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America’s Public Health Experiment: Federal failures


In the final episode of our series, America’s Public Health Experiment, Dylan, Dara, and Jerusalem discuss how the CDC and the FDA failed the American public in the early months of the pandemic. Plus, a white paper about excess deaths in the first year of Covid-19.


How the experts botched masking advice

Zeynep Tufekci on the case for masks (in March 2020)

Inside the Fall of the CDC

Can the CDC be fixed?

How the CDC failed to detect Covid early

Scott Gottlieb on CDC versus FDA turf wars

The Government Asked Us Not To Release Records From The CDC’s First Failed COVID Test. Here They Are.

Zeynep Tufekci in the Atlantic: ​​The CDC Is Still Repeating Its Mistakes

Dylan Scott on FDA approval of controversial Alzheimer's drug

White paper: Excess Deaths in the United States During the First Year of COVID-19

What happened to drug deaths in 2020


Dylan Matthews (@dylanmatt), senior correspondent, Vox

Jerusalem Demsas (@jerusalemdemsas), policy reporter, Vox

Dara Lind (@dlind), immigration reporter, ProPublica


Sofi LaLonde, producer & engineer

Libby Nelson, editorial adviser

Amber Hall, deputy editorial director of talk podcasts

Sign up for The Weeds newsletter each Friday: vox.com/weedsletter 

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This is an unofficial transcript meant for reference. Accuracy is not guaranteed.
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my idiot sister when a jazz stuff for engineering, so clearly one of my own way to live in the past hello, and welcome to another episode of the Medes. I'm your host Dylan Matthews and today I am joined by Vocs Paulson writer, Jerusalem, dumpsters and profitable. His darling alone,
and for our last episode in our serious peddled America's public health experiment and also our last new episode of the year. We're gonna be talking about the advice we got from the government throughout the pandemic and wise. So much of it was so bad. We're primarily gonna, be talking about two agencies here. The first is the CDC: the centres for Disease Control and prevention wishes. America's main public health agency collects data fails new ceases and it's meant to handle disease outbreaks like covered. The second agency is the FDA, the Food and Drug Administration, which is the regulator in charge of approving new tests, new vaccines, treatments for covert another disease,
is, but we also want to mention a few other actors like Anthony Fatty who was of course, the main spokes person for public health last year, but is at the National Institutes of Health rather than the CDC Fda. We also my touch on trumps surgeon, general room atoms and his successor under bite in vivid Murphy and the surgeon general is also not base of Caesar after its ups are complex, interagency process, but but those are the two main ones. The pandemic was the Guess challenge that these individuals in these institutions had ever faced, and they made a number of really consequential mistakes, for example. In February and March. Twenty try, CDC chief Rather Redfield, Anthony FAO cheese surgeons are items they were all advising people not to buy masks for fear that there will be enough to staff
frontline medical workers, and it wasn't just about to preserve its play. They would say that Basque would not help that they were not effective at preventing covered at that point. That was, of course, not true, and it seems like we should have known it wasn't true at the time and after a lot of pushed back on this, notably from say, nap defect, she Conniston your times by April, the government spokespeople reversed themselves and they were recommending even cloth. Masks not even going for the hi tech ones, but but recommending people just use whatever mask they can get their hands on an initial bad advice to to ignore, masks. And then the swift reversal really hurt their credibility with the public at a pretty pivotal. No and there will be a lot more mistakes. This year On April, twenty seventh, the CDC announced that fully vaccinate people should keep weary masks, even in some outdoor settings of like when Europe's are outside at a bar.
The crowd, and that was a vice, that a lot of outsiders and in a lot of experts, size much too strict and then Barely two weeks later at the agency flipped and said fully vaccinate people didn't even have to wear masks indoors, which allowed the same experts thought went too far in the opposite direction, and it was also just a very confusing and fast turn
out and unsurprisingly, given the house or messy that public face inside of this was there was a lot of behind the scenes struggle. The trumpet ministration aggressively interfered, with the CDC, for example, by deleting guidance, Ed advised against squires and churches and other places of worship, otherwise, of inserting the trumpet instructions own views in place of what CDC experts were saying. Those experts were not without mistakes. The CDC lab those tests with creating a test for covered completely botched it they violated or basic lab cross contamination procedure, and that delayed accurate testing by months in the spring of twenty twenty, which was a huge deal in February that year, there was an effort to tests. Americans he'd been evacuated from we on where the outbreak started, to get a sense of how many of them have been exposed to covet how bad this is gonna, be the CDC shut it down on
frankly ridiculous ethical grounds, and that still have done a lot to tell us about this pandemic as it was by breaking out, and they just refused to do it, and in this long litany of mistakes, I haven't even mention of turf battles between the CDC in the FDA. At the ape locking testing programme early in the pandemic and refusing to speed up trials for vaccines and treatments on, and I know that the point is there a lot of mistakes here. These agencies did serve heroic, important work, but there also government agencies and it's important to like look at their record and see what they did rotten and so we're going to try to do that here today, Jerusalem, what's your basic evaluation of how these these agencies have done, how serious, where these takes. How did they balance against some of the successes that have had over the course? The pandemic, I think first, is I'm gonna. Do a lot of reporting of my own about kind of institutional failure, amino train, authorities, housing authorities, the federal government's housing response in general, and things like that and progressive
thence and and left governance has occurred, and also institutional governance, where there are a bunch of experts in really smart people involved in work. Frustrating parts of doings reporting is that very often everyone is very aware of all the problems, and also very aware of a lot of quite simple Superman, conceptually simple fixes to make it a better outcome for or whatever it is that All of that organization institution is amiss thing is also just like how much national inertia there really is to fix these issues. Dylan's would went through a litany of different problems here, present highlight that, like the same things that people were talking about a year ago and getting quotes from like very high up individuals in both the government and also in you know, the demon and experts and EP epidemiologist of our all. Just saying that this is the main problem. The same things are just like still happening today. You know Zeta fetched just how com in August, twenty one, splaining
