a single COVID shot to get vaccinated or to physically transport them to an appointment. Winning their trust is critical in controlling the outbreak stateside.
Other patients may refrain from vaccination even when it puts them in great personal danger. Jesse Rouse, photographed here in November suffering his second bout of COVID in Minneapolis, was reported to be unvaccinated at the time after he previously underwent a double lung transplant. Researchers have proposed that lung transplantees are especially vulnerable to respiratory infection and should be vaccinated for COVID.
Some people may refrain from vaccination for medical reasons – including confusion or conflicting information about how vaccination might interact with their health conditions or treatments.
Regardless of why particular people remain unvaccinated, thrusting culpability fully onto individuals is a harmful move. Like Ronald Reagan’s campaign against “welfare queens,” presuming public health problems emerge primarily from bad actors and individual decision-making obfuscates the systemic and structural roots of the failure of the U.S.’s response to the pandemic.
Much like Trump, the Biden administration appears repeatedly intent on turning the COVID page, no matter the state of the pandemic itself. The May mask recommendations, which stated that vaccinated people could stop wearing masks in most indoor spaces, were textbook on that account. The administration later ignored an October report from public health experts recommending free testing at a pace of 732 million tests per month in preparation for a holiday COVID surge:
The plan, in effect, was a blueprint for how to avoid what is happening at this very moment — endless lines of desperate Americans clamoring for tests in order to safeguard holiday gatherings, just as COVID-19 is exploding again.
Yesterday, President Biden told David Muir of ABC News, “I wish I had thought about ordering” 500 million at-home tests “two months ago.” But the proposal shared at the meeting in October, disclosed here for the first time, included a “Bold Plan for Impact” and a provision for “Every American Household to Receive Free Rapid Tests for the Holidays/New Year.”
Early in December, Biden spokesperson Jen Psaki scoffed at reporter Mara Liasson’s query about why the U.S. doesn’t just pay for home COVID tests for every American household like other countries do instead of making Americans submit for reimbursement from insurance companies that have routinely failed to pick up the bill. “How much is that going to cost?” Psaki asked.
I am a dual citizen of the United States and Britain, now living in Edinburgh, Scotland, and I am able get rapid antigen tests anytime I want to, at no cost and with no hoops to jump through. I know that Americans pay more than $20 for a package of two tests — if they’re in stock. Here you can walk into your local pharmacy, and they will just hand you packs of seven tests at no charge. In my neighborhood I can also go to the local recreational center and collect packs of tests free for my family, or swing by a coronavirus testing center.
It turns out the reimbursement for home tests wasn’t to start until mid-January anyway:
The administration has already said that the plan will not provide retroactive reimbursement for tests that have already been purchased, which means that any tests you buy for the holidays will not be covered.
The Biden no-plan, expanded to a whole four rapid tests per household and three masks for each American, appeared to be phase one of a campaign of further eroding American expectations. As self-described “shitposter” @fingerblaster tweeted about what’s missing:
Wild that the most unhinged republican president in history sent us $2000 checks back when we had like 12k cases a day and now we have 300k cases a day and a dem president who’s like “lol not my problem go to work jack”
The more august New York Times reported on the end of monthly child benefits millions of Americans were depending on:
The end of the extra assistance for parents is the latest in a long line of benefits “cliffs” that Americans have encountered as pandemic aid programs have expired. The Paycheck Protection Program, which supported hundreds of thousands of small businesses, ended in March. Expanded unemployment benefits ended in September, and earlier in some states. The federal eviction moratorium expired last summer. The last round of stimulus payments landed in Americans’ bank accounts last spring.
These benefit programs, as modest as they were, saved thousands of Americans from COVID deaths.
A March 2021 FamiliesUSA report summarized research showing a third of COVID deaths were tied to the lack of health insurance. The effect was multiplicative: “Each 10% increase in the proportion of a county’s residents who lacked health insurance was associated with a 70% increase in COVID-19 cases and a 48% increase in COVID-19 deaths.”
