Who Has the Tools? w/ Justin Feldman (08/18/22)
Dr. Ashish Jha (White House COVID-19 Response Coordinator) 0:01
[audio recording of comments made at a US Chamber of Commerce Foundation sponsored event] One of the things we've spent a lot of time thinking about in the last many months -- and we're going to continue this work, and you'll hear more from the administration on this -- is getting us out of that acute emergency phase where the US government is buying the vaccines, buying the treatments, buying the diagnostic tests, we need to get out of that business over the long run. And so my hope is that in 2023, you're going to see the commercialization of almost all of these products. Some of it is actually going to begin this fall.
[Intro music]
Beatrice Adler-Bolton 0:52
Welcome to the Death Panel, to support the show become a patron at patreon.com/deathpanelpod. As a thank you, you will get access to our second weekly bonus episode just for patrons. This week, we had Abby Cartus back on the show to talk about the social determinants of health. And if you'd like to help us out a little bit more, share the show with your friends, post about your favorite episodes, pre-order Health Communism, or request it at your local library, and follow us @DeathPanel_ . So for today's episode; Artie, Phil and I are joined by friend of the Panel, Justin Feldman. Justin is an epidemiologist of social inequality and state violence, and a Health and Human Rights Fellow at Harvard's FXB center. And he is back on the show today for the ninth time, Justin, welcome to the Death Panel.
Justin Feldman 1:36
Good to be here. I can't believe it's been nine times.
Beatrice Adler-Bolton 1:39
I think next time we have to get you like a commemorative coin, or like a special jacket or something.
Justin Feldman 1:44
I want my Death Panel challenge coin.
Beatrice Adler-Bolton 1:49
Thanks again for joining us today, Justin. I'm excited because we're going to talk about the latest CDC COVID guidance, which was eased late last week, just in time for the start of the school year.
And today, we're gonna get to the bottom of these guideline changes, and show you why these changes aren't actually a reflection of public opinion, but are more about continuing a project of shifting any and all remaining responsibility from the state to individuals. And currently in the United States COVID is still a problem, we have over 41,000 people in the hospital, over 450 deaths a day, that's more than 3300 deaths a week, that would be over 160,000 deaths a year if it stays at that level. And that is three times the deaths of a bad flu year. So this is also to say nothing about long COVID - the long term vascular impacts of COVID infections, which we very clearly haven't even fully realized the scope of yet. And according to The New York Times COVID data tracker, since January 2020, at least one in four people in the United States has been infected with COVID. And at least one in 321 people have died. And I think the question everyone is asking themselves is will it really be possible to even maintain this unacceptably high level of deaths while ignoring infections, which is the plan in the new CDC recommendations. But before we get into the bigger points about how these recent changes continue and solidify the sociological production of the end of the pandemic, I want to get to the bottom of exactly what changed, and what some of the justifications for these changes have been. And then I think we can talk about what these changes actually signal for the fall, and for returning to in person school. Now Justin, you were looking at side by sides of some of the earlier recommendations with the newest recommendations. What's the thing that sort of stood out to you most about these changes as a sort of bottom line?
Justin Feldman 3:45
Yeah, I would kind of think about these guidance changes in two ways. One is the kind of justifications they are using to sell them. And I think those are actually more important. CDC is saying, as you said, they're basically no longer trying to stop transmission. That's not exactly new, but they're using new kinds of arguments, especially this argument around what they're calling population immunity. So whereas much earlier in the pandemic, we had the promise of herd immunity, that enough people would get vaccinated or infected, and that would block transmission to others. And we would be at very low levels of COVID. They're now using a different concept that they have invented called population immunity, basically saying that people have been infected or vaccinated, and therefore if they get infected again, they're less likely to have severe disease, which is true, but it's not like, we're not in a good place. A lot of people are still dying, or becoming disabled from COVID. The actual changes to the guidelines themselves are not that profound, I would say. Some of them are more important than others. The thing that will have the most impact on people are the things relating to schools because some schools do follow, or state government education departments do follow CDC guidelines in terms of policy. And the biggest change there is the shift away from quarantine, or what was called test to stay, basically, we had earlier in the pandemic, if one person tested positive in a classroom, everyone would stay home for 10 days, that gradually got eroded. That's not to say that happened in practice.
Artie Vierkant 5:37
Right. Exactly.
Beatrice Adler-Bolton 5:38
Right.
Justin Feldman 5:38
It happened in some places.
Phil Rocco 5:39
Right.
Justin Feldman 5:40
Not everyone is following this. That gradually got eroded to a lower number of days, to only people who were within six feet, or three feet of the person who was infected, depending on whether they were wearing a mask, this other option got added called test to stay where instead of quarantining, an exposed person could take at least two tests within one week. And if the tests are negative they could continue to be in school. So this has been chipped away to the extent it's even been followed. And yeah, the latest recommendation is basically neither stay home nor test if you've been exposed in a classroom. There are some other changes, but again, I think they will probably have less policy implications.
Phil Rocco 6:27
So Justin, you've been following these guidelines for a while. And, you know, I wonder if you think about it, the thing that occurred to me was that, like, the big change, in a way was in February, which wasn't just like a change in the guidelines, the February change was like, an entire Gestalt shift from the CDC. It was like, don't think about the pandemic like a pandemic, think about it like...
