Reflections and Revisionism: Rethinking the U.S. Response to COVID-19

Wendy E. Parmet* June, 2026

In Covid’s Wake: How Our Politics Failed Us. By Stephen Macedo and Frances Lee. Princeton, New Jersey: Princeton University Press. 2025. Pp. xiv, 299. Hardcover, $29.95; paper, $19.95.

Introduction

Six years ago, life changed dramatically as COVID-19 spread prolifically around the globe, inflicting millions of deaths and imposing crushing burdens on healthcare systems. In response, nations around the world imposed a series of extraordinary “social distancing” or “community mitigation orders” that aimed to save lives by reducing social interactions.¹ These measures, which varied significantly in terms of scope and duration across jurisdictions, exacted significant economic, social, and personal costs.² So did COVID, which claimed over one million lives in the United States alone.³

Although the pandemic (but not COVID) is behind us, its scars linger. In the United States, these tragic effects include not only the lives that were lost but also the grief and trauma experienced by those who lost loved ones. They also include the significant deficits in education and socialization that students experienced due to lengthy disruptions of in-person schooling⁴ and the erosion of trust in our public health system.⁵ The latter losses seem especially salient today, as the Trump Administration targets biomedical research⁶ and public health programs,⁷ strips health data from government websites,⁸ undermines access to vaccines,⁹ and threatens scientific journals,¹⁰ all while promising to “Make America Healthy Again.”¹¹

In the face of all this loss, it seems especially important to reflect on the decisionmaking, politics, and policies that shaped the U.S. response to the pandemic. The recent book In Covid’s Wake: How Our Politics Failed Us, written by political scientists Stephen Macedo¹² and Frances Lee,¹³ promises to provide that reflection. In ten readable chapters, the authors argue that in the spring of 2020, members of the “laptop class,” ¹⁴ the term they apply to “adult knowledge workers and others able to work remotely,” (p. 14) quickly cast aside earlier misgivings about “non-pharmaceutical interventions” (NPIs),¹⁵ which include all public health interventions that do not involve the administration of a drug or vaccine. With those misgivings set aside, Macedo and Lee argue, the “laptop class” pushed “lockdowns,” based on “the China model” (p. 21). Later chapters purport to show that the “laptop class” stifled dissent as well as evidence that the pandemic was caused by a leak from a laboratory in Wuhan, China (ch. 7). They also claim that the NPIs, including community mitigation measures, were mostly ineffective (ch. 5) and costly (ch. 6). In short, Macedo and Lee suggest that the “laptop class” acted disingenuously and illiberally, pushing policies that caused far more harm than good (pp. 138–42, 177–97). At the same time, and somewhat in tension with the influence they ascribe to the “laptop class,” Macedo and Lee document the significant role that partisanship played in shaping state responses to COVID.¹⁶ The authors conclude by underscoring the limitations of expertise and calling upon “those on the progressive side . . . to reexamine their own conduct and beliefs” (p. 286).

As a progressive public health law scholar, Macedo and Lee’s critiques often bite. Without question, some of the assumptions and prescriptions made by public health experts and others involved in the COVID policy response have not stood the test of time.¹⁷ Self-reflection, as Sandro Galea has preached, is in order.¹⁸ Illiberalism is to be condemned. But especially at this moment, it is critical that self-reflection not descend into performative self-flagellation and the type of COVID-revisionism that is all too rampant.¹⁹ To understand what went wrong, those of us in the public health community need to be not only introspective but wide-eyed. We need to recognize not only our own errors but also what we got right. We also need to appreciate the forces that were aligned against us and learn how to better protect the public’s health in the face of those forces.

Unfortunately, Macedo and Lee often seem uninterested in such complexities. To them, the sins and need for penance are mostly on one side. Nevertheless, their account provokes many questions about policymaking during the pandemic that warrant interrogating. This Book Review engages with some of their criticisms while offering a sometimes personal (and hopefully not too defensive) reflection on the U.S. response to COVID.²⁰ Part I begins by examining Macedo and Lee’s indictment of the “laptop class,” emphasizing how they ignore its heterogeneity, as well as the important role played by other actors. In Part II, I consider their discussion of COVID-era restrictions and policies, looking particularly at the impact of those policies on socially and epidemiologically vulnerable groups. In the Conclusion, I offer some brief thoughts about the lessons the public health field should learn moving forward.