Controlling for stay-at-home orders, school closures and mask mandates, another study, first posted November 2020, estimated that lifting eviction moratoriums state-to-state resulted in between 365,200 and 502,200 excess coronavirus cases and between 8,900 and 12,500 excess deaths.
Omicron’s Delta Strain
So, public health clearly extends beyond necessary prophylaxes into necessary social interventions. But if there was any doubt about which constituency the political class serves instead, in December, the Centers for Disease Control and Prevention (CDC) cut down its recommendation for quarantine upon COVID exposure from 10 days to five. The act was decidedly in response to pressure from employers, notoriously Delta Air Lines’ CEO Ed Bastian in a letter that Delta proudly posted.
The Delta letter summarized the scientific literature in favor of its request in two sentences. The science is in reality more nuanced, marked by a variety of definitional complications.
Omicron, like new variants before it, is almost certain to evolve out from underneath the vaccine effectiveness that Delta Airlines cites as, full-stop, protection enough. Permitting COVID variants to circulate on Delta planes or elsewhere increases the chances they can evolve enough to circumvent medical and non-pharmaceutical controls.
Other drawbacks refute such summary boosterism. Omicron is already associated with increased reinfection. The variant’s other impacts on clinical courses and epidemiology are likely to be geographically specific, depending on a variety of local factors, including pre-existing immunity and the state of non-pharmaceutical interventions. What works as an intervention under one set of conditions does not necessarily hold under all.
More meta, the speed at which new variants are being allowed to evolve is outpacing even the frantic pace of the research conducted. “Flattening the curve” extends beyond our hospitals to research efforts aimed at discovering how to better control COVID.
In other words, under a more infectious Omicron, a variety of interventions, one layered atop another, is necessary, rather than stripping them back to serve criteria pretending to be scientific.
This isn’t the first time the airline industry tried to bend basic COVID science to its financial advantage. JetBlue CEO and reopen proponent David Neeleman funded and helped coordinate a Stanford University study that whistleblower complaints showed used a testing kit that erred on the side of false positives. By these tests, the study concluded the COVID virus was more widespread in the public and therefore, given the underlying number of deaths in the study population, was less dangerous of a pathogen.
National Institute of Allergy and Infectious Diseases Director Anthony Fauci, proving Lysenko on the Potomac, ran interference for Delta and other employers in the face of the twists and turns obvious in the COVID literature. Fauci parroted Bastian’s arguments nearly to the letter:
There is the danger that there will be so many people who are being isolated who are asymptomatic for the full ten days, that you could have a major negative impact on our ability to keep society running. So the decision was made of saying let’s get that cut in half.
CDC Director Rochelle Walensky once fought back tears over the likelihood of COVID mass deaths. Now, like a meat plant manager thinking only of the bottom line, she defends sending people back to work still infectious:
There are a lot of studies [from other variants] that show the maximum transmissibility is in those first five days. And [with Omicron] we are about to face hundreds of thousands more cases a day, and it was becoming very, very clear from the health care system that we would have people who were [positive but] asymptomatic and not able to work, and that was a harbinger of what was going to come in all other essential functions of society.
In short, the combination of economic compulsion and traumatic bonding that sent millions of workers into unprotected workplaces the pandemic’s first two years now represents state policy. The denialism for which liberals punch down on Trumpists is the labor law of the land. It is now a key part of the administration’s public health campaign.
“I’m not letting COVID-19 take my shifts,” one recent CDC ad declared. “My job puts me at high risk for COVID-19 exposure. I got vaccinated because it’s better to be protected than to be out sick.”
Another CDC post shamelessly used the U.S.’s privatized health care system as a cudgel of class discipline: “Hospital stays can be expensive, but COVID-19 vaccines are free. Help protect yourself from being hospitalized with #COVID19 by getting vaccinated.”
In that spirit, Biden economic advisor Jared Bernstein waxed optimistic on the economy. The depletion of personal savings would drive low-paid workers back into the labor market during a pandemic, Bernstein cheered.
