The COVID-19 pandemic has highlighted a tension animating the work of self-government in our technologically complex society.
We fancy ourselves believers in democracy — for present purposes, rule by lay people — but safely, successfully navigating the world in which we live requires no small amount of specialized, technical know-how.
In such a world, how can we prevent society from succumbing to rule by cadres of technocrats while also paying proper heed to experts and expertise?
This counts among the most salient questions prompted by the pandemic.
Commissioner Vilma Leake put it nicely last week when the Mecklenburg Board of County Commissioners met to consider a new mask requirement in response to the virus’s recent gains in the Charlotte area.
“I am not a medical doctor nor a registered nurse, but just a good citizen who wants to make sure my community is safe,” she remarked.
Leake and the other eight commissioners possess no special education or training in medicine, virology, or public health, but they bear the non-delegable burden of setting policy for the county.
In what manner should they discharge their duties? And how should we assess their work as they try to honor the imperatives of both democracy and science?
Well into the pandemic’s second year, we haven’t reached a public consensus regarding the answers to these questions.
One potential answer presented itself at last week’s meeting of county commissioners in the person of Gibbie Harris, our director of public health.
Harris, who holds an undergraduate degree in nursing and a master’s degree in public health and who, over her thirty-year career, previously worked as health director in Wake and Bumcombe counties, explained to commissioners the rationale for recommending a new mask requirement in Mecklenburg County.
She described the Delta variant of COVID as “incredibly infectious and transmissible” and pointed to recent data in support of this characterization: Between late June and mid-August, daily COVID cases in Mecklenburg increased from 44 to 473, while hospitalizations increased from 39 per day to 260 per day and the positivity rate climbed from 3.1% to 13%. (Over the same time period, the county’s vaccination rate climbed just five points, from 45% to 50%.)
These increased numbers, Harris said, are driven by the decreased efficacy of the vaccines against infection over time, though she stressed the vaccines are holding their own in preventing severe illness and hospitalizations, something she said was documented in multiple studies described in a recent issue of the Morbidity and Mortality Weekly Report published by the Centers for Disease Control.
Put differently, the vaccines do a great job of keeping the vaccinated from hospitalization and death, but not necessarily infection. And with half the county still unvaccinated, increased infections mean increased spread to those who are not vaccinated and who, as a result, are at a greater risk of suffering severe illness or death if they become infected.
“What we need to do if we’re going to keep our children in school once they go back, if we are going to prevent overwhelming our healthcare system, and if we are going to keep our businesses open and our economy thriving, we have to control community spread, and the way we’re going to do that is with vaccinations and with masking,” Harris explained.
She added a qualifier befitting a science-based, data-driven approach to mitigation: “Nothing’s 100%. The vaccine’s not 100%. Masks aren’t 100%.”
Harris added that in the coming weeks and months, the community can expect to experience “peaks and valleys” of infection, and public policy will account for such changes: If rates dip, public health officials will ask commissioners to remove any mask requirement, and if rates increase again, officials will ask commissioners to once again impose such a requirement. This re-evaluation will occur every thirty days.
In sum, Harris spoke tentatively and cautiously, reflecting a certain scientific modesty and recognizing the likelihood that circumstances in the community will change over time and public policy will need to change as a result.
Perhaps most important, her advice to commissioners aligned with the overwhelming majority of medical and public health experts who’ve concluded that a combination of policies, including face coverings, can mitigate, but not eliminate, COVID’s spread.
In contrast to Harris’s narrow, qualified claims, the roughly one dozen anti-maskers in attendance at last week’s meeting, while trying to appear scientifically-minded, made the kinds of assertions fueled by ideological fervency.
“We have no way to know if masks even affect the disease,” Matthew Childs claimed to the sound of applause. This is false, as the American Medical Association, the Centers for Disease Control, and the World Health Organization, among others, have stated.
But who needs experts?
“One reason we disagree with the proposed mandate is the wealth of information we can find on the internet,” Childs said.
As an example, he pointed to an alleged anti-mask observation by Michael Osterholm, director for the Center for Infectious Disease Research and Policy at the University of Minnesota and a former health advisor to President Joe Biden.
So erroneous is this characterization of his work that Osterholm has publicly disavowed it. “Again, I want to make it very clear that I support the use of cloth face coverings by the general public. I wear one myself on the limited occasions I’m out in public. In areas where face coverings are mandated, I expect the public to follow the mandate and wear them,” he wrote.
Another anti-masker, John Hoedeman, rejected the overwhelming scientific consensus regarding the efficacy of masks and likened face coverings to “a magical amulet to ward off spirits.”
He noted the only randomized clinical trial to study the efficacy of masks found no relationship between face coverings and transmissions rates, a claim both true and irrelevant: The study in question occurred in Denmark amidst what its authors described as low levels of community spread during a lock down, which is not at all like our current circumstances, making the study inapposite. (Of note: While anti-maskers regularly cite the absence of such trials as grounds for rejecting masks, experts have explained other kinds of data can be properly considered when assessing the effectiveness of face coverings.)
