While Covid-19 cases surge in Vermont, officials have begun speaking to another threat: the misinformation that’s led some to become skeptical about the danger of the coronavirus. “Our country and way of life is being attacked by this virus — not the protections we put in place,” Gov. Phil Scott argued at his twice-weekly press conference on Tuesday.
Limited data shows that only about 6% of Vermont’s population defies the state’s mask mandate. But there are a range of skeptical opinions about Covid-19 proliferating online, from people who believe the economic toll of safety measures outweighs the health risk of the illness, to people who promote disproven conspiracy theories about the virus being a hoax.
Wearing masks to stop the spread of illness is commonplace in other countries, said Dr. Turner Osler, a research epidemiologist and an emeritus professor at the University of Vermont Larner College of Medicine. “In the United States, uniquely, we just turned it into some other thing,” he said. “We turned it into a flag of partisanship, which has had catastrophic results. And it's not going to be easy to walk back.”
Osler and his colleagues recently analyzed county-level survey data on mask-wearing across the U.S. They found some unsurprising predictors of high compliance, he said, like whether Covid-19 had caused more fatalities in a particular county. But the strongest predictor of residents failing to wear a mask was whether a county voted for Donald Trump in the 2016 presidential election. “The greater the margin for Trump, the fewer masks are worn,” Osler wrote in a VTDigger commentary.
The finding is alarming, he said, in light of the clear science that masks work to help curb infection. “I think if you're looking for partisan advantage, something as obvious as a mask, that marks you as this tribe or that tribe, is a terrific symbol,” he said. “The problem is, it's not actually a symbol. It's actually the best technology we have to keep from dying.”
This week: As Covid-19 cases surge in Vermont, officials have been reminding well-intentioned Vermonters to take the state’s health guidelines seriously. But they’ve also begun addressing another group of people: skeptics who believe the government response to Covid-19 is overblown.
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On Tuesday, Gov. Phil Scott opened his press conference with a brief update on the state’s recent ban on multi-household gatherings. Then, he delivered a message directly to the nonbelievers.
Gov. Phil Scott: Make no mistake, I understand that if you want to ignore the science or choose not to believe it, there's not much we can do to stop you. I want to be clear — the number of people in hospitals is growing across the country, because some care more about what they want to do, rather than what they need to do to help protect others...
Scott said the goal during this surge remains the same as it was back in March and April: to keep people out of hospitals, so the health care system doesn’t get overwhelmed and lead to unnecessary harm. But he also admitted that this logic might not get through to some people.
Gov. Phil Scott: So, again, the skeptics are right. They can do what they want. But please, don't call it patriotic. Don't pretend it's about freedoms. Because real patriots serve and sacrifice for all, whether they agree with them or not. Patriots also stand up and fight when a nation's security is threatened. Right now, our country, and way of life, is being attacked by this virus — not the protections we put in place.
Who exactly is the governor addressing here? There are those who push back on simple measures like masking and social distancing, although limited data on masking compliance shows that’s only about 6% of Vermont’s population. But there are also a range of skeptical opinions about Covid-19 proliferating online, ranging from people who believe the economic toll of safety measures outweighs the health risk of the illness, to people who promote disproven conspiracy theories about the virus being a hoax.
It’s hard to quantify how pervasive these opinions have become, and how dangerous they are to public health. But this week I talked to one researcher who’s been trying.
Turner Osler: I think if you're looking for partisan advantage, something as obvious as a mask, that marks you as this tribe or that tribe, is a terrific symbol. The problem is, it's not actually a symbol. It's actually the best technology we have to keep from dying.
This is Dr. Turner Osler. He’s a professor emeritus at the University of Vermont Larner College of Medicine and a research epidemiologist. He says part of the reason it’s been so easy to sow confusion about this virus is because it really is like nothing the world has seen before.
Turner Osler: We've been on a rocket sled to learn how to take care of patients with Covid. When I talk to groups about Covid-19, a lot of questions come up. And often I have to say, “We just don't know.” We've had six months of experience with this virus. We have other coronaviruses to fall back on. But Covid-19 is an entirely different virus. It's unlike anything we've seen before. It’s fascinating to study it because it has so many tricks up its sleeve. It's a worthy foe.
