“COVID – Three Years Later: Looking Back, Part One” – with Emily Oster

Dr. Fox: Welcome to the “Healthful Woman” podcast, the fastest-growing podcast in women’s health. Today’s Monday, April 17th, 2023. As you all know, from last week’s podcast, we recently celebrated the three-year anniversary of the Healthful Woman Podcast. If you didn’t hear my tearjerker podcast last week, definitely check it out. For today’s podcast, I asked our very first guest, Emily Oster, to come back and talk about COVID. Emily has been on the podcast many times, but in our first podcast together three years ago, we spoke about “Pregnancy in the land of Corona.” So, I thought it would be fitting to do a three-year recap on COVID, where we went right, where we went wrong, and what lessons we might learn for the future. The podcast is dropping in two parts, the first one today, and the second one next week.

Today, we talk in general about looking back on COVID, and next week we’re gonna talk about specific topics like lockdowns, masking, school closures, and vaccines. Good stuff. Thank you, Emily, for being our very first guest and for always agreeing to come on the podcast. We really do appreciate it. Reminder for all of you listening on Apple or Spotify, if you could, we would love it if you could rate us preferably with five stars, and leave a few comments. Thanks for listening. See you next week for part two of my podcast with Emily. Welcome to today’s episode of “Healthful Woman,” a podcast designed to explore topics in women’s health at all stages of life.

I’m your host, Dr. Nathan Fox, an OBGYN and maternal-fetal medicine specialist practicing in New York City. At “Healthful Woman,” I speak with leaders in the field to help you learn more about women’s health, pregnancy, and wellness. All right, Emily Oster, welcome back to the podcast. How you doing, my friend?

Emily: I’m good. It’s great to be back. Thanks for having me.

Dr. Fox: So we are speaking nearly three years to the day of the first time we podcasted together, which was in…we dropped it in April of 2020, but we recorded in March of 2020 and it was called “Pregnancy in the Land of Corona.” It was the first podcast that the “Healthful Woman” podcast dropped. We are at our three-year anniversary and I thought, “Come on back, Emily O.”

Emily: Well, I am very pleased. I always like to talk to you and I’m also glad that it is three years later, and we are talking about COVID in a slightly different tone.

Dr. Fox: It’s definitely better to talk about it sort of in the past rather than the present and future. It’s been a crazy three years. And somehow during this time, obviously we spoke several times about COVID, but you kind of, you know, got thrust into the role of COVID expert and explainer and, I don’t know, distiller of information to the masses. How did that happen?

Emily: Almost by accident. So basically in, say February of 2020, I started a newsletter called Parent Data on Substack. And I’d started it with the intention that I would write about parenting and pregnancy sort of things that followed up on my books or, you know, people who were interested in hearing more. And then it almost immediately was the case that every question I got was about COVID and you know, particularly about COVID and kids and COVID and pregnancy because that’s the audience that I was writing for. And so I ended up just, because that was what people were interested in, writing a lot about that, learning a lot about that. Eventually doing a bunch of data collection around schools, doing some advocacy around schools. And so it just sort of turned into a whole thing that was very, very different than where I had been before. But not obviously in February of 2020 had not planned that.

Dr. Fox: You know, looking back on that, you know, your role you had locally and let’s say nationally or internationally on COVID, I’m just curious, what are your thoughts on that? Like, how do you feel about yourself afterwards? Do you feel, like, proud of it? Is it sort of like you kind of feel like, “Ugh, I wish I wasn’t doing that.” Or, I’m just curious.

Emily: I think that I’m very proud of a lot of the work that I did. You know, I spent a lot of time advocating for schools to be open more than they were in the U.S. in particular. And I think that work was right and was useful and I’m glad that I did it. And I think if it meant that some people were back in school, that was good for them. You know, there are certainly parts of this like the last three years that have been pretty difficult. And people have yelled at me quite a lot more than even usual, and that’s been hard. But I would say, you know, I feel like I got a chance to contribute and that is broadly something that I want to be doing for the world. So in that sense, I’m glad that I was able to.

Dr. Fox: You know, it’s interesting. I’m curious when you say people yelled at you. Were the yells coming from a particular side, meaning where people are yelling at you because you were too lax with COVID restrictions, because you were too strict? Again, you weren’t making restrictions, you were just sort of talking about them or recommending them, you were too strict with them? Or did it come from both sides?