the ways that masking guidance had changed around Delta over the course of just literally for days on First the chief medical adviser found she told CNBC. The delta was quite clearly different and that fully vaccinated people might wanna it are wary mass indoors. One day later, at the CDC director, Doktor Rasha, one ski says that wearing mass for the vaccinated was a quote individual choice and a vast since it individuals enjoyed an exceptional level, action. Then, two days later, Doktor Fouche confirms that bringing back mask mandates are under quote active consideration, then two days after that, doctor Lansky addresses the issue again and says deltas behaving very differently in the CDC, was now recommending that even the fully vaccinated wear masks indoors in public places, wherever transmission was quote substantial, so that the point here,
Not that, like me, none at all on this and this podcast is, you know as in depth into the research of any of the people I just mentioned. People are not like somehow like dumber than anyone else here. The problems that are going on here, just like so clearly just like this, what would occur, As these institutions or get large and lose the ability to sort of govern themselves, I think it is worth taking seriously ever gonna get into his room. I'm sure do a lot of you know Ruben, really angry about a lot of the problems that have occurred here. But I think that, like theirs is broader question here like we don't actually know how to reform institutions like this, despite knowing very clearly a lot of the specific problems that are in place both when it comes to messaging, but when it comes to risk tolerance and end, I you know interaction with the public in general, so I think those are caught. My broad sense is right now laughter. I've spent some time looking into this, but go even a little further Jerusalem, I would say like it's, not just that we don't know how to fix institutions that get themselves in this kind of
double. We also dont know how to restore the reputation of institutions once its clear that they do not have public trust me like here's, where I think be early obvious. Missteps uncovered, like especially regarding masks, were both probably very influential and might have obscured some stuff. Because what we ve seen, certainly over the course of twenty twenty one. As you know, Democrats who have and positioning themselves is like the pro Science Party and the party that trusts experts have actually being control of the federal government. So some of those cross cutting pressures where, like you wanted to say you trusted doktor, proud you, but you don't want to save the Trump administration like no longer exist. We ve seen that there are a lot of people who just do not trust the experts and eat wouldn't surprise
eyes me f, a lot of what was attributed to early missteps on the part of the CDC and the FDA was in fact a damaging of their reputation among the limited population that had trusted them. plus the existing scepticism of a lot of people who might not have trusted them, even if they ve been very consistent out of the gate, and so we are really talking about problems that predate any of this and for which there isn't really clear playbook for like once. You have people who can point to specific things. You ve done wrong and say this is why dont trust you, and once you have a population of people who, even if they can't point anything, regular. You ve done wrong, say I don't feel that those people are speaking to me. I'd thereat speaking for me. They have you know I just I don't trust that there
on the level. How you create a clear pipeline of communication so that your guidance will actually be followed is not something that we know do, and I would say to one of the things that I was I am thinking about was comparing the CDC in the FDA to an institution that has done like really well, I'm, which is the FED, the Federal Reserve, which is were performed remarkably well during the pandemic, and just thinking about the clear differences between dusty. Set up of these organisations and their mandates in the FED it extremely independent, I mean relative to the CDC update extremely independent from the political point the seas of Congress in the terms that line up or anything like that, drum palette cannot be. Hired and appointed it at will the same way that the FDA Cdc, cheap achieves can be, and on top of that, their funding streams are not like you No one is saying we're funding x program at the FED via on this line item in the budget. You just give most money just like given to federal reserve for for those for their operations, and I think, secondly,
the thing is, I give a very clear mandate. The Federal reserve like like we do these two things. We try to maximize employment and we try to hook you no limit inflation and we will you know that's what we're trying to do here at the Federal Reserve and the cds he'd have deviating when a big thing that is actually not quite clear to me that they all have a a governing goal that they all fully understand and agree to. I think you can like think about this very clearly, when you look at like what's going on with testing, we know we had a good episode, her understood amicable weeks ago on America's testing failures. I think the big take there is that, like there's, not a like decision, that's been made at this point around whether or not the point of testing is to make sure that I could know with really high degree of certainty that I and positive or negative from covered or whether it's the goal is to have a surveillance trot and no like what is generally happening in this area. How should we be responding from public health perspective and, in fact, that still has not generally been
really concerning like really concerning, and that's why you have a lot of weird, really weird back and forth, where we cannot get a bunch of tests of freely and cheaply available United States, you can, you can see them in other countries, so I think a big thing is just thinking about like what can actually be changed. Our things possibly can make the CDC and FDA a lot more independence and the government. I think it's harder to try to like mandate. There have a specific outlook on how to approach problems like this particular, because I think that they are very susceptible to public opinion released institution They have been in a way that the Federal Reserve has been able to be insulated from
Yeah. I've also not sure that the track record indicates that you can make a federal agency more independent and more responsive to events. At the same time I mean the FED is an interesting case. Here is as tourism side, because it was both extremely independent. I remember once had an off the record interview with Jack Lou when he was Treasury secretariat, and I can say anything else you said during it, but as something about the values like. I would never even answer anything off the record about the fat, because that would undermine the fact independence ends of another report or told me that TIM gardener had told them