I. Who Made COVID Policies?

Throughout In Covid’s Wake, Macedo and Lee castigate the “laptop class” for engaging in a dangerous form of “groupthink” (p. 295) and imposing ineffective or counterproductive policies that harmed the most vulnerable populations while saving few, if any, lives (pp. 14, 138–42). The implication of their critique is that the “laptop class” is largely responsible for the loss of trust in public health.

No doubt, members of the “laptop class” made mistakes during the pandemic. Who didn’t? Nevertheless, Macedo and Lee’s indictment offers an overly simplistic and one-sided analysis that neglects, among other points, the heterogeneity of the criticized class²¹ and the significant role of other actors.²² Below I discuss each point in turn.

Consider first the issue of heterogeneity. Although Macedo and Lee define the “laptop class” broadly,²³ in much of the book they treat it as a relatively homogeneous group comprised of public health experts, academics, journalists, policymakers, progressive activists, and politicians.²⁴ Yet, as Samuel R. Bagenstos says of science, the “laptop class” is “not one set of people with one background and one set of shared norms.”²⁵ The epidemiologists who advised government officials about COVID did not have the same training or perspective as the government lawyers who drafted orders and regulations. The latter, in turn, did not share the professional outlook of economists, health policy experts, journalists, or community organizers. And some who Macedo and Lee seem to include within the “laptop class,” such as teachers, lacked the affluence that Macedo and Lee presume the “laptop class” casually enjoyed. Members of the class also varied in terms of their own age, health, and family situation. No doubt some could, and probably did, write articles from the luxury of vacation homes; others likely cared for children in crowded apartments or experienced the loss of loved ones. Some undoubtedly became patients in overcrowded hospitals. Somehow these possibilities seem to have escaped Macedo and Lee’s imagination.

Macedo and Lee also ignore the inconvenient fact that some of the professionals who were the most influential during the pandemic did not work remotely and thus did not fall within their definition of the “laptop class.” Indeed, some were on the front lines of the pandemic response.²⁶ Remarkably, Macedo and Lee ignore the influence of doctors, nurses, and other frontline healthcare workers and omit discussion of the views of any professional healthcare organization, other than to note, disapprovingly, that some medical organizations signed an amicus brief claiming that the government had a compelling interest in combatting vaccine misinformation (p. 281). The absence of a discussion of how and why these organizations came to their views, or the influence that they—as opposed to remote workers—may have had, is telling.²⁷

Equally problematic, Macedo and Lee overemphasize the influence of a few public health experts and pundits while diminishing the influence of the officials and agencies that actually wielded power. Macedo and Lee do show that the decisions made by governors followed a partisan pattern (ch. 5), but they fail to explore why Republicans, many of whom had supported the robust use of NPIs in prior outbreaks,²⁸ began to minimize COVID’s threat, with several Republican governors pushing for early reopenings even as the Republican White House counseled a more cautious approach.²⁹ Yet, if we want to understand how COVID policies were formulated, we need to know not only what academic pundits preached, but also why many governors ignored their advice.

More troubling, Macedo and Lee often seem to treat the policies and recommendations of public health experts as unaffected by the actions of conservative politicians and media personalities.³⁰ In their telling, progressive elites were motivated primarily by their own imperatives—saving lives (p. 121)—and engaged in a type of groupthink (p. 295) that was uninfluenced by what President Trump and his allies said and did (or failed to do). Thus, Macedo and Lee fail to discuss why conservatives came to reject NPIs, and the possibility that that rejection changed not only the political climate, but the social and informational environment in ways that may have affected the virus’s prevalence and the policy options that were available to reduce it. In short, Macedo and Lee never consider the possibility that progressive support for extending school and business closings may have been influenced, at least in part, by the fact that conservative media was pushing COVID-denialism and misinformation in ways that undermined the public’s willingness to adopt less draconian measures, such as masking and vaccination.³¹ By omitting any critical analysis of the actions and influence of conservative actors, Macedo and Lee give the misimpression that progressives were both all-powerful and paranoid in imagining dangers that did not exist. Those dangers did exist, and they helped to shape (for better or worse) both the risks faced by the public and the policy options that were available. They were part of the politics of COVID, yet they are largely ignored in Macedo and Lee’s account.