Artie Vierkant 6:50
Or maybe, don't think about the pandemic, period.
Phil Rocco 6:52
Or don't think about it at all, right? That seems like that was the big change. But the way that that change was softened, in a way which was like, really, like, if you think about, like a really radical departure from even like, what the gradual changes had been, or accommodations had been. But it was a pretty radical departure. But the way that I think that the blow was softened for people who are critical of it was they were like: Well, this is based on what we know now. And this is like, based on what is happening now. And that if this situation changes, or like our knowledge, you know, is altered in some way, like whatever, we'll revise at that time. Whereas I wonder if you see what's happening here is like one, they're doubling down on what they did before. And two, they're trying to come up with some way of justifying why current conditions, and what's likely to happen in the fall, won't actually warrant going back to the pre-February status quo.
Justin Feldman 7:51
Yeah, I mean, I think there's a challenge in periodizing this, as historians might say, but yeah, there has been a process, if we think about the Biden administration, there have been attempts to basically, and not only, the non-pharmaceutical interventions meant to disrupt transmission... non-pharmaceutical intervention policies, but also to shift social norms such that people go about their lives, and don't feel burdened with the fear of getting COVID, or transmitting COVID to others, especially with an eye towards bringing back the service sector economy to full levels. And there have been attempts at that, that failed. I think especially about the May 2021 shift to no longer recommend masks for vaccinated people among other things. For me, one of the more troubling moments was the late December shift in isolation guidance. So that's what to do when you are knowingly infected. And that's when it was cut from a recommended 10 days to five days based on essentially no evidence. But they had certain vibes that people would be less infectious after five days. They were going to produce some kind of scientific justification. They didn't because there was none. But now over the months, we've had evidence accumulating that a lot of people are still probably transmissible after five days, though it's a little bit hard to study that epidemiologically, and this you know, in another world, revised guidance could have been changed to reflect the science, and provide a longer isolation period. And, I don't know, build momentum in more progressive states to continue or renew paid sick leave laws that were put in place on a temporary basis. But what we instead have is acknowledging that testing exists...
Artie Vierkant 10:15
Right.
Justin Feldman 10:15
But now instead of using testing as a way to extend isolation, they're using it as a way to shorten the recommended post-isolation mask period.
Artie Vierkant 10:26
Yeah.
Justin Feldman 10:26
So they're saying five days of isolation, five more days of masking, but if you test negative, you can stop wearing your mask. So I see this as a gradual continuation over the last year and a half of the Biden administration aimed at removing non-pharmaceutical intervention policies, and removing social norms that were aimed at preventing illness and transmission. Those efforts to normalize high levels of transmission and sickness and death, have faced setbacks in the past, but they are going full speed ahead with it. They have been... I don't see this right now as a major paradigm shift, really, except that I think people are really struggling out there to put a narrative around our current moment in the pandemic. And, I think, you know, the title of Katherine Wu's article in The Atlantic, that this is a soft closing of the pandemic is how it's meant to be framed. So that they're saying, like, if you were unsure about what you're supposed to do now, well, we're gonna reassure you that it is nothing unless you're a person who sees yourself as high risk, then...
Artie Vierkant 11:48
Then it's on you.
Justin Feldman 11:48
Then it's be careful. Yeah.
Artie Vierkant 11:51
Well, yeah. And so here, I mean, and this is kind of the thing that I think is most interesting to me about these particular changes, and I don't want to downplay them, I mean, any sort of reduction in these guidelines, especially for how much it became kind of a, you know, a media event around this, and what that sort of signals in terms of every single time we see the headline CDC eases guidelines. It always is, you know, it sends a pretty clear message beyond whatever the actual specifics are. And so, you know, again, not to downplay that, but I would say, of course, I think from what a lot of us were expecting, based on what was sort of telegraphed in the media, about CDC showing draft documents to different publications, and getting all of these write ups that were saying, you know, this is coming. I think, considering what was sort of telegraphed. To use an overutilized pandemic word, I think these changes ended up rather relatively mild. But I think the, you know, it's interesting to me though, and I'm wondering kind of where we all think that this comes from, because I think there are a lot of possible interpretations of you know, what it means exactly, but it is very interesting to me that there are so many different, unique but similar takes, like the different but the same takes that are saying essentially, that this, this specifically, these sort of ultimately, relatively minor, again, not to downplay it, they're bad changes, but still relatively minor in the scheme of things... changes to the CDCs guidance constitutes this massive paradigm shift in the pandemic. For example, the New York Times says of this, quote, the changes shift much of the responsibility for risk reduction from institutions to individuals. Washington Post, quote, a strategic shift that puts more of the onus on individuals rather than on schools, businesses and other institutions. The Hill, the new guidance puts the onus on individuals to assess their own personal risk levels rather than businesses, governments or schools. That Atlantic article that you mentioned, quote, this new relaxation of COVID rules is one of the most substantial to date. The virus won’t budge. Nor will Americans. So the administration is shifting its stance instead. And I would just say to all of these statements, like, Where the fuck have you been? No offense.
Justin Feldman 14:15
Exactly.