when he was treasury secretary that, if any of his successors ever commented on the FED to tell him so easy going kill that will put an end so like they have this insane intense reputation for independence, and they were incredibly fast moving. So just like run down some things, they did. They stood up wholly new facilities to buy up our loans to state and local governments, which is something that had never done before within like a week or two. They did the same thing for loans to big corporations that they had not like from merrily invested in before they mostly done government bonds or mortgage bonds. They set up these things called swap lines that basically allowed governments around the world to get dollars when they needed dollars to pay for stuff that is sold in dollars like oil, and you did all this without Congress just or very quickly. It's an emergency undoing. Whenever I can, I think per was interesting about the city
see- and this is something that gene in Ireland, the who's, a writer than your times red and a very, very good piece or the Times magazine called too in the CDC be fixed. One point is making is just like: they dont have a lot of formal powers, they can declare of quarantine. They did this eviction moratorium. That seems on extremely shaky legal grounds and like at the far limits of what their their powers might be. But
can't like. They can't say all the site and we're gonna send attesting care to everyone in America every week I case they need at, they can't say we're going to serve mandate, contact racing for everyone in the country. They can't impose this vaccine mandate when biting wanted to do that. He had to go through through the Occupational health Channel and make it sort of workplace safety requirement and even their ability to collect data, which is, is a very core part of what they do and part of how they are meant to be an advisory agency to the president in an updating him and demonstration. Unlike the progress about but are heavily dependent on state local health departments and those instruments are not always reliable. They are not always well integrated at federal level. It's a lot of bureaucratic wrangling with individual agencies
and so I think some sometimes you get pushed back from people in the city, see saying you know like we're trying our best, but we were were given no power. We have to rely on the shaky data. That's been sent us by these, like hacks and the while Mean Department of Health. No disrespect people in the way it Department of Health is now loud sake. Sake of example, the New Hampshire Department of Health Sand from New Hampshire. I'm allowed to make funding into bathing like that kind of defence. Well accurate, as far as it goes serve only feeds into the broader thing of like this. This is not an agency that working like, regardless of whose fault it is like. It cannot continue to be structured this way during the next outbreak the other thing that I think is worth pointing out if we're talking about the FED, in particular as a comparison point and like, I think that this is actually like a reason that it's a good comparison point and gets back, there's some stuff we ve been talking about, and episodes throughout the air, most notably in the weeds time. Machine about the history of the fact is that, like a lot of the bed
job, is not in its. You know like it. It's too. from the powers that it has to do things unilaterally by its job is to communicate clearly about its expectations and thus in form other actors in the economy. So that things can unfolded in a predictable way. Unlike in that respect, it is similar to the CDC responsibility to get. You know up to date, information about public health and to do so best practices, except that the FED is only talking really directly to other professionals and there isn't the obligation like in a word, old where the FED was responsible for goosey. Consumer spending, for example, not by lake cutting interest rate, but by saying hey everyone, the economy's doing really well, you should go spend a lot of money like that. Might it is easy for them to do, but because there are these intermediaries mechanisms, where mechanisms where able evil
unity with people who know the rules of the game and do have every reason to trust them, and then those people These institutions are the ones that the public is actually interacting with. That makes it easier for that kind of trade. Parent expectations. Setting work to happen. We're going to go away break and then we're we're. Gonna talk about a few others of failure, his end and also talk about the FDA since so far, we ve been talking a lot about the CDC so so stay with US the holiday season is the perfect time to get into the spirit of giving don't need money to help the less fortunate as a great way to do that. But it can be tough to make for every dollar you give, is really doing something Forgive welcomes. Spent hundreds of thousands of ours, researching charities to find organizations doing the most with every donation they receive their means you can Rest assured that when you give to a give well approve charity, every dollar you donate being effectively deployed, help save and improve lives. I bet a big fan of
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In fact, when my best friends in high school is awake, I was concerted, guy loved Ronald Reagan. I Ronald Reagan. We would just Baden argue about it all the time, but we were friends. I miss her feeling that you can this debate and disagree without distrust. Somebody without disrespecting each other, and I just one of brain that back, and that is the point of the uncommon ground cast. You probably got some people in your life who you to be able to talk to you now you can't everything is just too polarized. I think there is still a chance, a better conversation in America I'll bring special gas into the conversation like Megan Mccain. Sarah Silberman Deep October and others. Our goal is to find common ground. we meet every Wednesday by following on common ground on Amazon, music or wherever you get. Your pipe casts.
Ok, so we ve been discussing some cdc. Failures are messaging, especially round masks and some of the testing difficulties, but I wanted to do. more into the FDA and our second section, they approved vaccines very quickly by historical standards, but they refuse to combine phases of tests or do challenge trials for humans would be actively infected with covered all which we could have sped up this process Jerusalem, Would you make it their performance? Rock of it? Are you a lot of the stuff you talking about? It's obviously and all the criticisms that people have had of the CDC in the FDA and all these public health institutions has felt like? Oh, you know covert? Is it Huge international emergency, a scale which, like no one's ever, had to deal with before in a globalized world, but I think one of the things in that way What matters here is that a lot of the problems with these institutions, including the FDA, is that these problems are our systemic, be even before covert sort of hit and indiscriminate, Alex taboos