Emily: Yeah, it came from both sides. One of the great things about being in the center is that you can get criticism from both sides. And there were a lot of people depending on precisely what I was saying, you know, there were many people who said, “You’re sort of pushing, you know, reopening of schools too much, and you’re kind of not thinking enough about COVID.” And then people on the other side saying, “You know, you’re not pushing this enough and, you know, we don’t need any restrictions.” And sometimes there are some things that I’ve written where the anger came from both sides and was so similar that I often could not tell from a tweet whether the person was mad on one side or the other. And I would have to like look in their profile to see like, “Oh, is this person…Like what is this person mad about?” Which sort of gives you a sense of like, how like in some ways deeply shared these experiences were, even though there were people on such different sides.

Dr. Fox: You knew they were mad, but not about what.

Emily: Yeah, not about what.

Dr. Fox: Do you know that that’s sort of the experience a lot of people have in marriage, I would say.

Emily: Yeah, I’m trying to figure it out.

Dr. Fox: I know that someone’s mad at me, but I don’t know why yet.

Emily: Don’t know what I said.

Dr. Fox: Yeah. So in October of ’22, you wrote, it’s actually a pretty short piece for “The Atlantic” called “Let’s Declare a COVID Amnesty.” What was that about?

Emily: So, that piece was motivated. It’s really useful to start with why I wrote that piece. So, you know, as I said, I did a lot of work on schools during the pandemic and a bunch of work on test scores and sort of impacts of COVID school closures on test scores. And in that period of sort of fall of 2022, we had started talking about that again. And one of the things that had happened in that conversation, at least to my perception, is that there were a set of people who had advocated for opening schools who were saying, “You know, look, by closing schools you kind of ruined everybody. And you know, we win and we were right and you were wrong. And like, this is all your fault.” And that push, that attitude, attitude, but that kind of rhetoric has led I think a lot of people on the other side, people who have been sort of more in favor of school closures to push back and actually say, “Well, you know what? Like these test scores aren’t important. This wasn’t a big deal. Actually, you know, well, it’s really hard to know if it was school closures or something else.” And you know, for me, looking at the data as I had in published research and in other settings, it’s very clear that school closures contributed to this. It doesn’t mean it’s somebody’s fault, but it was very clear that the school closures had contributed. And so I was sort of thinking a lot about like, how can we move to a place where we can both acknowledge that but also focus our attention on moving forward? And rather than spending time like litigating whose fault things were during a period, particularly early in ’20, you know, the 2020 kind of March, April 2020 when it was really unclear. Like, there was a lot of things that we didn’t know about the pandemic, and people made really different choices. Some of those choices turned out to be wrong, but maybe not for badly-meaning reasons.

So, at any rate, I wrote this piece that said we should try to like forgive each other, and we should try to move forward and think about, you know, solutions for things like how can we bring kids back to kinda school achievement levels that they were at before. How can we, you know, return mental health to where it was before? Whatever it is, like, we should move forward to looking for solutions rather than look back at who to blame. And I use this phrase, pandemic amnesty for the idea that we should try to like, you know, give people amnesty for the choices that they made or the decisions they made that turned out not to be right. But people weren’t ready to give each other amnesty, I would say.

Dr. Fox: The response was kind of heated. It’s interesting, I mean, it was a very sort of… It wasn’t a very controversial article, like, on the face of it. It’s just like, “Hey, you know what, time to move forward. We’re probably better off, just people made mistakes. They were incorrect.” Most people who are let’s say, making recommendations and in hindsight seemed to be wrong, were not doing it because they were, like, evil and nefarious. They were just wrong. And that happens and, like, time to move forward. But people seemed to be very upset by that.

Emily: Yeah, I mean, I think what was very in some ways quite sad about what sort of came out from that and that I hadn’t sort of fully obviously understood before I wrote it, is the extent to which people on both sides felt that the things that had happened during the pandemic had ruined their lives basically. So, I mean, a fair amount of the pushback I got was people who said, “You know, like, I chose not to get vaccinated or I chose, you know, not to wear a mask. And now, you know, no one in my extended family will speak to me anymore. And, you know, these relationships that I cultivated, you know, for decades are over.” And then on the flip side, people saying, “You know, I like kept my kids inside for this whole time, and I did all this stuff to protect people, and still no one respected that. And still, you know, this person showed up and I got COVID because they didn’t tell me about what it was or that they had it.” So there’s just like on both sides kind of people feeling like the experience of the pandemic in whatever way it happened to them, they’re just still suffering. And I think the idea of forgiveness was not something that many people, at least, you know, eight months ago or whatever were ready to talk about.

