New Coronavirus News from 3 Mar 2023

When covid politics collides with covid science, public health loses [Grid, 3 Mar 2023]

By Jonathan Lambert

Quick takes about what works and what didn’t obscures the inherent uncertainty of the scientific process, eroding trust in science.

With covid now an afterthought rather than an emergency in the minds of many Americans, politicians and pundits are rushing to have the final word on who handled the crisis well — and who dropped the ball.

These recent declarations of pandemic winners and losers often ignore the iterative and uncertain nature of science in favor of blunt headlines and slogans bolstered by cherry-picked studies. And they often elide scientists’ and policymakers’ honest grappling with major decisions in the face of limited and evolving data.

“The Mask Mandates Did Nothing. Will Any Lessons Be Learned?” New York Times columnist Bret Stephens declared last month, flattening a highly nuanced, heavily caveated scientific study of mask-wearing into a single talking point. And after reports this week that the Energy Department concluded with “low confidence” that a lab leak in China likely caused the pandemic, several prominent Republicans touted it as ruling out a natural origin. They included Sen. John Barrasso (R-Wyo.), who tweeted that “China is responsible for COVID.”

Such black-and-white pronouncements can muddy the public’s understanding of what worked (like vaccines), what didn’t (ivermectin), and the wide gray area around other measures, like mask mandates or school closures, that scientists are still evaluating. Three years into the pandemic, the United States’ political war over covid has eroded public trust in science, with the biggest drop — more than 20 percentage points — among Republicans. That polarization makes responding to the next crisis, whether it’s a pandemic or something else, even harder.

“Those who have dogmatic positions and are playing to the politics can be extreme, use hyperbole and be definitive in their pronouncements,” said Timothy Caulfield, research director of the Health Law Institute at the University of Alberta. “Those who are trying to be close to what the science actually says have to have all these caveats and hedge what they say, and it’s just like [they’re] going to gunfight with a knife.”

Politicization leads to mistrust
Before covid entered the global consciousness in early 2020, Americans’ trust in science was largely bipartisan, with relatively small gaps between the parties.

“There just wasn’t much of a political divide,” said Cary Funk, director of Pew Research’s science and society team, which has tracked public opinion on the topic since 2016. But during the pandemic, a gap appeared — and it continues to widen.

In January 2019, a Pew poll found that 88 percent of Republicans had a great deal or a fair amount of confidence that medical scientists act in the best interests of the public, compared with 87 percent of Democrats. By September 2022, only 68 percent of Republicans reported the same, compared with 91 percent of Democrats. The partisan gap is even wider — 63 to 89 — for trust in scientists generally.

That split didn’t start right when the pandemic hit, said Funk. “For about six weeks, we saw very little partisan division about what was happening,” she said. “But shortly thereafter, we started to see this political division open up, and that really became a hallmark of public opinion around everything connected with the coronavirus outbreak.”

By that point, the country was in the throes of the first covid wave — battling a virus the world knew little about, while politicians sniped over how to handle it and who to blame.

President Donald Trump called the coronavirus a “new hoax” at a campaign rally in late February 2020, and continually downplayed the threat during weeks of daily White House press briefings. Democrats lobbed heavy criticism at Trumpfor moving too slowly and minimizing the potential risk, at times exaggerating how Trump’s policies affected the nation’s readiness to detect and fight pandemic threats.

“Those political cues can be very sticky and hard to strip away,” said Rebekah Nagler, a health communication researcher at the University of Minnesota. “When you introduce that politicization element, you’re inviting people to interpret new information through a political lens.” A recent history of polarization around health policy, including support for the Affordable Care Act, may have also primed the public to take political sides on covid, she said.

In those early weeks and months, uncertainty about the scale of the threat the virus posed, how it spread and what could be done to stop it further fueled the partisan divide, creating an opening for mis- and disinformation to flourish.

“Politicization can involve the strategic elevation of uncertainty around science for political gain,” said Sarah Gollust, a health policy researcher at the University of Minnesota.

In early 2020, “science was moving so rapidly, for good reason, as the scientific community was trying to make sense of a novel pandemic,” she said. Scientists raced to post new findings online as preprints, bypassing the normal slow process of peer review, to get information out as quickly as possible. That created a flurry of often conflicting information that was challenging for the research community to sift through, much less the public.

“There was so much evidence being produced so rapidly, there was so much more to pick from and potentially elevate conflict,” said Gollust.