an economist, adored maize University has been I'm harping on for a while. I remember you know, and I went back and found this twenty fifteen posts that he wrote about on the FDA. Too conservative and its approvals for new drugs? The incentive structures like really bad for them are not really fully against their fault here because, like essentially like you know, a type. One error is like approving a bad drug. For instance, you can get a bunch of hate for that like if you have like some kid who had really bad illness. If anybody up a drug that you approve give him gives him like a better smallpox or whenever it is, I don't know how drug would do that. But, let's just say it did her for argument sake, and you know that me tvs. Cameras outside of his house, like his parents, are gonna, be freaking out. Like all this kind of pressure, I congressional inquiry will occur and things like that. You have a massive incentive not to be approving drugs, have these kinds of negative side effects, but you know there's not that kind of countervailing. issue and fear around not approving good drugs, you know, if you who say: hey my kid has, as you know, strange illness and they just say
hey, there's no drug available for you! That's been deemed safe, you're, just gonna, be like Kay, there's no drug available, but deem safe and you're not going to know to point the finger at the FDA. You're, not gonna, know the increase likelihood of your kid being able to potentially have a good life organ of the disease or whatever, and so that kind of Yo Inter Play is really dangerous and problematic and Henry Miller, whose at the Hoover institution now, but who work for the FDA, Eightys and Ninetys Yoke, counted his own experience there and he talked about how their arena drug for approval and a four months after the application was submitted. When the average time for review was more than two and a half years. I basically what he decided, that they were going and often distributors, obviously good, but his supervisor refused to sign off on it. The even though he agreed that the data provided compelling evidence the drug safety effectiveness, because quote, if anything, goes wrong. Think about how bad it will look that we approve the drug so quickly
and you know it's easy, like dunk on this one guy or whatever, for saying something like that, but it does say something about how we need to reform whose getting you no pressure on these institutions, especially when taboo oxides, quite a good amount of research, showing that these costs are actually quite high. If you look over the course of how may drugs that have not been approved- and you know that comes of these illnesses are people who likelier like ok, we're gonna die anyway. I private would like to take an experimental drug if that's possible. Yes, yes, so I am glad that you know but this is kind of the biggest theme. a concern with the FDA rate, where the concerned CDC was, to a large extent, in its public health messaging function. The frustration with the FDA has largely been how unresponsive, it seemed at times to the urgency of the pandemic and, like you know it, if you want a point to it, For example, I think there was a lot of frustration this time last year when it seemed like it was enough
Both the FDA was going to approve the Johnson and Johnson vaccine, and it hadn't yet, but no one knew what was going to? U, whenever new is going to at a certain time- and it was just it for- people who were following. The news seemed like the only thing holding it up was bureaucratic intransigence, and I do think that that's really that is exactly the kind of circumstance that you know the Alex Tab, Iraq situation doesn't into account that there are sometimes when people actually do know that there is an answer out there, because it's something that such a large portion the public is concerned about and wants to protect against, and then they can really pay attention to it, but I do think that it's it's a little bit easy to assume that there aren't any cost, associated with approving and even if it is totally safe. I think, in particular the fact that everything is
operating on an emergency use authorization because that's the quicker try, of the process. Ruby fifty eight to engage in, has created at least a talking point, and I'm not. I don't want to be too confident in whether or not it's actually made some people. Vaccine skeptical, who would not have been vaccines, skeptical otherwise, but there was is a certain amount of rhetorical. You know, certainly in the early months of the pandemic, the idea that this was not really FDA moved and as the FDA move further along in the process in kind of said, no were serious about this that talk in point went away, but it does seem to me that phrases like emergency use, authorization or the careless language from the Trump Administration publicly and privately last year about how important it was to be able to announce that they had a vaccine available before the election like that sort of stuff ease and great in terms of actually increasing uptake. I think it's just difficult to balance that
if you like, present an urgent need for the people who were enthusiastic about getting vaccinated. I mean, I think one of the interesting things about the participation stuff is that I think a lot of people have started using it as a sort of like fully explanatory there. able for what went wrong here, and it means there is a lot of bad things like you know, Trump wanted to have emergency. The relation for early end. If anyone members, I was a plant extract, which had absolutely no scientific backing and found out later that it was because MIKE Lyndal. Thus ceo of my pillow dot com, was like the had recently acquired a stake in the company. Whose developing you experimental work, IDA company developing the experimental dietary supplements, which, as you know, I guess just clear legal, probably the best. I am anecdotal Trump years, as is his just like windows entire exist. But you know something that is having beyond that joint everyone. Numbers of course, like all of the effort,
on the Trump administration to install changes in the communications of the CDC. I mean they installed a spokesperson at the head of the agency. Her entire backgrounds, of being in a gun rights advocate and doing things, have nothing do with public health, it didn't have any kind of particular expertise, and you know agency officials were terrified that basically for public communications were being used to pump up the administration, but at the same time too, I would say this is like it's not really clear to me that we think in general that it's bad there's, not political pressure on these agencies, for instance, there's a story that was really popular is dad news that talks about how quote Trump had launched an attack on the FDA. Will the scientific integrity of it to survive, and one of the things they talk about is how Trump and aggressively support a quote right to try inflation which became law in twenty eighteen and essentially it was that you do. Patients with terminal illnesses should be able to request unapproved drugs from pharmaceutical companies as a last resort, even if they haven't been fully vetted for safety and effectiveness and gotten that full authorization,
