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WASHINGTON — Even without a presidential winner, one thing is already certain: The 2020 election results were a disaster for public health.

Results from Tuesday and early Wednesday underscore just how many Americans agree with a president who has called the nation’s top scientists “idiots,” openly mocked mask-wearing, and has insisted states must be “liberated” from lockdowns. No matter who wins the presidency, more than 67 million Americans already seem to have sided with Trump on public health. In preliminary exit polls, just 14% of Republican voters surveyed said the coronavirus pandemic was the deciding factor in who they voted for, despite the fact that the virus has killed more than 233,000 Americans and is spreading unabated across the nation.

That leaves public health officials to grapple with hard, existential questions: How can they forge new relationships with this huge swath of the country as the pandemic continues to unfold? Where does the public health field go from here?

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“Even if Trump does not win, much of the population will have voted for him, so that still seems like a big wake-up call!” said Heidi Tworek, an associate professor at the University of British Columbia, who has studied the successes of various countries in getting their populations to comply with Covid-19 mitigation measures.

“We’re going to have to do some serious soul searching,” said Georges Benjamin, the executive director of the American Public Health Association, who insisted that public health officials don’t deserve the blame for the political backlash to their message, but can “play a big role in making sure that we come up with ways to deal with this in the future.”

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Public health measures and guidance are not ideological in nature; nor is the response to them a monolith. But polling shows that Democrats, broadly, tend to favor a more robust public health response to the pandemic while Republicans have tended to oppose such measures.

Scientists, epidemiologists, and public health experts who spoke with STAT were divided about the future of public health. Most insisted there were straightforward, albeit challenging, ways to win over the people who have, until now, disavowed public health measures and who seemed to have voted against a more stringent public health response on Tuesday.

But at least one expert said the cause was hopeless.

“If there was a way to fix it, we would have done it,” said Holden Thorp, the editor-in-chief of Science and its family of other journals. “Science was on the ballot and this means that a significant portion of America doesn’t want science. … Science is now something for a subset of America.”

For Lindsey Leininger, a public health educator and clinical professor at Dartmouth College, winning more people over to the side of science is an existential imperative. Failing is “simply unacceptable.” For her, the first step is simple: acknowledging the problem.

“We have a huge gaping hole in our cultural intelligence and I think that that is really important for us to recognize and embrace,” she said. “We need to know that this is a blind spot, and we need to partner with people who believe in the science and have credibility in conservative circles.”

Others suggested that strikingly simple tactics — like listening to skeptics thoughtfully, like asking them to help brainstorm solutions — would also make major inroads.

“The approach often used is, ‘We just need to tell people who have those beliefs that they’re wrong.’ Maybe not that directly, but in other ways. Maybe what we need to do is invest in listening to their concerns, and understanding their perspectives, before we start giving them our messages,” said Glen Nowak, a longtime communicator at the Centers for Disease Control and Prevention who now heads the University of Georgia’s Center for Health and Risk Communication.

APHA’s Benjamin said similar. “Take it seriously. … Sit down and talk to folks and say: Hey, we want to stop the spread of this disease, what are your ideas?”

Krutika Kuppalli, a physician and professor at the Medical University of South Carolina, suggested doing in-person community outreach to make reluctant communities “feel empowered.”

Gregg Gonsalves, an assistant professor at Yale School of Public Health, added a caveat: target that engagement to those who seem willing to listen.

“You give people the benefit of the doubt as long as you can,” he said. “You see where you can engage … you don’t waste your time on the trolls or the ones who see public health as a punching bag for a larger political debate.”

There are reasons for hope for public health. Officials, for example, successfully helped quell the West Africa Ebola outbreak partially through door-to-door outreach. Taiwan, which publicly struggled to contain the 2003 SARS outbreak when its citizens resisted public health measures like quarantines, is now considered one of the best countries in terms of its response to the Covid-19 pandemic.

“Our fate really is in our hands … it is wholly possible to reform your system,” said the University of British Columbia’s Tworek, who studied the Taiwan example. “It’s an extraordinary difficult challenge, but that doesn’t mean that we should be nihilistic, give up, and do nothing.”

But knocking on doors and taking the time to make outreach to reluctant Americans could be harder if the public health workforce continues to dwindle — as several predicted it might after Tuesday’s election.

