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Thinking a lot about how we can be ethically critical of public health in the time of COVID-19.
By "ethically critical of public health" I mean how to be critical
(1) while being deferential to the best evidence-based recommendations and best practices available (1/?)
By "ethically critical of public health" I mean how to be critical
(1) while being deferential to the best evidence-based recommendations and best practices available (1/?)
(2) while also flagging both real and potential oversteps or abuses of power, including observed missteps (i.e. criminalization) and emergent complex problem areas (i.e. cell phone surveillance)
(3) without being overly speculative or alarmist (2/?)
(3) without being overly speculative or alarmist (2/?)
(4) while acknowledging that some interventions that may appear to be very invasive or over-steps may need to be seriously considered - and promoted by those of us who are often critical of public health - because of the extraordinary circumstances (already happening) (3?)
(5) while not being afraid to call out public health agencies or other institutions that are moving in a clearly bad direction or that are acting out of line or against their own stated policies (including non-public health agencies acting in the name of public health). (4/?)
(6) while not reacting to new developments immediately, while also reacting quickly enough to keep pace with the rapidly changing environment so that the many stakeholders involved can stay informed about new best practices and potential over-steps. (5/?)
(7) while supporting our colleagues in the health workforce - not only our friends who are caring for patients, but also the public health workers and bureaucrats who are laboring under extreme pressures.
(8) while not falling into the trap of moralism (see: Douglas Crimp) (6/?)
(8) while not falling into the trap of moralism (see: Douglas Crimp) (6/?)
(9) while not only being pessimistic
(10) while not being overly optimistic
(11) while being critical of public health while also reinforcing good public health messaging (7/?)
(10) while not being overly optimistic
(11) while being critical of public health while also reinforcing good public health messaging (7/?)
(12) while working to proactively engage and improve the overall public health/COVID-19 response through the process of critiquing public health over-steps, while also not succumbing to the pressure and temptation to make all critical public health research outcomes-driven (8/?)
I will add to this thread as time goes on.
The overarching question: how can we be ethically critical of public health in the time of COVID-19?
The ethics of critique change in times of crisis, but old critiques do not just go away or lose relevance.
It's a big question. (9/?)
The overarching question: how can we be ethically critical of public health in the time of COVID-19?
The ethics of critique change in times of crisis, but old critiques do not just go away or lose relevance.
It's a big question. (9/?)
(13) How should we draw attention to tensions between mandatory public health reporting requirements and informed consent in the time of COVID-19?
Not just (or even primarily) for novel coronavirus/COVID data, but for other kinds of public health data (e.g. HIV, TB, Hepatitis).
Not just (or even primarily) for novel coronavirus/COVID data, but for other kinds of public health data (e.g. HIV, TB, Hepatitis).
(14) How will we determine when lines have been crossed when we are only likely to have limited information about specific incidents or areas of policy?
(15) What will be the first step in developing a critique of the incorporation of whole genome sequence data for the novel coronavirus into routine public health surveillance and disease control in the United States (noting that critiques can also be appreciative and supportive)?
(16) What is critique in a genuine state of pandemic emergency?
(17) How do we process and prepare for the strong likelihood that COVID-19 is going to change (and in some places, has already changed) the legal and infrastructural relations between public health and police agencies, and that this will have long-lasting effects?
(18) How do we talk about the legitimate distrust that many marginalized communities have for public health at a time when trust in public health is necessary and many public health institutions are not being very reliable or trustworthy (i.e. ability to make/distribute tests)?
(19) When will - and when should - the declared state of emergency end, even if the pandemic persists?
(20) What will the process of exiting the state of emergency mean for healthcare and health data exchange, given the many regulations currently waived under emergency powers?
(20) What will the process of exiting the state of emergency mean for healthcare and health data exchange, given the many regulations currently waived under emergency powers?
(21) How do those of us who are critical of public health abuses - but who also support the goals of improving the public's health and evidence-based interventions - support our allies who are working in health depts and allied professions?
How can critique become affirmative?
How can critique become affirmative?
(22) What is evidence-based public health in the time of COVID-19?
(23) How should societies decide when “the time of COVID-19” is over, and is this the same thing as (or coextensive with) the end of the state of emergency and ongoing uses of emergency powers?