Trump and his allies, however, are not the only actors who get short shrift. Oddly, in a book on the politics of COVID, Macedo and Lee pay almost no attention to congressional leaders (Speaker Nancy Pelosi is not cited in the index) or the policies that Congress enacted,³² even though relief acts passed by Congress helped to sustain social distancing measures and provided critical economic and social supports (such as expanded access to Medicaid)³³ to the very populations that Macedo and Lee claim were overlooked.³⁴

Macedo and Lee also ignore the influence of business interests. One of the Supreme Court’s early COVID cases, Calvary Chapel Dayton Valley v. Sisolak,³⁵ offers a prime example of how economic interests frequently trumped health concerns during the pandemic. Calvary Chapel Dayton Valley was a Free Exercise challenge to the application of a Nevada health order prohibiting in-person worship.³⁶ In an unsigned opinion, the Supreme Court refused to lift the order.³⁷ In Justice Alito’s dissent, which Justices Thomas and Kavanaugh joined, he noted that Nevada had reopened casinos even as it shuttered church services.³⁸ Likewise, many states reopened restaurants and bars before schools, an ordering that many public health experts decried.³⁹ The fact that states prioritized the reopening of casinos, bars, and restaurants over schools and churches, however, shows not only the power of the “laptop class” and teachers unions, but also that of the hospitality industry.

Macedo and Lee’s treatment of the Great Barrington Declaration (GBD),⁴⁰ which was signed by hundreds of scientists in the fall of 2020, also exemplifies the narrowness of their analysis. The GBD called for eliminating NPIs and allowing COVID to spread until the population achieved “herd immunity.” It also called for “focused protection” for those most vulnerable to COVID.⁴¹

The declaration was controversial. Critics lambasted it for assuming that high-risk individuals could realistically be separated from the rest of the population (pp. 29, 101) and claiming that the lifting of restrictions would quickly lead to “herd immunity”;⁴² in fact, deaths continued long after almost all legal restrictions were lifted.⁴³ Critics also assailed the GBD for rejecting solidarity and undervaluing the health and lives of vulnerable individuals in order to vindicate the liberty and economic interests of those who were less vulnerable to COVID.⁴⁴ Perhaps most importantly, the GBD did not explain how a policy focused on protecting those at high risk could work practically, in a nation in which over 176 million people are estimated to have one or more conditions qualifying them as at high risk.⁴⁵

No doubt, Macedo and Lee are correct to say that some public health experts reacted hyperbolically to the GBD. Most troubling were Dr. Francis Collins and Dr. Anthony Fauci’s efforts to quell the debate generated by the GBD.⁴⁶ To Macedo and Lee, the “takedown” of the GBD—which they also term the “[s]tigmatization of herd immunity” (pp. 106–07)—demonstrates the illiberalism of progressive public health experts (p. 121). Yet, the very existence of the GBD and the considerable debate it generated can also be viewed as a sign of healthy discourse within the class—unless of course, Macedo and Lee assume that the economists, scientists, and pundits who supported the GBD were, somehow, not members of the “laptop class.” If so, the homogeneity of the class’s views is simply a function of the ideological litmus test that Macedo and Lee implicitly apply to the class’s definition.

Finally, in their discussion of the GBD, Macedo and Lee also underplay the extent to which many of the GBD’s key recommendations were already in effect when the declaration was issued. Responding to that inconvenient fact, they point to restrictions imposed in the Netherlands and United Kingdom after the GBD was issued, as well as the continued closing of some schools and universities (pp. 101–02). But restrictions in other countries do not prove the “laptop class’s” influence in the United States. And though the “laptop class” may have “won” academic debates over reopening, in the real world, by the summer of 2020, most governors hewed far closer to the views of the GBD than to the views of those who rejected it (p. 129). And it was not academics or pundits who determined the stringency of NPIs but rather governors, most of whom were Republicans.⁴⁷ In short, the “laptop class” was neither as uniform nor as influential as Macedo and Lee suggest; nor were its opponents either as sage or victimized as they portray. Indeed, looking at the leadership of federal health agencies today, it seems fair to say that the GBD’s proponents prevailed.⁴⁸

