The Collapse of the Public Health Establishment is the Collapse of the Professional-Managerial Class

By Lambert Strether of Corrente.

The collapse of the public health establishment — or rather, its transformation into an instrument of stochastic eugenics[1] with “business-friendlyLet ‘er rip” policies — is indicative of a collapse in the moral (and technical) authority of the Professional Managerial Class (PMC), whose hegemonic fractions implemented, facilitated, and propagandized the “urgency of normal,” whose effects (or, if you prefer, success) can be seen in the chart below:

(See NC here for a discussion of using wastewater as a proxy for case counts.) We are now in the midst of the second biggest Covid surge. That’s a lot of infection. Being infected with Covid is bad. Being reinfected is worse. Not that Covid is even visible as a public health problem, or any kind of a problem. Move along, people, move along! There’s no story here (except on the blogs, of course):

“We are in possibly the second-biggest surge of the pandemic if you look at wastewater levels,” said Dr. Monica Verduzco-Gutierrez, who runs a long-Covid clinic at the University of Texas, San Antonio, and has had ongoing Covid symptoms since August 2022. “There is no urgency to this. No news. No discussion in Congress. There is no education.”

In meditating this post, I recalled Dark Age Ahead (PDF), by Jane Jabobs (2004). From a recent review (2023):

What exactly is a dark age? This is the topic of her first chapter, which introduces the most interesting idea of the book: that dark ages are essentially episodes of large-scale amnesia…. Regardless of the quality of life of early medieval European people, it’s clear that they had forgotten many of the technologies, ideas, and institutions that made up life during classical antiquity.

Worse — in many cases, they suffered from what I might call “double amnesia”: they had forgotten what they had forgotten. … A dark age, according to Jacobs, is that: a breakdown of culture to such an extent that people forget what life used to be like, and even forget that life used to be different at all. Though the post-Roman Dark Age is the most readily available example in the West, dark ages have happened many times across the world, for reasons spanning from economic collapse to genocide.

“Double amnesia” seems familiar. We in the United States, for example, seem to have forgotten how to build aircraft; in a century, will we have forgotten that we ever knew? More to the point, the same goes for measles; when measles returns, how long will it take us to forget that we once conquered it?

I recalled Dark Ages because it treated the collapse of self-regulation and self-policing in the professional classes as a sign of societal collapse. Ian Welsh writes (2016):

Jacobs’ final example is about professional self-policing. She uses the decline of the accounting profession (right after their failure to notice Enron’s problems before it collapsed) as her case example, but arguments could be made for many professions, certainly including the clergy, medicine, and American psychologists. It’s very hard for government to regulate professionals properly, because they don’t understand the profession, so it is ideal for professionals to do it themselves. If they can’t, then the government must, and something important is lost.

Jacobs herself points to the management of professional identity through public relations as the central problem:

And it is true that the three characters I am about to look at are very much “the glitter is the gold” types. (I don’t view Dark Age Ahead as Jacobs’ finest hour — I would prefer a fully worked sociological case study, not rumination — but what is clear is that she was, in 2004, directionally correct, as her many critics were not.) Anyhow, a general theory of how and why the PMC collapsed in the face of the Covid pandemic must wait for another day (although this diatribe from 2016 is very suggestive).

These three ideal types are all PMCers at the pinnacles of their professions: A White House Press Secretary, the Director of a national public health agency, and the Chair of the Department of Medicine at a major public university. All have failed, morally and technically, as professionals, in dealing with the pandemic. In what follows, I will refer to them, for maximally insulting familiarity, as “Karine” (Karine Jean-Pierre), “Mandy” (Mandy Cohen), and “Bob” (Robert M. “Bob” Wachter).

Some may say that I’m guilty of the adhominem fallacy, but I’m with Taleb:

“In matters of expertise, you look at the credibility.” Karine, Mandy, and Bob should have no credibility. None.


From Press Briefing by Press Secretary Karine Jean-Pierre and NSC Coordinator for Strategic Communications John Kirby, January 4, 2024, at the White House:

Q Thanks. Some hospitals in at least eight states have brought back some form of masking now due to rising cases of respiratory viruses, including the flu and COVID. Does the White House think more hospitals across the country should be considering that right now?

MS. JEAN-PIERRE: The masking piece?

Q Mm-hmm.

MS. JEAN-PIERRE: That is — and we’ve been — always been very consistent on this. That is something that is localized or — that — or hospitals, communities, cities, states, . That’s not something that we get involved in.