Artie Vierkant 14:15
But this is literally I mean, as you're saying, this has been sort of the ideological project for the Biden administration. That's one of the... that's become in the last more than a year, one of the main things that we talk about. The whole thing is built on this like House of Cards of personal responsibility, effectively, at this point. I don't know what the pandemic of the unvaccinated line, for instance, was, if not a personal responsibility line. I clearly, as you know, Phil's mentioning, like the community levels change. I think that's a really, you know, like there's all these moments that we could call this turning point towards, you're on your own, right?
Justin Feldman 14:53
Well, yeah, over a year ago. [Rochelle] Walensky (CDC Director) said your health is in your hands. It's like, there's no clearer message than that.
Phil Rocco 15:02
And it's worth highlighting, right? You couldn't write in a writers room, a more like reductio ad absurdum, like version of what neoliberal public health might look like? You know, we're gonna assume that you the individual will be able to do some essentially impossibly difficult calculation in your head about what your risk level is.
Artie Vierkant 15:31
Right. But I am interested in the degree to which it seems like at least to some extent, it is sort of message received now at this point, right? I mean, I am genuinely curious, is it just that the CDC has had to say, like the CDC and the Biden administration had to say, over and over again, this is a matter of personal responsibility, we are cleaning our hands of this? And because this slow, ongoing process of it being over, you know, it strikes me as strange that this would be the moment when, all of a sudden... the message that we've been pounding at the gates about forever, has sort of come through. I don't think it'd be surprising. You know, none of the things that we're saying about the long arc of this will be probably surprising to people who've been listening to the show for a long time. But I do think it's, you know, I wonder if it is just possible that it has become clear to enough people that the language of personal responsibility is a problem within the pandemic, and within the way that we've kind of done this, you know, horrendous neoliberal overall pandemic response, right?
Beatrice Adler-Bolton 16:42
Right. Because there's nothing about the current changes that actually hasn't really been there from the beginning of the Biden pandemic response. I went back to our episode from December, COVID year two, and I went back to your post, Justin, that you did, which was the big long four part post of the timeline of Biden's pandemic response for the first year. And, you know, both of these two things that we, you know, we all did, like, we were very focused on the fact that this language of personal responsibility was really actually what Biden was proposing to come in with, you know? For example, in your piece, Justin, you talk about one of the things that's just very clear from the beginning is this kind of framework that Biden's coming to it with, where he says: Listen, I'm gonna, you know, prioritize interventions that don't shut down the economy, we're gonna get kids back in school, everything's gonna be in person, this is going to be fine. You know, the campaign message was like, quote, I'm not going to shut down the economy, I'm going to shut down the virus, there's going to be a return to normalcy. And we've proceeded apace to this, quote unquote, safe normal, that was sort of promised along this timeline that has been narrativised as sort of just moving forward, right? We basically had the situation where vaccines were being rolled out, and we started to shift to a vaccine only strategy, and we started to reopen even before vaccines were already rolled out. So to just read Justin's piece from January 5 2022, quote: "This tone was struck early, even before Biden assumed office. First, the transition team distanced itself from one of its scientific advisors who in a New York Times Op-Ed called for a national shutdown of four to six weeks. Later, after internal debate, Biden's transition team decided not to warn the public against attending social gatherings during the 2020 holiday season, even as few were vaccinated, and hospital beds were quickly filling. When Biden assumed office in January, he warned the public that there was nothing that we could do to change the trajectory of the pandemic in the next several months." And I think in the same way that this kind of message of; Oh, we're just on this sort of trajectory where we can't change the virus. We can't do zero COVID. That's unrealistic. You know, anyone who calls for zero COVID is as bad as anti vaxxers. You know, this is a message that is pervasive right now. And I think it reflects a very steady and long term project of rhetorically imposing this kind of idea that there is nothing that the state can do for COVID, and that's it's all about personal responsibility. And ultimately, this is reflective, I think, as we've all been documenting of not some sort of new aberration in the way that we do health care, but more of this kind of landscape of just the normal process of commodifying health in the United States. And this is a process of the system of health capitalism absorbing the COVID response. And the Biden administration has been doing a great job of keeping this moving forward apace, and I think if anything these new recommendations are just sort of a shift to them maybe being more open and acknowledging it as Artie is saying. Maybe finally people are sort of getting the picture that this is what's going on. But in many ways this has always been the project. The Biden administration came in promising to shift this response from the state to the private sector. And we are in the middle of that process. And it is happening, you know, regardless of what the science says, ultimately. And I mean, I think Justin, this is something that you've really focused on for a long time now. Right?
Justin Feldman 20:14
Yeah, I agree with that. I think what's going on here in what some people are calling the the fifth wave in the US of COVID infection. It's basically like, mission accomplished, but not mission accomplished on the mission of taking care of the virus. It's mission accomplished on fully normalizing COVID transmission because I do think in these earlier attempts to not just shift towards personal responsibility but to push people to assume higher risk levels through social norms, or trying to make masking a thing of the past which has been going on in ways subtle or not. I think this is the wave where people genuinely don't even know that it's happening, not as some natural result of human psychology or whatever, but because of these, many years now, of efforts to obscure and individualize, and not provide any better options for most people, other than exposing yourself to the virus, and exposing yourself to others once you're infected. So yeah, that's where I think we are now, and this is just them saying; Hey, this thing we tried to do before, well, it's done now. And I think they're implicitly saying that the level of death and disease we have right now is acceptable.