I’d like to hope that the state of emergency will end before the time of COVID-19.
I’d like to hope that the state of emergency will end before the time of COVID-19.
(24) How do we bear individual and collective witness in the time of COVID-19?
(25) How can we ask departments of public health to sever ties and coordination with law enforcement while also holding onto the demand that health departments work to ensure that people in prisons and detention centers (and those arrested at protests) receive services?
(26) How can we re-envision public health surveillance and contact tracing investigations so that they do not so closely resemble police work, even if/when departments of public health do move to formally cut ties with or further distance themselves from law enforcement?
(27) We should be actively working to distinguish between (a) political repression in the name of COVID-19 disease control and (b) genuine COVID disease control measures. This is particularly true for restrictions on protest gatherings or contact tracing connected to protests.
(28) Now that the initial frenzied reaction has passed, how do we talk about this COVID-19 paper retraction fiasco, which instigated multiple rounds of policy change and activity re: clinical trials by @WHO?
See: https://www.theguardian.com/world/2020/jun/04/covid-19-lancet-retracts-paper-that-halted-hydroxychloroquine-trials and http://retractionwatch.com/2020/06/04/lancet-retracts-controversial-hydroxychloroquine-study/
See: https://www.theguardian.com/world/2020/jun/04/covid-19-lancet-retracts-paper-that-halted-hydroxychloroquine-trials and http://retractionwatch.com/2020/06/04/lancet-retracts-controversial-hydroxychloroquine-study/
(29) What role should COVID-19 EHR data w/little standardization across (a) users, (b) systems, (c) professions, (d) jurisdictions, (c) [add variable] play in producing research?
How is the answer to this question different than the same question in public health surveillance?
How is the answer to this question different than the same question in public health surveillance?
(30) If the U.S. is basically just going to allow the COVID-19 pandemic to continue in the way that it is, is it really appropriate to remain in a declared state of emergency? There should be a clear path out of the state of emergency while the pandemic continues.
(31) Mask requirements should not be enforced by police, by fines and arrests or by other means. How do we say this while also not undermining the public health message that folks without a legitimate medical reason should certainly be wearing masks at this time when in public?
(32) How do we respond to this practice, which is almost certain to become more common?
Thinking about both (a) punitive public health orders involving fines or enforced isolation and (b) subpoenas issued by law enforcement at the request of health depts. https://www.nbcnewyork.com/news/coronavirus/rockland-county-probing-a-new-covid-cluster-resorts-to-subpoenas-as-people-refuse-to-give-contacts-to-tracers/2494189/
Thinking about both (a) punitive public health orders involving fines or enforced isolation and (b) subpoenas issued by law enforcement at the request of health depts. https://www.nbcnewyork.com/news/coronavirus/rockland-county-probing-a-new-covid-cluster-resorts-to-subpoenas-as-people-refuse-to-give-contacts-to-tracers/2494189/
(33) Yep. https://twitter.com/thrasherxy/status/1278703871053963269?s=21 https://twitter.com/thrasherxy/status/1278703871053963269
(34) Young folks are taking outsized levels of blame for COVID spikes. I encourage reporters exploring these issues to read about the history of journalistic assignation of blame to marginalized groups in the name of public health, and harms it can cause. https://www.sfchronicle.com/education/article/Parties-beer-and-coronavirus-Surge-in-cases-15398310.php
(35) In the context of COVID-19 and university re-openings, how do we discuss marginalization? Young people are marginal by default in our society. But even very institutionally powerful people (eg. full profs) are marginalized here. They have to do what the admin says. #HigherEd
(36) New work questioning COVID-19 immunity for ppl who recover (Eg. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31483-5/fulltext) shows how irresponsible premature proposals for "immunity passports" were (Eg. https://jamanetwork.com/journals/jama/fullarticle/2765836, https://onlinelibrary.wiley.com/doi/abs/10.1111/kykl.12227).
Bring evidence, then propose interventions. #bioethics
Bring evidence, then propose interventions. #bioethics
(37) How can societies build COVID-19 plans that account for the fact that basic knowledge about the disease will likely change?
