The COVID Speech We Need

(The following is a speech I would give if I were allowed to replace the current head of the Presidential task force on COVID-19, Dr. Anthony Fauci. We have had a huge loss of trust in our public health institutions and a change must be made. This is the speech someone needs to make as they replace the current regime which has had a run through two presidential administrations.)

My fellow Americans, it is a great honor to receive this appointment to head the US task force on COVID-19. I want you to realize that I approach this position with great humility recognizing that I can never have enough knowledge and must rely on others to gather the most complete picture on this virus. The fact that this is a new pathogen means that our knowledge is ever-evolving and we must be nimble in our course of action.

It has been a long and dark 22 months that we have been dealing with this pandemic. SARS-CoV-2, the virus that causes COVID-19, has killed hundreds of thousands of Americans and millions world wide. Make no mistake, this virus can be deadly.

Unfortunately, throughout the pandemic’s response, the American people’s trust in public health, modern medicine, and government authorities has eroded significantly. Large swaths of our population no longer trust voices whom they deemed trustworthy just two years ago. This is mostly the fault of those in charge of public health and I seek to reestablish that trust.

Of course, regaining lost trust is not easy. It requires those who were in authority to accept their missteps. It requires a whole profession to admit it was wrong.

Admitting you were wrong or pursued the wrong course of action is very difficult. But it is the right thing to do. It is essential if we ever want to be trusted again by the public. As scientists, physicians, and federal, state, and local public health authorities we need to begin to mend those divisions today.

It begins with those of us in positions of power (those with greater scientific knowledge, the backing of government laws, access to media outlets) to start exhibiting some empathy. We need to begin to approach every conversation with the public with empathy as our number one PERSPECTIVE. It is through accepting the validity of the emotions of others that we can begin to come to a way forward that is no longer divisive.

We also need to accept that there is a lot we do not know about COVID. Our information is imperfect and so have our responses. This is to be expected and nothing to be ashamed of. However, acting as if we have perfect information or guaranteed solutions when no such thing exists - is not allowed.

Too often, we have guessed at the best policies for controlling the pandemic and then ridiculed, shamed, and chastised those who disagreed. We not only told them they were wrong, but we accused them of being uncaring, selfish, and sometimes even murderers because they wouldn’t adhere to safety protocols. We did not meet them with empathy or attempt to understand their concerns.

I have seen countless popular figures in medicine, friends, colleagues, and family resort to accusing anyone with a deviation from the dominant strategy as evil people. The ‘othering’ of those who disagree and smearing of their views in order to make them submit is not effective and just polarizes those in medicine and the public who might have honest disagreements.

This behavior needs to stop today.

I cannot stress this enough. This is one of the most ineffective persuasion techniques and will only further harden hearts and minds against your positions.

This is not to say that there isn’t a lot of misinformation and terrible advice out in the public sphere. There is a lot. But the most effective way to dispel bad information is with good information and engaging it honestly. Some, you will never convince but if you approach them without empathy and as unredeemable people then you will never succeed.

So let’s begin with how we, as public health, science, and medicine have failed the public.

Initially, very little was known about the virus. It is understandable that strategies and efforts to control the pandemic were misplaced and ineffective. No one had a proven strategy to control a global pandemic of a highly transmissible respiratory virus. There was plenty of panic, fear, and uncertainty especially after seeing images of what was happening in Northern Italy and then New York City.

We were unprepared for the pandemic. And maybe one can never be truly prepared for something like that. We had fragile supply chains and a lack of enough personal protective equipment for our medical staff. But most of all, we had only educated guesses as to what the best strategy for containment and treatment was for this novel deadly respiratory virus.

Fortunately, through trial and error, observation, and the tremendous work of scientists and physicians - we now have made tremendous strides towards minimizing the damage caused by COVID. We have multiple extremely effective vaccines for preventing severe disease and hospitalization. We have learned a lot about treatment and know how best to ventilate and treat patients. We even have new promising therapeutics.