What do you mean? What's so unique about it?
Turner Osler: Most diseases, you know what they are. But Covid spans a spectrum, from "you didn't know you had it" to "you drop dead as you walk out to get the ambulance." Almost no diseases have that broad spectrum of manifestations.
We haven't seen a disease like this since syphilis. Back in the day, it was said that if you knew syphilis, you knew medicine, because syphilis could present in so many different ways. Covid really can do so many different things. It's an astonishing virus, and it seems to invade hosts in ways that are particularly mean. It slips into the human body and then cuts the wires, the alarm system, so it has a day or two or three to start multiplying before the human immune system catches on. Which is this period where the virus can multiply, and people don't even know they're sick. If your immune system hasn't noticed, the virus can propagate, and you're spreading virus and don't know. This was a property that no one had really expected. And it's the thing that's made Covid-19 such a dastardly thing to deal with.
Given the accelerated timeline that you've talked about, what are the main things that we've learned, even in this short period of time?
Turner Osler: What we've learned is that an ounce of prevention is worth a pound of cure. We know that once people become ill with Covid, it's hard to say what's going to happen, no matter how young or how healthy. Things can go catastrophically wrong. And so really, you simply wish never to become involved with this virus.
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We’re relearning what we learned in the pandemic of 1918: Masks are the single best technology. It's astonishing to think that we’ve been masking ourselves against diseases for at least 100 years, and yet, it's still our best technology. We've got vaccines on the way, and that's terrific. But they're not here yet. And until they're here, and until we get wide penetrance, a lot of people willing to be vaccinated, masks are going to be with us.
Dr. Osler said the science is clear that masks work. He said Covid isn’t one of these things where a single particle will make you sick, like salmonella. You need a certain number of particles to enter your nasal passages. So if two people wearing masks keep those numbers way down, you’re exponentially less likely to get infected in the first place.
Turner Osler: If you're wearing a mask, first of all, you can't express virus at any quantity, because it has to get through the mask. And secondly, if you're wearing a mask, and you're in the room with somebody who's shedding virus, now as they have to get through his mask, it has to get through your mask. So if only 10%, or 1% gets through his mask, and only 1% gets through your mask — these aren't additive, these are multiplicative — the amount of virus that gets through is 1% times 1%. So it's a tiny fraction that gets strained up if everybody is wearing a mask.
It's really pretty simple. Everybody in Japan already wears masks, right? If they have a cold, they wear a mask just to be polite, because why would you want to give somebody your cold? The Japanese understand that's rude. In the United States, uniquely, we just turned it into some other thing. We turned it into a flag of partisanship, which has had catastrophic results. And it's not going to be easy to walk back.
Dr. Osler said there are a few reasons for this. One dates back to early in the pandemic, when the CDC specifically recommended that Americans not seek out masks. When the agency changed that guidance later on, Dr. Osler said, it was hard for people to adjust.
Turner Osler: They said that because they wanted to preserve the supply of masks for people at the tip of the spear — the ER nurses and the ambulance drivers and some people in the ICU getting Covid spewed on them. You want to be sure that those people are protected, for two reasons. First of all, if they get sick, you’ve got fewer people to take care of the sick people. And secondly, if you don't protect those people, they may not show up for work.
So in order to preserve the mask supply, I think, we told a little white lie, which is a catastrophic squandering of credibility. We've since tried very hard to walk that back. Everybody should wear a mask — we've said it many times now. But for those seeking partisan advantage, it's easy to say, “Yeah, well, before, you said you didn't need to wear masks. So why should we believe anything you say?” Our bad.
I think we need radical honesty and clarity of messaging, because dealing with a pandemic, it's only partly about technology. It's mostly about understanding ourselves and managing our response to the pandemic. If everybody just sat down in their own bathroom and stayed there for two weeks — take some chips and salsa or something — the virus would disappear, right? We know that by isolating every person, we could immediately put an end to this in two weeks. Well, it's not really practical. But if everybody wears a mask, you're a long way there.