II. Understanding NPIs

Early in the book, Macedo and Lee discuss an open letter signed by hundreds of public health-related scholars in March 2020 “aimed at influencing the U.S. response to the pandemic.”⁴⁹ Macedo and Lee use this letter to convey two important points: First, pre-COVID, there was a strong consensus among public health experts against the use of NPIs. Second, those same experts rapidly ignored their prior advice and endorsed China-style lockdowns⁵⁰ once COVID broke out in the United States.⁵¹ Worse, those same experts, Macedo and Lee assert, went on to stigmatize and stifle dissenters, while ignoring the heavy costs of NPIs (pp. 166–67, 270–71).

As I have written elsewhere, I helped write that March letter,⁵² as well as other papers and reports that criticized some pre-COVID pandemic plans for their emphasis on the use of some types of NPIs.⁵³ As a result, Macedo and Lee’s criticism hits home.⁵⁴ Were my colleagues and I hypocritical? Did we—and more importantly, did the officials who imposed NPIs—fail to consider their costs?

These questions ought to be taken seriously. The community mitigation measures implemented during COVID were extraordinary (though not totally unprecedented) in their scope and impact.⁵⁵ In addition, although a variety of questions can and should be raised regarding Macedo and Lee’s conclusions about the efficacy of COVID-related restrictions⁵⁶—including their failure to consider the costs of losing parents and their casual discounting of long COVID⁵⁷—there is no doubt that the restrictions were not as effective as many hoped.⁵⁸ That is due, in part, to the fact that the virus continued to mutate, causing additional waves of outbreaks. Further, it might be impossible to stop outbreaks of (and deaths from) a virus with COVID’s epidemiological characteristics without a vaccine or far more sweeping measures, such as those imposed by China.⁵⁹ Here, it is important to reiterate that despite Macedo and Lee’s claim that the United States followed the “China model,” it did not do so.⁶⁰

Macedo and Lee are not wrong to argue that experts sometimes lost sight of the difficulty of controlling COVID. Once a pandemic hits, the imperative to “do something” to save lives when no other options were available can be overwhelming. Nevertheless, Macedo and Lee tend to understate the risk that COVID posed, especially before the development of vaccines. By so doing, they make the restrictions that were imposed seem utterly indefensible.⁶¹ They also fail to consider important distinctions between the NPIs that were employed against COVID and those that experts warned against. And they ignore the many ways in which equity was addressed, albeit imperfectly, during the pandemic. Below, I first discuss some distinctions that Macedo and Lee overlook between NPIs. I then turn to the question of equity, noting their failure to consider the efforts that were made to address it, as well as the inequities they ignore.

A. Scapegoating vs. Solidarity

Although Macedo and Lee note that the stringency of NPIs varied between states, they generally fail to distinguish among NPIs. NPIs come in many permutations. At one end of the spectrum are more restrictive policies that surveil and confine individuals to their homes or other places of confinement; at the other end are less draconian policies that limit some mass gatherings, set ventilation standards, or require people to wear masks in crowded settings.⁶² The epidemiological, liberty, and practical costs of each and all other policies vary. Unfortunately, Macedo and Lee ignore these distinctions.

They also overlook another key distinction: whether NPIs are employed universally (i.e., are community-wide mitigation measures) or are targeted at discrete individuals or demographic groups. Historically, health officials have often used NPIs to control and scapegoat socially vulnerable populations. For example, during the early twentieth century, officials rounded up and forcibly treated women who were thought to have lax morals on the theory that they spread sexually transmitted infections.⁶³ Early in the HIV epidemic, a majority of Americans believed that AIDS patients should be quarantined.⁶⁴ Although quarantine was not employed broadly, the federal government did detain HIV-positive Haitian refugees in Guantanamo Bay.⁶⁵ International quarantines and travel bans have also long been used to single out nonnationals and immigrants.⁶⁶

