Macedo and Lee’s “In Covid’s Wake” (long post)

Stephen Griffin

Stephen Macedo and Frances Lee, distinguished political scientists who teach at Princeton, have published a deeply provocative look at the nation’s response to the Covid pandemic.  The book is based on extensive medical research and sorts through the effectiveness of the different policy responses to Covid in the fifty states.  Their analysis is thought-provoking and frustrating at the same time.  “In Covid’s Wake” is really two books.  The first is an evaluation of how “elites,” especially medical and scientific elites, but also academic and media elites, gave advice on what was at best partial knowledge while striving to avoid any reasoned debate with those who disagreed.  The second is an evaluation of state and national policymaking during the Covid crisis.  With respect to the latter, although Macedo and Lee evaluate decision making by the nation’s governors, they studiously avoid evaluating national policymaking, most especially decisions made by President Trump.  The result is an odd mix of startling revelations and sharp elbows analysis combined with a studied lack of curiosity about how national decisions are made in crises, both during Covid and in the past.

I’ll begin by citing an example of Macedo and Lee’s startling research from near the end of the book.  For those who followed the Covid policy debates, this should be of interest.  They summarize an article in one of the journals of the American Medical Association which argued that action needs to be taken against physicians who spread “misinformation” about Covid.  Macedo and Lee say that some claims cited in the article are indeed erroneous such as “assertions that exaggerate the risks of vaccines or that make false claims about vaccine ineffectiveness.” (276)  But they go on to argue that other assertions of “misinformation” are made too broadly by the article’s authors, including: (1) the virus originated in a laboratory in China as part of a NIH study; (2) government and public health officials withheld key information; (3) effectiveness of masks was doubtful; (4) natural infection and recovery contribute to population immunity; (5) Government actors were contacting social media companies telling them what to censor.  Keep in mind that the point is that the authors of the journal article are certain that these five points are "misinformation."  In response, Macedo and Lee invoke the lessons learned in their prior chapters: “Readers of this book will already know that those five categories of supposed ‘misinformation’ may actually be correct, or, at minimum, within the scope of reasonable disagreement.” (277)  Macedo and Lee provide evidence worthy of serious consideration against all five points.  In so doing, they upend what I suspect are the assumptions of many “informed” Americans about what happened in the pandemic.

There’s more, much more to Macedo and Lee’s account which almost amounts to an alternative history of Covid.  Some notable examples: prior to Covid, most studies did not recommend non-pharmaceutical interventions (known as “NPIs” – that is, lockdowns, school closings, and social measures such as masks and distancing).  Democratic governments panicked and followed the example of . . . China (?), an extremely repressive regime.  Experts stigmatized disagreement with measures on which, before Covid, there was no widespread agreement.  The different measures taken by governors of red and blue states made no difference to Covid mortality.  The cost of the interventions was incredibly high, especially for essential workers, young people, and the poor.  Inequality increased.  And no one shows any interest in learning from this experience, especially in academia.

This is quite a list.  And it’s something of a challenge to explain why their analysis strikes me nonetheless as frustratingly partial and for that reason not terribly helpful.  But that’s why I’m writing this post.

Macedo and Lee’s critique is partial in the sense that it is most effective against the overly confident assertions of medical and scientific elites who converged much too quickly on recommending measures like lockdowns and masks.  Their critique is far more dubious when directed at the policy decisions that were made.  Because lockdowns and masks were in fact implemented, how can this be the case?

Let’s begin with a familiar legal concept, that of a standard of review.  What standard of review should be applied to policy decisions made during the pandemic?  Without surfacing this key point, Macedo and Lee in effect apply a “strict scrutiny” standard to actual decisions while applying the easier “rational basis” standard to the recommendations offered by outside critics.  But suppose we apply a consistent standard across the board.  What result?  Applying a rational basis standard would mean, believe it or not, that all the most important government decisions were justified.  This is because Macedo and Lee concede that prior to the pandemic there was evidence, argument, and support for NPIs such as the lockdowns – at least as short-term measures.  The lockdowns generally went on too long, but that is a judgment which could have been affected by local conditions.  Furthermore, with respect to the different courses of action taken by blue and red state governors, Macedo and Lee say: “Public health scholarship has yet to reach consensus about the effectiveness of [NPIs].” (125) In other words, it is possible that they were effective, contrary to what most scholars argued before the pandemic.  Yet Macedo and Lee emphasize all the ways the measures taken were likely ineffective or too extreme.  This is what I mean by saying they apply a strict scrutiny standard.  Applying this standard across the board would show substantial flaws in all the studies and recommendations prior to the pandemic.  This is presumably because a worldwide pandemic in contemporary circumstances had never happened. 

Macedo and Lee object to the use of the metaphor of “war” to describe the mobilization that was necessary to respond to the pandemic.  They do so without seemingly being aware that there is a body of scholarship on the development of the American state arguing that such metaphors are the only way in a crisis to spur action in our divided and separated constitutional system.  This is the familiar argument that our system is so well designed to slow down any kind of government action that we risk not being able to act at all in a true emergency.  To be sure, this point is not an adequate response to Macedo and Lee’s detailed argument that the war metaphor facilitated ignoring a rational assessment of the tremendous costs of the NPIs.  But it is a reminder that there was and is a rationale behind the adoption of the war framework.  It also points the way to a more measured judgment as to how it could be the case that the costs were never adequately assessed.

