This was a painful example of motivated reasoning and a whole bunch of other psychological nonsense that leads people, people who should be in some sense scientific and rational, to glom onto a paradigm and not let go in the face of evidence.

At the point that aerosol physicists are telling you, *No, really, what you believe doesn't make any sense*, and you are telling the aerosol physicists, *You're not medical professionals, what could you possibly know?* is the point – if not long, long past it – to notice something has gone COMPLETELY off the epistemological rails.

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But that going off the rails didn't just happen during our pandemic. It's been going on for decades.

And it's not limited to rigidly clung to, fiercely defended wrong beliefs about the range of dispersal of exhaled infectious agents.

My on-ramp to the pandemic – the point at which that which was going on in Wuhan came to my attention – was a point in January 2020, where all of a sudden people were talking about social distancing in terms of *the flu*.

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In case you had forgotten this little bit of recent history: at the beginning of the pandemic, US media and *social media* was full of people – left leaning, science prizing, generally sensible and humane people – SCOFFING at the idea that what was happening in Wuhan could possibly come and touch them in their lives, and MOCKING the very idea that anyone should be concerned about it.

One of the frequent things that was expressed in those circles was that whatever was happening in Wuhan would never be as bad as the flu, so if you wanted to be worried about an infectious disease, be worried about influenza.

Consequently, people took that in the direction of discussing how to protect oneself from the flu.

And that was the first thing to come to my attention. All these people sanctimoniously repeating "six feet apart".

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One of the frequent things that was expressed in those circles was that whatever was happening in Wuhan would never be as bad as the flu, so if you wanted to be worried about an infectious disease, be worried about influenza.

Consequently, people took that in the direction of discussing how to protect oneself from the flu.

And that was the first thing to come to my attention. All these people sanctimoniously repeating "six feet apart".

To which I was of course responding in my head, "Six feet? No, at least ten. Dust and Lyons, 1918."

But that just piqued my curiosity: where the hell were people getting 6 ft from?

Well, I chased it down.

It was the CDC of course.

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Before the CDC had anything to say to the US public about COVID, their influenza page said six feet.

And I was like ????

My first assumption was, Hey it's been a century, I bet there's been more science between then and now. Presumably somebody has disproven Doust & Lyon if the CDC thinks it's 6 ft.

Certainly, as a graduate student in a medical field, I was quite explicitly told not to trust old research papers. My school had a standard that any research paper more than 5 years old was not to be, well, cited for one thing, but really considered valid at all.

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So I went looking for the source of the six feet guideline.

This was the first point at which I noticed that the CDC does not cite its sources.

I figured, Well this is information about social distancing and influenza is for the general public. Surely on their other pages, the ones for medical professionals, they'll have references. They'll let us know which science they are basing their recommendations on. Because that is how you do in the sciences. And also that is quite literally what the World Wide Web *was invented for*: the dissemination of research papers, with hyperlinked sources, so you could go right to them.

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But nah. There was nothing on the CDC's website to explain why they thought it was 6 ft, when here I am staring at a research journal article from 100 years ago that says 10 ft is not sufficient.

(For the record, I did reach out to the CDC, asking them, using their contact form, but somewhat understandably given this circumstances – a nascent global pandemic – I never heard back.)

This was the point at which I began to get a very bad feeling.

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Like I said, my graduate program told us that any research older than five years was not valid to be cited in our assignments, and we were cautioned to assume that all older papers were invalid.

That immediately struck me as... Odd. And by "odd" I mean bad.

For one thing, I'm a historian, even if an amateur one, and it is offensive to me to scorn things just because they're old. My area of work in history is in early music, and as a natural consequence of that, I had spent my twenties swimming upstream against prejudices about the artistic worth of pre-classical musics. Assuming older research papers were wrong not because of their contents but because of their date stamp smelled entirely too similar to scorning pre-classical music not due to any exposure to it, but arrogant, ignorant presuppositions about what would be found in it.

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But for another and much more important thing, the obvious logical consequence of discarding older research papers as presumed to be invalid, was that all it took for previous research findings to be discredited was the tick of the clock.

