When the Covid pandemic first emerged in the winter of 2020, I was shocked by the level of scepticism and outright denial on my social media feeds. One of the first rumours, stoked by President Trump, was that the Covid death rate was no worse than that of the seasonal flu—which he claimed takes the lives of between 25,000 and 69,000 people a year. By spring, it seemed clear that Covid, with a 0.5–1% infection fatality rate, was going to cause more deaths than even the worst flu season. But how much more death, we did not yet know.
As for those flu-death numbers: in April 2020, Jeremy Faust, an emergency medicine doctor, wrote a fascinating piece for Scientific American in which he points out, “In four years of emergency medicine residency and over three and a half years as an attending physician, I had almost never seen anyone die of the flu.” When he investigated further, he found that his experience was not unusual. The CDC had historically hyped the number of flu deaths.
The figure of 25,000 to 69,000 flu deaths, he explains, is based on CDC estimates produced by “multiplying the number of flu death counts reported by various coefficients produced through complicated algorithms.” He writes, “The CDC’s … confirmed flu deaths—that is, counting flu deaths the way we are currently counting deaths from the coronavirus—has ranged from 3,448 to 15,620” per year. In other words, the CDC estimates routinely quadrupled the annual number of confirmed flu deaths. Faust concluded that the CDC’s reporting on flu deaths was “dangerously misleading.”
The public health officials who originally came up with this method could not have known that someday their inflation of flu-death numbers would make it harder to convince some members of the public that Covid was a real threat. But that history of exaggeration facilitated Trump’s misinformation and made it harder to gain support for necessary public health measures.
Unfortunately, the instinct to exaggerate the danger of a disease in order to encourage good public health behaviour continued well into the pandemic and has yet to abate. It is a deliberate feature, not a bug, of our public health culture.
For example, a recent article by Kerrington Powell and Vinay Prasad describes how, throughout the pandemic, public health expert Dr Anthony Fauci told a number of what they call “noble lies.” In March 2020, he publicly downplayed the utility of mask use in order to prevent a run on surgical and N95 masks because he feared that a shortage would deprive front-line medical workers of the personal protective equipment (PPE) they needed. Then, in December 2020, he acknowledged having told another fib: as he explained to New York Times reporter Donald McNeil after he saw survey data suggesting that Americans were growing more willing to get vaccinated, he had purposefully increased his estimate of the threshold needed to achieve herd immunity.
The CDC also seems to have lacked transparency about the motives behind its guidelines. In July, after the highly contagious Delta variant had come our way, they reversed their previous, more relaxed guidelines, and recommended that even fully vaccinated people should wear masks indoors in high-spread areas. The CDC’s director, Dr Rochelle Walensky, initially justified the recommendation on the grounds that vaccinated people might in rare cases spread the virus to others, but soon thereafter acknowledged that the real reason for the decision was that many unvaccinated people were refusing to mask up. This suggests that the CDC was disingenuous about the reasons for its mask guidelines in order to make it easier for local governmental groups and employers to institute mask mandates.
In a way, these lies are understandable: public health officials wanted to protect PPE supply for frontline healthcare workers, and to convince the public to hang in there longer to achieve herd immunity, and to make it easier to require unvaccinated people to wear masks. But by not being completely transparent about the underlying reasons for their recommendations, Fauci and the CDC may have sacrificed their credibility. This may be partly why, according to a survey in May 2021, most Americans do not trust the national or their local public health institutions. (The responses of many doctors to the gatherings during the BLM protests was also a probable contributory factor.)
In his account of the 1918 pandemic, The Great Influenza, John Barry writes, “If there is a single dominant lesson from 1918, it’s that governments need to tell the truth in a crisis. ‘Risk communication’ implies managing the truth. You don’t manage the truth. You tell the truth.” During the pandemic, our public health establishment has been in the spotlight like never before, and this has exposed its penchant for “risk communication” (bending the truth), which has damaged its reputation at a time when we urgently need to be able to trust our public health experts and institutions.
In normal times, when people are not paying much attention, it might be understandable to exaggerate or even lie to achieve better public health outcomes. Such white lies may even save lives. But in a pandemic, when people’s long-term health and livelihoods are on the line, the public is much more engaged, reading multiple sources and hearing numerous perspectives. Thus many people will either discover the truth and be disillusioned, or they may read or watch something that convinces them to believe an even more destructive set of lies.
Dr Michael Osterholm, one of America’s leading epidemiologists has recently urged health officials, “Just tell the truth … What do we know, and what don’t we know … Don’t minimize issues. My job is not to scare people out of their wits, it’s to scare them into their wits.” Even when public health officials first began advocating masks, Osterholm was more circumspect: he just cited the data, allowing people to judge for themselves. If public health is to restore its standing, it must adopt Osterholm’s advice.
As Jonathan Rauch painstakingly details in his recent book The Constitution of Knowledge, Americans are facing an epistemic crisis, a multi-faceted challenge to our country’s ability to distinguish fact from fiction. The greatest source of misinformation is not people like Drs Fauci and Walensky, but an increasingly unhinged media environment made up of cynical politicians, talk-show hucksters and self-appointed experts without a background in epidemiology. It would be easy to place the blame for the current vaccine denial solely on their shoulders.
But it is precisely in such a fact-challenged environment that we need our government institutions—especially public health institutions—to be above reproach. The tendency of public health institutions to twist the science, even with the best intentions, undercuts their credibility at a crucial moment in our nation’s history.