This question of tribalism, this becoming a symbol that you either are marked with it or marked as not having it — how do you go about quantifying what role that plays in how this has become such a divisive issue?
Turner Osler: That's a sociological question, and I can't claim any special expertise there. But what we have done is we've cobbled together a database from available public resources — New York Times, Johns Hopkins, places like that — so that we can kind of get a handle on some of these issues.
The New York Times very helpfully put out a poll where they polled half a million people asking whether they wore a mask always, usually, sometimes, rarely, or never, and recorded the results county by county. Now we have data at the county level about who's wearing masks, and we also have lots of other data at the county level — about the average age, and the number of people who work in factories, and the number of people who voted for Donald Trump, whether or not the governor of that state is a Republican — lots and lots of different pieces of information about every county.
You can very quickly find that one of the most powerful predictors of whether someone is likely to wear a mask or not, is whether there are a lot of people in that county who have or are dying with Covid-19. People are smart: If the people around them are dying, everybody puts on a mask. These kinds of things are not surprises. We went through a number of variables and most of the variables make sense.
The variable that shocked us was when we looked at the percentage of people who voted for Donald Trump [in 2016], which we have for every county in the country. And it turned out that counties where most people voted for Donald Trump had very low rates of mask-wearing, as low as 60%. Counties where people voted overwhelmingly against Donald Trump had rates of mask-wearing as high as 95%. So there's this very, very clear distinction that in places where Donald Trump is revered, wearing of masks is much less common.
And it's been catastrophic. You can compute how many deaths are added on to the toll by doing a little more math and find that the business of refusing to wear masks has cost tens of thousands of lives.
Another study Dr. Osler recommended took place at the University of Chicago. Researchers compared outcomes for people who watched two back-to-back Fox News shows hosted by Tucker Carlson and Sean Hannity. Carlson told his viewers to take Covid seriously, while Hannity was skeptical.
Turner Osler: And by doing careful analysis, they found an immense increase in the number of deaths for people who watched Hannity versus Tucker Carlson. What they showed very clearly is if people are systematically told things which are not true, from sources that they trust, they will behave in ways that, in retrospect, are irrational, dangerous, even fatal.
You have to ask, why is it that population is willing to accept information that's false? One other variable that we have in our data set is level of education, which we have in the data set as percentage of kids who finished high school. Turns out that's one of the most powerful predictors for wearing masks. In areas where kids finish high school, people are much more likely to wear masks, as opposed to places where people don't. So it may be that ventilators aren't the answer. And even vaccines aren’t the answer. It may be that more valedictorians is the answer. A better educated population that behaves coherently, in the face of something as dangerous as Covid-19, despite disinformation, misinformation from sources, is probably the best way to protect a population.
More valedictorians, more access to education, seems great. But it seems like in the short term that you would need to take these findings and really apply them towards getting good public health information to people who just aren't getting it right now. How do health officials do that?
Turner Osler: Well, where is Dr. Fauci when we need him? I'll tell you where — he's muzzled under somebody's desk. I mean, we have people who can tell the story very well. And they've been muzzled.
I think getting a new team that brings their A-game will help a lot. We have some (high)-level players now. I mean, Fauci has seen us through several other epidemics. But they've been benched. The Covid Response Force at the White House hasn't met in months. We're headed for 2,000 deaths a day. Think on that for a moment. That's 9/11 every day. It’s difficult to get your brain wrapped around the enormity of that. I mean, we spent a trillion dollars and fought a couple of wars over 9/11 and it only happened once. You know, it's breathtaking.
Do you think that change in administration is enough? Do you think that they'll be able to rebuild that trust that seems to have been lost among this sector of the population?
Turner Osler: I know that they will do their best, because people don't go into public health for the fame or the money. That's not these people. The incoming team will do the best they can. We have the tools now — there's a vaccine on the way, and we understand masking. My concern is that the disinformation machine is a harder thing to turn off. That's a heavier lift. You hope that social media will somehow find a way to find and excise posts that are really dangerous and harmful. And I'm sure that the people who are putting up these posts believe what they are saying. But propagating falsehood, when people are dying in large numbers, seems like something that we ought to have a remedy for.
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