Dr. Fox: Yeah, I think that’s fair. I think that I can see why the article would have caused a lot of people to be upset. I mean, feelings were very strong. You know, people, you know, will say the pandemic or the response to the pandemic, let’s say, caused them to lose their job, or it caused their income to drop, or it caused their kid not to be in school, and to not learn something, or on the other side caused a family member to die. I mean, like you’re talking about, these are very high-stress type of things that people went through, and yeah, I could see why people would be upset. But you know, it’s interesting just, you know, looking back it’s very hard to know about these things because clearly, I think there are people that made decisions sort of in a flippant way or without being thoughtful and without having consideration for others.

But I think a lot of it, like you said in your article, is people just trying to do the best with the information they had. And it’s hard to know in a given person or a given decision how much of it is the first versus the latter. And to assume it’s all bad is obviously not right. And to assume it’s all, you know, peaches and roses is also probably not right. And I dunno, people look at it differently.

Emily: Yeah, I mean, I think that’s right. And some of the point of the article was, you know if we’re spending too much time trying to litigate which pieces of this were like, whose behavior was because they were confused, like genuinely confused, and who sort of knew that it was a mistake, but they were pushing some policy for a nefarious reason and had to do self-promotion. Like if we spend too much time on that, we lose the energy that we could have on trying to recover. And particularly in the space of kids, that time, we don’t get that time back. Like if kids don’t learn to read in the second grade, then they can’t read to learn in the third grade and if they don’t learn math in fourth grade, they can’t move on to math in fifth grade.

And so sort of particularly in that space, I’m just very, very anxious about the idea that we’re sort of too focused on the look back and not focused enough on the look forward because kids are not, you know, they’re not frozen in time. We don’t reach them now, we don’t reach them.

Dr. Fox: Yeah. And I think that you have somewhat of an advantage in that just that baseline, you kind of look at things objectively like from a data perspective. And so in some areas, you will have seen, like, someone “on the right” and other times like someone on the left, meaning you just sort of, you actually kind of follow the data and it takes you where it takes you. And so I think that for you it’s kind of like, “Well, why would people go crazy about this? This is what the data was.” But then not everyone thinks like that and not everyone can think like that. It would be great if everyone did, but it just doesn’t work like that.

Emily: An important lesson for me in the pandemic was, like, that people don’t all find data as comforting as I do. That was something I learned a number of times over.

Dr. Fox: So I did wanna revisit all this though. I think it does make sense to go back and I wanted to go sort of decision by decision or whatever, you know, category by category to revisit it. And not so much as a reckoning, you know, for like who was right, who was wrong, I’m happy to give an opinion what I think ended up being right or wrong. But it’s more so to like revisit our current systems and our structures because this could happen again. I mean, clearly something like this could happen again or will happen again. And I think that unless we kind of look back and learn lessons and agree to learn lessons from what happened, again with or without anger, whatever, we’re really not gonna be able to address the next pandemic in a better way, which would be the hope that we take some of these mistakes we made or some of the things we got right, and sort of apply them for the next time around.

Emily: Agreed.

Dr. Fox: So, I do think that one of the interesting parts about why it was a little bit crazy, obviously this was somewhat unprecedented as we heard all the times. I mean, you know, people went back to the Spanish flu, but most of us weren’t around back then. And you know, in modern times we haven’t had something like this. And also, at least in the U.S., it happened already during a time of polarization, distrust, and this information explosion so that people can make real quick decisions about sides and whose side they’re on. And I think that that was not a great environment to drop this in. Although I will say in other countries, which everyone thinks they’re so much better than ours, they also had all this fighting about it. So I’m not sure that was the biggest factor.

Emily: Yeah, I think that’s right. I mean, I think the polarization didn’t help. But as you say, I think that, you know, at the end of the day you got the kind of protests that we had on both sides of this in almost every place. So I’m not sure the U.S. was…maybe we were more extreme in some ways, but I’m not sure that that was like… That was not unique.

Dr. Fox: Yeah. I wanted to start, and the first decision that I want to talk about is actually something more high-order processes, meaning not specific medical decisions. But there’s like three things that I think that really happened that we should talk about. And the first is this idea that like the government sees control, you know, that there’s, you know, governor saying, you know, executive powers and sort of the CDC taking sort of control, you know, putting a lot of faith in Fauci, Dr. Fauci, a lot of stuff there. That was very shocking to a lot of people for that to happen. On the one hand, people were very in favor of it because things could move quicker and you could have sort of decisions made without 12 days of subcommittees.