Beatrice Adler-Bolton 21:54
Right. And I think one of the things too that is very clear is that opening schools, and having no mitigations in place in schools is really the plan for the fall, correct?
Artie Vierkant 22:04
It's a big priority.
Beatrice Adler-Bolton 22:05
Yeah. I think in a lot of ways these guidelines are centered around schools. And it's frustrating, because, of course, they're using the same old line of well, we have the tools and, you know, with vaccination, and with all the tools, we don't need masking in schools, we don't need to worry about quarantining, you know, we don't need test to stay. We can discourage testing. And in some sense, it's not only incredibly frustrating that this is happening but I wonder what tools they actually mean because it's not like little kids get access to Paxlovid. And it's not like kids are vaccinated at high numbers. We have Vinay Prasad to thank for that. We have Lucy McBride to thank for that. And all of the urgency of normal people, and all of the people who've been advocating really hard against child vaccination. Kids more than anyone else don't have the tools, and to focus this phase of rolling back protections in schools is pretty heinous and pretty frustrating because the school and daycare guidelines are going to be really reflective of what we've been seeing happening in camps, where camps really don't know what they're doing. They're telling people well, just send kids even if they're symptomatic and sick, don't test, just send them anyways, don't keep them home. And this is supposed to somehow work through the fall in schools with higher density. As the weather gets colder and people spend more time inside, and this has been promised to somehow occur without disruptions. As I'm just laying it out it just doesn't add up how this is even going to be possible even if this wasn't COVID and this was just the flu. It would be a disaster.
Justin Feldman 23:48
Yeah. To me the most interesting thing about the guidelines, interesting and morbid in a sociological kind of way, is how they talk about masks and the internal contradictions. So there's a line that's about consider not punishing students for wearing masks.
Beatrice Adler-Bolton 24:12
Yeah.
Artie Vierkant 24:13
I have that right here. I was actually just about to bring that up, quote: "Schools should consider flexible, non punitive policies and practices to support individuals who choose to wear masks regardless of the COVID-19 community level."
Justin Feldman 24:27
And that's gotten some attention, the part that has gotten no attention, as far as I've seen, but is kind of baffling, or maybe not really, is the general statement they make around masking in schools and the guidance. It doesn't straight up say, hey, masking should be a choice - It kind of just presupposes it. It's like, we recommend that students and staff should have the choice to mask especially following the community risk levels, which are county level metrics that you've covered before, and are quite complex, and are based on hospitalization and transmission, etc. And then it goes on to say, you shouldn't exclude disabled children from the classroom. And that might mean in an environment where there are high risk students you might have to do mask mandates. But, what environment doesn't have high risk students?
Artie Vierkant 25:29
Yeah.
Beatrice Adler-Bolton 25:29
No, absolutely. And I think that like every other change that we've pointed out, that the CDC has put forward in this guidance, there's evidence that they're conceptualizing high risk people as somehow not being in and around "normal" people, quote, unquote. And I think this prioritization of, okay, well, let's go ahead and put in language to say that we need to protect students who choose to mask. The framing of it as a negative problem in the first place is just highly discouraging. I think that there's already so many pressures that kids are having not to mask socially. The fact that the CDC is fully rolling this back, and then pointing towards public opinion and saying: Well, we're just trying to reflect public opinion, we have no influence on it ever. How could we possibly have influence on it? So they're issuing these guidance changes, which are going to again, continue to normalize much higher levels of spread, that frame masking as this negative choice that we have to protect the small minority who choose to do it. And we are beginning a brand new school year with the majority of the country in the highest level on the transmission map. The old map is angry red. The pastel map is nice yellow and orange right now. We've hit the second highest rate of pediatric hospitalizations in recent weeks. And again, the majority of kids are not vaccinated. And here we are basically trying to normalize even higher levels of transmission in schools, and promising that somehow things are not going to get disrupted.
Artie Vierkant 27:07
I think this is why it's actually really instructive to look at some of the things that are not coming out of what the CDC is saying itself. But what some of the people who have been pushing for the CDC to do things like this have been saying in response to this. I'm thinking specifically of pretty shortly after the CDC released these guidelines, Emily Oster, show favorite, did a blog post on her substack where the subtitle of the post was in all caps, "NO QUARANTINES!"
Leana Wen, also on the same day that the guidelines came out, did a Washington post Op-Ed, praising them for heralding a change to a new normal, and I find some of her commentary actually rather revealing about this. She sets up, well masking is no longer required if you're vaccinated, and then says quote, "masking in areas of high transmission remains part of the guidance, which schools will not follow anyway."
Beatrice Adler-Bolton 28:12
Oh my God.
Artie Vierkant 28:12
Then says, quote: "Those opposed to the CDC easing restrictions warn that the new policies will lead to super spreader events at schools. They are right. But daily outbreaks already occur at conferences, weddings, restaurants, gyms, and workplaces, etc...."
Beatrice Adler-Bolton 28:32
What's a few more super-spreaders?!
Artie Vierkant 28:31
"...Instead, everyone engaging in public life should be aware that those around them could be infected with the Coronavirus"
Beatrice Adler-Bolton 28:39
If you're vulnerable, don't forget to not engage in public life.
Artie Vierkant 28:44
Well, she does very literally say in this, if you're immunocompromised, or you're otherwise somehow vulnerable then masking is still for you, or whatever.