Meanwhile, Michelle Hoedeman advocated for humanity’s surrender: “The unscientific belief that we, as human beings, can outsmart a virus with our intelligence and our edicts” qualifies as “a fantasy.” She added public officials were “wildly delusional and arrogant to think the policies you dream up could actually mitigate COVID-19.”
Anti-masker Nicole Rega demanded commissioners demonstrate a negative: “Can any of you prove that wearing the mask is not causing harm?”
She already had her answer, citing Dr. Russell Blaylock, a retired neurosurgeon who exists in the backwaters of the internet and is frequently cited by anti-maskers for the proposition that face coverings are not only ineffective, but affirmatively harmful.
Rega may well view Dr. Blaylock’s lack of prominence as his primary credential; after all, she pointed out, the Centers for Disease Control is “a subsidiary of the pharmaceutical industry.” If true, and if other mainstream scientists and experts are also in on the grift, then Dr. Blaylock’s obscurity becomes proof of his integrity.
While the anti-maskers tried to sound like empiricists and scientists and statisticians — “Where’s the data?” they frequently asked — they were, in fact, zealots posing as pragmatists, true believers pretending to be skeptics. Their pseudo-scientific observations sought to conceal the essential truth they accept as a matter of faith, one that will remain unshaken no matter the data: COVID’s no big deal or, worse yet, a fraud and a fabrication.
Multiple speakers observed the virus has a survival rate of more than 99%, while others noted maladies like heart disease caused more death last year than did COVID.
Deploying these simplistic, seemingly scientific talking points constitutes an acknowledgement by anti-makers that carrying the day in public debates requires at least the appearance of scientific thinking.
That said, most anti-maskers at last week’s meeting were content to eventually drop the pretense of relying on the scientific method and instead boldly indulge paranoid talking points emanating from the fever dreams of Facebook, Fox News, and the far-right.
Masks are vehicles of tyranny, not modest public health measures, local businessman Jeff Johnson alleged, and placing masks on children is “child abuse.”
He likened public health officials’ arguments on behalf of mitigation to the boy who cried wolf, ignoring the virus has so far killed 635,000 people in the U.S. — about the number who died in the Civil War — and the death toll is now increasing at a clip of about a thousand a day.
Stu Lockerbie alleged the vaccines, not the virus, have killed “potentially hundreds of thousands, possibly millions” of people. (According to the CDC, about 6,800 people in the U.S. have died after getting the vaccine — not from the vaccine, only after the vaccine — a bit of nuance sure to be lost on most anti-maskers and not proof the vaccine is killing people.)
He also encouraged COVID patients be given access to hydroxychloroquine, a therapeutic fantasy peddled by former President Donald Trump and rejected as a treatment for the disease by the World Health Organization and Food and Drug Administration.
Bob Stebbins suggested “Democrat-governor states” like North Carolina were run by officials aiming to strip the people of their liberty. “This gig is up. We know what’s going on,” he said. “It’s time to come clean.”
Stebbins further suggested COVID patients be given access to ivermectin, a de-worming drug used in livestock not proven to do anything to treat the virus. (Despite this, some people are taking the drug and, predictably, getting sick. Meanwhile, these same people refuse to take a free, safe, effective vaccine.)
Another speaker, Henry, whose last name we never got, warned we were headed toward “a surveillance state” and said if we weren’t careful, the U.S. would end up like Australia, which he described as “a military state.”
And David Olson argued the CDC is “just a big pharma arm of propaganda”; the upper echelons of government have “censored” the truth about COVID; the virus’s death rate “was so grossly exaggerated early on to create panic”; and the vaccines are “illegitimate”: “They’re poison. They’re killing people,” he lamented, adding the proposed mask requirement “is a fear-mongering step toward forced vaccines, social credit scores, and taking away all of your liberties.”
Doing his best to channel Mel Gibson’s William Wallace, Olson closed, “Resist and do not comply with any of these mandates!”
Other speakers had already volunteered they would defy the law.
Jacob Packett said it three times — “I will not comply” — trying to strike the pose of a twenty-first century Patrick Henry, but achieving the look, sound, and feel of a petulant toddler throwing a temper tantrum, mistaking childish contrarianism for human liberty.
As the madness rained down during the public comment period, a lone doctor stood athwart the meeting, yelling, “Mask!”
Dr. Arin Piramzadian, a board-certified emergency medicine physician, took a stand for reason, science, and community with his remarks.
“We know that masks work. Physicians have worn masks for hundreds of years. Children are taught to cover theirs mouths when they sneeze. It is literally the same concept,” he explained.
Face coverings aren’t harmful, he said: “Masks do not lower your ability to breathe oxygen. They do not increase carbon dioxide levels. I wear a mask twelve hours a day. Nothing happens to me. They do not cause life-threatening medical issues. If they did, your surgeon would not wear it for twelve hours a day.”