“We are intent,” Jeff Zients declared mid-December, “on not letting Omicron disrupt work and school for the vaccinated. You’ve done the right thing, and we will get through this.” The vaccinated are presented as pure enough of soul to get back to working the gears of the economic machine. The unvaccinated are cast, to appropriate Hillary Clinton’s characterization, as a basket of eschatological deplorables.
Zients, a Biden campaign donor, was the CEO of investment firm Cranemere and director of Obama’s National Economic Council before becoming COVID czar with no public health experience. His primary portfolio of priorities was always apparent.
The quarantine switcheroo follows CDC’s changing recommendations for school distancing from six feet to three, which it now pretends is the virus’s limit. In reality, even six feet isn’t enough for the airborne virus. But in changing it to three, CDC could legally accommodate efforts to stuff students back in brick-and-mortar schools without changing day-to-day public health precautions.
Keeping kids out of school can have terrible impacts on learning outcomes and emotional well-being. Keeping kids in school, potentially leading to the deaths of other students or teachers in school, and older adults back home, can incur a different kind of emotional damage. Both risks serve as more the reason for bringing the outbreak under control with a full-spectrum intervention.
The CDC’s position, sending students back to school without controlling the outbreak, is geared toward other aims. It’s about putting the economic cart before the epidemiological horse. The kids need to go to school so that the parents can go to work.
Such misguided campaigns extend beyond the administration. Among the American Heart Association’s new interim pandemic recommendations for medical staff is starting CPR without personal protective equipment.
Artist Rob Sheridan designed a series of counter-CDC posters:
- We Can Do It! We Can Sacrifice Grandma So Dave & Buster’s Can Stay in Business!
- Quiet! Don’t Cough! Pretend to be OK! Your Boss’s 8th Boat Depends on It!
- America’s Youth is Ready to March Back to School! The Economy Demands Sacrifice!
Across the internet — over the political spectrum — other observers expressed outrage in scathing terms:
- Comedian Zak Toscani: CDC recommends splitting up your quarantine over your two 15 min breaks.
- Sociologist Jennifer Jennings: I guess I missed that rewrite of the Hippocratic Oath: first, do no harm to late capitalism.
- Comedian Roy Wood Jr: CDC just said you only need to quarantine if you on a ventilator. But if ya ventilator got wheels and a battery pack you gotta take yo ass to work.
- Songwriter Certified Lover Girl: Y’all keep talking about the CDC, the CDC, the CDC….The CDC left you fa dead hoe.
- Author Alexander Chee: If you have to deploy the military to support hospitals you may have spent your budget on the wrong part of the system given the challenges we actually face.
- Designer Char: CDC okays pull-out method as “eh, good enough.”
The administration is too full of itself to see it is losing the country. Its caustic claims about “the science” aren’t supported by the science, further undercutting research as a trusted source of both state strategy and public response.
The original 10-day quarantine that the CDC changed was grounded in the evidence-based realities of the virus itself, specifically its incubation time, generation time and serial interval. At the same time, the 10 days aren’t a matter of essentialist measures of central tendency.
Against CDC Director Walensky’s characterization, it’s about the variation in patients’ infectious periods. Some patients exit out of their infectiousness early, in the five days Walensky cited. Others can be infectious much longer. No one knows who’s a late bloomer in transmission. As a matter of practical public health intervention, it’s an unknown.
A public health campaign must therefore institute mask and quarantine policies that cover for the late transmissions, so that they don’t serve as the means by which the outbreak rolls on — particularly as Omicron’s infectiousness approaches that of measles and a 100% attack rate can still result from even a small group of infectious people walking around.
Instead, we have slashed public assistance, shortened quarantines, offered no-to-little remote schooling, hired few community health workers, conducted little genomic sequencing of the virus, and let hospitals get overrun. The CDC gave in upon the subsequent furor around the shortened quarantine by adding only a recommendation — not a requirement — of a negative rapid antigen test before workers returned to work.
