David Wallace-Wells writes:

In the event of a sudden pandemic, what should we do? This month, Jay Bhattacharya, the director of the National Institutes of Health, offered a remarkably blunt answer: nothing.

It’s been nearly six years now since the United States’ first reported cases of Covid-19, and the country is in a merciful lull when it comes to pandemic recriminations, as Robert F. Kennedy Jr.’s ongoing war on vaccine confidence now dominates the public health culture wars. But Bhattacharya, writing with his deputy Matthew Memoli in City Journal, returns with a bill of Covid complaints, arguing that to prepare for a future infectious disease threat, the country should toss out the longstanding “pandemic playbook” and focus instead on making the population “metabolically healthy” — what you might think of as being fit.

Forget social distancing, in other words; forget masks and forget even a next-generation equivalent of Operation Warp Speed to deliver a next-generation equivalent of miraculous Covid vaccines, which saved millions of American lives and tens of millions of lives abroad. The best way to fight off a novel infectious disease, Bhattacharya and Memoli write, is to get the country into better physical shape before the emergency arrives and bet that our fitter bodies will be capable of simply fending it off, whatever the pathogen, however quickly it might spread and however deadly it might be.

Perhaps this sounds half reasonable since, theoretically, a healthier population should fare better facing any health threat. Or perhaps it sounds like eugenics, since it suggests that we should think of infectious disease as a kind of fitness test for the country — and should worry more about getting Americans to pass that test than about protecting those who can’t. How exactly might we go about doing that? “By stopping smoking, controlling hypertension or diabetes, or getting up and walking more,” Bhattacharya and Memoli write.

This is all fine as generic health advice, of course. But 38 million Americans have diabetes. More than 100 million have heart disease. More than 100 million are obese. Massively improve those numbers and there will still be tens of millions staring down a novel pathogen in ill health. And as a program of pandemic response? Like much of MAHA, it is magical thinking that has the secondary effect of laying responsibility for public health outcomes at the feet of the individual. Imagine sitting in the National Institutes of Health, contemplating the arrival of a disease like H.I.V./AIDS, which has killed 700,000 Americans, and advising the country that, as Bhattacharya and Memoli write, “the best pandemic preparedness playbook for the United States is making America healthy again.”

Or, for that matter, take Covid-19, which many contrarians will now tell you killed only the sick and vulnerable. The claim is flattering to survivors but otherwise deeply misleading: Poor health mattered for individuals and at the population level, but it was hardly determinative on its own. Age, which of course one cannot change, was the overwhelmingly dominant factor. Anything you might have done to improve your health before the pandemic arrived would have proved trivial compared with how old you were — and the fact that SARS-CoV-2 was a rapaciously infectious novel pathogen spreading through an immuno-naïve world. [Continue reading…]