HIV researchers have done this. See Ribes and Polk (2015), on the MACS study & "organizing for ontological change." #bioethics https://www.nytimes.com/2020/07/07/health/coronavirus-aerosols-who.html
HIV researchers have done this. See Ribes and Polk (2015), on the MACS study & "organizing for ontological change." #bioethics https://www.nytimes.com/2020/07/07/health/coronavirus-aerosols-who.html
(38) In my dissertation, I argue that U.S. HIV surveillance and prevention has also been re-organized to anticipate changes in basic science to quickly apply new findings (e.g. treatment-as-prevention) in public health. Maybe COVID-19 folks can learn from the history of HIV here.
(39) These... *things* being put out by Cuomo's people more closely resemble old P.T. Barnum posters than the 19th and early 20th century political flyers his people are trying to aesthetically emulate. https://twitter.com/NickReisman/status/1282717828395737089
(40) How can scholars describe truly unprecedented actions like this?
Many bemoan the "politicization of science," but science (esp. health) has always been political. Like war, "science is politics by other means" (Latour, 1988).
This is something else. https://twitter.com/charlesornstein/status/1283754463086481410
Many bemoan the "politicization of science," but science (esp. health) has always been political. Like war, "science is politics by other means" (Latour, 1988).
This is something else. https://twitter.com/charlesornstein/status/1283754463086481410
(41) Great thread by @alexmcclelland on the fraught relationship between public health and queer sexual cultures, following guidelines that recommend glory holes for COVID-19 prevention.
This first happened in NYC, and now in the Canadian province of BC. https://twitter.com/alexmcclelland/status/1285915053485707265?s=20
This first happened in NYC, and now in the Canadian province of BC. https://twitter.com/alexmcclelland/status/1285915053485707265?s=20
(42) Add CLEAR to the growing list of firms that sell facial recognition and biometrics products to pivot to capitalize on COVID-19. Not great.
CLEAR is a paid service ostensibly developed to help people move through lines faster, most notably TSA lines. https://twitter.com/hypervisible/status/1287475875450159107
CLEAR is a paid service ostensibly developed to help people move through lines faster, most notably TSA lines. https://twitter.com/hypervisible/status/1287475875450159107
(42.1) From the @voxdotcom article on CLEAR's pivot toward COVID-19 control: https://www.vox.com/recode/2020/7/23/21336245/clear-tsa-covid-19-screening-service-health-pass. #bioethics #biosecurity #AIethics #digitalbioethics
(44) Fines for mask-wearing violations are on the rise here in California. #PolicingthePandemic https://www.dailybreeze.com/2020/07/29/hermosa-beach-latest-city-to-fine-people-for-not-wearing-masks/
(45) This is so irresponsible, and does a major disservice to the open science movement. It is a clear abuse of open science norms. It is also far from first abuse of those norms that we have seen arise during the pandemic, but this is next level. https://www.vice.com/en_us/article/k7qpky/scientists-just-released-a-diy-coronavirus-vaccine-under-a-creative-commons-license
(46) How can we critique abuses of open science in the context of COVID-19 while also acknowledging the benefits that open science practices can bring to the response, particularly regarding accelerating the pace of scientific discovery and translation into health interventions?
(47) There are emergent disputes over the need for phase three clinical trials for potential COVID-19 vaccines. #bioethics
See this thread from @ZoeMcLaren, who takes the position that going through phase three trials will be very important: https://twitter.com/ZoeMcLaren/status/1290003562601185280.
See this thread from @ZoeMcLaren, who takes the position that going through phase three trials will be very important: https://twitter.com/ZoeMcLaren/status/1290003562601185280.
(47.1) The thread ends with a link to this tweet McLaren made in Mid-April, which I think is really awesome: https://twitter.com/ZoeMcLaren/status/1250961885236772864.
(48) Why did Mayor de Blasio take primary COVID-19 contact tracing responsibilities from the city's health department and give them to the hospital system?
Contact tracing is usually done by health departments. Providers play a supporting role.
Very odd. https://www.nytimes.com/2020/08/04/nyregion/oxiris-barbot-health-commissioner-resigns.html
Contact tracing is usually done by health departments. Providers play a supporting role.