That seems good do that there should be pressure on the FDA Cdc to be doing things like that, and he behaving that way, and I think it's like very here that we are mixing up these things like yards, really bad. That Trump was like using the my pillow c, o guy too, like push for certain drugs to be authorized, but it's good that using two other things. I think that, like the problem here, that is not the place is eight iberian adding positions its own problem, but the end result here is like the process by which these agencies are determining. Which of these things are good and bad is partially also their own kind of politics. It feels like where they'd really just didn't, like the idea of any kind of political body indicating that their level of reserving nest around and gauging and Quickoffice Relations was was worthwhile I mean I've, I've sort of mentally compartmentalized. The polarization concern from the service is the institutional culture at the CDC, FDA, optimal concern imports, because the institutional cultures serve exists throughout time, so like the day after
being extremely conservative on approving new drugs relative to european regulatory agencies and stuff is like a very well known fact that goes back to at least the little might. The FDA is serve a superhero Jen story. If you talk to people who are in the FDA or or love the FDA is that whereas most european drag agencies, holy cool with the latter might as a new drug for mothers and men pregnant women, the FDA The line- and I will not allow it- and so they had generations of kids with with terrific life threatening disabilities caused by the dragon, and we didn't and good on us and the other side of that is what you like, Alex TAT Rock call: the invisible graveyard of people who have died because of a lower pharmaceutical innovation in the United States, who might not be if we were more lenient in terms of letting drugs on the market and that's a
a mess of things. But it's my point is that its very independent tromp, I think I d the culture that was asserting itself in twenty twenty twenty one was in part a reaction again this decision by think it was, was also to serve how these agencies have always been an one thought that occurs to me. I'm polarization and, as I have to tell you about it, is like there's a lot of discourse about arms during the Trump administration, and I think I was we on the side of like people are talking about norms as a way to avoid talking about. First order. Concerns like Trump wants to take your health, caraway trumpets, putty kids in cages on the border trump is, is lower and legal immigration, and so people and tat talk about him like contrary Dini, norms of what the president is, in essence, those decisions or in circumstances to seem hymen
ended and non partisan and and and hide the ball but late, you should not believe the CDC into saying things that offend religious constituencies that are important to you was definitely norm, and it is important that would not have occurred to me as especially important until twenty twenty, but turns out to have been I don't know how many people died, because Trump refused to tell choirs not to saying, but it seems like the numbers, nine zero, and this is a really concrete case where those norms seem super important and and not like worth laughing off. The FED has some legal protections for its independence. But a lot of this stuff is norms the stuff about him you're going to be new up. If you, if you talk about the fetters Treasury secondary, that's just a norm, this is like a dude. Having an opinion her foreseen head on other
It's you share his job. However much I want the norms and these agencies to change I've revised feeling on how important norm erosion under up under tromp was in light of some of those displaced cessation, controversies This is making me wonder about the counterfactual in which this happens less than three years into the from presidency, because from like where I'm standing. It seemed that a v our government in early twenty twenty, was in a pretty weak point in terms of its reality to use institutional culture to resist the political whims of the White House and lake. Maybe this is me over indexing on immigration, but its. It does kind of seem like logical if you play it out that three years is of career civil servants you know getting fed up leaving and three years of political appointees, getting leg urgent message. is from the White House, and you know being
in danger of like losing their jobs, if something, if President Trump decide They were doing a bad job like that. That's going to take, it Oh and turning the kind of policy that aside. I do wonder what their response might have looked like in a world where, unlike for better or worse right, like it's entirely possible that ace then FDA, where Lake every one was a hold over from the Obama administration might have. Then even slower in approving vaccines, because they would have been like look. We have a critical mass of points in the agency that we control and it is very important to us that we not be seen as intervening on the president's behalf. So you know that that can kind of go both ways to Jerusalem was saying about the importance, be you know the kind of merits of policy being kind of independent of concerns of about independence, but It does seem to me that you know
all the concern about whether or not the U S is prepared for the next ten in his learned from the last one and like frankly, for all the concern that, for other that truth, that in meaningful ways the binding administration has not lake hasn't done alike. one hundred and eighty turn around on the things that failed under trumpet does seem that the? U S, got shown at a particularly bad moment for the federal government to get stuff done, and that makes it difficult to know what the baseline have been for you note from being true and saying things, but not having the kind of pull within the agencies that he ultimately dead. There's a big problem that indirect do with the CDC having to deal with all this at once, which is that, like the government's technology systems, are like really really bad miter standing from the article that deal Mr Leon, New York, magazine's at the CDC, maintains more than a hundred separate disease, specific computer systems and all Oh, the CDC cannot require that Eddie State Health agency or local,
agency like input their data at any particular way or into any particular system. There's one ETA from that article, which shows how there was a equal. I are outbreak involving Roma lettuce and officials had to like base these decisions on which products to pull from the shelves. On like dad's being screen shotted and texted the Tec Abbe Ology and health officials. I mean that to me, as just like so indicative of like a larger breakdown governance we already know about and like it is clear to me from my car. lived in and around the DC area. My father's Agus offer engineering does like cloud computing for the federal government and different agencies, and, like advising, and people on whether or not like their systems are doing well, and it just like this. companies been happening like for like decades at the government, federal government does not have technical systems that are up to date is aware of this problem, As billions and billions of dollars in order to rectify it- and like does not do this, and I think that like