If you just drew a moving line 5 years ago across the scientific corpus, then all you had to do to invalidate a finding is *wait*. You didn't actually have to *prove it wrong*. You could just airly wave your hand and say, Well you know that was from way back when.

And THAT made my skin crawl.

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Because that is not how science works. That is not how reason works.

And it most definitely should not be how medical science works.

The business with 6 ft social distancing was my first inkling that something very bad had taken root and proliferated in the CDC. Something I had first seen as a graduate student studying psychotherapy, and subsequently had started recognizing in the rest of medicine. A kind of epistemological disease.

A lot of people were invested in the idea that the CDC's..."missteps"... were the fault of the Trump administration. But while some things improved under Biden, many did not.

I recognized the pathology and knew it was not specific to any presidential administration.

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The earliest scientific article (the best of my knowledge) that reported on the possibility there was asymptomatic transmission of COVID was a case study published ⭐February 19⭐, 2020, in the scientific research journal The Lancet Infectious Diseases:

Pan X, Chen D, et al. (2020) "Asymptomatic cases in a family cluster with SARS-CoV-2 infection"
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30114-6/fulltext

This was very quickly followed by another case study, published ⭐February 21⭐, 2020, in the Journal of the American Medical Association (JAMA, a very high-prestige medical research journal):

Bai, Y, Yao, L, et al. (2020)
"Presumed Asymptomatic Carrier Transmission of COVID-19"
https://jamanetwork.com/journals/jama/fullarticle/2762028

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These were followed ⭐March 5th⭐ – two weeks later – by another case study, this one in the high-prestige scientific journal The New England Journal of Medicine (NEJM):

Rothe C, Schunk M, Sothmann P, et al. (2020) "Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany."
https://www.nejm.org/doi/full/10.1056/NEJMc2001468

In case you don't remember, the US has not yet "shut down" at this point. Indeed most people in the United States are at best only vaguely aware that there seems to be some sort of outbreak in China and, by March 5th, Italy. The week in which everything shut down in the US was the week that started Monday March 9th, though most of the businesses that started to shut down did so starting on Thursday March 12th and accelerating through that weekend.

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One hero at the CDC – if I understand correctly it was Nancy Messonnier – broke ranks to issue a public statement advising the populace of the US to prepare for the pandemic on Feb 25. https://www.statnews.com/2020/02/25/cdc-expects-community-spread-of-coronavirus-as-top-official-warns-disruptions-could-be-severe/ (But "In a press briefing Tuesday afternoon, other top health officials pushed back on the perception that the public needs to take direct action now to prepare for community spread of the virus. They also doubled down on the message that the U.S. has successfully contained the spread of the virus thus far.")

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(As a side note, I do want to focus this on bad medicine and bad medical science, as opposed to the widely attributed bad governance, but I want to acknowledge – while I have that STAT article open – that this happened:

Quote:

It goes– It goes through air, Bob. That's always tougher than the touch, you know, the touch– you don't have to touch things, right? But the air, you just breathe the air and that's how it's, uh, passed. Aaaand so, that's a very tricky one. That's a very delicate one. It's also more deadly that your, you know, your– even your strenuous flus. You know, people don't realize: we lose twenty-five thousand, thirty thousand people a year here. Who would ever think that, right?

[...]

And then I said, well, is that the same thing? This is more deadly. This is five per... you know, this is five percent versus one percent and less than one percent, you know? So, this is deadly stuff.

End quote

You know who said that?

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That's Donald Fucking Trump, in an interview he was giving to Bob Woodward on ⭐February 7th⭐ 2020.

And here he is on ⭐March 19th ⭐ 2020:

Quote:

DT: Now it's turning out it's not just old people, Bob. But just today and, and yesterday, some startling facts came out. It's not just old, older...

[...]

Young people, too. Plenty of young people.

[...]

Well I think, Bob, really, to be honest with you–

BW: –Sure! I want you to be.

DT: I wanted to, uhhh... I wanted to always play it down. I still like playing it down–

BW: Yes, I–

DT: – because I don't want to create a panic.

