A checklist for COVID policy

How to know someone's brain is working

Lots of people commented about COVID-19. Some were more right than others. It isn't fair to judge people by facts not known at the time. Instead here is a list of issues where a person who read actively, and whose brain was working (aka not riddled with anxiety) could be right in the moment.

1. The evidence for community cloth masking was awful, nonexistent, negative and poor and we should have run cluster RCTs. This view was obvious based on reading pre-pandemic literature and is why the CDC, WHO and Tony Fauci himself initially advised against masking. Instead, in the weeks that followed many lied about the evidence of cloth masking to push this intervention. It was propaganda, not science. It was shameful how real scientists lied and exaggerated and virtue signalled, all of which prevented randomized trials.

2. Without embellishment, I will think it's ok to have supported cloth masking initially, but smart people understood the residual uncertainty and wanted cluster RCTs. Unfortunately, they were defeated by zealots, and we have zero cluster RCTs in high income countries. Aka we learned nothing. This is embarrassing.

3. Masking kids 2-4 and mandates (oh, of course, except when they nap for 2 hours in the same room!) was a stupid policy and it's hard to understand how anyone whose brain was working would support it. They napped together in the same room unmasked! Use your brain! How could that possibly work? Moreover, the World Health Organization advised against doing it.

4. School closure in the spring of 2020 was arguable, but closure any time after Aug 2020 was clearly wrong. Enough data had accumulated by then to know it was a fools errand. Most Western European nations had returned in person by then. Liberal American cities remained the last hold outs. They paid lip service to vulnerable children, but their policies crushed their future.

5. Vaccinating 20 year old health care workers and teachers and 'first responders' before the elderly was clearly stupid. It only happened because anxious first responders are more powerful lobbying force than old people. Society, particularly America, does not value the elderly. Anyone who could do basic arithmetic would know this would cost lives. Even assuming first responders were much more likely to get the virus, the IFR by age was so steep, it could not be overcome by exposure. Wise nations didn't do it. You only needed a calculator and 2 seconds to realize how stupid it was.

6. When J&J was found to cause VITT, it was obvious the product should be pulled from the market. Bad policy makers analogized it to DVT after oral contraceptives. They apparently did not understand the difference between the cerebral sinus, and the leg. Or a simple clot and runaway platelet activation. Alternatives were available. The FDA and CDC kept the product for one more year and many people were harmed.

7. Mandating the mRNA shot was always a stupid idea. First, remember mandating a medical intervention is not done to protect the person getting the intervention. We don't mandate you take your blood pressure pills. And you're allowed to decline life-saving therapies. Mandates only exist when there is sufficient benefit to third parties that the intrusion on autonomy is justified. It has to clear a high bar.

   In the beginning, it looked like the vaccine provided massive individual level protection. Thus, it didn't matter if someone else didn't get the shot, you were protected. Modeling studies suggested that thousands of people would have to be excluded to avert one acquisition of COVID. It was clear that many people would be angered, a few would not comply, and there was no justifiable case that coercive vaccination benefited third parties. If a third party was worried, they could get vaccinated themselves. Later, by the fall of 2021, when it was abundantly clear that vaccines were unable to halt novel variants and breakthrough was inevitable, then vaccine mandates were unethical because vaccines could not protect a third party from transmission anyway. Ironically, vaccine mandates were always unethical because they never conferred sufficient benefit to 3rd parties. Instead, some people argued that protecting someone from their own choice was a valuable use of coercion. These people are ignorant of medical history, and do not see the fact that there is no end to this principle. You can mandate people to get any medical intervention by this logic. Moreover, they are aloof from Americans. Americans would never tolerate such an intrusion.

8. Wearing a mask after vaccination. Or distancing. Or avoiding weddings or avoiding other things. After vaccination, there was nothing more you could do to lower your individual risk. Weight loss, optimizing medical issues, and vaccination by the only three risk reducing interventions. Before it was evident that breakthrough was inevitable, there's no point to take precautions after vaccination because you were very well protected. The moment it was evident that breakthrough was inevitable, there was no point to take precautions after vaccination because if you live long enough, you'll eventually get the virus. So what's the goal of delaying?