The anti-maskers were unimpressed.
Stebbins, whose remarks followed Piramzadian’s, began, “I listened to all these speakers. I agree with everything they said regarding the masks, except the doctor that just spoke.”
There exists perhaps no finer explanation for the predicament in which we find ourselves — plagued by a deadly pandemic we seem unwilling to defeat — than the sight of real experts quietly offering modest, qualified policy recommendations while non-experts loudly, confidently, and mindlessly repeat the latest falsehoods, non sequiturs, and conspiracy theories they’ve picked up online.
Suppose you suffer from a terrible malady with debilitating symptoms.
In the search for a solution to your condition, you visit ten doctors. Of these, nine diagnose the same illness and recommend the same course of treatment. The tenth makes a different diagnosis and offers a different remedy.
The experts have weighed in, but only you can choose: Who are you going to believe? Who’s advice will you follow? What are you going to do?
You are perfectly free, of course, to heed the advice of the dissenting doctor. Doing so would be your right, but this misses the point: If you aim to act wisely when freely choosing, how should you go about deciding?
The nine-doctor majority in our example possesses two key characteristics.
First, it possesses expertise. The doctors are trained in the human body and what ails and cures it. They know more than you do, even if they don’t know everything. (You, of course, know how you feel, but this tells you only that something is wrong, not what it is or how to fix it.)
The dissenting doctor also possesses expertise. He went to medical school just as the the other nine did. He’s licensed the same as they are. He treats patients all day, too.
By this criterion, the majority and the dissent stand on the same ground.
The dissenter, though, does not possess the second characteristic held by the other nine: numerosity. There are nine of them, but only one of him. That means nine experts, in light of their education, experience, and skill, all independently reached the same conclusion, while the dissenter stands alone.
Of course, he might be right, and they could be wrong. This possibility cannot be denied, but neither does this possibility compel you to accept the dissenter’s view and reject the majority’s.
What you need in this situation is a practical rule to guide your decision-making: When faced with this sort of lopsided split among experts and when you, as a lay person, must choose a course of action following one or the other group’s advice, how should you go about the business of choosing?
Quite simply, you should play the odds: Yes, the dissenter might be right, but the chances are small that he is correct while the other nine experts each independently reached the same erroneous conclusion. Faced with an unavoidable choice between the two, and absent any persuasive reason to do otherwise, you ought to follow the advice of the doctors who enjoy both expertise and numerosity.
The same practical rule ought to govern our collective work of assessing scientific opinion and engaging in informed, democratic decision-making during a deadly pandemic.
This rule allows us to acknowledge outliers among the experts while also rejecting the folly of binding ourselves to the public health consequences that would likely follow from adopting policies informed by an overwhelmingly dissentious perspective.
Without offering a compelling reason for doing so, America’s anti-maskers and COVID denialists would invert this practical rule of action, granting a sort of heckler’s veto to online cranks and armchair virologists and rejecting the norms of both science and democracy by embracing and seeking to impose upon us a regime of scientific minoritarianism.
Fortunately for our community, county commissioners rejected the anti-maskers’ counsel last week and chose to follow the advice of the vast majority of experts.
By a vote of 6-2, they adopted a new policy for all of Mecklenburg County requiring masks be worn in indoor, public spaces. (Neither of the dissenting commissioners seemed to cast their votes for reasons aligned with the anti-maskers: Commissioner Ella Scarborough didn’t say a word to explain her vote, while Commissioner Pat Cotham voted against the requirement on the basis of a misunderstanding of local government, claiming the mask requirement would be inappropriate because some towns in Mecklenburg don’t want it. She overlooked that it is the county, and not the towns, that sets public health policy.)
Commissioner Leigh Altman stated she would make her decision to support a mask requirement based on “science, not politics.”
Added Commissioner Laura Meier, “We’re in this together. We should work together. We should protect each other. … It is so simple. All we have to do is wear masks.” (She also took a shot at anti-mask hysteria, criticizing constituents who compared a new mask requirement to slavery. “Shame on you!” she scolded.)
Commissioner Leake, who is African-American, pointed out the racial disparity in COVID infections and deaths in our community. As she recounted that friends of hers have died from the virus, a white anti-masker seated in the audience shook her head in disagreement.
An angry Leake, while looking away, responded, “Let me turn this way because this lady’s distracting me saying I’m not telling the truth by shaking her head. … These are my friends! I’m not talking about your friends. These are my friends!”
Commissioner Susan Rodriguez-McDowell spoke to anti-masker’s claims of liberty: “I don’t understand how there can be liberty and freedom when disease is allowed to run rampant.”
It was left to Chairman George Dunlap to make the final remark among commissioners: “Woe is he who fails to comply, who gets the virus and that be their death knell.”
Woe to us all that we shall continue to experience needless suffering and death because so many of our fellow citizens don’t know how to think about democracy and science.