Medical Examiner

Don’t Blame the Public for Public Health Failures

No matter how they behaved, COVID patients aren’t at fault. The government is.

a crowd of people on an escalator
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In the initial month of New York’s reopening, I found myself sanctimonious as I walked by large unmasked groups huddled into makeshift sidewalk bars and restaurants. I felt visceral disgust as I read news and saw pictures of people across the country ignoring evidence-based scientific guidelines. As a newly minted doctor, beginning the job as COVID-19 ravaged New York in April, I felt entitled to my anger: I lost five of the first 10 patients for whom I cared. As cases began to ramp up again across the country, I wondered, had the people going to pool parties and brunches learned nothing from what we had gone through?

But also, as a doctor, I knew I had to reframe my thinking. While I haven’t yet cared for anyone who has openly admitted to being crammed together with friends at a bar, if cases climb again in New York, I well could. My outrage would have ramifications for the care of these would-be patients. Health providers’ internalized moral biases about other drivers of poor health—such as addiction, obesity, homelessness, and tobacco use—have repeatedly been shown to affect the quality of care provided. As I tried to find empathy for potential future patients, I realized that rising case counts really aren’t the fault of individuals behaving recklessly.

My mind changed while rehashing the debate around plastic straws with a friend. More broadly, we were arguing about the role of the individual in combatting climate change. My friend saw plastic straws as a representation of the evils of American consumerism. He insisted that each of us needed to combat the way our individual actions, easily swayed by mindless inertia and luxury, led us to contribute to the destruction of our Earth. While I was moved by his call for individual responsibility, I was also pessimistic about the efficacy of reducing individual consumption—as opposed to demanding governmental action against corporate greed and irresponsibility—in solving climate change. A narrative about the personal failures of those who use plastic straws is ultimately a harmful distraction from the corporations and political institutions that ought to be the true object of our efforts at reform. Moreover, enthusiastically blaming individual people who are imperfectly making their way through a plastic-filled world might serve to alienate instead of recruit them to the cause.

The same applies to managing the COVID-19 pandemic and to the significance of those who ignore public health guidelines. Insofar as we blame individuals for the spread of COVID-19, we fail to center our attention on the massive, monthslong systematic government failure that has been the chief cause of our failed response. Of course, the stakes are more immediately high than with straws—one person not wearing a mask could directly lead to another human being’s death. But by angrily condemning individual choices people are making, doctors—indeed, anyone trying to communicate risks to someone close to them—stand to weaken a valuable line of communication with those who most need it.

The reality is that we’re all making capricious choices. Even I, as a doctor, have found it difficult to assess risk and probability these past few months. Usually, this means I err on the side of caution even beyond what’s supported by evidence. For example, I continue to this day to wipe down my groceries and packages, even though this kind of transmission via surface droplets seems not to be of big concern. But I also engage in behavior that comes with some level of risk to myself and others. After finishing a string of grueling night shifts in the hospital at the end of June, a group of my co-residents decided to go out for a celebratory brunch. I was hesitant to join: How could we ask others to stay home if we weren’t ourselves? Though we’d be outdoors, I knew that it would be impossible for us to fully keep our distance from restaurant staff; so many of my COVID-19 patients worked in the food industry. I worried that, as hospital workers regularly exposed to sick people, we could pose an increased risk. My co-residents countered that we deserved something nice after such a tough week. I caved. Though it was odd to feel viscerally nervous while at a restaurant—do I keep my mask on in between bites?!—just the quotidian experience of eating out on a muggy summer day was cathartic.

As a human being, I understand the toll that pandemic restrictions take on us—how hard it is to feel personally responsible for stopping the spread of the virus. I found myself unexpectedly moved reading a piece that ran in the Washington Post in early July in which five epidemiologists discussed their comfort with various levels of social interaction. Even these experts handled things like sanitizing mail and seeing friends a little differently—they too were just trying to figure it out one day at a time. One expert got a haircut from a stylist, inside her home, without a mask. Another reportedly had people over frequently enough to make his daughter angry. Anthony Fauci himself admitted to having a house cleaner enter his house twice a month.

The real problem is not the understandable foibles of individual people. The real problem is the decades long near-total neglect of our public health apparatus; the lack of any coherent national strategy for dealing with the virus; and corporations claiming “we are all in this together,” and then prioritizing their bottom lines instead of their employees and customers. In reframing things this way, I have actually found myself quite touched by the scale and durability of the response of the American people. Citizens and public health officials were able to quickly initiate and maintain a monthslong quarantine, significantly slowing the spread of COVID-19. People lost their businesses and received sparse government aid; workers in warehouses and food delivery took on risk and, instead of getting adequate support, were celebrated as “essential”;  health care providers worked countless hours often without PPE in grim settings to provide care and solace. A significant portion of the American people have engaged in a beautiful and heroic communal project. But individual actions work when they are supported by institutions and contribute to a larger plan. Leaders have failed to turn the initial success into the remission that has been achieved in much of the world—that’s what deserves our outrage.

Since the government has failed at its job, it’s now up to us to pick up the slack as best we can. To social-distance with no end in sight is an enormous and unfair task. It is natural that we may do it imperfectly, or feel done with it altogether. It’s up to my fellow health care workers and I to empathize with those who ignore recommendations, instead of falling into the facile trap of shaming or looking down on them as we provide information and guidance. In talking to my patients, I have found it doesn’t require much to break through: an acknowledgment that we are all going through something incredibly difficult, that it is important to care for one another, that our fates are now inextricably linked