No, it is again not wasted a top up, so it is not a question of like whether people who are smart, who are in government, are aware of this and want to fix it. The bigger problem ultimately also seems to be just that when there are moments of crisis, every single dollars being spent on the crisis and when their moment not of crisis EVA. Sometimes you not funding available to fix the problem, but there's also be not attack Shannon and like adequate pressure to be able to actually institute institutional reforms, which you know. I think this is like a really really like terrifying issue for us to not be taking even more seriously, not just because I feel like covert encoded, strange gonna go away, but because pandemics, likely for a lot of various reasons: ticket actually increasing frequency and that something that, if we don't have these things set up to adequately respond, it is concerning me up: a million super gonna die and we should not. I think the like my usual take pre cove. It is that you know if hundreds of thousands of Americans died, that that would force institutional Reform
as it would just be so unacceptable appreciate that we just reached a hundred thousand Americans dead of that is not the trajectory that I'm witnessing right now and looking at these agencies. My main take away from from this discussion- and this is this- is a boring takeaway, but I'm gonna do it, because this is the way it is we need a non partisan commission now run so hear me up. Ok, I heard all the debates about the when it came to two January six, I agree that with generous six there was of a red herring, any bigger, like investigation into generous Ex was gonna, be like insanely politicized, one half the spectrum was never going to listen to it. I was literally dispute over like who got to win the presidential election of theirs way for that to happen without extreme polarization covered is extremely poor, polarized issue, but I think, like in Congress,
You have a lot of Democrats in a lot of Republicans. You can look at what happened and say you know what the masking advice was screwed up. You know like this. This thing where they lay like botched the tests and early twenty twenty like that bad, though just like objectively bad, no matter how you look at it and well then I living commission, like has sometimes become the sword like like atomic example. In these discussions of like an agency that got stuff done. I dont have faith that you would get the extent of reforms we got to intelligence agencies after dinner. the commission too the CDC Fda. After a like covert response review. Commission, I, like perhaps naively think that Congress would be more receptive to it. Then they went on something like January sex like a report. That said actually the CDC. is to get better data and x Y, see ways I think you can. You can get both Mitch Mcconnell and light touch. Him are on board with that. Actually, it was bad that they screwed up mascot
Guidance seems almost uncontroversial at this point. For for anyone he's like answering that honestly and I think the important it's we were report, all this together from some really interesting investigator reporting. This been happening. The masking was I in the open, because there is a failure of messaging but they're. All these other failures, like the testing one that had to be revealed by a team of the Wall Street Journal, investigating it and just a thorough like investigation and accounting, what went wrong seems like it actually has the potential to like produce some legislation that that might not be complete, we doomed from the outset by polarization, but maybe I'm just like a hopeless romantic. I mean what I say is that I feel like the real problem is that there is such a large sense of anti bureaucracy, and time
government sentiment that has kind of really put a bunch of government officials on edge and bureaucrats on edge. In response, like, I think anything like this, I could occur where it's hard to dysentery like you know the very real, like a lot of shit, what really badly and you guys aren't self policing and self changing in any real way, whether it's because a funding, whether it's because of whatever it is structural like you're, not doing it and its key stealing a ton of lives and So, like you know, any attack at either anything that kind of like, including a lot of the republican rhetoric on against this evening, days necessarily gotta come off is like very anti status and I'm gonna brings us back dodge earlier point about like does that end up? Potentially undermining trust. Even more so in these institutions I mean I'm team
I think, when the government old self accountable people in general feel better about the government, and I think people should be straightforward about anything when the biggest failures of the FDA. It's easy messaging is that you try to treat people their dumber than and people can like. Tell that's what's happening. Affairs is telling people like, oh, like the reason we're not recommending mask is because we think that you might compensate by doing less social decency, like that's treating people they're, like children play patent you're trying to like manipulate, and they got kind of behavior thing to me as, like I understood and why there's a sphere of like just giving people the end nation, but declared this point that its eroded norms to release of your points out I don't I don't amongst. I got nice optimistic as you are, but I think that it ain't. No, I'm not I'm not a big fan of commissions, but I guess it couldn't hurt didn't hurt on that rousing know we're going to take our second break out. When we come back, we have a white paper that is also about covert. You can't escape it, a bizarre, a slightly different issue, inches exactly how many people have died due to cover it.
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The weeds listeners get ten percent off their first month at better help, dot com, slash weeds, that's, b e t, T, R, H, E Lp, dotcom, slash, weeds, all right, we're back and our last section of the pursued and our last new episode of twenty twenty one is on a paper Christopher Room whose own economist at the University of the paper is titled access deaths in the nodded states. During the first year of covert nineteen it is not a clever title, but it's exactly what the papers about. So the big takeaway here is that if you compared us from March two thousand and twenty through February, two thousand and twenty one to the number of deaths, would have expected without covered. You get a little under six hundred and fifty thousand excess deaths. So to compare that turn to what we thought before I double checked:
de our world and data tracker, which was tracks all the official death numbers in countries around the world and officially as the end of February? Twenty one, the death toll in the: U S from covert was five hundred forty thousand one hundred and ninety three people. So Room is finding that excess deaths were about twenty five percent higher than the explicit covered toad. All that the CDC in and then our world and data reporting and to be clear, her room is not saying that these were all covert. Deaths gives a separate. Remember that that that is a little bit higher than the official covert total, but but not that much higher, but he's including everything that might have happened to increase DES relative to the user twenty twenty baseline. So if you died of pneumonia because of like shortages of hospital beds in twenty twenty that should be showing up in his numbers,