However, despite all of these amazing treatments and innovations we need to keep our eyes focused on what is achievable and what cannot be done. This will help establish our overall approach to the pandemic going forward.

First, what was suspected before is now beyond doubt, SARS-CoV-2, is a virus that will transition fully into being endemic. This means that it will never be eradicated. From now to the end of time, human beings will get infected and transmit it to others. It can infect other mammals which means that even if we successfully kept it out of every human on the planet, it would be waiting in the wings in the animal world to reinfect humans.

Second, it is clear that if you have long term immunity to the virus either through a prior infection or vaccination - you are generally more protected from serious disease. As with other viruses, we would expect that each subsequent infection (or vaccination) will work to provide a better long term protection from bad outcomes.

Third, although the vaccines and previous infection are effective at preventing severe disease they are clearly not especially effective in preventing infection and spreading the disease to others. This has been especially true with the newer omicron variant. Therefore, it is important that we no longer base our public health strategy on vaccination as a means of controlling the spread of disease. Likewise, interventions that failed to control the virus before will obviously be of little benefit in controlling a more infectious variant like omicron in the future.

Fourth, previous attempts to control the spread of COVID with masking, mandates, lockdowns, school closures, and distancing have been largely ineffective. There is so little difference between different states and cities with varying non-pharmacologic interventions that it is not worth the disruptions that these cause.

Fifth, fortunately, children are largely spared from serious complications with COVID and we should start treating them as such. For those wishing to vaccinate their children, vaccines will be available but it does not make sense to try and control the spread of the virus through vaccination of young children for the reason mentioned previously. Vaccination should be seen as protective for the person receiving the vaccine - not the community.

Sixth, we need to start having serious discussions within the academic world where we openly debate therapeutics and interventions. There is a lot of disagreement both in America and the world for many of the mitigation strategies employed during the pandemic. There is hardly consensus on topics such as masking in general, masking for school children, the effectiveness of lockdowns, the risks and benefits of vaccines, etc. Only by hosting conferences, panels, and debates with respected scientists and clinicians can we arrive at best practices.

Seventh, related to the last point, it is time for us to acknowledge the costs of interventions that are implemented by public health officials. During the pandemic, we have seen a massive increase in mental illness (especially in children), childhood obesity, speech difficulties, plummeting academic scores, economic displacement, and more. Sadly, much of these have been borne most by the most vulnerable in our society who have the least means to recover academically, financially, and medically.

Eighth, because the pandemic strikes hardest at those who are the oldest and sickest, we need to prioritize protecting them and providing them with the care they need. This includes encouraging all Americans who are obese (a majority) to start exercising and eating better. This is a great time to encourage everyone to get outside and get active.

Finally, I believe one problem with the lack of dissent and discussion within our scientific circles has been related to how basic science and research is funded. Currently, funding for most academic centers, foundations, and public laboratories is through the federal government and directed by only a few people. A great many scientists and physicians have felt incapable of offering a difference of opinions on current policy because they feared it risked them losing funding. We need to find a better and more decentralized way of funding science so that people are freer to pursue innovative research and challenge orthodoxy in robust public debates.

In closing, I want to be clear that there is still a lot that we do not know about this virus or how it behaves. We don’t know why it comes and goes in waves throughout the world or regions. It is important that we accept that we cannot control a virus that has rampaged through every continent (including Antarctica) despite our best efforts to contain it. But we have the tools to minimize its impact and generally keep people safe from the worst of outcomes.

That’s often all that we can do in life. We control what we can control. Accept what we cannot. Continue to learn more so that we can improve outcomes and the lives of those afflicted. While remembering our mistakes and errors in judgment so that we do not repeat them again.

It’s important to not do something just because it feels as if something needs to be done. We must use reason and an understanding of human nature to think through the tradeoffs of whatever we do. Too often we have failed that task but it is never too late to start. So please join me in celebrating life, each other, and our determination to make tomorrow a better day for all Americans.

Thank you.

Eric Larson, MD — Dr. Eric Larson is the creator and host of the Paradocs podcast.

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The COVID Speech We Need

Episode 158