Beyond trying to circumvent the rancor of partisan criticism, why did Trump and Biden alike aim at pretending the pandemic away? Biden’s trajectory is illustrative that capitalist realism has a way of eating away at even good faith efforts at addressing existential threats.
In October 2020, candidate Biden put the failings of his opposition in perspective: “We’re eight months into this pandemic, and Donald Trump still doesn’t have a plan to get this virus under control. I do.”
“This crisis,” President-elect Biden added, “demands a robust and immediate federal response.”
A year later, President Biden pivoted: “There is no federal solution. This gets solved at a state level,” months after many state governors had lost or abandoned their emergency powers to impose mask mandates and shelter-at-home orders.
Other countries see federal jurisdiction differently, as if the very health of their ostensible constituencies has something to do with governance.
- New Zealand – 51
- China – 191
- Taiwan – 20
- Japan – 477
- Hong Kong – 18
China’s reactions are both broader and triggered more quickly, with the public health results to show for it. Xi’an, a metropolis of 13 million people in Shaanxi Province, underwent an arguably arduous lockdown upon the emergence of 175 COVID cases. Western media has played on the difficulties in obtaining food in the city over the 12 days’ quarantine, but not the campaigns to alleviate those problems.
Some may argue the Biden administration’s reaction is better late than never, but that’s not how controlling COVID’s lightning strikes works.
As epidemiologist Rodrick Wallace models, whatever the intervention, there’s nothing worse than dithering. Given the insidious nature of the virus, we are routinely six weeks too late if spikes in cases, rather than anticipatory planning, are the trigger. Repeated delays mark U.S. COVID planning — among them, the spread of the original wave out of coastal cities to the rest of the country in spring 2020 and the arrivals since of Delta and Omicron stateside.
Rapid Confusion Test
It happens that the mass at-home testing the Biden administration passed over in October, setting up a program several months too late, is itself already a failure. Big picture, like vaccination, it represents yet another technicist intervention that, while necessary, is also insufficient. It’s more of a grand gesture that detracts from the administration’s refusal to pursue multilevel systemic public health programming.
The specifics of such a rollout and the tests themselves also get in the way. It’s much more than a matter of rapid tests permitting an exit out of the shots for the deplorable unvaccinated, as the Biden administration feared. It’s also not merely a matter of doctors defending their testing territory, as rapid test proponents argued.
One important note is that at-home antigen tests will give VERY poor results (both high false-positives and high false-negatives) if you are sloppy or misuse them.
These are complex molecular assays and the EXACT usage is critical. You MUST read and follow every single detail in the instructions to get a reliable outcome….
The difficulties extend beyond administering the tests. Interpreting them is a difficult task; it is swayed by our hopes as well as by technical matter:
Now comes the tricky part… what happens if you get conflicting test results.
Let’s say you get a positive result on an at-home antigen test (like the BinaxNow) and decide to take it again “just to be sure”.
Then you get a negative result on the 2nd Binax test. Now you schedule an appointment to get a PCR test.
A couple of days later, it comes back negative.
ARE YOU INFECTED? Absolutely positively YES!
If you’re non-symptomatic and get a [Binax+ Binax- PCR-] set of results … a positive and two negatives in any order.
In that case, it is 56-times MORE likely that you’re infected than not infected … 5600% more likely!
And if you’re FULLY symptomatic and get a [Binax+ Binax- PCR-] set of results, it is 20-times MORE likely that you’re infected than not infected … 2000% more likely!
Even if you get ANOTHER PCR test and THAT test comes back negative as well [Binax+ Binax- PCR- PCR-] you are still 4-times more likely to be infected than not … 400% more likely!
And it does NOT matter the order of the test results … the math holds true regardless.
Even medical doctors conducting these tests in clinics stumble:
I know this seems VERY counter-intuitive and even most doctors who prescribe these tests (other than Infectious Disease specialists) tend to NOT understand this!
And when faced with multiple conflicting test results, most medical people will incorrectly select the LAST result as the “correct one”.
This is a DANGEROUS mistake! Again, outside of certain specialties, few medical staff are trained to think in terms of Bayesian statistics.
