The fifth anniversary of President Trump’s statement in March 2020 of a national emergency COVVI-19 caused a construction in retrospective evaluations. The government agencies, the qualified panels, the reflected image teams and the media contributed to an extensive post-mortem. The purpose of being informed of the devastating toll pandemic in the hope that greater preparation for long -term crises will be prepared.
A giant component of this research is healthy: calls to actions, to rationalize the exchange of knowledge, speak more obviously in a crisis and develop public trust in government and science, are difficult to challenge.
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But these post-mortms also reflect a disturbing trend: they do not fix them together to evaluate the express policies and interventions that have worked, which did not do so, and that would have caused damage. This basic consultation, the balance of what stored life, of what is the position of lives and what was the attributable collateral economic damage, is still in large part without response.
In public aptitude and social sciences, this is called the evaluation of the results. This is how we distinguish between intelligent intentions and effective policies. And his almost general absence of the COVVI-19 autopsy is the dog that did not bark. Perhaps many are looking at the elephant in the room: can we distinguish between “what the virus has done to us” and “what we have done”, for the whims of judgment and human institutions?
During the pandemic, many interventions were rapidly deployed, with ethical urgency and certainty. It was understandable. But five years later, we will have to ask ourselves which of these decisions has given effects and which ones may have bothered things. On the other hand, the same erroneous executives who missed the crisis continue to consult our understanding of this. The autopsy of the status quo of public fitness now uses the same distorted lens that has misunderstood the facets of the pandemic in a genuine time.
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Throughout the crisis, science was used to justify politics, not to consult it. The messaging was occasionally inconsistent, listening politically and depended too much on the hypotheses and hypotheses that were not founded in fact. Instead of adapting the hypothesis to evidence, the political reaction was occasionally only the opposite. From time to time it was formed through orthodoxy, institutional thinking and partisan polarization.
It is not just the wisdom of the decline to say that. Many of those mistakes were evident at the time. Science has become a rhetorical shield, “follow science”, when it deserves to have been a process of testing, refinement and correction without stopping. This did not take place enough.
Some examples are now well known. The virus was basically extended through aerosols suspended in the air, not in the drops, making divisors of plexiglass and in deep cleaning rituals. The closure of beaches and prohibitions in outdoor meetings lacked clinical justification. The check deployment was slow and chaotic. The 6 -foot social distancing rule was arbitrary. The mask recommendation has been replaced several times and have been delivered with condescension instead of clarity. Perhaps the maximum tragically, inflamed patients returned to breastfeeding houses at the beginning, which resulted in avoidable deaths.
The greatest policy disorder was even more substantial. The blockade, school closures and border controls would possibly have had short -term public services, but in many cases, social and economic prices have exceeded the benefits of physical aptitude, especially when they last long after their initial justification. Mental aptitude crises, loss of learning, small closed businesses and generalized distrust were not collateral, were predictable consequences.
And we still do not know how effective many of these policies were because their effects have not been systematically measured. The “science of pandemics” is intrinsically disorderly, but it is also rich in opportunities, especially now. We are sitting on a mountain of data. The decentralized federalist reaction of the United States has worked as a big and out of control experience. Some states and districts have closed schools for more than a year; Others have reopened for months. Some mandates and masks are imposed; Others did not. Some have accelerated tactile tracking; Others have not tried.
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All this variation, combined with demographic data sets, health, education, mobility and detailed economic, creates an unprecedented opportunity to perceive what worked. We can compare the way in which policies have influenced hospitalization rates, excess deaths, long and dressed in prevalence and subsequent effects, such as loss of learning and labor.
Have states with longer locks increased more or worse than those that have lighter restrictions, once demography and fundamental aptitude are recognized? Do you have particularly reduced masking mandates of hospitalizations? What were the long -term effects of distance education, not only academically, but economically and socially? How are the essential effects of disseminated personnel not an essential personnel in a similar way? We have no concept because we don’t look.