But on the other hand, a lot of people got very upset that they thought that this was somehow, like, an infringement on their constitutional rights. I don’t know the solution to this, but I thought we should talk about it. Like, how do you feel about this concept that during a pandemic the government gets to make these decisions quickly without sort of the typical democratic process playing out?

Emily: I mean, I guess it’s interesting. It’s an interesting question, and I think probably, almost unanswerable. One of the places I think that we fell down and [inaudible 00:16:49] talk a lot about this in his book on the pandemic was that in some ways there was this sort of like top-down organization, like these groups are gonna take charge, but in other ways, they did not. So there actually wasn’t like a military-style like COVID task force that took over. Not that they would take over governments, but I think that there was actually a lack of management. And I saw this a lot on the school stuff, right? So if you sort of think, like actually the decision to close schools and when to reopen them and how to do that, that was a very consequential decision for many people’s lives.

There was basically no data that was brought to bear on that because nobody inside the government thought that it was their job. Like no individual agency thought it was their job to figure this out. And so the CDC didn’t think it was their job because they’re not the education department. The education department didn’t think it was their job because they weren’t the CDC. And so in the end there was just like no information to make that decision. So yes, it’s true those decisions were coming, you know, in a kinda dictatorial way from school districts, or from the governors, or from the overall, from the federal government to some extent. But it wasn’t being that there was no one who was in charge of actually figuring out in a reliable way what was a good decision. So I think one place where centralization fell down was in this question of kinda of data collection.

Dr. Fox: Yeah. I remember early on there was all this…You know, this is before we had reliable testing and this is pre-vaccination, everything, that one of the things that was so confusing is there was such bad data on how many people are infected or were infected, how many people were asymptomatic, how many people had antibodies, like what was the infection rate. And the reason is we didn’t have a way to properly test and to do this systematically. And every sort of community was left to their own devices, whether that be a town, a city, a state, the country, whatever it is. And because of that, we really had so much varying opinions on all of this. And I do think that like from a pure data collection analysis perspective, that’s something that you want to be on a larger scale, like a governmental scale because they have authority, they have numbers, they have money. Like there’s a way to do that. Even if they didn’t have to make decisions for every community, they could have said, “All right, here’s the numbers that we got.” And again, the CDC sort of does some of that, but not really. They just sort of take the data that’s there and analyze it. They didn’t do a tremendous amount of, you know, going out in the community and testing or anything like that.

Emily: No, and the CDC also was constrained to move at the pace that the CDC moves. I mean, there were things that happened more quickly than they would have otherwise, but in many of the sort of…I mean, we saw this, particularly as the pandemic, you know, wore on that many of these decisions inside the CDC took a very long time or took, you know, data releases took a long time and went through many, many reams of review. I mean, you sort of see people inside the CDC complaining about this, but that they were not like equipped to sort of move in a like sharply, responsive manner just, you know, because of the way the CDC works. I mean, there was this episode from like the spring of 2022 maybe, which the CDC had relaxed some guideline about early childhood that would have made it like more available, like would’ve made there be fewer restrictions on kind of quarantine requirements for early childhood, I believe.

And they had updated… The way that they decided to like communicate this was they put like a yellow banner on top of a website that below the yellow banner said the old guidance. And then the update of a yellow banner was like, “We’ve changed this.” But they didn’t change the main webpage. And then I complained about this and someone from the CDC basically emailed me and was like, “Yeah, we’re just trying to get this information out, but like it takes a really long time to change our web pages.” And it was like weeks before they had updated this webpage. And so that was an example of where like, actually that’s not a great way for information to be kind of conveyed out into the world.

Dr. Fox: Yeah. It ended up being, for a long period of time, the way that information got conveyed out is like someone would just interview Dr. Fauci on TV, and he would say something and that was…

Emily: Yeah.

Dr. Fox: I was like, “Okay, that’s what we’re doing, master bad, master good, stay indoors, stay outdoors.” Like, it’s like literally it was every single day he’s just the guy. I happen to have a lot of problem with his role, not in like the conspiracy type of way, but I just always think it’s a bad idea to put all your eggs in one basket, just like pick one guy and say, “You’re the czar. Like we’re all listening to you.” No matter how smart one person is, it just doesn’t make a lot of sense to me. And that one person would become like the celebrity about COVID, and I’m sure he’s a bright guy. I never met him, but I’m sure there’s a lot of other smart people, and it just seems like that’s something that should probably go to committee of some sort that should be assembled.

