Francis Lee (10:19)

Thank you very much.

Susan Ettlinger (10:20)

Thank you, Mike.

Mike Pesca (10:21)

So I'll let you determine which one of you answers, but we'll just start off by laying the predicate. And your claim is that the non pharmaceutical interventions NPIs just flat out didn't work, the lockdowns didn't work, the mask mandate didn't work. I don't know if there are any slight ones that you think were better than not, but can you explain to perhaps a skeptical audience this idea that all that we did and all that we suffered for was for naught?

Francis Lee (10:52)

Do we want to start with the pre COVID pandemic plans and what they said about these measures, or do you want to start with your thing?

Mike Pesca (10:58)

We can, or we could just summarize that by saying they anticipated a huge respiratory infection and in general said nothing will work. That was the state of the, the intellectual examination of this issue before it actually happened. Right.

Francis Lee (11:12)

They said that the evidence in support of the effectiveness or efficacy of each of these measures was poor, that they were of uncertain efficacy. They went through all of them individually, the masking, the school closures, the social distancing measures, border closures, contact tracing and the other measures, everything before the vaccines and aside from drugs. And they were assessed, these measures were assessed in multiple pre COVID pandemic plans. And in every instance the evidence supporting their efficacy was rated weak. And it was also predicted the costs would be certain and considerable. So those are the messages coming out of the pre COVID pandemic planning documents.

Mike Pesca (11:50)

And so why do we say though, that when that theory was put into practice, why do you claim the theory was actually borne out, that it didn't work?

Francis Lee (11:57)

There's no evidence that it worked, let's put it that way. My colleague Frances is the empiricist in the group here and she's looked at the evidence from the 50 states, the CDC data across the 50 states, which varied widely in the length and stringency of the lockdowns. There's very strong partisan effect. Democratic states stayed closed longer than Republican states. And we just don't see a payoff in terms of morbidity or, you know, deaths from COVID in those states that had the longer school closures, the longer lockdowns and the more stringent application of these measures. Overall, we have good information on what the state policies were. We have CDC data on deaths before the vaccines and after the vaccines. And we find that after the vaccines, Republican death rates diverge from the Democratic states. They go up because of vaccine hesitancy. So it's not like we don't have any information about anything.

Mike Pesca (12:57)

Because if you look at the it is true if people are saying wait a minute, I just looked at the stats and red states did have worse death tolls per million hundred thousand than blue states. That is post vaccine and that's a relic of vaccine uptake.

Susan Ettlinger (13:09)

The data are consistent with that interpretation that we see the red states and blue states diverge in their Covid outcomes after vaccines became available, but not before. And you had the better part of a year basically from March until the end of December 2020 before vaccines were available at all, where red states and blue states pursued different policies. And yet at the end of that, there's just not a difference in their outcomes. That was evident in the summer of 2020 when it became clear that the speed with which states had locked down had not had an evident effect. And I was sort of surprised that there was so little of attention to that fact at that point because there were a lot of predictions in the news in the lead up to the issuing of those stay at home orders that every day that stay at governors delayed and in issuing those orders would have a negative effect on the outcomes. And yet at the end of the summer, those predictions that were based on mathematical models, those predictions were just not borne out in the data.

Mike Pesca (14:21)

So it's very important. You used a phrase, you mentioned cost benefit analysis, risk harm analysis. What you're not saying, I mean, you're saying this but you're not saying on net it wasn't worth it. You're going way beyond that and just citing the data and saying there was no effect. There is no discernible empirical effect of having done lockdowns for four months or lockdowns versus two months, of having mask mandates or no mask mandates, of having the schools closed for a lengthy amount of time or having the schools open. No difference.

Susan Ettlinger (14:57)

That's what the data show, that we don't see a difference based on the variation in the types of non pharmaceutical interventions that states implemented. The non pharmaceutical interventions mean all of the different types of physical measures that are used to keep people apart and to try to prevent the spread of disease. That states varied in their use of those policies. And yet at the end of that time Period when the vaccines began to be rolled out. We still, we don't see a difference in outcomes. Now we can't say based on that that we know for certain that these policies don't work. All we can say with confidence is that there's a lack of evidence that they do.

Francis Lee (15:41)

Right.

Mike Pesca (15:42)

So why is it that in other societies, G20 countries, European countries, even Canada, death tolls per whatever your denominator is were lower, much lower. Canada half, about half as much as ours. I shan't touch Sweden that. But Germany, UK didn't do great. But Germany, France, all throughout Europe lower than ours. And they did have interventions, they did have non pharmaceutical interventions. I know their schools were actually open more than ours were. But there seems to be some difference and it's not genetic. It would seem to. And it couldn't have been that the vaccines got there sooner or more quickly. What explains that difference?