Shifting guidance
Official guidance often shifted as a result of that evolving understanding and a dynamic environment. Initially, public health officials dissuaded people from buying masks to ensure limited supply could be used by medical professionals. But in early April 2020, that guidance changed, in part because of new science on how the virus spread.

The rapidity of such changes, while likely necessary, can erode trust, said Gil Eyal, a sociologist at Columbia University: “If the surgeon general says you don’t need masks, because they won’t protect you, and then the CDC corrects course, that sequence is not going to elicit trust.”

Often, public health officials failed to clearly communicate the rationale for those changes.

“Guidance was necessarily going to change because so much was unknown,” said Nagler. But how those changes get communicated is crucial for maintaining trust. “I think CDC in particular really let us down by not being more transparent and clear about setting that expectation,” she said. For example, in May 2021, the Centers for Disease Control and Prevention said vaccinated people no longer needed to wear masks indoors but abruptly reversed advice in July because of the delta variant. Administration officials tried to explain that the situation had changed, but not being explicit and forceful about that uncertainty upfront opened them up to charges of “flip-flopping.”

“Political actors weaponized this uncertainty,” said Caulfield. “It creates an opportunity for those who want to generate distrust to generate distrust because they can say, ‘This institution said X, and now they’re saying Y, that means you can’t trust them,’” he said. Fast-forward to today, and virtually every aspect of the pandemic — from treatments to the value of masking — is viewed through a partisan or ideological lens.

“Once something becomes about ideology, it becomes very difficult to change people’s minds,” said Caulfield. “It almost doesn’t matter what the science says.”

Despite evidence that covid vaccines and boosters are safe and effective, uptake remains lower among Republicans, likely contributing to partisan gaps in covid deaths that emerged after the vaccine. And ivermectin — an anti-malaria drug touted by Trump in 2020, which study after study has shown to be ineffective for treating covid — continues to be pushed by some doctors, who are even expanding their recommendations to diseases like RSV and flu. (In the meantime, the promotion of ivermectin as a covid cure resulted in a rise in poisonings linked to the drug, which is also used to deworm horses and other animals.

While evidence against ivermectin is well established, questions around the effectiveness of policies aimed at reducing covid’s spread, from masking to school closures, are still being studied. Answers are likely going to be complex and context-dependent, arising from many, many studies carried out in the coming years. Some questions, like whether the coronavirus was leaked from a lab or jumped naturally from animals to people, may never be definitely answered.

Polarization around these questions favors quick and easy answers, as the past several weeks have shown. Ideological actors can seize a study and label it as completely definitive when it’s anything but, said Caulfield. But that nuance can get lost among those of a similar ilk, he said, creating a revisionist history of the pandemic.

“There’s this profound cherry-picking, they select a favored scientific story, then try to ossify it as the truth,” said Caulfield. “It’s damaging on so many levels.”

Can trust in science be rebuilt?
Three years into the pandemic, the trust-in-science partisan gap shows no sign of shrinking.
Covid politicization is still on display as candidates and potential candidates for the 2024 presidential race look to score covid points, and as House Republicans launch inquiries into the Biden administration’s handling of the pandemic.

That has profound implications that go well beyond how we understand this pandemic — which is still killing more than 300 people a day in the U.S. — to what we do when the next public health crisis emerges.

Depoliticizing covid after so long may be challenging. “I wouldn’t say I’m super optimistic about a reframing at this point, in part because these beliefs are so sticky,” said Nagler. But there are strategies scientists and public health officials could employ going forward.

One is to be clearer about how science works. Emphasizing that the scientific process is our best way of making sense of the world, but that it’s iterative and inherently uncertain, can go a long way, said Nagler. “We have some data to suggest that if you remind people about how science works, it can be somewhat protective in how they respond to conflicting health information,” said Nagler. That doesn’t change the messy information environment, she said, but it can improve people’s ability to operate within it.

For public health officials, being transparent about decision-making is crucial, said Kasisomayajula Viswanath, a health communication researcher at the Harvard T.H. Chan School of Public Health. “We have to admit that we don’t know certain things and will get some things wrong, that’s just the nature of science,” he said. “But we’ll need to be honest and open [with the public] and provide that information,” on how decisions are being made, he said. “This needs to come from the highest levels of government.”

But public health messaging can’t come solely from on high, Viswanath said. Local organizations and leaders often hold more credibility for community members, making them better messengers, he said. “We need to engage them in this process of rebuilding trust.”

There’s no easy way to reverse the loss of trust in science and public health — but “we don’t have a choice,” said Viswanath. “How we do that is the big question.”