Non-Pharmaceutical Interventions Wrapup

 I started this tedious series of posts with a look at other Government-sponsored health initiatives.  The Physical Activity Guidelines and The Dietary Guidelines.

I highlighted the fact that both claim to reduce the risk of various conditions by around 20%, and I made a case that a 20% reduction is significant in aggregate but maybe not so significant for a specific person, given the low risk that some of the conditions already have.  I also ran down the basic requirements for a successful public health initiative namely: the initiative has to be easy to understand, easy to follow, widely communicated and medically effective.

Regarding the "Easy to understand" requirement, these non-pharmaceutical interventions (NPIs) would clearly get an "A".  "Wear a mask", "Wash your hands", "Stand six feet apart" and "Stay home" are about as simple as you can get.

Regarding "Easy to follow", the grade is a bit lower.  "Stay at home" and "Stay apart" had devastating effects on the economy as a whole and on small businesses in particular.  It's very hard to comply with an order that you know will ruin you.  I'd guess that I'd have to score those two as an "F" or a "D".  The other two were relatively easy to follow, but soon became hated images of government over reach.  I think I'd have to score this category as a D or a C overall.

Regarding "Medically Effective", about the most generous score I could give is "Incomplete".  Actually I think the guidelines fail this score as well, but since I don't have any scientific studies proving that,  I can't really say.  The comparison between relatively restricted areas and relatively unrestricted areas does not demonstrate clear benefit, but there are so many variables it's hard to say.  Yet, the burden of proof is clearly in the other direction.  The default mode of a free society is to be "free".  Government restrictions have to be demonstrably beneficial and the rona was still running wild with these restrictions in place.  Maybe the virus would have taken a bigger toll, but it's impossible to say.  So I think I'll stick with my gut and give this score and "F".

Regarding the "Widely Communicated" category, the NPIs get an A+++++++++.  Just about every area of life was tagged with reminders about the coronavirus recommendations.  YouTube would tack on a little link to most videos, especially if its algorithm thought the video was health-related.

In the screen-shot above, YouTube is supplying official information.  What I mean is they are repeating official information from the CDC and other official sources.  Everybody did that.  The Evening News featured talking heads from CDC, NIH, WHO and other health-related alphabet agencies almost every night.  News Reporters flatter themselves as guardians of the truth, holding public officials to account for falsehoods or injustices.  But starting in February 2020, they started repeating every utterance of the Medical-Industrial Complex unquestioningly.  It was Important™ to stay on message.  If you had counter situations, like a bad reaction to the vaccine or just complaining about having to wear a mask, your post on Facebook could be flagged or fact-checked or in extreme cases, deleted (you'd have to really go against the narrative for that, though).

It would be a gross understatement that I heard about these guidelines every single day.  Even now almost two years after the rona started and with vaccines widely available, the signs are still up and we get PSA's on TV on occasion and a constant drumbeat on social media.   Apparently there are still people that need to hear the message.  Hearing the same message every single day is tedious, but not as tedious as having to deliver the message every day.  So it seems like something else is going on when you see it.  A single example will suffice.

In Texas, the head of the executive branch of the County government is called a "County Judge".   The County Judge of Dallas County, Clay Jenkins, tackled the communication issue with a level of enthusiasm not seen anywhere else.  There are beavers building dams less committed to dam construction than Clay Jenkins was to getting the word out about wearing a mask.  There are bees collecting nectar with less determination than Clay Jenkins spreading the Gospel according to the CDC.  If cases were going up, it was extra important to wear a mask.  If cases were going down, it was extra important to not let our guard down and keep wearing masks.  If cases were neither going up nor down, this was no time for complacency -- wear your mask and encourage others to do the same.

In my experience, the percentage of people wearing masks in Dallas County never dropped below 90% or 95%.  So what was all the fuss on Jenkins' Twitter feed about?  On the one hand you could say he was effective, but it's hard to believe that every Dallas County resident was checking their Twitter feed every day to see if King Clay (as he is colloquially known) says it's OK to take the mask off.  There seemed to be another aspect to the story.

King Clay was especially irked that people didn't like wearing a mask.  "We should not see this as an infringement of rights but rather as a common sense proposal from the best scientists" would be a typical nag-o-gram (Clay Jenkins has a sorrowful face and always gave the impression of a long-suffering nurse trying to get his patient to take his pills).  Often enough he'd outright blame non-maskers for whatever rise in cases might be going on.  It seems that Jenkins didn't want people to wear a mask, but wear a mask and love them.  