Very odd. https://www.nytimes.com/2020/08/04/nyregion/oxiris-barbot-health-commissioner-resigns.html
(49) There's a sign-on pledge circulating for public health workers: "Pledge of Non-Collaboration: We Will Never Police Our Way to Public Health."
It was started by the group @endpolviolence.
Statement: http://tinyurl.com/noncollaboration
Sign: http://tinyurl.com/publichealthpledge
#PolicingthePandemic
It was started by the group @endpolviolence.
Statement: http://tinyurl.com/noncollaboration
Sign: http://tinyurl.com/publichealthpledge
#PolicingthePandemic
(50) The latest COVID-19 safer sex guidelines for gay and bi men, from @mpactglobal: https://mpactglobal.org/sex-during-covid-tips-for-gay-and-bisexual-men/.
Includes more glory hole discourse! cc @PozPrevention @alexmcclelland
Includes more glory hole discourse! cc @PozPrevention @alexmcclelland
(51) This new Illinois law reminds me of HIV criminalization statutes that are specific to police and/or corrections officers. Assault is already a crime. Advocates and affected ppl have long known that using the criminal law for public health is harmful. https://thehill.com/changing-america/well-being/prevention-cures/511364-assaulting-a-worker-whos-enforcing-a-mask-order
(52) What do we think of the “hotspot” discourse, as it is developing re COVID-19? I’m ambivalent on (but not indifferent to) the term itself. I guess I am more interested in what the hotspot discourse is being used to say about the areas so designated. https://twitter.com/T_Inglesby/status/1294629984682815491?s=20
(54) Horrifying. https://twitter.com/ReichlinMelnick/status/1295848511397912576
(55) A new edited volume on #DataJustice and COVID-19 has dropped. https://twitter.com/JohnPhilipSage/status/1295697435726143488
(56) This story by @edyong209 on COVID-19 “Long-Haulers” is extremely interesting and has some of the most robust discussions that I have seen of COVID-19 patient advocacy that somewhat resembles patient advocacy around chronic illnesses. Very interesting. https://www.theatlantic.com/health/archive/2020/08/long-haulers-covid-19-recognition-support-groups-symptoms/615382/
(57) Yikes. Someone should tell Dr. Schlissel that it was the opposite; gay men invented contemporary safer sex in the face of government inaction and indifference to AIDS. // 2020 Has Been Our Year of Magical Thinking by @gregggonsalves via @thenation https://www.thenation.com/article/society/coronavirus-response-winter/
(58) Underestimate Trump and co. at your own risk.
This development is deeply unsettling. But, in addition to bemoaning the "politicization of science," this move is best understood as a political strategy that should be met with a political response. https://twitter.com/ASlavitt/status/1297599761617506307
This development is deeply unsettling. But, in addition to bemoaning the "politicization of science," this move is best understood as a political strategy that should be met with a political response. https://twitter.com/ASlavitt/status/1297599761617506307
(59) If COVID-19 lays bare anything at all, it should be that politics and science are constitutive of one another and that both the social experience of truth and the nature of scientific facts are structured by intense conflicts over power, resources, and policy.
(59.1) Stop trying to "take the politics out of science" and health, and start from the premise that science and health are thoroughly political.
The right will continue to dominate the science wars and health policy battles until folks start waging more active counter-offenses.
The right will continue to dominate the science wars and health policy battles until folks start waging more active counter-offenses.
(59.2) I'm in many ways an admirer of Slavitt, but his group's explicit mission is to "put health care over politics." This bespeaks either a basic misunderstanding of what politics is, or a desire to ignore the fact of the political in health policy (to what end, I don't know).
(60) If you are implementing COVID-19 containment protocols, do not call your public health workforce "mobile strike teams," even if you are deputizing the military to perform public health functions (probably something that you shouldn't be doing anyway). https://twitter.com/bluestein/status/1298335752066158592
(61) Interesting thread on the use of wastewater testing to detect coronavirus at the University of Arizona before widespread transmission began occurring: https://twitter.com/cfishman/status/1299049476288544768.