the hard thing we're doing this can research is that you have to establish a baseline. You have to estimate how many people would have died if covert hadn't happen, That's always going to require a lot of assumptions room is extrapolating based on the decade before covered by tired, and and there are a lot of things, the change in that decade, we had the opium eight academic. We had some progress against things like HIV and AIDS because of of Crap what's happening, and there is always room for error when you're trying to establish that baseline away Jerusalem, DORA would you make it appear sir, do you change your mind on anything? What what seemed like the big take last year period? MR always my favorite, because conceptual it's extremely simple, like all he's doing, is he saying what are the actual number of deaths and, let's subtract the expected deaths? If Cove it doesn't exist and lights basically that the overall math and the paper and then you gonna, get access debts for back and then like as don't you just.
engine like the really difficult part of that is figuring out like what is it actually was a kind of how you build a counterfactual world and accurately sale. How many people would have died of covert has had an existed, and that requires like mapping out a lot of what covert did. It requires a lot of mapping out exactly what was going on in like previous years and building a counterfactual world that is accurate. That is not being confounded by no there's a lot of variation. If you look in the paper, you can look at them study year, two years from previous years and pretty as they took a lot of differences. There's also some weird variations happens every January, where there's a much larger uncertainty band and another month and his bunch to correct for a bunch that we don't know why that there are differences, and so that's what he's trying investigating his paper and I didn't top line number- is it's obviously interesting? It's you know as a dimensions like the big thing is that he does find six hundred,
excess deaths, but I think the heterogeneity when you look at the difference in a graphic artist, what I found most interesting. So what we already knew is that for people above eight hundred and sixty five, like almost all the deaths, are concentrated here, so he finds three point: five million actual deaths, two point: six million deaths are people above sixty five. He finds six hundred and forty thousand access for fifty thousand of those excess deaths are for people above sixty five and then what I think is interest that for people who are under twenty five, which mean it. You know we expect those people are not going to be a fact by covered much. There's really proportion of their excess debts, have nothing to do directly, decode it at all and are attributed to a bunch of other like potential factors. In particular, we saw homicides going up last year, but also one of things I think is really interesting is like a vehicle debts when a bless. Your time others on the show, but I gotta make like clearly you we in economic downturns, vehicle debts tend to go down on and also vehicles, mild travelled amino did go down and what we know from
doubts. I don't have any an actual research. I haven't haven't seen this YAP alike, from anecdotal findings and and reporting that, like risky driving behaviour, likely what's driving a lot of this, and you know the open roads or may be ins and invite people to drive faster than they would have otherwise cause more people are staying home. What I'm thinking Christopher Room. Also, like looks out is in his research is on debts of despair, which we ve talked about on the show a bed I'm so obviously this is the end Angus at Dayton and encase research around whether or not people's dust adieu to show sides, drug overdoses and alcohol has been going up in and they found that that it has, especially in particular for particular sub groups like white banal college Kate men, so he finds a lot of heterogeneity here too, when you look at depths of despair, so suicides are, stay below, it would have expected. He finds us like white robustly, but drug deaths are thirty percent higher than we would expect
and rarely sure why this is the case is potentially a recession effect, but it also might be the fact that there is this thing. The Herman Lopez may rest peace, I'm wrote about on the hook. The website is that you know there's offend no breakthrough that occurred right around the time that covert. Actually you asked, which has found no usually stayed east of the Mississippi, and then For some reason, it actually started moving west right around the time of covert heads. There might be a supply. Driver to why there is actually a lot more overdressed. That's happening so anyway. There's a lot of like really interesting small things going on in this data. The other thing, I would point out with regard to drug overdose. Debts in particular, is like a lot of these. Residential facilities that are supposed to be supporting people who use drugs had to reduce capacity substantially, just like every other residential facility, which means and a pretty basic level. A lot of people, including people who were getting released from prison, undercut passionate release policies would not. Unable to get like the full support, and this is just kind of the Tipp of the ice.
for a phenomenon that has been described as a kind of Asia and experiment in the mollusk the Social Safety net fork over purposes, because, especially during early lock downs, there was kind of a sudden tearing away of a lot of things that vulnerable people are used to in terms of supporting them and providing monitoring and accountability and leg. It is not. It is not that surprising, whatever your problems would like the rehab industry might be that if you have to you as a matter of law, reduce your bed capacity substantially, you can help fewer people and more people are gonna, be left out at risk. Related to that, though, in thinking about be kind of extent to which are Healthcare capacity relies on the physical, like how many beds are any facility where people can help you and how many people. Do we have to help them like the updated? of the excess debts information, to attribute higher
care to non turvied causes is particular early concerning for me right now, because, as of this particular moment in time when we're taking this episode and when it seems there won't be any like phenomena, No change in the science between now and when it comes out, but with covert, who knows, We're dealing with the Omicron variant, which lemon Mary indications are that it is less severe previous variants, but much more contagious, which public health experts are warning that that is even if it does not lead to more deaths. Going to lead to increasing hospitalizations over what we're seeing right now, which will lead to the same hospital com ass. It concerns that we ve seen recur Lee in various places in the U S throughout the pandemic, and so if we have asked we been wrong all this time about just how much this has been a covert problem, verses, a covert, but also the capacity of the healthcare system problem. Then a strain of covert
