RUTHFULLY YOURS

In Uncontrolled Spread, Scott Gottlieb, former US Food and Drug Administration commissioner, observed that the six-foot social-distancing rule was ‘probably the single most costly intervention’ recommended by the US Centers for Disease Control and Prevention (CDC) that ‘was consistently applied throughout the pandemic’.

You might have expected such a significant intervention to have had a strong evidential basis. Yet in remarks made in January before the US Congress, though only made public last month, Dr Anthony Fauci, the lead Covid-19 adviser to Donald Trump and Joe Biden, described how the social-distancing recommendation came about:

‘It sort of just appeared. I don’t recall, like, a discussion of whether it should be five or six or whatever. I was not aware of studies that in fact [supported the six-foot recommendation]. That would be a very difficult study to do. I think it would fall under the category of empiric. Just an empiric decision that wasn’t based on data or even data that could be accomplished.’

This was a curious admission coming from the man who described himself last year as ‘fundamentally about science’. In 2022, he said in an interview with a medical journal:

‘There are, in many respects, people who have complete disregard for facts, or distort facts, distort reality, deny data and make statements that are not at all backed by scientific information. What scientists have to do is just stick with the science and stick with the data. It is very frustrating when you’re dealing with individuals, institutions or groups that actually deny the reality or make statements that are not backed by facts. You can’t get rattled; just make sure you stick with the science.’

But did Fauci ‘stick with the science’? Of course not.

Earlier this week, when testifying before Congress again, Fauci walked back his ‘sort of just appeared’ remark: ‘When I say it was not based in science, I meant a prospective clinical trial to determine whether six-foot [distancing] was better than three [or] was better than 10.’ But where was that Faucian candour four years ago, when the rules about distancing dictated much of human interaction across the US?

The truth is, there was something resembling an evidential basis for the social-distancing rules. But if Fauci ever acknowledged the true origins of this policy, it would expose just how badly he bungled the Covid-19 pandemic – and how far away from actual science he and his fellow public-health officials strayed.

The data behind the six-foot recommendation were well-known to all the researchers involved with Covid-19 recommendations in the US, Great Britain and western Europe. It is inconceivable that Fauci or his boss, Francis Collins, were unaware of these data. They have been cited directly by the US CDC and the World Health Organisation (WHO) since the beginning of the pandemic.

By denying there was any basis to the six-foot recommendation, Fauci is trying to avoid discomfiting questions about one of the biggest scientific failures of the pandemic response – namely, the failure to take into account that Covid could be spread by airborne transmission, and not just by droplets.

The story of the six-foot separation recommendation emerged from work that began in the 1930s and continued during and after the Second World War. Researchers studying tuberculosis established that bacteria usually travel no more than three feet from an infected person and rarely more than six feet. For over half a century, six feet in the US, or its near equivalent of two metres in Europe, had been a well-accepted standard for distancing to avoid bacterial infections. When the Covid-19 outbreak began in 2020, the WHO recommended ‘at least’ three feet of separation, based on the same research.

Science is the process of developing a hypothesis – in this case, applying a six-foot rule to prevent Covid-19 transmission – making subsequent observations and, if the observations disprove the hypothesis, developing a new approach. The studies that Fauci now denies existed were part of the self-corrective process of science. The issue wasn’t that there were no studies involving six-foot distancing, it was that those studies did not pertain to Covid-19, and should have been recognised as irrelevant early on. Neither Fauci, nor the CDC, nor the WHO reexamined their information – they clung stubbornly to their initial pronouncements that six-foot or three-foot distancing would offer protection. That was anti-science.

Those early studies were about the droplet transmission of bacteria. Droplets are the relatively large particles you can see in a sneeze or a cough. The Covid-19 virus is much smaller than bacteria, and can travel much further and remain airborne for longer. That’s because Covid is transmitted primarily by aerosols, a much finer spray than droplets (comparable with invisible cigarette smoke). Despite ample documentation by aerobiologists (scientists who study airborne disease patterns) and other specialists, Fauci, the CDC and WHO were regrettably slow to pick up on the fact of aerosol transmission – with devastating consequences. At the outset of the pandemic, they had an obligation to establish whether the prior research on six-foot distancing applied to Covid-19. It didn’t – yet they behaved as though it did anyway.