End quote. (See https://siderea.dreamwidth.org/1655431.html for cites, links to the audio)

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Meanwhile, as captured in that STAT article from Feb 25:

Quote:

Department of Health and Human Services Secretary Alex Azar said the government is committed to “radical transparency” in keeping the public informed about its response and preparedness planning. [...]

“Transparency is being candid with people about what the continuum of potential steps are, so they can … start thinking about, in their own lives, what that might involve. Might. Might involve,” Azar said.

End quote.

So it seems pretty clear that various members of the Trump administration were knowingly, at his behest, "down playing" the incipient pandemic while assuring the American public of their "transparency".

End digression.)

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One of the things that I recommend you take from this is to note how certain kinds of bad science wind up being excellently congruent with certain powers that are motivated to in some sense reduce access to medical care.

One of the driving engines of bad medical science is the various institutional and governmental payers for medical care. In the US, it's the health insurance industry; in the UK, it's the NHS (or whoever is in charge of it).

The kind of emotionally motivated irrational bad science I am talking about isn't just a stochastic phenomenon. It constitutes an intellectual movement that is a *faction* in medicine. And that faction makes common cause with illiberal governments, grasping corporations, and any parties who consider themselves to have a vested interest in preventing access to healthcare.

End digression.)

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So as I was saying:

There we were, by the first week of March, 2020, there are reputable reports in three very prominent journals that we have reason to believe there is asymptomatic spread of COVID.

That's just the scientific literature. At the same time, the government of China is quite certain that there is asymptomatic spread, and is behaving accordingly – both in its own infection control measures, and in the warnings they are trying to pass on to other governments around the world, including the US's, as the Trump interview betrayed.)

At this point, all of the CDC's recommendations are predicated on the notion that one can tell who has COVID by the fact they have symptoms.

This includes their recommendations to healthcare facilities on using masks.

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A lot of people have said a lot of unbelievably dumb shit about how the CDC's recommendations must have been to protect the health care system. "Surely."

But, no, the CDC was also making the same sort of awful recommendations to health care facilities, too.

It helps here if you understand what CDC recommendations are and how they work – politically, as much as anything.

As a practical matter, in healthcare, CDC recommendations are no more recommendations than an IETF RFC is an actual "request for comment": it's the medical equivalent of a specification. It establishes the minimum standard of care or practice.

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Consequently, when the CDC issued guidance on COVID to health care facilities that said masking was unnecessary except in the case of symptomatic patients who had tested positive for COVID, or that surgical masks were sufficient and n95s unnecessary, what that meant was that hospital systems were free to not provide their staff with PPE. Because it was "unnecessary." The CDC said so.

Worse, they could even FORBID their staff to wear masks – either at all, or to wear N95s or KN95s. Even if they brought them from home themselves. Since they were "unnecessary", per the CDC.

And that is in fact a thing that happened:
https://siderea.dreamwidth.org/1618316.html

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Whatever the CDC establishes at the minimum necessary PPE medical professionals working in hospitals need to have becomes EXACTLY the amount of PPE the people who work in hospitals are provided, or even allowed, and not one bit more.

For the love of all that's holy, please start grasping how decision-making in healthcare is made. Hospitals are not doctors. Hospitals employ doctors. Hospitals are run by executives. Hospitals, and more broadly health care systems, do not make their decisions as to how medical care will be provided and clinical issues handled on the basis of reading scientific evidence and coming to their own educated conclusions as medical professionals.

No.

They do the absolute minimum the CDC says they can get away with and still be within current standards of practice.

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So the CDC issued "guidance" to health care facilities that, to be as generous as I possibly can be here, failed to account for the possibility of asymptomatic spread.

(That's not the only terrible thing about the guidance they issued at the time, but it's such a handy example and so easily documented.)

To do so, they either had to be in ignorance of scientific papers that even *I* had access to, or, it seems more likely, they had to decide to ignore them.

And then there's this other form of evidence they had to ignore.

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COVID was, as you will recall, a novel coronavirus. The seventh one to be discovered infecting humans.

But we knew about the previous six.