(61.1) Good piece on wastewater testing: Lancaster, K, Ritter, A, valentine, kylie, & Rhodes, T (2019). “A more accurate understanding of drug use”: A critical analysis of wastewater analysis technology for drug policy. Intl. J. of Drug Policy, 63, 47–55. https://doi.org/10.1016/j.drugpo.2018.10.011
(62) Here is an example, from today, of "silent spreader"/"silent carrier" discourse. From my vantage, this is not the best way to talk about folks with asymptomatic COVID-19. It seems like it could become a stigmatizing designation. https://twitter.com/DrEricDing/status/1299639509412442113.
(63) Are we ready to politicize science yet? https://twitter.com/emilyrauhala/status/1300868885311348736
(64) More COVID-19 prevention glory hole discourse. I wonder (a) how much this is actually a rising practice vs. a media narrative stemming from the guidelines, and (b) how long the discourse will stick around.
Cc @alexmcclelland @PozPrevention https://slate.com/human-interest/2020/09/glory-holes-pandemic-rise.amp?__twitter_impression=true
Cc @alexmcclelland @PozPrevention https://slate.com/human-interest/2020/09/glory-holes-pandemic-rise.amp?__twitter_impression=true
(64.1) I also have some issues with how the author historicizes the glory hole and glory hole culture but w/e lol. I’m here for the discourse.
(65) Interesting new group focused on K-12 COVID-19 surveillance. https://twitter.com/STOPSpyingNY/status/1301222108115210241?s=20
(66) A very scary headline. Imagine being a student, away from home/where you live when off campus, getting sick with COVID-19, being shuttled around by your uni, and knowing that the institution may have nowhere to put you, and no idea what it's doing. https://twitter.com/AP/status/1302260220203278336
(66.1) I hope that universities are allowing their social science and health studies faculty to conduct studies to understand the experiences of students who get COVID-19 during campus reopening.
(67) Gonna throw it out there that striking is definitely an ethical form of critique when faced with a horrible institutional response to a public health problem :-). https://twitter.com/geo3550/status/1302997870002536448
(68) Power works in strange ways. Never thought I'd see biopharmaceutical firms asking the FDA to slow down an approval process.
But then again, I never thought I would see the FDA become such an overtly political (rather than tacitly political) agency: https://www.statnews.com/2020/09/08/pharma-pledge-reassure-covid-19-safety/
But then again, I never thought I would see the FDA become such an overtly political (rather than tacitly political) agency: https://www.statnews.com/2020/09/08/pharma-pledge-reassure-covid-19-safety/
(69) Add “warp speed” to this list of gripes/bad metaphors/phrases that should not be used to describe the development of health interventions. The potential damage to trust in public health if there’s a botched COVID vaccine rollout is hard to overstate. https://twitter.com/mattburgess1/status/1303816902226182144?s=20
(69.1) Not to mention the damage to trust in public health that has already been done.
I don’t study vaccines, but I do study the development and implementation of public health interventions. Trust in public health is hard to win and maintain, and is far more easily lost.
I don’t study vaccines, but I do study the development and implementation of public health interventions. Trust in public health is hard to win and maintain, and is far more easily lost.
(69.2) I am often critical of public health institutions, but now is really a time to support the hard working people in this sector – career scientists and others who are now often being run roughshod over by politicians who do not know what they are talking about.
(69.3) Politicians making promises about public health interventions-to-come that are not rooted in science isn’t new. HHS Secretary Margaret Heckler infamously said that an HIV vaccine would be ready “within two years,” in 1984.
There’s still no vaccine. https://www.niaid.nih.gov/diseases-conditions/hiv-vaccine-research-history
There’s still no vaccine. https://www.niaid.nih.gov/diseases-conditions/hiv-vaccine-research-history
(69.4) However, as with everything COVID-19, lies and false promises manifest more intensely, with greater frequency, and with higher stakes and more potential consequences than probably any other earlier event in the history of contemporary public health.
(70) I think I made peace with this today, during one of the most difficult pandemic weeks in recent months for me. Not that I will become a COVID-19 researcher above all else, but that that it will structure my scholarship in basic ways for a long time. https://twitter.com/USofDisaster/status/1303051934841085958?s=20
(71) This is sad. https://twitter.com/politico/status/1304611807437508608
This thread picks back up here: https://twitter.com/StephenMolldrem/status/1306146760201400320