The knowledge of aerosol transmission should have prompted an entirely different approach to Covid-19. Public-health officials could have encouraged relocating activities outdoors (in Chicago the mayor closed the beaches, but kept crowded bars open). Schools could have held classes outside rather than cancel them.

The importance of indoor ventilation was also downplayed. Many more ventilation systems could have been installed in homes, schools and offices. Too much time and money was spent on plexiglass barriers and surface disinfection instead. It turns out you didn’t need to scrub down your vegetables or wear gloves to handle your mail. For far too long, experts told us to worry only about droplet transmission instead of advising us on how to control aerosol transmission.

Fauci did not acknowledge the importance of aerosol transmission until at least six months into the pandemic. More than a year after the pandemic began, some scientists felt it necessary to call on the White House and implore Fauci and the CDC to update their ‘out of date’ Covid guidelines. Then and now, Fauci shifted blame to the CDC, which admittedly did not acknowledge the importance of aerosol transmission until nearly a year and a half into the pandemic. The WHO waited even longer – two years. At no point did Fauci or those organisations highlight the dramatic implications of this. They did no press conferences or public-advertising campaigns. This contributed to a misdirected response to the pandemic, especially in the second and third years. The relentless focus on social distancing by Fauci and Co made it difficult to change the playbook and concentrate on mitigating aerosol transmission.

Admitting error is a fundamental part of science – and admitting error isn’t Anthony Fauci’s strong suit. This week’s congressional questioning over six-foot separation rules was an excellent opportunity for Fauci to tell the truth about the misguided early advice. He could have explained that the rules had been generated decades ago and, as researchers quickly discovered, didn’t pertain to Covid-19. When it became obvious that the six-foot rule wasn’t protective, especially after the appearance of later Covid variants, science demanded that we throw out the rule and approach the pandemic differently. Yet Fauci and the CDC didn’t ‘do science’. They kept the six-foot rule until August 2022, presumably to avoid admitting error. That stubborn refusal to change course may have helped protect their professional reputations, but did it protect the public? Essentially, they put public relations ahead of more effective transmission control.

Nothing of lasting significance came from Fauci’s recent congressional testimony. The Democrats on the House subcommittee tried to butter him up (one Democratic representative gushed, ‘Thank you for your science’). The Republicans, meanwhile, were ill-prepared to ask important questions. They mostly fired politically motivated queries about improperly hidden emails and research funding. Whether his answers to those questions were honest or artful evasions means little in the long run in terms of public health or future pandemics. Republican Marjorie Taylor Greene deserves special mention for her opera bouffe. She refused to call Fauci a doctor and claimed he should be in prison, thereby earning him the sympathy of millions and virtually guaranteeing there would be no substantive examination of his science, motives or actions during the pandemic. Memo to Dr Fauci: send Representative Greene a Christmas card this year for her helpful performance.

It speaks volumes that no one from either the CDC or the WHO has come forward to refute Fauci’s claim that the six-foot separation recommendation arose out of thin air. The scientific papers from the start of the pandemic include references to those older studies and are in plain sight.

This is all too typical of the Covid-19 response. The ‘science’ that was presented to us was nothing of the sort. It was simply the consensus view of certain experts, given a rubber stamp of authority by key scientific institutions. All too often, that narrow view was wrong. This unscientific approach resulted in economically destructive lockdowns, disastrous school closures and a lethal inattention to the dangers of inadequate indoor ventilation.

Fauci and his collaborators at CDC and WHO certainly bear significant responsibility for each of those debacles. We can’t let him get away with trying to whitewash his legacy.

Cory Franklin’s new book, The Covid Diaries 2020-2024: Anatomy of a Contagion As It Happened, is now available on Amazon in Kindle and book form.