In the fog of coronavirus, there are no experts
By Ross Douthat
Ross Douthat has been an Opinion columnist for The Times since 2009. He is the author of several books, most recently, “The Decadent Society.”
Since the election of Donald Trump, the American media has become invested in the idea that the modern information landscape is defined by a great struggle between truth and falsehood, facts and misinformation, the real news and the fake. In this drama, there are enemies of truth, and then there is a besieged edifice of expertise, which needs to reclaim ground — whether via better fact-checks or better Facebook regulations — that’s been lost to trolls, populists and scam artists.
This has always been a dubious and self-regarding framework, but in the coronavirus era it has become particularly useless. Not because it misdiagnoses Trump himself: Our chief executive is, indeed, bumptiously dishonest, a manure-shoveler without precedent in the modern presidency, a man with little capacity to handle even a mildly inconvenient truth. No one expects a truthful and realistic appraisal of the crisis from this president; any sensible person should look elsewhere for the truth.
But once you look elsewhere, it quickly becomes clear that no unitary and reliable edifice of truth exists. The only place you can find it is in fiction, specifically the cinematic anticipation of this outbreak, Steven Soderbergh’s film “Contagion” — in which the professional health organizations are admirable, nimble, evidence-based, with just enough rule-bending here and there to make the necessary leaps toward a vaccine. Meanwhile, the internet is terrible, embodied by a sinister blogger peddling a quack cure. Only institutions can be trusted; outsider “knowledge” leads only to the grave.
That’s the movie; the reality has been otherwise. In our actual pandemic, most of the institutions that we associate with public health expertise and trusted medical authority have failed more catastrophically than Trump has.
The worst offender was the World Health Organization, which didn’t side with “facts” and “science” in the early days of the pandemic: It followed its own political imperatives and sided with China, accepting false and propagandistic assessments and ignoring crucial evidence because it came from Taiwan and not Beijing.
Less corruptly but no less disastrously, the Centers for Disease Control and Prevention and the Food and Drug Administration committed serial malpractice across the crucial month of March, botching, delaying and impeding the development of the necessary tests. Both American and international medical authorities lied to people (or, if you want to be kinder, to themselves) about the efficacy of masks. And Britain’s public health experts confidently rolled a complex plan that was supposedly smarter than a simple lockdown — except that it turned out to have missed some basic facts about the virus.
Failure and recklessness aren’t universal; plenty of public health authorities have acquitted themselves better than Boris Johnson’s advisers or the W.H.O. But there is no definite pattern of outsiders being wrong and dangerous and insiders being trustworthy and good, and indeed up until mid-March you were better off trusting the alarmists of anonymous Twitter than the official pronouncements from the custodians of public health.
In part this reflects the decadence and incapacity of Western institutions (Pacific Rim institutions proved themselves a lot more trustworthy), but in part it isn’t any institution’s fault. A pandemic is a novel circumstance and challenge, a pandemic in a globalized world even more so, and the institutional ways of acquiring information and acting on it — the bureaucratic approach to science and policy — were never going to be commensurate to the problem the coronavirus posed.
That doesn’t mean you should ignore experts and just take random posts and Twitter rants as gospel. But under conditions of fog and uncertainty, armchair epidemiology will sometimes reach truths sooner than officialdom. If one Medium post foolishly lowballs the disease’s contagiousness, another will make a cogent case for masking long before the C.D.C. did. If one nonscientist offers some dubious casualty projections, another may tease out a high-profile model’s crucial faults. And if a certain line of argument is bad — as I think, and argued last week, that the right-wing anti-lockdown argument is bad — then it has to be judged on its own merits, not just dismissed because it lacks the C.D.C.’s patina.
The official experts, under such conditions, are most trustworthy insofar as their admonitions track with nonexpert common sense. The approach that most experts are currently urging, for instance, is not some complicated high-science approach to disease management, but the most basic pre-modern method of disease control, as obvious to 15th-century Florentines as to 21st-century New Yorkers — shut things down, quarantine the sick and hope for the best.
Whereas the more specific and granular the experts get, the more the fluidity and chaos of the situation makes their pronouncements dubious. It’s good that we’re modeling the arc of the pandemic, but that doesn’t make any of the models trustworthy. It’s good that we’re trying to figure out how the disease spreads, but none of the claims so far about how you’re most likely to get it (from air, surfaces or otherwise) or who is most at risk (whether from viral load or pre-existing conditions) can be considered at all definitive. It’s good that we’re practicing social distancing, but all of the rules we’re implementing are just rough and ready guesstimates.
And you don’t want to overweight the pronouncements of official science in a situation that requires experimentation and adaptation and a certain amount of gambling. Yes, you should trust Anthony Fauci more than Donald Trump when it comes to the potential benefits of hydroxychloroquine. But the exigencies of the crisis require that experiments outrun the confidence of expert conclusions and the pace of bureaucratic certainty. So if you’re a doctor on the front lines trying to keep your patients from ending up on a ventilator, Dr. Fauci’s level of caution can’t be yours, and you shouldn’t be waiting for the double-blind control trial to experiment with off-label drugs that Spanish and Chinese doctors claim are helping patients.
The same logic applies for policymakers, for whom there is never going to be a definitive, one-size-fits-all blueprint telling them how and when to reopen cities or communities. Every single reopening will be its own unique experiment, with confounding variables of climate, density, age and genetics that are nearly impossible to model, and the advice of epidemiologists will only go so far. Governors and mayors will have to act like scientists themselves, acting and re-acting, adapting and experimenting, with expert advisers at their shoulders but no sure answers till the experiment begins.
And the logic applies to individuals as well. Most Americans who contract the coronavirus, at this point, won’t even get a test, let alone sustained medical care or supervision. Many people who do get a test will have solid reasons to doubt the negative result. Which means that they will have to make countless important decisions — about what to ask of their doctors, what medical websites to trust, how to take care of their spouse or kids or parents, whether and when to go to work — in a context where the only relevant sample size is one, themselves, and where there is no advice that can be considered medically definitive.
No doubt some of them will behave stupidly or recklessly, just as some governors and mayors will make terrible mistakes once reopening begins. But we don’t have enough information to know what counts as wisdom yet. Is it stupid to ask your doctor to prescribe you an off-label drug if your breathing is constricted, hospitals are overcrowded and 2 percent of people with your condition end up dead? Is it stupid for rural states to reopen schools if their infection rates seem low? Is it stupid for religious organizations or community groups to bend the rules of quarantine to help people survive isolation and avoid despair? Neither Dr. Fauci nor any official institution can answer all these questions. We’ll have to answer them one experiment at a time.
As a society our struggle with the coronavirus resembles the experience of the sick person afflicted with a disease that’s unknown and or misunderstood by medical science. Before falling ill, this person imagined the world of science as a stable room, well-built and well-lit, with a sturdy floor beneath. But now the floor has given way, the patient has fallen through, and in the basement there is darkness, strange shapes, things you can possibly identify by feel but not by sight.
There’s still some light coming through from above, from the world of certainty and expertise, and it’s important to make use of it, to see what can be seen in its illumination. But those shafts of light don’t fill the whole basement, and what they do light up can be partial and misleading. So if you’re going to find your way out and up to health and safety, you have to be prepared to grope, to stumble, to make your own light, and sometimes to move by feel or instinct through the dark.
Source: The New York Times