“We’ve been working on this pandemic for 10 months. … We are already exhausted, we are already overwhelmed, you are asking us to put our lives on the line,” said the Medical University of South Carolina’s Kuppalli, who noted she has colleagues who are already putting application packets together to work overseas.

“We could have what we call a brain drain in the United States,” she added.

As of August, at least 49 state and local public health officials around the country have left their post, according to an investigation by Kaiser Health News and the Associated Press. And that count does not include infectious disease doctors working in hospitals or academics working in universities.

Yale’s Gonsalves, insists, however that many people are not “cutting and running.”

“This is what we were made for. This is a pandemic, this is our challenge, this is our calling, this is our mission,” said Gonsalves. “We do what we do: Doctors don’t give up on patients and we don’t give up on the public health.”

“If scientists shut up, there’s no countervailing weight to the crackpot theories and charlatanism,” he added.

  • I’m appalled that Stat would publish this piece. It’s one more insulting “Trump voters are stupid” take and I expect better from my source for medical news. I’m not a Trump voter – and I work in health care. My belief that Covid policies are over the top and harmful does not reflect a lack of understanding or rejection of science. It’s a measured assessment of the risks and benefits, leading me to the conclusion that the name epidemiologists have overresponded, putting children, addicts, the disabled, the elderly and the poor at tremendous risk.

    Please don’t insult me – or my friends on the other side of the aisle – with slanted insinuations that we have a “gaping hole in [our] cultural intelligence.”

    • Completely agree…this is the problem in a nutshell. If you’ve done your homework and have a different opinion that doesn’t make you unintelligent or uninformed. It means you don’t agree.

    • Agree with your comment. I think the imperious tone tells one everything they need to know about the response of the “scientists” and the medical community – or those that speak for it through articles like this. Touted as one of the big medical discoveries of C-19, is to put patients in the prone position – on their stomachs. Duh. This is really simple at its core – effective hygiene and social distancing in all its aspects. Add in people taking responsibility for themselves and the ones they love. What beyond that does science have to offer?

    • Thank you! You are 100% correct. This piece is insulting. The pretense that the *correct* science on a NOVEL virus-induced epidemic is a unitary set of unchanging tenets that only liberal epidemiologists and public health “experts” are privy to just makes it glaringly obvious that those claiming the exclusive mantle of “science” in this piece do not care for or understand the basics of scientific thinking. (Not a Trump voter either and the fact that I even have to state this makes me sad.)

  • The arrogance and cluelessness of the public health experts quoted in this article is breathtaking. There is a spectrum of decisions that could be made with respect to suppression of the virus vs. banking on immunity, versus other impacts of extreme measures like shutdowns, which all of these experts seem to simply handwave away and refuse even to consider. See, for example the Great Barrington Declaration – composed by eminent scientists from top universities, and simply scoffed at or ignored by so many who simply assume that the risk calculus only favors shutting down so many people’s lives and businesses for a virus that has an IFR (even by the WHO’s statements) similar to influenza for most of the population. Science means asking questions, engaging in debate, not clubbing people into submission with appeals to authority.

  • “The 2020 election results were a disaster for public health.” – Sorry, is this a news article or opinion? Many legitimate factors influence voter decisions. To tar voters as anti-health or anti-science is both unfair to those voters, and condescending to voters this way is unhelpful to the cause of science and public health.

  • I would not read it as rebuke of science and healthcare. If it is to be read as such, then there is a long list of other items that could be added to the rebuke such as honesty, decency, truth, allies, relationships, service, etc.
    I reflected on the results and think the outcome is a combination of
    – Pocket book issues;
    – Aversion to Democrat party policies (including the ones labeled ‘socialism’);
    – Democrats stubbing their toes again and again on proper planning and execution of the plan;
    – Effectiveness of the messenger (DJT) and the message
    – Preference for the ‘known’ devil than the ‘unknown’ angel (see objective results here)

    I am sure there are other issues including some amount of ‘racism’ but I refuse to believe that to be the reason for half of the nation going with DJT.

  • There was more than science on the ballot. This outcome of this ballot tells about respect for races, doctors, Covid, equitable treatment of all, and real democracy. I am shocked at the 67 million. How deep will America sink if the current President gets four more bizarre years. He filed a lawsuit so the ballot counting would stop. Despicable. Just a spoiled brat. Laughing stock of the whole world.