There definitely is a sense of religious fervor to the CDC guidelines and their promotion by petty tyrants like Jenkins.  In the Gospels, we have the story of the Good Shepherd who leaves the 99 sheep behind to chase after the 1 lost sheep.  So Jenkins devoted his Twitter feed to pestering the 5% who don't regularly wear masks to the annoyance of the 95% who do.  And in Catholic Theology, it's taught that sacraments have power of their own, but are only effective is openly received by the recipient. So a person could be baptized, and Baptism has saving grace, but that grace won't be operative unless the recipient of the baptism embraces it.  It seems that Jenkins thought the same applies to masks.  They won't block the virus unless you not only wear them but love them.  Perhaps even hang your mask at home before a statue of Anthony Fauci or -- more likely -- King Clay himself.

(In reality, Jenkins is not a Catholic but instead a confessional Democrat).

This is unlike anything else in society.  There are no coordinated campaigns to get people to eat less red meat in the name of reducing heart attacks.  YouTube doesn't stick an unwanted link for information about smoking cessation to every video.  Facebook doesn't fact check your posts if you mention twisting your ankle while going out for a run.  There is a pervasive effort to ensure that The Message gets out and no counter arguments go unchallenged.

But did they work?  I specifically chose the counter examples of the Physical Activity Guidelines and the Dietary Guidelines to demonstrate what you get with basically-free interventions: a 10% to 20% reduction in risk.  And I basically support that.  If I haven't said it before I'll say it now:

20% is 20%

If you can do something simple to reduce your risk of something by 20%, and it doesn't cost you anything, then why not?  If someone gave you a quarter for free, it doesn't matter if a quarter isn't worth much, it's free money.  Why wouldn't you accept it?

So with regard to the NPI's there are two questions.

1. Did they produce a 20% reduction in cases?
2. Were they "free" or without other problems?

As to the first question, it's hard to say "Yes" or "No".  I suspect that they did have some effect, but I'd be surprised that they reduced the risk of infection by 20%.  But it's impossible for me to say (especially since I know nothing of virology).  But if they helped even a little, I'm inclined to give the NPI's a passing grade on item #1.  The 20% rule is kind of a coincidence in the other two guidelines.  I don't want to be a stickler on that point.  It's a modest impact for a given individual but if applied globally can have a big impact.  That's good enough.

But they certainly were not "free".  The stay at home orders were devastating and, in retrospect, complete overkill.  The "social distance" guidelines had serious and disparate impacts, favoring big chains over small restaurants.  The cost of those two actions alone are incalculable.

The other two can be said to be "free", I guess, but there's another wrinkle to think about.  When considering the Physical Activity Guidelines, the benefits are universal.  That is, someone might start exercising to reduce his blood pressure, but he gets all the other benefits as well: improved mood, improved cardio-vascular health, reduced risk of some cancers, stronger bones, better sleep, and on and on.  But wearing a mask is just wearing a mask.  There's no serendipitous benefits to mental health, sleep or anything else. Quite the contrary.  Masks reduce the small friendly interactions between people meeting casually. No smiling to strangers.  Adults look even more frightening to children. Masks can harbor other germs which lead to illness.  Masks are uncomfortable.  Even if those are minor downsides (which I think they are) they still must be considered to see if there was a net benefit.  Then there's the "Karen" aspect of masking where already unstable people use masks or the lack of masks as an excuse to lash out at people they are already suspicious of.

To look at it another way, people commonly start working out to lose weight. But you absolutely will not lose weight by working out.  The number of calories you burn by running or biking or aerobics is less than the calories you'll burn eating a candy bar to celebrate your workout.  So, if you work out to lose weight, you will fail.  But you still get all of the other benefits.  By contrast, if you wear a mask to stop the rona, you might fail, but there are no additional benefits that come from wearing a mask, unless you're just shy and don't really want to talk to anyone.  So there's actually a lot more riding on the effectiveness of the mask to determine if it's worth it.

On the whole, I'd score the NPI's as a well-executed failure.  The public relations aspect should be studied for decades to come but the results just aren't there.  I can't count the number of people that didn't die or didn't go to hospital, so it's inevitable.  But I can count the costs of the lockdown and the loss of social cohesion.  And those costs are way too high.