After a haystack of should-have-been last straws, the most recent COVID guidelines from the CDC have finally pushed me over the edge. As a physician who saw COVID patients on a regular basis during the pandemic, I completely understand the logic of the new recommendations and, in fact, agree with most of them. Regardless of whether one agrees with the new guidelines, however, we can probably all agree we are confused by them.
We are confused, for instance, that only now is the CDC telling us what millions of us already knew many months ago: that walking outdoors with your own household does not require a mask. We are also simply confused that we have so many rules to remember. I guess we should not be surprised by the CDC botching another simple task, as that has been the story of the entire pandemic. I do not question the intentions or expertise of those at the CDC. Their handling of the pandemic, however, has been a massive failure—a reminder why, whenever someone recommends a “panel of experts” as a solution to any societal problem, I cringe.
There’s no reason to be walking around with a mask. When you’re in the middle of an outbreak, wearing a mask might make people feel a little bit better and it might even block a droplet, but it’s not providing the perfect protection that people think that it is. And, often, there are unintended consequences—people keep fiddling with the mask and they keep touching their face.
It was not Donald Trump who said this. This was Anthony Fauci on March 8, 2020, on 60 Minutes. Ironically, this is the most honest and accurate assessment on masks I have seen during the entire pandemic. His analysis made sense to me because this is how we would expect a coronavirus to behave. Big droplets (think sneeze particles) could be caught by a regular mask (for this reason, it always made sense to wear a mask when being close to people was a necessity), however, unless it is an N95 mask that is perfectly fitted, the virus itself is still moving completely unimpeded during talking and breathing. What’s more, the virus accumulates in indoor spaces and the likelihood of infection increases with the amount of time exposed. Think of airborne transmission much like a kitchen filling up with smoke when you use a dirty oven: The longer the oven is on, the more smoke is produced, and this smoke lingers in the air for hours after the oven is turned off unless a window is opened.
On April 3, CDC updated its guidelines to recommend wearing cloth masks outside the house. Okay, fine. Around the same time, with relatively strong conviction, the CDC is telling physicians that COVID is not transmissible via airborne mechanism, and regular masks are sufficient for all patient encounters except certain high-risk “aerosol generating procedures.” This assertion horrified many physicians, including myself. How can the CDC be saying this? We all know that most respiratory viruses, including other coronaviruses, spread via airborne transmission to varying degrees. Why would this virus be different, and even if it is, how can we be so sure? To assert so boldly that we should suspend our understanding of virology was shocking to me. Quietly, several months later—after intense pressure by physicians and scientists—the CDC finally reversed its absurd assertion that SARS-CoV-2 is not spread via airborne mechanism.
Early on, other small but nonsensical things were happening. The CDC initially recommended (correctly) that during patient intake at doctors’ offices, questions be asked about recent travel. The list, however, was a disaster and always way behind the curve. While it still included China (which had been mostly shut down for a couple months), Italy, Spain, and other specific foreign countries no one would dare travel to at the time, it did not include New York, where there was obviously an outbreak and still a lot of travel. It was not long before New York and others were added to the list, but it was ridiculously late for something that was so obvious. Sadly, it became increasingly clear to me: The CDC is either incompetent or in some way politically compromised, and there will be mass confusion as people have to figure out the rules of COVID for themselves.
In the first couple months of the pandemic, and before our own data were available, we thought the death rate was around 3-5 percent, with a higher chance of death based on advanced age and having a compromised immune system. Using this risk assessment, I was terrified to go into work, even though I was blessed to work for an elite hospital system that always provided the PPE we needed. Still, I had recently moved in with my now fiancé who has Crohn’s, which requires in her case bimonthly administering of immunosuppressive drugs. I had come to the realization, given the nature of job, that it was likely inevitable I would contract COVID and bring it home. In my head there was perhaps a 10 percent chance she would die in the next few months because of me. This prospect tore me up inside and forced me to seriously consider quitting my job. Ultimately, my work granted me the ability to work from home temporarily in May, for which I am forever grateful. I will never forget, however, the fear I felt going in to work during late March and in April.
In late May, though, I stumbled upon data and models from the CDC itself that dramatically changed my perspective on COVID risk for the better. The data showed death rates closer to 0.2-0.4 percent, including much lower rates in younger adults and no increased risk to children relative to other viruses. While some physicians started hypothesizing as early as April that a lower death rate than initially thought seemed to be where the preliminary data pointed, that idea had been slammed as a dangerous conspiracy. A few of my lesser informed former medical school colleagues even took to social media to warn people about the dangers of floating the idea that the death rate could be much lower than we thought initially. To see more comprehensive data showing a much less deadly virus, even if it was from the CDC, immediately de-escalated my fears of returning to work, and I did so a few days later.
Despite the data indicating a major course change was necessary, surprisingly few people noticed, and the CDC did not push hard enough, if at all, for the removal of limitations based on a new cost/benefit analysis. Instead, the CDC appeared to double down on strict lockdowns as a means of controlling the virus. No limitation ultimately was more harmful during the pandemic, however, than school closures. I know the CDC has been technically in favor of school openings for a while now; it is just that they appear to have zero outrage at the disgrace that has unfolded and, in some cases, continues even today in mainly poor and minority schools, despite widespread vaccination of teachers. The CDC, along with Democratic politicians, seem terrified to offend the teacher’s unions—all at the expense of the children.
Given what we have learned from an overwhelming amount of data and studies since the pandemic began, the cost/benefit analysis has been so heavily skewed in favor of kids being in school for so many months that any negotiating position where the school is not open by default is completely unacceptable. During the 2009 swine flu (H1N1) pandemic, CDC modeling projected at the time that up to 1800 children had died from swine flu. Swine flu was specifically dangerous to children and relatively sparing of adults and the elderly, yet long-term school closures did not happen. According to the American Academy of Pediatrics, 296 children have died from COVID-19 as of April 22, 2021. Keep in mind that a regular bad flu season can kill 100 children a year, and the COVID pandemic has now encroached on two flu seasons. These numbers, unfortunately, force one to deduce that we completely abandoned children during the coronavirus pandemic for political purposes, not medical ones.
Of course, that’s entirely fitting with the overarching pattern of ill-informed, medically nonsensical decisions issued from the highest levels of the public health apparatus under COVID. Take a step back. Look at the big picture of what has transpired over the past year and more of the pandemic. The only common thread running through it all is that “the experts” have managed to be wrong every step of the way.
Alon Bloom is a physician who worked on the front lines during the pandemic.
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