  • I think the “public health” professionals need to take a step back and critique their own behavior before criticizing the reponses of many citizens. Examples of mistakes by such scientists are plentiful. First, SARS-2 was not initially considered to be a major problem for the U.S. (per WHO, Dr. Fauci, et al), Second, the CDC did not consider it to be a critical issue…taking their time to develop a three-part test that was overly complex and resource-consuming…and getting it wrong…and then the FDA preventing others from developing their own tests. Third, telling people that masks are only for health-care professionals, and that others do not need them…until they then decided that such masks are essential requirements. Fourth, increasing testing beyond the binding constraint of lab processing capacity so test results were delayed for many days, making them worse than useless since resources were used, but limited, if any benefits were obtained. Fifth, arguing that more testing is the answer, instead of emphasizing the necessity of quarantine procedures for those testing positive, and creating spaces for people to stay (per Korea et al). Sixth, emphasizing cases instead of deaths/illness, and identifying the actual risk for someone of a given age/health. I think the first step such public health professionals should take is to say that they were often wrong, and should have done better, to help people understand how and why to protect themselves.

  • The words we use have an impact on how our message is received. Although I have no data to support this, is it possible that our focus on the word “science” is part of the problem? To many Americans, science is “hard”; something they were not good at in school and therefore a source of discomfort; an elitist enterprise. Furthermore, for many Americans, “science” calls up associations with climate change, evolution, and genetically modified food and babies – topics that are at best controversial among many Americans. Similarly, perhaps “public health” is heard as “government healthcare” and therefore is another term we should avoid. Of course, scientists should get better at educating the public, but that is a long-term goal. In the midst of an acute crisis like the current pandemic, might we get people to hear the message if our leaders just said that Covid-19 is a medical disease and we need to follow the recommendations of our expert doctors (which of course is true)? People in the US consistently report dissatisfaction with the healthcare system but satisfaction with their doctors.

  • The head of a C-19 unit, gearing up for patients in March 2020 decides to take the family to Disney the last week it is open. Upon return from Disney they go back to work. They test positive for C-19 and the staff goes home to quarantine for 2-weeks.

    There are simply too many anecdotes like this to take a holier than thou attitude. Between Fauci and Sanjay Gupta – its just the flu and the Surgeon General – don’t wear masks that ship has long since sailed.

  • These 67 million people didn’t side with Trump on Public Health. They sided with Trump on White Supremacy, That’s what I believe. And, White Supremacy is what I have to fight with all my heart and mind and soul. I’m a 76 year old white woman.

  • Typical article written by a miffed liberal opinion writer.
    If public health really wants to do soul searching other than writing about the idiocy or stupidity of Trump voters.
    The reality is that public health experts sot a lot of their authority when they did not get behind Pres Trump’s travel embargo and then far worse initially claiming that masks were not useful, unless you were a care provider. That was simply false, and knowingly false. I understand that these “experts” were trying to save masks for healthcare providers, but they should have said that unless you are able to get masks you simply are at major risk. Trust the public to do the right thing–dont lie to them!. Similarly, the “experts” told us to stay inside to “flatten the curve” for 2-3 weeks to prevent the hospitals from being overloaded. By and large the public did so. We were never going to wreck the US economy by staying inside and hiding for 6-9 months…nor were we ever told that was needed. Finally, the experts gave wildly exaggerated estimates of deaths caused by COVID. I remember the headline “2 Million” dead. Instead we are likely to be around 400,000, a tragedy to be sure but way way less. Similarly, the public health experts basically single sorted for THEIR interests, recommending shutdowns that cost 10,000,000s of jobs and nearly destroying the world economy. Economists were aghast at that. It was as if the “physicians” were satisfied that the operation was a success even if the patient died. Finally the rank politicization of so many public health experts where maskless demonstrators of BLM and ANTIFA were fine because of “racial injustice” but much smaller church and synagogue meetings were condemned as being irresponsible.

    Could you folks not realize that that type of naked political advocacy on your part meant that basically no one on the entire right side of the political spectrum believed you any more. do a bit of soul searching. Is that primarily their fault, or yours?

    • I don’t agree with a how some of it was handled, because I’m in public health and many of the people making decisions and communicating were medical doctors and infectious disease specialists. But there was no way that this was ever going to be accepted by Trump voters no matter what was said. Once scientists changed their minds they were accused of lying. Trump himself clearly did not care and talked about it magically going away. I can tell you what could have been done differently, but I’m not going to pretend like it wasn’t going to be politicized.

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