It is not going to create as many deaths in the first category. But wait a bit more strain on. The second should be especially worrisome to us yeah. The the point about drug does, as it is the early interests enemy diseases is also found. A fairly massive increase in indirect ass. The same way that does by their numbers in twenty nine here we had about seventy thousand six hundred overdosed ass. In it we had ninety three thousand and twenty twenty, so that's twenty three thousand extra DES, particularly among young people, that might account for a substantial amount of the d under twenty five access. Ass that they came up in the study, and I think, as rules more say in a lot of it is, is that no? I was looking our commonwealth find report on this found that in twenty fifteen
Only eighteen percent of overdoses deaths involves, since that echo, your it's that spent in all current and all other others synthesized opiates and in twenty twenty. It was me and sixty percent, so the share that attributable to them has tripled over the course of five years. But one thing that was pretty really interesting to me and as a cost. Yet with alive reprieve. Seen recently is that, like math seems to be back in a really big way ass, involving math increased by about fifty percent just in the last year, the national did you have drug abuse found that between between fifteen and twenty nineteen, as by recent study? That is that the number of Overdosed s formats, So so we weaken fighting a fairly specific opiate battle on drug abuse and still where the bulk of the deaths are. I dont want to serve obscure that, but one things on these numbers are suggesting to me: is that that we have a stimulant problem as well, and that probably requires different solutions,
we ve done a lot on the lock sewn on replacement therapies. Like other prefer in methadone. All these are very targeted to two opiates and we probably need a new set of of techniques if we want to do harm reduction and and curb deaths in our stimulant based drugs, surge one of things that side concerning to me generally, whenever the stuff happens is, is it feels like nobody, wants to. Ah, but he was too tat the supply issues? Everyone really liked keep out linked demand potential, determinants of of of drug abuse, even the popularity, but do you know the debts of despair lit sure, seems to be in particular because, like the media, like your politicians, really struck, This idea of you know the lower income high school educated. You know white man living in the midwest who is suffering from time to spare and engaging in this? And you know a doing drugs has resulted in preyed upon by on pharmaceutical companies,
and die, you know falling susceptible to that ages. To me, like you know, I'm not! there's nothing to any of that, but it just feels like it's very it really disappointing when, like you know, that's the kind of damage narrative you here but from politicians and from from me outlets within, like you, I look down these numbers and you dont They see like alcohol and suicides tracking with drugs in a way that you would have wished to marry. You dont like see it happening to people who are just all poor in a way that you would, if, if it wishes poverty driving it like there is some then, going on here with them the weighted supply markets for drug markets for These are inter playing in different places in different regions of the country, and we see very clearly that, when financial becomes available in your area, more people die of Sentinel like select. We should profit right away, do not make that open and I'm not. That's like an easy, so there's an easy solution to that, but it feels like it would be better if more, the rhetoric was focused on that, unlike less on trying to like look at these I'll trends and draw a large sweeping social generalizations about where America,
is now which you know who knows it is pause Fifthly, wild to hear you saying that we focused too much on issues of demand and not enough on issues of supply? Currently As somebody who covers a b where leg is routine, for politicians to pretend that if we could somehow lake just crackdown more, we could prevent drugs from entering the. U S and therefore no one would ever get addicted to drugs leg. this is a massive industry and the more pressure you put on it, the more sophisticated it gets and while I am not saying that, like the- U S, government is doing a perfect ah of preventing drugs from being imported into the country. It's like also through that there is new that there are new techniques being done, every day that there is a really strong incentive to push supply to other drugs once there's a crack down in one drug, and so you know those aren't really easy prey comes either and their problems that have pretty substantial lake
downsides. If you, for example, you know conflate like drugs muddling with human smuggling and decide didn't anti that lake, because there are people who profit from both that you have to prosecute people who are being smuggled the same way. You had prosecute them. If they were, you know involved in the criminal enterprise like there all kinds of of mostly political downsides here, but it's also just like. I don't. I haven't seen a focus on supply. That is, RO war on drugs. That was known As- and I know I know I just I don't know what a what an what a non war on drugs supply focus. Conversation looks like. We just haven't been able to model that because it does not having, I would just say we would stop. We would stop saying that people can just. We should stop making people choose like if people are happier they wouldn't use drugs like that's, clearly gets no out, I mean only thing out here is that, as part of me, hammering home, that math is back, Beth is, is a hard supply problem then heroin,
I gather when you have to import from the golden triangle: old, Afghanistan somewhere. I live main Hawaii and they have the lowest rate of opiates deaths in the United States cause you are a drug trafficker. It does not make a lot of sense to sound like a special shipment that's, where a string of islands in the middle of the Pacific, but but they do have, is a ton of math, because you can make math in Hawaii and I think we're in for another round of pseudo that fights yeah. That's it we're we're building back better. The american drug industry is research and she sits, and with that I think, would Chirac written on honestly story note about America's economy from DORA up. That is all for us today and those all for us in terms of new episodes in twenty twenty one. Thank you so much to vices Jerusalem dumps theirs and Republicans darlin for joining the panel and for all work on the series, America's public health experiment are produced,
so we will launch a living person. Is our editorial adviser amber all? Is the deputy editorial director for talk podcast and your hosting Matthews arbiter. Sign up for a newsletter for more arguments and insights from the weeds team, gotta, vocs, dot com, Slash Eads letter This is more or less new episode forbid. Vocs audio is hungry down for the how they break. So you won't hear much from us until next year, but we are so publishing an episode next Tuesday. It's just going to be an older one. From earlier this year, we will see that the weeds is part of the box media pockets network.
Transcript generated on 2021-12-21.