Susan Ettlinger (16:25)

Well, a lot of the difference between the US and other advanced democracies happens in the second year, in the year after the vaccines were rolled out. So you have to compare that the first year and the second year separately. So that's something to keep in mind. That second year mattered a lot. Now we cite in the book, but don't discuss at length, another paper that came out in 2024 in the Lancet Regional Health Europe which looks at the use of non pharmaceutical interventions across the 29 countries in Europe. They find no relationship between the stringency of the restrictions that were adopted and Covid outcomes in Europe. They look separately at 2020, 2021 and 2022 and there was wide variation with, you know, Sweden as you mentioned, which never had a lockdown or Switzerland which only had one lockdown and many countries that had three or even more lockdowns and yet there's no relationship there. They do find like we find a relationship between vaccine uptake across European countries and excess mortality, but they don't find a relationship between the use of these, these, these restrictions and, and the outcomes.

Mike Pesca (17:54)

Now I mentioned, you mentioned the risk benefit analysis. There was a dearth of talking about risk. The benefit would be supposedly lives saved and that became not just the North Star, that became the end all be all. Whose, who is responsible? Whose fault? I'll use the word fault. Whose fault was it that we just ignored the risk part of the risk benefit analysis while we were going through it?

Francis Lee (18:19)

Well, I think we can say that many people bear some responsibility for that. I mean one other thing that these pre COVID pandemic plans warned about, aside from the lack of Evidence for the efficacy of these measures and the certainty of the cost was the fact that in a time of crisis, pandemic crisis, political leaders might be tempted to use these measures to show that they were getting tough, to show that they were in charge, to show that they were doing something dramatic or just doing something.

Mike Pesca (18:44)

Which is very important in politics.

Francis Lee (18:46)

Yes, absolutely.

Mike Pesca (18:47)

During the snowstorm, or you will be elected out of office. Every northeast mayor knows.

Francis Lee (18:53)

Right. So this is a snowstorm on steroids. And political leaders felt the need to do something. They also saw other states, Italy institute the first national lockdown and then it spread from there. But those pre COVID pandemic measures acknowledged this and then insisted that public health officials needed to be had the responsibility of informing political leaders and the public of the uncertainty. The evidence for the efficacy of these measures and the certainty really that these measures would be extremely costly. They were pointed out over and over. And so public health officials certainly should have been more vocal about the costs that were bound to follow. Evident. There was plenty of evidence for this in March 2020. We just talked to a colleague up at Harvard who had himself written an article on school. No, it was. That's a good guess, though. It's Paul Peterson, who's editor of Education Next and who wrote an article very early on pointing out that based on our knowledge of snow days previously, but also teacher strikes, that there was good evidence for the big consequences, big negative consequences of school closures for children's learning, but also for parents who had to stay home with them and other kinds of effects.

Mike Pesca (20:12)

Yeah, sorry to interrupt, but there were governors who are arguing, look, we go out for two weeks for spring break and nothing bad happens. But actually, that's wrong and it should be, you know, taken. Taken in stride or taken in conjunction with the entire risk and benefit picture.

Francis Lee (20:30)

Yes. And closing for two weeks wasn't going to do a whole heck of a lot of good given the grounds for suspecting, for knowing that the virus had circulated pretty widely in society at that point. There were skeptics about these measures who pointed out in the middle of March 2020 that, you know, we've got people just following each other off the edge of a cliff here with these school closures and lockdowns because they're not thinking.

Mike Pesca (20:52)

I mean, elected officials falling off a cliff.

Francis Lee (20:54)

No, there was. Yes. Elected officials. Yes. Decision makers falling each other off the head of a cliff. Yes. By engaging in these lockdowns. Because what happens after you close down for two weeks? The virus is still there when you release the clamp the virus will still be there circulating and will break out again. So in the first instance, public health leaders should have been involved. But, you know, governors and other political leaders are responsible for taking account of everything that's related to or part of the public good. When enacting these kinds of measures, they should have taken broader responsibility for thinking about the costs as well as the benefits. I think it was certainly part of governors and local officials who are making decisions should have thought the public good broad.

Mike Pesca (21:37)

Yeah, well, epidemiologists, public health officials, public health experts are not public commerce experts or public economy experts. They will tell you. And Foushee did tell you. Or are they? Or should be. Or should they be? Because there are many. I read a lot of public health papers where they talk about, say, the cumulative effect of a recession. Economists will also opine, but here's the effect of a recession. Here's the effect of lifelong learning, lifelong earning. Here's the effect of, you know, health outcomes if you don't have sufficient income. So that is my question. Were public health officials abandoning part of their remit, or is it more on the elected officials to know that they're never going to tell us that the economy is something to keep an eye on?