Vanity Fair’s palace intrigue set the COVID Collaborative of high-end epidemiologists recommending the holiday testing surge against the administration that ignored them. But that isn’t quite right. Both sides agree on turning public health into an individualistic (and commodifiable) option:
Once [ex-Harvard epidemiologist and now chief science officer at the eMed diagnostic company Michael] Mina began to advocate for rapid home tests, he encountered the same mindset: doctors “trying to guard their domain.” Some doctors had long opposed home testing, even for pregnancy and HIV, arguing that patients who learned on their own about a given condition would not be able to act on the information effectively. Testing, in this view, should be used only by doctors as a diagnostic instrument, not by individuals as a public-health tool for influencing decisions.
The U.S. approach sticks the American people with the job of administering and then interpreting the conflicting results of multiple tests. The false positives might be low in part because nearly 100 percent specificity aligns with peak viral load. But, as Harrison describes, even should the test be administered correctly, the false negatives are legion and the results of one test do not necessarily change the implications of previous ones.
Techno-utopianism offers another iteration of blaming the victim if the outcome goes south: “It’s your own fault you didn’t do the test right.” Don’t let the easy lines on the lateral flow ag card confuse matters. Against Mina’s insinuation, it’s decidedly unlike a pregnancy test.
There is also the matter of what happens when organizing society’s access to work and recreation around such tests collides with a run on the tests at local stores already suffering supply chain problems, making the tests both unavailable and priced beyond working people’s budgets.
If, on the other hand, the Biden administration hired and trained a million community health workers to go door-to-door across the country administering these tests for free — like really free — we wouldn’t be in such a free-for-all, if you’ll excuse the phrasing.
If such teams had been put in place from the beginning, they may have been able to build the trust necessary to successfully introduce a variety of time- and place-specific public health interventions that would likely have minimized the duration and impact of each wave of the pandemic.
Surprising the Supposedly Surprised
What’s interesting about Harrison’s direct and clearly written posts is that his recommendations are framed by the context of what the U.S. can, or is willing to, offer right now: not much.
Yes, everyone should be able to test themselves whenever they wish, all the time. But the U.S. chooses to position itself as unable to pursue such a public health program. Should the sensitivity and specificity reported on the test boxes match their actual outcomes? Yes, they should, however righteous the original testing went into bringing the products to market. Should the efficaciousness and effectiveness of vaccines match? Yes, that would be nice.
There are expectations that individual American consumers hold about solutions — cheap and immediately effective — that the market repeatedly promises but can’t deliver. In this case, the multifactorial virus doesn’t cater to such an ideal of a single packet solution. And the public health response we need, and the market treats as a rival, is starved to near-death.
The U.S. government, and governments around the world, treat the capitalism that helped spring the COVID virus out of commoditized forests as more real than the ecologies and epidemiologies upon which the global system depends. To protect that mirage of a difference, each new variant that has since emerged is strangely presented as the beginning of the pandemic’s end, resetting the next round of denialism, instead of alerting us that in reality, without a change in public health practice, we’re caught in a daisy chain of viral evolution.
Each “surprise” that the COVID virus refuses to cooperate with such an expectation, acting in its own interests instead of ours, also serves to protect the system from the implications of its refusal to act. Surprise — pretending we don’t know what we know — is itself an ideological project. The business of governing a system in decline, after all, is about managing expectations. All is well, get back to work, until, suddenly, it isn’t, as it always was.
From the virus’s vantage, the resulting public health dithering and half-measures serve the virus as both escape hatch out of our control efforts and selection pressure to evolve around those campaigns. A combo that leads to the worst of epidemiological outcomes.
If we wish to unplug out of this trap, we have to organize together against our rulers and their financers. We must deploy a full-spectrum intervention that drives the COVID virus under its rate of replacement.
That requires we reject not only Washington’s business bipartisanism, but also the core model of our economy around which our civilization is organized. That’s no small matter, of course, but with climate change and other pandemics also in the wings, likely our sole option out.