These tactics are troubling for many reasons. First, such NPIs violate the human rights and dignity of individuals who are already vulnerable due to their social or health status, treating them as a source of contagion rather than persons whose health conditions warrant protection.⁶⁷ Second, because they are motivated by animus and prejudice rather than epidemiology, such approaches are unlikely to be effective. For example, policies that forcibly detained female sex workers overlooked the fact that men also spread sexually transmitted infections.⁶⁸ Third, by treating some discrete groups as “the problem,” targeted NPIs divert attention and resources away from population-based measures such as paid sick leave or government-supported healthcare, which enable many more individuals to comply with health recommendations, thereby reducing the risk they may pose to others.⁶⁹ Finally, punitive approaches can undermine social solidarity and trust in public health officials, leading people to go “underground,” which can increase the risk of contagion.⁷⁰

Early in the twenty-first century, such concerns led many⁷¹ public health experts, bioethicists, and scholars to raise serious concerns about quarantines (which limit the movement of individuals who are thought to be contagious but are not yet ill) and travel bans (which limit the movement of people who are thought to raise a risk of contagion but are not known to be ill).⁷² Importantly, these critics of quarantines (and I place myself in that category) did not assert that NPIs were uniformly inappropriate. Instead, they argued that highly restrictive targeted NPIs should not be the first tool utilized, and they stressed the need for safeguards to ensure that states do not discriminate against or unfairly target vulnerable individuals.⁷³

In the winter of 2020, there were good reasons to worry that quarantines and travel bans would be deployed in discriminatory and ineffective ways. After all, President Trump demonized immigrants at the very start of his presidential campaign.⁷⁴ Additionally, one of Trump’s first responses to COVID was the imposition of a travel ban on China that exempted American passport holders, as if passport status determined viral status.⁷⁵ At the same time, the President and his administration took few steps to prepare the country for COVID or mitigate its impact. They did not enhance the procurement of personal protective equipment (PPE) or commence community surveillance.⁷⁶ Given that context, there were reasons to worry about how the United States and its states might employ NPIs. Would they quarantine people of Chinese origin? Close only businesses owned by Asian Americans? These concerns spurred the March letter’s reminders that “[a] successful American response to the COVID-19 pandemic must protect the health and human rights of everyone in the US,” and “[g]overnment and institutions must also actively prevent discrimination and scapegoating of individuals or groups.”⁷⁷ Macedo and Lee overlook this critical distinction between universally applied community mitigation measures and discriminatory NPIs.

This is not to say health experts believed that all of the NPIs implemented during COVID were well-designed or effective. Indeed, many members of the “laptop class” recognized the risk of overreach and called for more oversight of executive authority.⁷⁸ But what most public health advocates rejected, and Macedo and Lee (not to mention the GBD) implicitly support, was an approach that asked no sacrifice from those who were least vulnerable to COVID’s toll.⁷⁹ It was an approach that underplayed the reality of contagion: that the risk of a virus depends in large measure on its prevalence in the community.⁸⁰ Instead of community mitigation, Macedo and Lee seem to prefer a type of “do it yourself pandemic” that views risk purely in personal or individual terms.⁸¹ With such an individualized approach, those who are healthy and young can live life as they had; those who have preexisting conditions or are older are, well, out of luck.

B. COVID’s Unequal Toll

One of Macedo and Lee’s more searing arguments is that the “laptop class” failed to consider the distributional impact of COVID-related restrictions (pp. 13–15). First, the authors show that Dr. Anthony Fauci and Dr. Deborah Birx, as well as other influential public health leaders, relied heavily on mathematical and epidemiological models that considered the impact of various policies in terms of lives lost or saved, while ignoring “collateral costs.”⁸² Macedo and Lee further assert that there was a “remarkable dearth of academic panels, conferences, and workshops examining the trade-offs entailed in non-pharmaceutical interventions” and that “academia tended to view such questions as either not worth asking, or too uncomfortable to ask.”⁸³ The authors then summarize some of the costs of COVID restrictions: additions to the public debt, inflation, social dislocation, educational losses, harms to mental health, an increase in global inequality, unemployment, and business failures (pp. 178–97). Throughout this discussion, Macedo and Lee emphasize the costs borne by low-income groups and racial minorities (p. 185).