Beatrice Adler-Bolton 28:56
How did these people think all the vulnerable people are making all of the money to hide inside all the time? Where do they think we're all hiding? I don't.... God.
Justin Feldman 29:04
They also literally have gone from schools aren't super spreaders to schools are super spreaders - but does it really matter? You're just basically encouraging people to go out into the world and infect people. This is just nudging people in that direction - have COVID? Whatever, go out and do your thing.
Artie Vierkant 29:27
Well go to work sick and stuff. It occurs to me that this new easing of the guidelines feels like we're saying that we are responding to the conditions such as they are, meeting people where they are, as it were. But we're not acknowledging, of course, that we have created those conditions specifically. For example, in terms of testing it's very interesting that at the same time that they're saying - Okay, now just keep in mind schools, you don't have to test, except for under these circumstances, you might want to do some testing - they released this Biden plan for what they're going to do in terms of reopening schools, what the school year is going to look like, etc. in terms of COVID aid, and things like that. And if you look, it says very triumphantly, we have secured 5 million rapid tests, and 5 million PCR tests. And those are going to be available for school districts to order, and things like that. And that's all well and good. But there are something like 50 million kids in K through 12 in the United States. And that's just the kids, not the staff and everything like that. And when you consider that there was that study that just came out that showed that right after the community level system was introduced, when Massachusetts dropped its masking requirement for schools, and all but two school districts dropped masking, there was an immediate increase in new positive COVID tests in both the school, and the surrounding community of the places that had dropped the mask mandates in the schools. And that effect was found to be more pronounced among the staff too. But it's not just that, in general, there is more infection and transmission happening in the school. it was disproportionately happening. More and more of the teachers and staff were testing positive. It's a nightmare. But if you also know that you're not planning to provide any of the quote unquote, "tools", that we're supposed to rely on then asking people to use the tools less, I guess, makes sense as a horrible Faustian strategy.
Beatrice Adler-Bolton 31:57
Yeah. I mean, it's like saying, you know, we've got to center equity by burning the whole neighborhood down, not just the one house.
Artie Vierkant 32:06
That would be equitable.
Beatrice Adler-Bolton 32:07
It would, right? It would.
Justin Feldman 32:10
First of all, that study was led by my FXB colleague, Tori Cowger, who's a really excellent epidemiologist, and works at FXB but has been stationed in the Boston Public Health Department. And one of the things they were able to do in the study was extrapolate from how long absences tended to be with COVID infection. And they found that rescinding the mask mandate led to a huge number of days of absences that could have otherwise been avoided. So these arguments around learning loss, and we need to get back to normal life by removing all public health measures are bullshit, because they never consider that getting COVID is actually bad, even solely on the basis of being in school physically. And now that there's no remote options in many cases, disrupting learning. So really there's a battle over two different new normals, and one new normal involves public health measures that make it so fewer people get sick and die, and fewer people miss school for illness, and another new normal, where we just kind of ignore the disease process in a public way, though people are still affected in their private life.
Beatrice Adler-Bolton 33:30
Right. And one of the things that entered into the conversation this week as well are some comments from Ashish Jha, which have been elaborating on something that he has mentioned a couple of times over the last couple of months, which has been about this impending transition to the commercialization of COVID. And this shift that they've been signaling not just in the vaccine market, but in terms of all tests and treatment, that this is something that in the medium to short term the Biden administration is prioritizing pushing this stuff into the private market. And when you think about that coupled with Justin, as you're saying, categorically there is going to be spread as a result of these decisions, as you're saying it's bullshit to say that this is not going to disrupt school. To think about how this is going to collide with the shift of COVID being turned into not just a personal responsibility framework but something that is mediated through the financial technology of personal private insurance I think is going to be really devastating.
Justin Feldman 34:34
Yeah. So first of all, part of the justification for the changing CDC guidance was "we have the tools". So a line that should be familiar to anyone at this point who's been following government communications over the last year.
Artie Vierkant 34:51
Classic
Justin Feldman 34:51
And the tools they're really referring to at this point are vaccination, boosters, paxlovid, pharmaceutical treatments, that either prevent illness, or treat illness once it occurs. And so the justification for this shift, to the extent it is a shift is coming at a time when the accessibility of tools, not just accessibility, the availability of tools is being threatened. So Jha has basically since he started his role in the White House been warning that money to buy boosters, money to buy paxlovid is running out. And he's been lobbying Congress to get some more money for that, unsuccessfully, at this point, but it hasn't really been a big public campaign. They haven't been willing to expend much political capital, the inflation Reduction Act has been the priority. So what's going to happen now is that there has been an order placed for these Omicron specific boosters. And they have not ordered enough for the entire eligible population. So the 260 million people who have been vaccinated, only something like a third would be able to get the boosters under the status quo with the money that's been allocated for it. And that creates a really perverse condition in my mind where few people are getting boosted. And it creates this disincentive for governments to even promote boosters to the highest risk, most marginalized populations, because there's rationing, and I think a lot of governments will find that it's more politically beneficial to them to let the people who want it most get it, rather than the people who need it most. And then, similar thing, paxlovid funding running out. And if this gets shifted to... if the money runs out... So Jha actually mentioned something that I think hasn't been getting enough attention. It was very brief in his statement to the Chamber of Commerce, which again, the audience is noteworthy.