Q And what about Americans broadly now? There’s 31 states in the latest data that have high or very high levels of respiratory illness: RSV, flu, and COVID. What should Americans be doing? What’s the recommendation?

MS. JEAN-PIERRE: So, look, .

We have a range of tools. Right? That is something that we’ve been able to do these last three years for people to feel — to protect themselves from the impact of COVID — whether it’s a vaccine, whether it’s at-home testing, whether it’s treat- — and treatments. Right? All of these things are incredibly important.

So, there are tools available for folks. And we’re going to certainly — certainly encourage Americans to — to take those steps.

We’re not going to — .

No mention of ventilation, of course; the implications of #CovidIsAirborne are entirely erased. That’s one dereliction; and a greater dereliction is the utter failure of the Biden Administration to lead by example (or rather, they are leading by example; right over the cliff). But to see Karine’s real professional collapse, you’ve got to watch the video:

The eye-rolling, the headshaking, the warding gestures, above all flipping through the briefing book while the reporter asks the questions; one might almost suspect Karine of having a guilty conscience…. And for a White House Press Secretary, that’s the ultimate failing? Also, why not just toss the ball to the CDC? And speaking of the CDC–


A collection of memes on a single theme: #WheresMandy:

Everybody wants to know:

Mandy’s last appearance. Maskless, of course:

Now is not a good time:

Mandy, we’re worried!

We need your leadership!

The CDC Director vanishing during the second largest Covid surge in the current pandemic is surely an example of professional collapse.


Finally, Bob Wachter. We awarded Bob our coveted Sociopath of the Day Award on May 12, 2022, and you can check that post out for how he chivvied his wife to a writer’s conference that turned out to be a superspreader event (she got Long Covid).

I’m pressed temporally, so I will merely present “Tin Can Bob[2]’s” latest iteration of his personal risk calculator, which is the most outlandish example of the PMC fetish for homework that I have seen in a long time. I have helpfully added some notes:

[1] See the note at “**.” All Bob’s indicators are lagged, wastewater by days, and hospitalization by weeks (Bob doesn’t say if he’s using CDC’s infamous “Green Map,” but he would, wouldn’t it?) If a variant is really taking off, a two week lag could mean the difference between “not to worry” and “extremely dangerous.” So right off the bat — never mind Bob’s own health, or his poor wife’s– he’s built in the possibility of infecting many others if he has a case of asymptomatic transmission.

[2] It’s not clear whether Bob uses a respirator or a Baggy Blue (I’d guess the latter). Also, Bob doesn’t seem to understand aerosol transmission; Covid spreads like smoke through the entire institution, so only wearing a mask while treating a patient doesn’t prevent transmission or infection.

[3] Bob has an amazing fetish for “indoor dining.” Brunch, I guess?

[4] Bob, again, seems not to understand either asymptomatic transmission (no cough needed) or aerosol tranmission (if he did, he would include talking and breathing, as well as coughing and runny nose).

[5] Carry it? Why constantly doff and undoff? Why not just wear it?

[6] “When no need to talk”? Absurd. I can talk in a mask just fine.

[7] Bob always has these enormous loopholes in his masking policy: “When no need to talk,” “when no need to eat or drink.”

[8] Bob doesn’t seem to understand that reinfection (hence transmission) can happen in less than ten weeks.

[9] What the heck do “lean a bit to the right” and “not a full column-worth” even mean?

Why not Keep It Simple, Stupid? Forget all the homework, which is useless to begin with because of lag times. Just settle on a simple protocol and stick to it ffs.

Oh, and Bob is the dude who called our current Covid surge — second highest in history — an uptick:

Bob is also the dude who emitted this absurdity in Time:

“We’ve got to somehow reprogram our minds to think about this as a threat that is just not as profound as it was for a couple years,” Wachter says. “When your minds have been pickled in terror for a couple of years, it’s very hard to do.”

Given that Bob — after he knew that both he and his poor wife had Covid — actually considered staying overnight at her parents and then flying home — can hardly have been “pickled in terror” at any point, it’s hard for me to understand who is referring to. Perhaps people with a rational apprehension of inhaling an airborne Level Three biohazard?

Anyhow, I’m not an idealist like Bob; I’m a materialist. If we are to reprogram our minds, we should do so not to further promote infection, but to demand clean air, free from pathogens, for ourselves and our children.


All I can say is don’t listen to these three people about Covid, ever, “professionals” though they be. They have and should have no credibility at all!


[1] See, e.g., Record of the Proceedings, August 22, 2023, HICPAC, p. 72.

[2] One would wish to sympathize:

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