Macedo and Lee are correct to focus on the inequitable costs of NPIs. Nevertheless, as the discussion above suggests,⁸⁴ not all the inequities came from NPIs—some came from the virus itself, or its interaction with preexisting social structures. For example, Macedo and Lee rightly lament the emotional and cognitive harms experienced by long-term care residents due to policies preventing visits from family members (p. 193). But they ignore the pain that such residents and other seniors felt when they lost friends and neighbors—not to mention the loss of life itself for those who died! They also ignore the fear of the virus that many older or immunocompromised Americans experienced or the survivor’s guilt felt by healthcare workers and loved ones who transmitted COVID to vulnerable individuals.⁸⁵ Policy was important, but so was the virus.⁸⁶ That’s one reason why public health experts sought to reduce the virus’s transmission in the community, including by masking, which Macedo and Lee quickly reject without considering that it could serve as a form of harm reduction or as a less restrictive alternative to social distancing laws.⁸⁷

Macedo and Lee also understate the “laptop class’s” concern for equity. For example, although they state that that the March letter noted that compliance with NPIs would depend on the “degree of support provided, particularly for low-wage workers and other vulnerable communities,” (p. 69), they do so in a section of the book designed to show that before mid-March 2020, public health experts rejected NPIs (pp. 68–70). Somehow, the letter’s focus on equity, and the fact that it insisted that “[w]here mandatory measures are used, steps must be taken to ensure that people are protected from job loss, economic hardship, and undue burden,”⁸⁸ seem to escape Macedo and Lee’s attention when they turn to issues of equity.

The letter’s signatories were hardly alone in emphasizing the need to consider the impact of COVID-related policies on vulnerable populations. Once the pandemic began, many public health experts focused on the heightened risks to and the costs incurred by low-wage workers and other vulnerable populations. The two-volume COVID Law and Policy Playbook, featuring contributions from over fifty public health experts that my colleagues and I edited,⁸⁹ included a list of recommendations aimed at addressing the costs borne by low-income workers, as well as racial and other minority groups.⁹⁰ But in contrast to Macedo and Lee, the Playbook’s contributors also recognized that an appropriate response to COVID should not only help low-income individuals bear the costs of mitigation strategies⁹¹ but also protect those at high risk from the virus itself. For example, prisoners and immigration detainees were at especially high risk throughout the pandemic.⁹² Their plight, however, escapes Macedo and Lee’s attention, as do the risks faced by people who are immunocompromised. In their calculus, the only inequities that mattered were the ones created by NPIs.

Fortunately, many policymakers did not share Macedo and Lee’s myopia. In fact, Congress passed numerous measures designed to cushion the economic pain caused by the pandemic.⁹³ Among these were laws that guaranteed paid leave and extended unemployment benefits,⁹⁴ eased access to Medicaid⁹⁵ and SNAP,⁹⁶ and temporarily halted evictions.⁹⁷ Later, once vaccines became available, public health workers joined with community groups to vaccinate racial and ethnic minority populations.⁹⁸ And to protect blue-collar and essential workers, the Biden Administration issued a regulation requiring large employers to either mandate vaccination or require masking and testing of their workers.⁹⁹ Although the Supreme Court ruled that the administration lacked authority to issue the regulation,¹⁰⁰ the regulation aimed to protect blue-collar workers, showing that the disregard of the interests of working-class Americans did not come solely (or even mostly) from the progressive side.

True, these measures were insufficient to ensure that either the virus’s biological or economic costs were borne equitably across the American population. And the interests of many groups, especially K–12 students, were often undervalued. Still, in a book that purports to show how our politics failed us, Macedo and Lee’s failure to discuss the formulation of supportive measures is surprising; their failure to consider the impact of the policies they implicitly support on high-risk individuals is far more troubling.