Susan Ettlinger (22:24)

Well, public health should be broadly construed as in all the things that affect the health of the public. And we know that there are social determinants of health. Among those are education, employment, the state of the economy, the state of your connectedness or social ties. All of those things affect your health. So broadly understood, public health ought to take all those things into account. But that isn't what happened during the pandemic. And public health officials are quite frank about that, that they were focused on the spread of this one pathogen and its effects on public health. So it was a kind of tunnel vision around Covid. And then the policy advisory groups that were formed to provide information to elected officials were made up of epidemiologists, virologists, public health folks who were focused just on Covid and then generalist government officials. So there were not experts who knew things about education or the effects of the economy, or there were just no broader perspectives being brought to bear. It was this disease and how it might be slowed, and those were the only considerations that were being brought to bear.

Mike Pesca (23:51)

So the analogy is, and you use it in your book, Generals, Generals in a war. In fact, the public health community saw themselves as in a war, much of laptop America, which is one of your delightful phrases about the kind of knowledge workers that made the calls Here they were involved in this war, this analogous war on Covid. But when we think about generals in a real war, when we think about politicians, there is always going to be that kind of general. And it's subsided a bit, you know, post Vietnam. But Curtis LeMay, bombs away LeMay or the General Ripper from Dr. Strangelove, the General who insists, we got to go in there and we got to kill everyone. And the only. The only factor that we use in our determination is defeating the enemy. And what we hope is that our elected officials, the civilian representatives of the public, have and weigh other competing interests. But that did not happen. This is what we were just talking about. That did not happen here. And do you think that there are all these reasons why, and there is a bias towards action, but do you think there was something else going on, something else related to the culture of the kind of people who were making these decisions?

Francis Lee (25:03)

Well, I mean, as you said, epidemiologists are experts on epidemiology and disease. I mean, that's part of it, though. As Francis said, social determinants of health is a central part of public health. And that should have been brought to bear as well. I mean, 2020 was an election year in the United States. I think one other thing that happened was that reopening the economy rhetorically got associated with the Republican Party over the summer of 2020 in particular, and Democrats were less willing, I think, to attend to, you know, concerns being expressed by Republicans and policies being embraced to a greater extent by Republicans because of the deep polarization of our society. So dissent was coded as coming from the other side of the political spectrum. And I think it tended to be discounted for that reason. So the politics of it definitely played a role. President Trump being on the ballot in the fall of 2020 probably played a role in making these divisions especially hard, deep. But on the other hand, once he lost the election, things didn't really change dramatically. There was still an unwillingness to listen and consider the costs on the part of many progressive states. I mean, we do think you're absolutely right about the wartime metaphors. We found that those were quite prevalent in April 2020, after a period in March where there was some dissent by experts in major newspapers like the New York Times and the Washington Post. As we moved into April 2020 and into May, wartime metaphors were used more and more. And the kind of rhetoric that was used was, we need vital unity, that universities, the public health profession, media, journalists and so on, all need to be on the same page. We need to be working with government and we need to be reinforcing the strategy that we have adopted. And the sense was, we think at that point that people became intolerant of dissent, that there needed to be vital unity was a phrase used by a center up at Harvard in its national Covid plan. And dissenters were seen as risking lives by discouraging people from complying with the chosen strategy. And that was unhelpful.

Mike Pesca (27:16)

And as promised, more of this conversation, including questions of President Trump's response and the counteraction to that action. All up after the break. Don't miss your chance to spring into deals at Lowe's Right now get a free 60 volt Toro battery when you purchase a select 60 volt Toro electric mower. Plus buy three 19.3 ounce vegetable and herb Bonnie plants for just $10. It's time to give your yard a grow up Lowe's we help you Save valid through 423. Selection varies by location while supplies last. Discount taken at time of purchase. Actual plant size and selection varies by location. Excludes Alaska and Hawaii.

Francis Lee (28:08)

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Mike Pesca (28:40)

So we're back with the authors of In Covid's Wake, how our Politics Failed Us. And I want to ask about the polarized. That's the phrase they use, the polarized period that we're living in. I would go further than polarized. And this is something that political scientists such as yourself talk about. We are trending towards a low trust society. So to take one example, when Donald Trump tweets in the most incendiary way, not just that he's against school closures, but the lockdowns must end. And free Michigan exclamation. The result is not anyone's mind being open, but militia groups in Michigan ringing the Capitol while armed. I mean, I do not believe. I mean, you guys tell me, but I do not believe you could design a worse response. Or am I overly focused on President Trump?