This is surely one of Macedo and Lee’s strongest points against the very rationality of the policy process during the pandemic – the failure to consider the costs of the lockdowns.  These were so extensive that they devote an entire chapter to summarizing them.  The costs include massive public debt; unemployment and business failures; inflation; global inequalities; devastating losses to educational progress; physical and mental health consequences, especially among the young and very old; and social dislocation.  They also score public officials for not specifying their goals – were officials trying to “stop the spread,” “flatten the curve,” or (impossible) “eliminate the virus?”  Officials never said.  Macedo and Lee condemn this policymaking as “plainly irrational.” (165)

Let’s consider the charge of irrationality.  The argument I’m about to offer makes me uncomfortable, at least as an ordinary rational academic, but here goes.  As a scholar studying the use of war powers, I’m acutely aware that they are not exercised based on any prior systematic study of their costs and benefits, either to ourselves or to, say, civilians overseas in the way.  So, for example, the Bush administration successfully torpedoed any inquiry into costs before the Iraq War.  Then again, nothing like this occurred before the 9/11 War, the “global war on terror” which continued for decades.  Vietnam, the same (in addition, as I argue in my book Long Wars and the Constitution, public officials curiously had difficulty specifying precise war aims in all these conflicts).  Continuing, was there an assessment of the costs of the deregulation of the financial sector which contributed to the economic meltdown of 2008-09?  Nothing.  Prior to various hurricanes, realistically estimating costs of building in flood plains?  No.  Macedo and Lee are confusing how academics might assess costs if they were put in charge with our system actually works.  Not that I’m a fan (I’m a proponent of substantial constitutional and political reform), but I do detect a kind of rationality that Macedo and Lee do not.  All the decisions mentioned, including the pandemic, were arrived at through a (no doubt flawed) democratic process that involved the explicit agreement of both political parties.  As I analyzed in my book Broken Trust, our system can leave the American people bereft of options when confronted by policy disasters sponsored by both parties.  But that doesn’t mean the problem is a lack of rationality.  Perhaps what Macedo and Lee are missing is that the political system is more concerned with perceived legitimacy rather than a strict assessment of costs and benefits.  And if you’re convinced that millions of people, old people especially, are going to die unless you “do something,” you might rationally choose to do something.

Because democratic governments followed the example of China with its strict lockdowns, Macedo and Lee believe that leaders all over the world (not just President Trump) panicked and then failed to correct their mistake with a more even-handed assessment of costs and benefits.  They think the early estimates of massive death were seriously flawed.  Maybe they were flawed not just in hindsight but methodologically, but that is still different from saying leaders had no rational basis for their decisions.  Macedo and Lee should have at least considered that there was a legitimate and democratic logic behind the early decisions made such as the lockdowns.  Ironically, in reviewing the different courses of action taken by red state and blue state governors, they arrive at the conclusion that “state-level majorities” got the leadership and decisions they desired.  Democracy was served, in other words, although they also conclude that the differing policy paths made no difference to Covid mortality rates (although states that had better vaccine acceptance did achieve lower mortality).

Finally, Macedo and Lee want to assess policymaking during the pandemic without assessing President Trump’s record.  This is hard to understand.  They know it was bad, stating at one point “that leadership in the Trump White House was erratic and deeply flawed.” (121)  Their excuse for not devoting a chapter to executive decision making at the national level was that there were similar policy failures in “other Western democracies, led by men and women not named Trump.” (298)  At the same time, they devote a chapter to how the nation’s governors fared.  They comment: “The [Trump] administration’s decision to leave pandemic policy up to the governors was not merely buck-passing.  The federal government possessed limited authority to address the spread of disease within states.  The states, by contrast, retained the full range of their police powers.” (128) Well, no.  This is seriously off base.

Leaving aside that the states’ police powers were challenged in some instances by the federal courts, Macedo and Lee are overlooking an obvious reality – the effectiveness of state public health responses depended on federal funding, evaluation and coordination.  In the first place, the federal government sends an enormous amount of money to the states, including for public health, which can be used as a lever (you may have noticed this recently) to influence and implement national policy.  If President Trump wanted to lead, if he wanted more advice and if he wanted the states to change course based on more rational policy analysis, he could have done so.  The reins of funding were (are) in his hands.  Second, more generally, Macedo and Lee overlook that some of the key elites giving advice, such as Dr. Fauci, ultimately worked for President Trump.  The advice they gave might have been influenced by their knowledge that the White House had trouble making and implementing coherent policy.  That is, Macedo and Lee should have considered that Trump’s prior record on making policy decisions warped the ability of medical and scientific experts to give sound advice.  Third, Trump’s lack of inclination to lead diminishes the significance of Macedo and Lee’s objection that the war metaphor was inappropriate and caused various sorts of harm.  This is because Trump, the leader of the country (although they never describe him as such), refused to follow it.  Maybe Macedo and Lee think that’s ultimately a good thing, but by refusing to analyze Trump’s record at all, they can’t effectively address this possibility.

Macedo and Lee’s book gives medical and academic elites a lot to think about.  But are their many criticisms sound when directed to governing elites, the people who are, after all, responsible for decision making in a situation like the pandemic?  This is far more uncertain because they never compare it with any other crisis in American history.  They might find, for example, that decision making both initiating and during wars is equally questionable.  But is it irrational?  In a messy democracy with a fragmented state, that is a much harder case to make than they let on.