Conclusion

The six years since the start of the pandemic have been tumultuous for the public health community—that amorphous and heterogeneous group of government officials; community health workers; and academics in public health, epidemiology, and public health law and policy. Not only did public health officials at all levels of government have to respond to a global pandemic that defied epidemiological expectations,¹⁰¹ but they did so in the face of a series of novel challenges: a president who frequently issued misleading statements about the pandemic,¹⁰² social media amplification of conspiracy theories,¹⁰³ a growing populist backlash against institutions and expertise (that, to be clear, long predated COVID),¹⁰⁴ and a judicial system that became increasingly skeptical of the exercise of public health-focused executive powers.¹⁰⁵ They also had to confront a new virus in a nation that was deeply polarized and had both lower life expectancies and higher rates of many of the chronic conditions that increase the risk of dying from COVID than other wealthy countries.¹⁰⁶ As thanks for facing all of this, many public health workers experienced harassment and death threats.¹⁰⁷

Despite these challenges, by some measures, neither our public health workforce nor our policies failed us. After all, scientists developed and public health workers disseminated a new vaccine in record-breaking time.¹⁰⁸ Moreover, despite deep political polarization, Congress quickly enacted several relief bills that softened the pandemic’s economic pain.¹⁰⁹ And deep into the pandemic, a large plurality of Americans continued to trust healthcare workers, public health institutions, and public health experts.¹¹⁰ Perhaps the glass is half full!

Still, whether the glass is half full or half empty, the public health community (and the “laptop class” more generally) should learn from their mistakes. Among the most obvious lessons is the need for humility, especially early in an outbreak when scientific evidence is slim and the meaning of the data is uncertain. Likewise, public health (and all) experts should recognize the limits of their expertise. Epidemiologists and physicians have expertise about the causes and spread of disease, but they lack expertise about the legal and ethical implications of various social and legal interventions.¹¹¹ That means that while they can and should produce and explain the scientific evidence that can be essential for effective policy, they should also recognize that other voices and factors need to inform policymaking.¹¹² Yet, precisely because public health relies primarily on persuasion,¹¹³ public health experts, advocates, and allies (including those in law) need to engage more fully with communities outside of their own. Only by understanding the needs and concerns of different communities can public health experts gain the trust of those communities and design interventions that are tailored to their lived experience.

Nevertheless, if the public’s health is to be protected—and if America is to become “healthy again” in the face of continuing chronic diseases, stark health inequities, and the ever-lingering threat of another (perhaps far worse) pandemic—we need a broader view. The problems that confront the field of public health are not solely of its own making, nor are they the sole fault of the “laptop class.” Members of this class may have acted at times with hubris during the pandemic, but those missteps do not explain why the Trump Administration failed, in early 2020, to ensure the rapid and equitable distribution of PPE, ventilators, and accurate COVID tests.¹¹⁴ They cannot explain why the President chose to underplay the severity of the threat¹¹⁵ and promote ineffective treatments.¹¹⁶ And they cannot explain why many of his supporters spread conspiracy theories and rejected the vaccines developed thanks to the work of his own administration.¹¹⁷

If we want to understand why the United States fared so poorly during COVID, we need to understand the full array of actors and actions that shaped the nation’s response. We also need to consider the range of preexisting conditions that heightened our susceptibility to the virus. Many of these conditions were not of public health’s making. For example, the public health community is not responsible for the fragmentation and frequent dysfunction of the healthcare system, which left many Americans with uncontrolled chronic health problems long before the pandemic began.¹¹⁸ Nor is it responsible for the proliferation of products, from tobacco to highly processed foods, that have shortened Americans’ lives.¹¹⁹ And finally, the field of public health cannot be blamed for the growth of algorithms that accelerate the spread of false health information and conspiracy theories.¹²⁰

Further, although the field of public health should be held accountable for the impact of racist policies that stain its history—like the infamous Tuskegee syphilis study¹²¹—it is not the primary culprit for our deep-seated racial health inequities. Nor are public health workers the primary cause of the increasingly partisan and polarized political landscape (whose impact Macedo and Lee note (p. 153)) that soured Americans’ trust in government long before COVID.¹²² For that, the Supreme Court, which opened the door to unfettered campaign contributions and partisan gerrymandering, bears more of the blame.¹²³

So, yes, the type of self-reflection that Macedo and Lee prescribe is in order. But to move forward, the public health community cannot merely look in the mirror. It must peer beyond it to gain a deeper understanding of the complex and often hostile environment in which it operates. And it must learn how to navigate those forces and protect the public’s health despite the hurdles they create. Otherwise, it has no hope of doing a better job next time, and Americans have little reason to believe their nation will fare better during the next pandemic.

* Matthews Distinguished University Professor of Law, Northeastern University School of Law.