Artie Vierkant 37:07
He did a interview with the Chamber of Commerce that was somehow more combative than the one that he also did with Bernie Sanders in the last week.
Justin Feldman 37:18
So it's not just that, hey, this might be something that has to be purchased through the private healthcare system and through insurance. There's no guarantee that's even going to happen because under the status quo you would need regulatory changes. I think as is there's no purchasing structure for the vaccines yet that are not done through national governments. So that's if the money runs out this fall. And if they don't do the things they need to do to allow private insurers to even purchase them and reimburse them. There's no guarantee so something needs to change.
Artie Vierkant 38:02
I mean, I have a hard time imagining that if they're trying to kick it to the private market that they won't make arrangements to make sure that those things happen. But I do think it is important to highlight the thing that you're both referencing here, this specific quote, is; [Ashish] Jha (White House COVID-19 Response Coordinator) said, this week, to the US Chamber of Commerce in a live stream event, that was about an hour of him fielding various questions about the COVID response in the future, to the audience of the Chamber of Commerce, and he said during this, quote, "one of the things we've spent a lot of time thinking about in the last many months, and we're going to continue this work, and you'll hear more from the administration on this is getting out of that acute emergency phase, where the US government is buying the vaccines, buying the treatments, buying the diagnostic tests.
Dr. Ashish Jha (White House COVID-19 Response Coordinator) 38:53
We need to get out of that business over the long run. And so my hope is that in 2023, you're going to see the commercialization of almost all of these products, some of it is actually going to begin this fall. In the days and weeks ahead, you're gonna see commercialization of some of these things. So we just move them into the regular healthcare system. But this business of kind of day to day running of a pandemic, that needs to transition. And we are working very hard to make sure that transition is in a very kind of orderly, a very transparent way. So everybody sees it. That work is happening. And as I said, just to give you a bit of a timeline, some of it you'll see in the fall, most of it you're gonna see in 2023, so the government gets out of this business.
Artie Vierkant 39:34
And I want to talk about this a little bit more, because I think this is more significant, not to downplay the CDC guideline changes, but this is, I think, a more significant moment here. They said last week with the CDC guidance, we have the tools, and now they're saying by the way about those tools, they're not going to be free anymore. And also, even though it was already hard to get them, and in some cases they weren't free, even though they should have been free, you're going to have to pay for them if you want them. You're probably going to need insurance if you want to get them, or you will need to pay for some degree out of pocket to be able to get them even though it's also going to be your personal responsibility to make sure that you are availing yourselves of them. And I just want to really quickly before we get into this too much, I do want to point out that he also basically said almost exactly the same thing in June. We clipped it for an episode called "Jha watch" where [in] part of that episode we talked about an interview that he did with Bob Wachter (Professor and Chair of the Department of Medicine at UCSF), that was not really very widely watched or anything, where he said basically pretty much the same thing. Where in talks with people in Congress, he was saying: Look, you know, we're probably not going to commercialize it by the fall, different than what he says now apparently. But, you know, by 2023, we'll kick it to the private market.
Beatrice Adler-Bolton 41:09
Right.
Phil Rocco 41:10
Well, I was sort of curious when I had heard this reported exactly what the context of him saying this was. I was curious how it was being brought up because I remember talking about it in June. But the way that the Chamber of Commerce interviewer tees it up is basically this softball question at the very end of the interview. This is not something that he was trying to make the headline point of the conversation.
Audio clip of Ashish Jha's interviewer at Chamber of Commerce Event 41:42
How do you plan for a post pandemic world? So how do you plan for that science? And how do you plan for that social science? Maybe I'll give you the last word on, you know, how you're thinking about what we've all been hoping and praying for, which is the new normal?
Phil Rocco 41:56
But it gets brought up at the very end. It's like: Okay, well what is the transition to a post COVID world going to look like? And it's actually then when he brings it up, not when he's talking about what the strategy is going forward, and the persistence of the virus. It's brought up in this completely separate way. And he mentions it in the context of the fact that they had tried to get more money from Congress, but it wasn't forthcoming, and that they are shifting money around to go to vaccines for the fall. And it really does illustrate that if you wanted somebody who was going to actually lobby for what a meaningful, enduring public health strategy would look like, you should have chosen somebody else besides Jha. Because his number one talent is not just accepting half measures, but pushing for quarter measures, and then telling everybody that it's actually better this way. It is really horrifying that at the same time that he's saying that we have the tools, and he's saying, look, you'll be able to go out and get the vaccine or treatments just like you would any other treatment.
Beatrice Adler-Bolton 43:17
Right.
Phil Rocco 43:19
Because of course we know that people famously consume the appropriate amount of health care - that's something that everybody can do. But it does sort of reflect this... I'm actually curious about your broader perspective, Justin. It seems like there's a bunch of people within the public health field also going to bat for this guy. Are more public health people becoming like Jha pilled? Where is the attraction among people who actually know what the fuck they're doing?
