The Public Health Policy Nightmare

Covid has integrated itself wholly among society since March. This thorough insinuation of every aspect of life has had a deeply personal impact for contact, transaction, and social reciprocity. The general public has a responsiblity, like during the 1918 pandemic, to perform certain acts to prevent the spread of the disease. The 1918 pandemic flu was deadly for those aged 5 and younger, those aged 20-40, and those aged 65 and older.

The pandemic in 1918 appears to be eerily simliar to the pandemic we face today. In fact, there is documentation that masks played an important role in the pandemic, even in 1918:


In this picture, the trolley official is rejecting these men for not wearing proper masks, and prohibiting them from entering the trolley. So, the corona virus pandemic is not a novel situation in the U.S. In fact, while the 1918 flu was called the “Spanish Flu” evidence points to the fact that it started in the United States.

Noncompliance with mask wearing was also a problem in 1918. Several states considered imposing mask mandates to their populations, but in California there were “Anti-Mask Leagues” cropping up even as the virus surged.

This tells us two things:

  1. A modern U.S. population has experienced a deadly flu pandemic, and
  2. The U.S. population has a historical preponderance of rejecting government mandate

The Spanish philosopher George Santayana is largely credited with the now conventional quote: “Those who cannot remember the past are doomed to repeat it”. This seems a bit trite given the gravity of the current pandemic, but when the frictions of the past continue to press against evidence-based public health policy, one has to consider lessons of the past. The Spanish Flu killed approximately 650,000 Americans and 50 million worldwide. As a public health official, these figures must necessarily figure into your baseline of “knowns”. This means that while the virus may vary, the fact that the Spanish Flu was an H1N1 virus must at the very least inform your public health policy approach.

The 1918 flu political environment was missing something vital however: social media. In monetary policy, there is a term called “the velocity of money”. This term describes the relative movement of money in an economy. If a dollar of value is produced, how quickly is that dollar then spent toward some other product or service? Subsequently, how fast is that same dollar then spent on some tertiary product or service? How quickly or slowly a given dollar is spent determines the velocity of money(on an aggregate scale).

The same can be applied to sound, or pernicious ideas. With the advent of social media, public policy recommendations can either gain steam, or be rejected completely – at least on social media. The capacity for social media platforms to advocate for, or spread misinformation against, is staggering. Here we arrive at the situation of mask mandates. As an elected official, you will need to decide whether a mask “mandate”, or a mask “recommendation” is in the best interest of your constituents. A mandate implies that the government will enforce the wearing of masks, and that there will be a consequence for violating this policy. A recommendation stipulates that the government is benevolently advising you to perform a specific activity, but that there will be no reprecussions for violating the recommendation.

If a governor issues a mandate, this governor must consider whether the mandate will encourage more or less people to adopt mask wearing when in public. It is quite possible, given the U.S. history of mistrust of government, that a mandate will actually have the opposite effect, and will spur anti-mask groups. On the other hand, if the governor issues a recommendation, instead of a mandate, you run the risk of downplaying the severity of the crisis, and thereby prolonging the necessary shutdown.

So, as an elected official, what is to be done? Well, the answer is that there is no comprehensive answer that will both satisfy your public health mandate while allowing your constituents to live their lives free from government mandate. You will fail a group of people immediately regardless of which position you take. This is a natural rythm of politics in the most ordinary of situations, but particularly challenging here. The true answer is that you have to be a leader which is willing to advance unpopular policy decisions for the benefit of your electorate. This is particularly prescient in the case of mask mandates given the current media environment of conspiracy theories and opposition groups. If every single person wore masks from day one of the virus, stayed home when ill, and only ventured out when necessary, we could potentially be done with the virus in local economies. Our globalized world necessarily complicates our public health position, but the relatively mainstream opposition to even basic preventative measures belies not only our American freedom from government, but also a fundamental mistrust of science. Given this incredibly quixotic public philosophy of freedom from government interference, it will take the prolific minds of public health and elected officials to convince the public that while we are living a nightmare, we can with the right steps again relive the dream.

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