Leaders reacted to COVID with the same tools and without regard to actual dynamics

Politicians are not scientists, yet they have promised that their decisions to contain COVID-19 will be based on science, not politics. Is that even possible?  

The science of COVID-19 still has more questions than facts. The first models forecasting calamity alarmed us, but their predictions have been way off. Each week brings a new revelation. The first cases arrived earlier than the ones we caught. The number of us infected are orders of magnitude higher than we can count. Ventilators, we are learning, may be harmful. And, though tragically fatal for some, COVID-19 appears to kill less often than we first feared. Scientists are working at break-neck speed, but they are learning as they go along.  

Reacting to the specter of overwhelmed hospitals and ventilator rationing, leaders across the country reacted, mostly preemptively, with the same blunt tools and without regard to the actual dynamics of the epidemic on their ground. This was precautionary but not scientific. Every epidemic is local.

How it spreads and who is affected depends on factors very specific to a population. What happens in Wuhan, Milan, and New York doesn’t necessarily happen in San Diego, Houston, and Oklahoma City. As it turned out, in some places the responses have been insufficient and come too late, in other places overbroad and unnecessarily costly. 

The decisions affecting our lives involve more than science; they are explicit judgments about human behavior. Are we best served by restrictive mandates or can we trust in the common sense of most people?  Even before officials closed schools and ordered people into their homes, most people had started avoiding gatherings and unnecessary travel.

They had started applying disinfectants and stopped shaking hands. They had begun telecommuting and staying home when they were sick. For many, self-protective behaviors will now be cemented into their lives. Our need for ongoing government mandates depends heavily on whether we believe these new social norms to be durable.

The “stay-at-home” orders applied in many places throughout the country were decisive actions to protect us from a scary pathogen in the face of uncertainty about our medical response. Many have rallied around “flattening the curve,” yet even after the curve is flat some leaders argue that we all should remain sheltered. Others prefer a stepwise return to normality, tolerating some risk, as long as hospitals can cope. Where we strike the balance between pacing the COVID-19 epidemic and preserving constitutional freedoms and economic health is a question of science and politics.

All of us, not only government leaders and scientists, have weighty decisions in front of us: Where and when do we relax the restrictions? Who should go back to work? When will it be safe to open the schools?  Should the elderly and the ill remain sheltered? 

These decisions are human judgments, based on incomplete data, and value-laden. Decision-makers are reacting to uncertainty and fear and their decisions reflect, more or less, the tolerance they have for risk (and blame). With so little science to go on, decision-makers are influenced by their own priorities, hopes and biases. And, given our polarized political environment, also, their politics.

We all may not have the experience to digest and evaluate the science, but we all have a stake in the outcome. Unfortunately, we remain in a crisis mode with decisions being made behind closed doors and issued to us with prepared briefings. The media is full of information, yet the opportunities for critical engagement either by scientists or the public in decisions do not exist.   

Perhaps, to start, our state and local representatives should hold televised hearings and town halls discussions to have the experts explain the facts and reasoning behind their analysis and response. Even the best science deserves careful scrutiny — that is what makes science what it is. Whatever the forum, decision-makers need to be hearing from more of us.

Making decisions to respond to COVID-19 more openly and with more deliberation will not only make them less vulnerable to error but also will better ensure their acceptance and success. Without this, we risk misinformation, distrust, and, as we are unfortunately seeing, civil disobedience. The policies we implement must be optimized for local contexts and diverse populations, be mindful of obstacles to implementation and avoid unintended and inequitable consequences. 

In times of crisis, we tend to put our democratic principles on pause. No one should be under the illusion that the decisions being made today are objective. Let the scientists continue to inform the people. But let everyday people also help get the science and the politics of COVID-19 right. 

Rajiv Bhatia, M.D., MPH, is a practicing physician in Northern California and an affiliated assistant clinical professor of medicine at Stanford University. He is a former deputy health officer for San Francisco and the co-founder of Human Impact Partners, a non-profit that brings health data and science to complex social decisions.