They just caused colds. And one of the things we thought we knew about colds – from previous scientific investigation – was that the infectious period starts before onset of symptoms.

Certainly I've been hearing all my life – maybe you have, too – that someone can be contagious with a cold before they have any symptoms. That has never been some sort of obscure scientific fact buried in the back of some research journal. That had made it into popular knowledge.

But for ~some reason~, the CDC decided to proceed on the assumption that people who don't have symptoms of COVID (yet, even) couldn't be contagious, and green light hospitals telling their emergency department staff that they didn't get to wear masks.

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This is what is known as the Precautionary Principle, which is very much exactly not what you would think it is from that name.

You might think – I certainly do – that in the face of a contagious respiratory pandemic where there is any reason whatsoever to suspect that there is airborne, asymptomatic spread, one should attempt to mitigate that pandemic – to "flatten the curve" – by recommending *universal* adoption of measures that might plausibly reduce airborne spread. After all, if you can't rely on the presence of symptoms to indicate who is contagious, you kind of have to assume *anybody* might be contagious. Stands to reason, no?

That is precisely what the CDC did not do.

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We might call this perspective "better safe than sorry", a doctrine which seems to have completely fallen out of usage in modern life.

Put another way, one might look at the risks of wearing a mask, compare them against the risk of catching a novel disease against which our species has no previous evolved resistance which wearing a mask might mitigate, compare the likelihood of the two potential risk sets, and conclude that wearing a mask has a small risk of bad outcomes while catching COVID has a substantial risk of a very bad outcome, and decide running the risks of wearing a mask are worth it.

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I say the risks of wearing a mask, because one of the things that was much under discussion on the socials back in February and March of 2020, was the possibility that masks make infectious illnesses worse.

There was a study, one specific study, that found in one of three populations of healthcare workers looked at, the mask wearing cohort had a higher rate of some disease. There was much speculation of why that might have been so, with many people speculating, "Well maybe people who wear masks touch their faces more, fussing with their mask, and thus transmit infectious agents from the surface of the mask to their hands, and from their hands to their mouths or eyes."

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I cannot overstate the credence that was given on the internets back then. Many people repeated that as if it were a known scientific fact. To my knowledge there is zero evidence toward that hypothesis. It is entirely speculative, and it is offered up, as an explanation for a result in a study that is anomalous even within that study.

The rational thing would be to observe that there seems to be a lot of reason to believe that masks work, that's why we make surgeons wear them, even scientific evidence to that end, and that it is more likely this one cohort in this one study was anomalous and should be ignored.

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But again, the thing that I would like you to notice:

One anomalous result in a scientific study showing that an intervention had a negative outcome is treated as if it outweighs absolutely everything else we know, including all the other scientific evidence we have, to discredit that intervention – which happens to coincide with the interests of healthcare system administrators and funders to not provide PPE to their staff.

This is, I propose, is another splendid example of how bad science is seized on in healthcare as an excuse to NOT DO THINGS. Life-saving things.

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Not that I am suggesting that the vast majority of people thoughtlessly repeating that talking point – that not only might not masks work, but masks might make infections worse – were doing so to justify health care systems denying their frontline medical staff PPE.

They just got snookered by the bad science – which may very well have been promoted on the socials by people who are partial to the "side" of health system administration.

(I see a lot of that, by the way. As a mental health professional I often find myself seeing certain things promoted as "scientific" in the media, and on the social platforms, that I know is of rather less scientific basis than claimed but very conveniently aligned with certain commercial or governmental interests.)

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That, at least, could be an interesting discussion to have: what does one estimate the chances are that wearing a mask will worsen one's chances of avoiding COVID, versus what does one estimate the chances are that wearing a mask will improve one's chances of avoiding COVID? Reasonable people could differ.

That's not the discussion that happened in the CDC, is it?

At no point did the CDC promulgate anything that suggested there was any sort of negative consequence of wearing masks. They just said they were unnecessary for the general public, and in all but very specific circumstances in health care.

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The CDC did not set before the public – neither the general public, nor the health care systems of the US and all the other countries that take their cues from our CDC – a line of reasoning as to the pros and cons of PPE usage.