International comparisons are equally important. Countries have radically followed other approaches -Chinese “zero cocovable” zero with the auto -off model. Now that the virus has widely swept the world, we can use a rigorous comparative investigation to determine which methods have provided greater long -term results. Were the first triumphs only illusions of time, or have others been overcome? Why don’t we know?
The key is to use the “great knowledge” of fashion analytical equipment: automatic learning, causal inference, chronological series research) to sifle the noise signal. These teams stand out in the control of complex and multivariate relationships, adding confusion variables and we can perceive not only what happened, but why. In many cases, applicable knowledge already exists. What is missing is institutional will and methodological rigor to put it to work.
This inability to consult our pandemic reaction has serious implications for the future. Without a genuine investigation of the results, we are condemned to apply the same distorted lens to the next crisis. “Lessons learned” and the so -called omniscient and anodist and generic generic for coordination and trust do not update complicated and uncomfortable paintings to discover what failed and be willing to say it. Worse, the lack of calculation just deepens a more corrosive inheritance of the pandemic: a cave of public trust. Millions, in the face of combined messages and incoherent policies, resorted to conspiracy theories and have absolutely lost confidence in science. This erosion was not only unsatisfied, but won in many cases. If science needs credibility, you must see your own disorder consultation, not protect it. A rigorous and apolitical postmortem will not be simple; In fact, it can be political and institutionally impossible. But this is the main way to repair trust. Without this responsibility, the next time science asks the public to listen, except other people will. And the consequences of this distrust can simply be catastrophic.
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There is also some other deep problem. Public aptitude, as a discipline, has shown a reluctance to reflect on its own mistakes. Science is intended to be oneself. Public fitness sciences have hardened in political dogma, criticisms were rejected as connecting rods or supporters, and establishments surrounded the wagons instead of inviting a challenge. This will have to replace if we are involved in the future focused on evidence.
If we need to be in a position for the next pandemic, we have to adopt a two -step approach.
First, we will have to unravel science, culture and politics in the progression of pandemic policies. It is only through the understanding of its separate contributions that we can begin to create more resistant methods and based on evidence.
Secondly, we have to expand our preparation goal. The next pandemic would not be looking like Covid -19, it can also be faster, more fatal or biologically unknown. A narrow accessory in respiratory viruses leaves us exposed.
But using an apolitical examination based on the knowledge of our limited reaction is less difficult to say what to do. The same team that can simply: Megado, retrospective analysis, genomic genomic surveillance) require institutional confidence, solid investment and shared commitment with clinical rigor. None of these elements is guaranteed in an environment where science itself is politicized. The erosion of the era of Trump clinical standards, related to a broader cultural reaction opposite to experience, made self -evaluation honestly dictated and professionally heavy.
Meanwhile, many establishments located more commonly to direct this calculation, federal agencies, such as the centers for disease control and prevention and national health institutes, public fitness associations and the main university magazines, have made the decision to protect their positions beyond, marginalizing dissident perspectives. Even magazines committed to clinical integrity acted more as orthodoxy guards than as platforms to reconsider basic hypotheses. If we take the reform seriously, we want more than greater knowledge and analysis: we want interdisciplinary responsibility: a preference for virologists to listen to sociologists, so that modeling have interaction with ethics, epidemiologists to paintings with clinicians in the field. Without this high -level interdisciplinary opening, we threaten to learn that what we already believe.
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There is still time. While the memories fade and political stories harden, knowledge persists. Pandemia has created situations for an opportunity for great national and global learning. But only if we are in a position to ask the right questions and settle for the answers, even when they dispute our hypotheses.
Without this calculation, we end up with an autopsy that looks more like a compliment than an investigation. And with him, how genuine we fought the next war with the team, and the idea, which failed us in the last one.
Steven Phillips, M. D. , MPH, is a member of the American College of Epidemiology and Vice President of Sciences and Strategy for Covid collaboration.
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