Justin Feldman 43:54
Yeah, I mean, the people in public health who are most visible to those outside the field, I don't think represent mainstream public health opinion. There are certainly people who are deferential to Jha, on the same page as him, or view him... I would say, maybe things are changing but when he was first appointed they viewed him as something to be cautiously optimistic about, his appointment. Okay, here's someone who has actual public health credentials. And he's not really doing anything very different from his predecessors. I don't think he's shaping policy in the same way that [Jeff] Zients (former White House coordinator of the COVID-19 response) did. It's funny, there's been a few pieces about him (Ashish Zha) recently, for whatever reason, and he basically told one publication, I'm forgetting which one it was now, that he has no power. The way public health as a field is set up, it's basically... and I was just reading a great piece about this written almost 20 years ago now. And we've talked about this a bit on the show before, schools of public health are set up as mechanisms for extracting federal funding from the National Institutes of Health in the form of grants. That is the thing they do. And there's this great line in this article by Elizabeth Fee, she said of schools of public health; It is only on rare occasions and more or less by accident that schools of public health harbor public intellectuals or effective public advocates for the public's health. I think that just puts it perfectly. You don't really have many voices who are being listened to or feel even comfortable speaking out about these things.
Beatrice Adler-Bolton 45:51
Right. I mean, honestly, I'm glad that we got a chance to really talk about these comments from Jha because that's how I see these CDC recommendations, and these guideline changes more than anything else, is actually fitting into a broader framework of getting the things in place that are necessary to transition this into a normal day to day status quo, sort of health capitalist issue. And I think what we've seen in so many of the framings, and small changes, is ultimately it's not that there's some big ideological shift in how the pandemic is being run, or that this is a marked change in how we're thinking about the pandemic. These are sort of the necessary steps that we've been making all along to craft COVID into the mundane public health phenomenon that becomes this, essentially, extractive capitalist machine. And I think what we're seeing right now is not only just the process of transition into this commercialized or commodified new frontier of COVID. But I think it's also trying to assert a moment of cleavage where the state is somehow no longer responsible and this stuff doesn't bear on their public opinion ratings anymore. And I think that's a big part of what Jha's role is. I believe his statement that he has no power, he's a PR representative for them. He's a puppet, right? He's out there and his role is not to set policy, or to set guidance, or to advise. It seems like his role is to convince people to accept these compromises, and to accept, and themselves internalize this normalization of really high levels of needless sickness, ultimately, at the end of the day. And so I think the way to think about these CDC guideline changes is not as some big shift but as part of a broader process of building the COVID private market.
Justin Feldman 47:57
Yeah I think that's a great point. And thinking back on what we were discussing earlier, like, the periodization of COVID, which is hard to do in real time. But I would think if we, months from now, or years from now, we may look back at summer 2022, as the point where the pandemic was ongoing, but successfully hidden in plain sight, in terms of people not knowing they're in a wave or being confused about what that meant and what they're supposed to do as CDC basically affirming that people aren't supposed to do anything.
Artie Vierkant 48:38
And affirming they're not supposed to know either.
Justin Feldman 48:41
Yeah, exactly.
Artie Vierkant 48:43
That's the most important thing, it's not just about people.
Justin Feldman 48:47
And then finally with what he's calling commercialization but really is commoditization. I mean, it's already commercial, there are already companies making money off of it. It's a commodification of the tools. And yeah, I do think that this is a turning point. I see these people writing on Twitter and media, day after day, it's like, we need to end public health interventions. What purpose other than self promotion does it serve to say if you're Joseph Allen; We can't close schools in the fall to try to prevent COVID spread? That was never on the table. But I think the purpose that serves is that people have an innate sense of not wanting to get sick, or not wanting to get other people sick. So this very sort of artificial process of normalization is happening. But really swimming against the tide of what people want. And this is finally when they become fully successful. And it could, who knows what happens epidemiologically.
Beatrice Adler-Bolton 50:06
Right.
Justin Feldman 50:06
We could get more severe variants, we could be in a situation where vaccines are less effective, where paxlovid resistance happens. But barring any of that, I really think in a few months, a year from now, it will be even stranger for people like us to keep going on talking about COVID. Strange in the sense of how mainstream society perceives it.
Artie Vierkant 50:33
Well this is the important part about the privatization, of kicking vaccines and treatments for COVID to the private market. Things have already been quite horrible, obviously, over the course of the COVID pandemic. As much as we have criticized the response, one, light silver lining, was the fact that a lot of things like COVID vaccines and treatments were not exactly treated 100% in the way that we do every other health condition or illness.
Phil Rocco 51:08
Everything else.
Artie Vierkant 51:08
Yeah exactly. Everything else, right. that we treat everything else in the United States. And so, it will be a, you know, if you want to talk about profound shifts, when that happens, when that transition actually happens, it does not just mean all of a sudden in addition to being sick a couple times a year you're also having to pay for a shitty copay for a booster or whatever, and basically being fucking disincentivized from then getting a booster. It also means that basically what has been happening essentially over the course of the pandemic will get worse, which is literally the people who are surplus in society, whether it's medically vulnerable, or who are poor, or whatever. Those populations will continue to bear the worst of the brunt of this disease. And if you take Leana Wen, for instance, to her word so that the bourgeoisie can keep doing bourgeois stuff essentially. So that they can kind of carry on as though everything was normal. And that's profoundly a tragedy. But it also means that potentially the way in which things are bad when COVID vaccines and treatments get commodified could be qualitatively very different, and actually marking a quote, unquote new phase of the pandemic that we have not seen before, and that I think we are just fundamentally not ready for.