This is also a point where people sometimes say an incredibly dumb thing, along the lines of Well that's not what the CDC does because excuse excuse excuse.

No, they absolutely used to. Issuing guidance which is highly contingent on specific details of circumstances is totally normal in issuing treatment guidelines in healthcare.

I know this because in the midst of the pandemic we also had that little outbreak of mpox, and, because personal reasons, I dug up the CDC recommendations for handling smallpox vaccination to see what they said about edge cases like mine, and: god damn. We didn't imagine it. The CDC used to be competent.

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The CDC absolutely used to issue guidance documents that explained the various contingencies and considerations, so that the end user, presumably a physician or a public health authority, could make a reasonable decision based on their local situation and circumstances.

But that's not what the CDC did here. The CDC acted as if, in the guidance it gave, it was not the end user who would need to make a judicious decision based on the specific circumstances they were confronting.

In particular, there was no discussion of the comparative risks of anything in that guidance.

The end user of the guidance cannot make decisions for themselves if they are not apprised of the pros and cons of various courses of action.

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The thing I am trying to point out is an implicit worldview or mentality underlying the kind of "guidance" the CDC was issuing at the start of the pandemic (and frankly is still issuing). It is, I propose, radically different in assumptions as to what CDC guidance is even supposed to be, than that of the much earlier smallpox vaccination guidance.

The present assumption does not include the idea that the end user is going to be making a cost-benefit risk analysis.

There are two obvious hypotheses to come to here.

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One such obvious hypothesis is that the CDC is issuing guidance like that because it does not think the end user should be thinking for themselves.

Perhaps the CDC has entirely fallen victim to what is basically regulatory capture by health system administrators (and maybe the insurance industry, which, let us never forget, in the US includes Congress itself, thanks to Medicare) and now thinks its job is to issue edicts that justify health care administrators cutting costs.

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This is a reasonably horrifying possibility that is also horrifyingly reasonable.

It has a lot of face validity, given how the CDC has behaved all the way along. What I just explained about CDC guidance conveniently justifying hospital administrators disallowing frontline medical staff to use PPE is but one example. Another even more pointed one is the Christmas 2021 CDC guidance for healthcare facilities that reduced the "recommended" isolation for COVID positive staff to 7 days but – and I'm actually quoting the actual CDC here – "that isolation time can be cut further if there are staffing shortages" (cites and links, and a discussion of how that precipitated Meddit collectively flipping all the tables at https://siderea.dreamwidth.org/1737434.html ).

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The other hypothesis, unfortunately, has even more evidence to substantiate it from where I sit. Perhaps the reason the CDC no longer issues guidance with the assumption the end user will be making a decision among possible risks is because...

...the CDC itself no longer does cost/benefit risk analysis.

That's much more scary.

This brings us back to the Precautionary Principle, which does not mean what it seems to say on the tin.

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Here's Wikipedia on the precautionary principle ( https://en.m.wikipedia.org/wiki/Precautionary_principle ):

"The precautionary principle (or precautionary approach) is a broad epistemological, philosophical and legal approach to innovations with potential for causing harm when extensive scientific knowledge on the matter is lacking. It emphasizes caution, pausing and review before leaping into new innovations that may prove disastrous."

Now, different fields understand what this means differently. But under the hood, it's basically a rhetorical approach. It's an argument for how one it should choose a course of action. And what that argument is – pay close attention here – is that one should NOT pursue a course of action UNLESS one is certain it will make things better instead of worse.

That *sounds* like a good idea.

Until you think it through.

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That's not a cost benefit analysis. That's trying to play a "Get out of performing a cost benefit analysis, free!" card. It's an attempt to take a shortcut out of making hard decisions.

What it says is, if there's any question as to the outcome of an intervention, don't do it: don't evaluate the possible negative outcomes of NOT doing it, don't try to weigh their comparative likelihoods and severities, just DON'T.

For instance, if there is a possibility that masks might make infectious illness worse, don't evaluate the possibility that masks might make infectious illness better, don't evaluate the badness of being wrong about this, just don't wear masks.

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