9. Testing testing, testing. The United States not for 1 minute was able to control the virus through test, trace, isolate. The seed load or initial preconditions in 2020 made it impossible to do that. The idea we could test our way halting the virus and his tracks was delusional. Someday Congress should pass a bill asking testing companies to release the names of doctors and epidemiologists who they paid. Once you see the money trail, you will understand why people pushed testing.

10. After adult vaccination, the idea that wide scale testing was necessary or desirable was a delusion. Testing kids and quarantining them was massively disruptive. The loss of educational alone offset any potential gains. And the final outcome will be inevitable. 93 to 98% breakthrough.

11. The idea kids need a vaccine to return to normal-- was insane. This was absolutely a crazy point of view. Proof that it was not true is that many nations had very high sero prevalence prior to the debut of vaccines. The United Kingdom was nearly 100%. The US was at least over 70% but probably much higher, due to terrible data collection. If kids got COVID anyway prior to vaccine all the restrictions hurt them with no possibility of benefit.

12. Children never faced an emergency. The regulatory use of emergency use authorization for kids was unjustified. Their drug products should have come through traditional marketing pathways. The IFR in children was too low to constitute an emergency. Moreover, by the time kids vaccines arrived it was clear that breakthrough was inevitable. Ergo vaccinating kids would not protect anyone else. The abuse of expedited pathways benefits companies, but does not benefit people. This abuse has continued in cancer drugs for years. COVID makes people scared, which pharmaceutical companies use to enrich themselves with scant data.

13. Giving paxlovid to young vaccinated people. Anyone who knows the history of medicine knows that extrapolating data from very sick individuals to milder versions of disease is never a good idea. It's always better to run a randomized trial before you spend $5 billion dollars treating your anxiety.

14. Anyone who ever said the word zero COVID is an idiot. Because the opportunity for zero COVID ended in early December 2019, and firmly closed by March of 2020. Anyone who still thought it possible, particularly in 2021, should be muted and ignored.

15. By June 2022, anybody who thinks the United States should do anything to control infections is wrong. Such a person must be living under a rock to not notice the fact that 200 million plus Americans have returned to complete normal. Moreover, it is not biologically possible. These should be too good reasons for these people to stop.

16. Travel bans. Border closure. Testing to cross borders. It was evident that these measures could do nothing to stop spread. It's unbelievable we repeated that until 2022.

17. Long COVID: If you were very ill with COVID-19, if you were hospitalized, if you were intubated, if you were on death's door, it is entirely possible that you will have a prolonged recovery. You may never be the same. This has always been the case with respiratory viruses. Or any illness for that matter. But if you had a mild infection, if you didn't even know you were sick, then it would be astonishing that you would have serious long-term sequela. The burden of proof that this is due to COVID should be very high. That doesn't mean people shouldn't take you seriously. Doctor should always take patients seriously. And if a person feels bad, we should run studies to determine what makes them better. But that's very different than advising people that asymptomatic Long Covid is a big problem, and that we should try to control infections in perpetuity. Those are bold policy maneuvers. It requires extraordinary evidence. That evidence has never been met. The best study from the Annals of internal medicine compares patients with milder Covid to those without milder Covid and finds no differences in any of dozens of dozens of biological tests. That finding is astonishing. And should be replicated in larger sample size. But if it holds true, a serious rethinking of long COVID is needed.

18. Saying in 2022 we need to control infections to prevent mutations. Serious science writers are saying this. In top magazines. It's totally delusional. There is no political buy-in. Even if there were, you'd have to weld door shut like Shanghai to achieve it. That's not possible in free society. It's living in a fairy tale confusing it for reality.

19. Saying healthcare workers will mask forever. Before you institute a sweeping change in healthcare, don't you want to run a randomized trial to know it works? Evidence-based medicine is dead when people propose such changes without evidence. I'm pretty confident now that many people didn't understand it.

20. And the biggest way to know somebody doesn't know what they're talking about: when somebody suggests school reopening benefits rich and privileged kids. It benefits poor, underserved, minority kids. How clueless are you?

21. I forgot to mention boosting 12-year-olds, yearly booster, and a load of other things. That's for another column.

These were issues that were not just obvious in retrospect but at the time. A simple test for who knows what they're talking about.