You cannot actually measure public health
Throughout this pandemic the boundary between measurement and metric has been cancelled out by an intense and pervasive level of noise. Depending on the day or context, public health officials use cases, hospitalizations, deaths, or vaccination levels. These measurements are of varying levels of usefulness and are all subject to bias in unique ways, but, most importantly, they are just measurements. Public health officials rarely present them with the nuance that measurements require — instead, they use them as metrics when engaging with the general public. Much worse, these measurements are used to shape public policy as if they are metrics.
Metrics and measurements are not interchangeable. A metric is a standardized way of evaluation, and measurements are numerical observations. Just that.
Polymerase chain reaction tests are metrics used to evaluate a small sample of DNA and amplify it to a scale where researchers can study it in greater detail. But these tests can be set to different amplification cycles. The higher the cycles, the further the amplification. Thus, tests with different cycle thresholds are completely different metrics. The number of positive cases is a measurement using these metrics. The measurement alone without context makes it difficult to ascertain what exactly is being measured. In short, we any sort of context when the cycle thresholds used to arrive at a positive case are not given.
An analogy would be a tape measure that has two metrics on it, inches and centimeters. If someone were to measure an object using a tape measure and say that it is 12 units of measurement, the number is useless. We would need to know if the person measured in inches or centimeters to have even a vague idea of how long the object being measured actually amounts to.
Cases without context provide little insight into how the virus is impacting the population. Were the cases counted using rapid antigen tests, symptoms, PCR tests at 45 cycles, PCR tests at 30 cycles, et cetera? How many people were tested? What was the test positivity rate? These are just a few of the questions that need to be asked. There are many more and even these few questions can be further disaggregated by criteria such as vaccination status.
If, for example, 80% of the tests were taken by those without the vaccine, the effectiveness of vaccines will be wildly different than the alternative case where majority vaccinated individuals are taking the tests. The history of test recipients also matters. Individuals taking the test in a health care setting, where they likely have been exposed to the virus previously, will have different results than individuals testing for another line of work or in schools. Policymakers do often provide data for a few of these questions at a high level, and leave the nuance that might help inform the public out of the picture. Thus, the public is being informed by a simulacrum of the true situation. Doing so leaves ample room for those performing the measurement to control the ultimate messaging.
The real problem, however, is much more troubling. Policymakers and public health officials are using these measurements as metrics for public health. In other words, since public health cannot be observed directly, they are using measurements that are derived from different metrics as instrumental variables for public health. Anyone that has used instruments in statistical analysis understands that choosing the right instrument is difficult if not impossible. Most instruments are open to interpretation and bias. In this case, the bias is extremely clear, and thus it is a bad instrument and should not be used.
These problems are prevalent regardless of which instrument these officials have chosen to use, for example:
Hospitalizations — It is unclear whether people are being hospitalized from or with the virus. In fact, it seems that having the virus is ancillary to most hospitalizations as there are a myriad of comorbidites amongst the hospitalized.
Deaths — Deaths have long been considered to be a poor measurement for the effects of any disease or virus. A death in an 80 year old is not the same as a death in a 20 year old. Literature on public health has generally trended towards life years lost, which would provide a far more accurate depiction on the total impacts of this virus.
Vaccination Rate — Funny enough, officials have destroyed their own argument for vaccination rate as a useful target. Most models projected the pandemic to end once a certain vaccination rate was achieved. Vaccination targets continued to be increased as it was clear the models were wrong. Yet, public health officials have continued to claim that vaccination rate is the most important metric for reducing the spread of the pandemic despite all evidence to the contrary.
What about the other measurements lost in the noise? Such as all-cause mortality, increases in drug addictions, incidence of suicide, depression, or economic factors that directly impact individual health, such as relative income and steady employment. There are hundreds of measures that could inform public health, most of them ignored by those that claim to be in charge of public health. The simple reason is public health is nuanced to the point where it can be neither controlled nor measured.
Those that claim something is being done in the name of public health do not have a worldview based in reality. If, for example, no actions had been taken by the government during the pandemic, we cannot be certain the public would be worse off. In Florida, where they have ignored public health measures such as masking requirements and vaccination targets, the other measurements that health officials use to inform public health (cases, hospitalizations, deaths), have all dropped off sharply, much to the chagrin of the pandemic zealots.
Does that mean public health officials and policymakers should not have responded to the pandemic? I am not saying that. But with the uncertainty associated with their measurements, they should certainly not have been heavy-handed in any way, shape, or form. Basically every action they have taken in the name of public health has had disastrous outcomes with unclear or no benefits. All they have done is lost the trust of a large proportion of the public, which will have clear ramifications for decades.
Because public health is impossible to measure, they should have emphasized individual health: exercising, losing excess weight, taking vitamins, eating well, forming strong support networks, and washing hands. They could bolster the healthcare system by reducing duplicative regulations, increasing access, exploiting efficiencies, sharing transparent information, training more healthcare workers, and increasing resources to both the private and public health system. Instead, most of this has been ignored. Not just during this pandemic but for the decades leading up to it.
Blaming those who choose not to get vaccinated for poor decision making by officials is peak insanity. Further blaming them for things like variants and spreading the virus at an increased rate (things which the vaccine seems to have caused) is only a step below on the insanity scale.