The CDC continues to lead from behind
By Ross Douthat
While we wait to learn more about how Donald Trump was using blueprints for the doomsday machine from “Dr. Strangelove” to impress his guests at Mar-a-Lago, let’s check in on America’s public health authorities. They were set free, 19 months ago, from Trump’s science-denying reign of error; presumably since then the rule of reason and competence has been restored.
Sorry, I’m indulging in a little sarcasm. America’s response to COVID-19 went badly not just for Trump-related reasons, but because of problems inherent to our public health edifice, from bureaucratic sclerosis to the ideological capture of putatively neutral institutions. All those problems have extended themselves across the Biden presidency, so that its Trust-the-Science restoration has only deepened a crisis of authority.
I want to offer two examples. The first one is, at this point, relatively banal: the absurdity of the Centers for Disease Control and Prevention’s at-long-last updated COVID-19 guidelines.
In an ideal view of how expertise informs society, CDC guidelines would track the evolving nature of the pandemic closely and provide a road map back to normalcy.
In reality, the CDC has been consistently behind — behind evolving scientific knowledge, behind the curve of COVID’S evolution, behind how most Americans have already adapted. As my New York Times colleague Emily Anthes put it, gently, the new guidelines “effectively acknowledge the way many Americans have been navigating the pandemic for some time.”
Except, of course, in those institutions that still dutifully try to respect public health authority — like, say, the public schools that have been stuck trying to implement early-pandemic recommendations like the “6-feet rule,” or the “3 feet in masks in classrooms and 6 feet everywhere else” alternative, which the new guidelines finally jettisoned. The arbitrariness of those distances was widely understood even before the contagiousness of the delta variant made the rules still more absurd. Yet it’s taken a year, at least, for official science to finally catch up with the real thing.
That lag is, at this point, more familiar than maddening. But it’s genuinely infuriating to see COVIDian patterns replaying with a completely different disease — the broadly non-fatal but still-pretty-terrible monkeypox epidemic, which the Biden administration just officially declared a public health emergency.
If COVID-19 probably would have overwhelmed even the most effective public-health bureaucracy, monkeypox — which as of now is mostly spread through close human contact, especially sexual contact, and for which we already have a vaccine — offered a chance to replay the COVID outbreak at a milder degree of difficulty. Yet the same kinds of bureaucratic failure were repeated — too little testing early on, too little interagency coordination, too little preparation for what should have been predictable challenges.
And then along with these failures came an absurd ideological spectacle, in which health officials agonized about how to state the obvious — that monkeypox at present is primarily a threat to men who have sex with men — and whether to do anything to publicly discourage certain Dionysian festivities associated with Pride Month. As the suffer-no-fools writer Josh Barro has exhaustively chronicled, public-health communication around monkeypox has been an orgy of euphemism and wokespeak, misleading and baffling if you don’t understand what isn’t being said.
This, too, has repeated COVIDian failures. The political anxiety about saying or doing anything that might appear to stigmatize homosexuality mirrors the great public-health abdication to the George Floyd protests — in which a great many members of an expert community that had championed closures and lockdowns decided to torch their credibility by endorsing mass protests because the cause seemed too progressive to critique.
In each case what has been thrown over is neutrality — the idea that public health treats risky behaviors equally, regardless of what form of expression they represent. In June 2020 and again in June 2022, the message from important parts of public health officialdom has been that the rules bind only some groups — Orthodox Jews holding funerals, say, or parents hoping to find an open playground — while leaving others liberated if their political cause is just or the risk of stigma seems too high.
There’s a whole discussion about how when institutions of expertise politicize themselves this way, it feeds into populism and helps the alleged nuclear warlord down in Mar-a-Lago. But having a public-health community that appears both incompetent and biased is also simply bad in and of itself.
It’s bad news for what remains of this pandemic: The collapse of the coronavirus vaccination effort, for instance, has spread well beyond Trump country, with many parents especially inclined to regard all public health edicts with suspicion.
And it’s worse news for the next crisis. Because speaking for myself — as a citizen with a personal interest in medical controversy — when I read the kind of blathering, newspeak-infused monkeypox advisories that Barro highlights, all I can think is: I can never trust anything these people say again.