Phil Rocco 52:39
Yeah. it's funny, now that you put it that way, Artie, it occurs to me that the way vaccines were treated and protected from being maybe fully commodified, in the way that everything else is, was one of a series of things that were maybe more ideologically dangerous where capital was concerned. That you put that out there, and the White House maybe has to hold their nose for a while. Insurance companies, pharmaceutical companies maybe have to hold their nose for a while and accept that, but they're like, there's got to be an end date to this. You know, just like, there had to be an end date for the ability, to not just by law but by Norman custom, for people to be able to stay home from work when they're sick. All of those things were things that for one reason or another, to not bring on a full scale breakdown of society had to be tolerated, but then there also had to be a sort of end date, right? And so what occurs to me is that sort of where we are is that there's some forces in society that are now like, okay, we're cashing in at this point, right? We're bringing back the product, and we're going back to what we always demanded from the beginning.
Beatrice Adler-Bolton 54:11
And it's funny, actually it kind of reminds me of something from what we were talking to Abby about on Monday, which was Engels's condition of the working class in England. In one part of it, he's talking about how there are so many eye disorders that are sort of developed out of the lace trade and of all the fine detail work and essentially workplace conditions of people who make lace and how that leads to, you know, just a lot of suffering and illness. So Engles writes, quote, "This is the price at which society purchases for the fine ladies of the bourgeoisie the pleasure of wearing lace; a reasonable price truly! Only a few thousand blind working-men, some consumptive labourers' daughters, a sickly generation of the vile multitude bequeathing its debility to its equally "vile" children and children's children... Our English bourgeoisie will lay the report of the Government Commission aside indifferently, and wives and daughters will deck themselves with lace as before"
Artie Vierkant 55:17
Yeah, I would highly recommend to anyone who has not heard it, or is not a patron. Yeah, that episode that you're referencing Social Determinants of Health that we released on Monday, if you want more stuff like that, but...
Beatrice Adler-Bolton 55:30
Yeah, and I mean, you know, as we're saying, this is not so much like a sort of huge or marked shift as it's a continuation of a much broader and long term process of the normalization of COVID.
Artie Vierkant 55:42
And one that does not have to keep happening by the way.
Beatrice Adler-Bolton 55:44
Exactly. Yeah, absolutely. Justin, was there anything else you wanted to cover today that we didn't get a chance to get to?
Justin Feldman 55:50
Sure, I mean, I just say there's another way. I think at this point people are really confused about what a good response would even look like and I think that there's certainly debates to be had about that. But I would say we need a really strong program of pharmaceutical interventions, especially vaccination and boosters, we need a regulatory framework to keep workplaces and other environments at lower risk of exposure. And we need to bring back economic and social supports to allow people to quarantine and isolate and that sort of thing. And we need rights for disabled people whose living situations or working situations no longer work for them. And this is something we can build towards in the long term through organizing. It's never exactly clear when you're in a moment that looks like a moment of the feet, like the current moment, how you achieve those things, but it's always through long and painstaking organizing that is able to bear fruit when the political and economic situation is ripe for that. So yeah, I would say, don't give up hope. We need to be thinking about how to do a better job and working to fight for more protections.
Beatrice Adler-Bolton 57:13
I think that's a great place to leave it for today. Justin, thank you so much again for coming on. It's always so great to have you join the Panel.
Justin Feldman 57:19
Great to be on as always.
Beatrice Adler-Bolton 57:21
And if you want to follow Justin on Twitter, he is @jfeldman_epi . Patrons we will catch you early next week in the bonus feed. For everyone else, we will see you later in the week. If you want to support the show become a patron at patreon.com/deathpanelpod , you'll get access to that episode with Abby that we talked about a couple times in this one. And if you want to help us out a little bit more; share the show with your friends, post about your favorite episodes, pre-order Health Communism or request it at your local library, and follow us @DeathPanel_ . As always, Medicare for All Now. Solidarity Forever. Stay Alive Another Week.
Computer Generated Voice Over (UK Daniel) 58:04
Content Warning; Emily Oster
Emily Oster 1:03:32
Quarantines for exposure. This is a big change. The new guidelines suggest no quarantine for COVID exposure. This includes both in-school and out-of-school exposure. Prior guidelines suggested a 10-day quarantine or a test to stay as an alternative. So doing away with this is huge... But it did lead to concern from parents of the under-2 set. In particular, since that group cannot mask, the guidelines are a bit ambiguous about whether they still need to quarantine. A lot of you sent me panicked messages about that. I have good news. I wrote to the CDC directly about it, and a spokesperson replied, quote: Those who are exposed do not need to quarantine, including those who cannot mask (e.g., children 2 years and younger, students with disabilities who might have difficulty masking). Schools and Early Childhood Education programs can determine if they would like to use testing in these scenarios. Or, the other options include: masking of those who are able to and would be close contacts or implementing other layers of prevention, including distancing and ventilation." No quarantine, possibly do some kind of testing, or just do other things like better ventilation. So yay. No more quarantines... What if my childcare center doesn't believe the guidelines eliminate quarantine for the under-2 set? First, try forwarding this newsletter. Hopefully the quote from the CDC above will help. If it doesn't, I'd encourage them to reach out to the CDC directly.
Transcript by Scott McKenzie