Susan Ettlinger (29:36)

No, politicians tend to shy away from acknowledging trade offs, you know where. Well, you know this is a hard choice, but on balance, you know, we think, you know, this, this course of action is superior to this other course of action. This, this kind of rhetoric that's difficult to walk people through.

Mike Pesca (29:53)

I think Mike DeWine did it a little. I think Andrew Cuomo, weirdly, he liked to at least explain his thinking. So maybe there are some anti Trump examples.

Susan Ettlinger (30:02)

Well, Cuomo actually said that the only thing that mattered was saving lives, that everything else would take a backseat, whether it's domestic violence, whether it's people losing their jobs, not getting their unemployment, whatever it was, all of that took a back seat to saving a life. And if everything we did, he said saves one life, it will have been worth it.

Mike Pesca (30:26)

So, yeah, he talked about. But what I'm saying is he talked about the sacrifices we had to make. So there is an inherent trade off in that. Trying to convince people or decree to people that you will. You are being asked to make a sacrifice, but this is why the sacrifice is worth it. Anyway, maybe I'm working overboard to try to excuse Andrew.

Susan Ettlinger (30:44)

What I would say is that the, that the initial closures were very popular, and they were popular across party lines. You know, polling in the middle of March 2020 showed that 87% Americans approved of the broad range enclosures that were being implemented. So initially, I think the public was very inclined to accept that on the one hand you had the economy, on the other hand you had lives, and lives mattered more. And so that they could think in those terms. That framing, I think, carried forward for a long time until people began to feel the effects that the closures were evolving for society. Even then, though, as governors, red state governors, began to reopen in the summer of 2020, they didn't say, well, we're reopening because we need to prioritize the economy over lives. That's not what they said. What they instead would say is that we're reopening safely. That they just tried to reassure people that it was safe to reopen rather than trying to get into, trying to make that in the, in the balance between the economy and lives, we should give the economy more priority. That was not the kind of rhetoric that they were using.

Mike Pesca (32:07)

No, that's probably smart, though. I mean, America was freaked out, so you have to do a little hand holding.

Francis Lee (32:11)

I think Governor DeSantis did invite in some experts who, some of whom we discuss in the book, the eventual signers of this thing called the Great Barrington Declaration. And, you know, they emphasize the costs of these closure measures and, and the very variable vulnerability to people from COVID in the population. And that did lead him to insist on Florida schools or that, among other things, led to him insisting that Florida schools be reopened in the fall. So, you know, he had an elderly population. He might have suffered politically if that had not been a good call. But he did invite in these experts and he did follow their advice for whatever combination.

Mike Pesca (32:51)

Yeah. And the Florida death toll versus the California death toll or death rate was what they kept.

Francis Lee (32:57)

Florida did fine. I mean, Florida did a bit better in some ways once you adjust for, of course, the elderly population, but adjust for age and various background factors. So Florida did just fine again, according to the numbers that we have CDC data by state.

Mike Pesca (33:10)

So we were talking about some discussion within academia, especially early on, if this was the right call. There was some debate, there were some papers, but those papers got less and less attention. The debate got more and more muted. You tell me if on Princeton campus or virtually. They. They had a lot of teach ins debating whether these measures should be taken. In your book, you talk a lot about how there was just a flattening of dissent or discussion or debate. What do you think the mechanisms of that were? How did that come to pass? That, you know, my profession, journalism, you usually get some credibility and excitement if you could offer a point of view that isn't offered, if it's backed up by facts. In academia, your profession, that's a way to establish yourself if you can show something that the rest of the field has missed. But that wasn't going on with COVID Why not?

Francis Lee (34:12)

I mean, we spend more time in the book describing what happened than describing the motives or the causes, frankly, I think we both feel that there's a lot we don't understand. You know, and I think the extent of compliance here, again, there's the partisanship. I think it's not just that most academics are Democrats, it's also that they're members of, you know, educated elite class. And the phrase that was used, the slogan that was used to follow the science or trust the science, you know, members of the of educated elites are liable to be the ones who are trustful of science and trustful scientific authorities. I mean, if it comes down to Anthony Fauci versus Donald Trump, you know, your average professor is going to not to have a difficult time deciding which they're going to go with.