Emily: Yeah, I’m not sure that I agree on that exactly. I mean, when I think about the problems with the way a lot of this stuff was communicated early on, it’s not so much that it was coming through as sort of a single mouthpiece. I think the issue was that almost all of this stuff that came down, especially in those first few months had, even more than that, first maybe year and a half, had an error of certainty, which was not reflected in what we knew at the time. And it meant that we were going back and forth between recommendations frequently.

So I mean, masks were the sort of the most extreme example, but this came up in vaccines and transmission as well, like, you know, something would be said like, “You know, masks are not…Like, don’t wear masks. They don’t work for this.” And then a few months later, be, “Oh, actually masks are really important. They’re the most important thing.” Or you know, “Vaccines totally prevent transmission. Oh, actually, never mind, vaccines don’t do anything for transmission.” And sort of none of that is true. All of that is too extreme. But every time it was delivered with a kind of error of certainty that then made people very skeptical when you sort of moved it back.

I mean, I think one example of an alternative way to present information that has really stuck with me that somebody shared at some point was, you know, when you are at a fire, when there’s a wildfire and somebody is like talking to the community about the wildfire, what they do is like every day they have a press conference and they say like, “Here’s where the fire is today. Here’s like where we predict the fire is likely to be in the next…tomorrow. And I’m gonna come back here tomorrow, I’m gonna tell you where the fire is tomorrow. And like we’ll tell you, you know, what we predict in the future, but like we don’t know for sure.” I wish they had done more of that to say like, “Here’s what we know today, here’s what we’re doing to try to figure out more about this and we’re gonna come back tomorrow and we’re gonna tell you what we’ve figured out that’s more. We’ll come back next week or whatever it is.” Rather than kind of expressing a level of certainty that just simply wasn’t supported by the evidence that we had at any given time.

Dr. Fox: Yeah, no, I think that’s fair. We’re gonna switch to, like, certain decisions, but I’m just curious what your thoughts are about a state-by-state. I assume you know, I’m in New York. At least I work in New York, I live in New Jersey where the governors took control and made decisions. And I assume the same thing happened in Rhode Island. And the interesting thing is I understand why they had to do it. They’re like, “Listen, we gotta do things quickly.” And I think in certain aspects it worked very well. So like, for example, there was a whole thing about, you know, where are you gonna deliver your baby? Are they gonna let your partner in? Are they not gonna let your partner in? And the governor New York said, “Listen, I’m making a rule, all the hospitals have to do the same thing because otherwise, it’s gonna be pandemonium with people going from hospital to hospital.” So I think that’s a really good example of how that works.

And I think that maybe at the very early stages like, “All right, listen, we gotta flatten the curve. We’re all gonna lockdown. That’s the rule, we’re gonna do it.” Like, I get it. I think that probably that something that has to be abdicated after time, that it’s like after X amount of time when things are settled out, we really have to get out of that because it puts too much either blame on one person or too much credit on one person and it’s really not…I just don’t think it’s ideal and complicated decision-making after the sort of emergency is over.

Emily: Yeah, I think that’s fair. I mean, I think in general, we put too much decision-making on too many different people. I mean, yeah, space are one thing, but like in schools, we even had school districts basically saying, and then, and also, you know, individual childcare centers and individual hospitals like sort of making their own policies, which you know, often left them having someone make a policy who didn’t really have any expertise at all. And it would’ve been better if we had had more expertise making more generalized policies. I agree with that.

Dr. Fox: Okay. I hope you’ve enjoyed the COVID recap podcast thus far. Be sure to tune in next week when Emily and I talk about lockdowns, masking, school closures, and the COVID vaccine. Thanks, everyone, for listening. See you next week. Thank you for listening to the “Healthful Woman” podcast. To learn more about our podcast, please visit our website at www.healthfulwoman.com. That’s healthfulwoman.com. If you have any questions about this podcast or any other topic you would like us to address, please feel free to email us at hw@healthfulwoman.com. Have a great day. The information discussed in “Healthful Woman” is intended for educational uses only. It does not replace medical care from your physician. “Healthful Woman” is meant to expand your knowledge of women’s health and does not replace ongoing care from your regular physician or gynecologist. We encourage you to speak with your doctor about specific diagnoses and treatment options for an effective treatment plan.