Mike Pesca (34:55)

That's true. But let me interrupt. You cited scientists, first of all, before the pandemic, it was scientists who were saying what should happen and how these interventions wouldn't work. Scientists. And you cited scientists. I said, you said Peterson. I said, Allison, they were out there. So it's not as if, you know, Fauci has a major prominent role. But it's not as if there weren't scientists to choose from as opposed to Trump. It's just that those scientists weren't retweeted or held up or passed around is an interesting example.

Susan Ettlinger (35:25)

There was a dearth of dissent beginning in the summer of 2020. Like it really died out, like after the whole of government, whole of society strategy was adopted in the spring of 2020. You really, we don't see much departing from that, from public health, from scientists. Now, part of that, newspapers were maintaining an editorial line. There was also suppression of dissenting perspectives on social media. So some of this was imposed. But I also think there was a great deal of just pure deference to authority on the part of educated elites in all these, what we call truth seeking professions, you know, science, journalism, academia, that you, you just.

Mike Pesca (36:18)

And think tanks, you know, think tanks that weren't even left aligned. Rockefeller, which is left aligned, used to never make proclamations. But they did. But so did aei, which is, you know, generally libertarian. So did NIS Cannon, which prides itself on being very centrist. They were all in favor of lockdowns and these NPIs.

Francis Lee (36:39)

We're astonished, frankly, at the amount of groupthink. In retrospect, again, this is something we describe, we don't fully understand. We come from a profession of political science where, you know, skepticism is sort of the order of the day. You know, as Francis has pointed out to me before and to others we've talked to, you know, challenging the effects of various interventions, being suspicious of evidence, you know, until it's ironclad and been subject to rigorous criticism, is kind of what social scientists do for a living. But there seem to be a lot of credulousness around these measures here and an unwillingness to question them in public. We will say one other thing which we've observed, and again, we don't fully understand because we're not public health scholars, but, you know, there seemed to be an especial unwillingness within the field of public health in many ways to challenge these things. We quote Sandro Galea, Dr. Sandro Galea, who was dean of the Boston University School of Public Health, and he published a book called Within Reason, which is subtitled Towards a More Liberal Public Health. He means liberal in the classical sense of being open to criticism and open to critical evidence and so on.

Mike Pesca (37:46)

Yeah, in the more classical sense, but not the classical liberal sense. Oh, my God.

Francis Lee (37:49)

There are no phrases that really work well, I think. So Traditionally, academic Scientists have been liberals in that sense of openness to criticism, willingness to be self critical. You know, all claims are conditional pending the discovery of more evidence and the advancing of stronger arguments. But that really did seem to wane under Covid, beginning in more or less April and May, as Francis indicated. And the extent of it is still a bit hard to. I mean, some of it had to do with, again, China locked down, and the World Health Organization said that that's been a big success. Italy locked down as a nation, first national lockdown in the world and the citizens accepted it. That showed that it was possible, something that was never considered really possible before. So there were many factors that contributed to the embrace of these policies. And it really needs, we really need to look back in retrospect and try to figure out why there wasn't more dissent. As you mentioned, Graham Allison, who's a great scholar of crisis decision making at Harvard, wrote about the Cuban missile crisis in April. It seemed maybe in partly response to some of these other national plans coming out. He said, look, we need to step back and question whether we have the right strategy here. We need a team B, we need Devil's Advocates, we need to draw on a much wider range of experts just to make sure that the strategy that we're doubling down on is the right strategy. There are grounds for suspecting that it's not. You know, and we think looking back at that document that he put out, in retrospect, you know, it seems exactly right. And yet it got no attention whatsoever. None of these major foundations or groups, think tanks and so on, picked up that suggestion, you know, on any part of the political spectrum really, until much later. So it's really kind of astonishing that, you know, they have those kinds of sensible interventions which just get ignored during the crisis.

Susan Ettlinger (39:47)

I don't know of any major conference that was convened at a think tank or a prominent university to debate the strategy around how to respond to Covid. And when you think about the scale of the response, the disruptions to society that were involved, to society, to education, to employment, to business, to human beings, connectedness to others, the scale of the effects were just vast and just no debate. It's a fascinating period and I don't think we can offer a fully adequate account. One of the things that Steve and I felt throughout the whole time we were working on this book is that we're barely scratching the surface of a profound period in American politics and world politics, politics.

Francis Lee (40:36)

And there still haven't been many academic conferences. There still is an absence of critical remarkably, there was one out at Stanford that Dr. Bhattacharya organized that we went to. But there were various people calling for that to be closed down.

Mike Pesca (40:54)

That's it for today's show, just as produced by Cory Warra and cbso Michelle Pesca, Unproojee Peru duplicates Peru. And thanks for listening.