“Trust is the glue in patient care.”
Dr. Lucy McBride is a concierge primary care physician in Washington DC. While it’s not clear she’s ever treated a hospitalized COVID patient, she made an impressive number of media appearances during the pandemic, and in March 2022, she testified in front of the House Committee on Science, Space, and Technology Subcommittee on Investigations and Oversight. Dr. McBride’s core message then was that “Trust is the glue in patient care.” She testified:
Today I want to talk about trust. As we move forward into the next phase of COVID-19 and inevitably face more waves and variants, I of course worry about the ongoing death and destruction from COVID. I worry about the social, emotional, and economic fallout of the virus and of the mitigations themselves. But at its core, I worry most about peoples’ confusion and resulting anxiety about not knowing who to trust in a global health crisis. Specifically, I worry about the risk that the erosion of trust in medicine and in public health poses to our individual and collective health.
This pandemic is about a virus; it’s also about information, messaging, and the contagion of mistrust. To build back better we must start with trust…Trust is born when doctors first acknowledge uncertainty—and then lean into things that are certain.
Fair enough. Having studied the anti-vaccine movement for over a decade, I fully agree that trust matters at least as much as knowledge, and trust in medicine is low right now. Dr. McBride was not wrong when she testified:
That vacuum of trust has been and continues to be filled with a cacophony of voices calling out from across a variety of platforms, from celebrities, media personalities, and internet influencers. Without a source of truth, people look to the showy salesmen and get easily tangled in webs of harmful medical advice.
“That vacuum of trust has been and continues to be filled with a cacophony of voices calling out from across a variety of platforms, from celebrities, media personalities, and internet influencers.”
“I’ve been yearning for an end to the pandemic. Now that it’s here, I’m a little afraid.“
With Dr. McBride’s warning of “harmful medical advice” from “media personalities and internet influencers” in mind, let’s review some of her pandemic record. Though many scientists doubted herd immunity to COVID was possible in the spring of 2021, Dr. McBride’s message at that time was that we were “post-pandemic”, that brand new vaccines rendered people essentially bulletproof against a brand new virus, and that variants were of no concern. She shared her optimism on social media, podcasts, television interviews, and editorials in widely-read publications such as The Washington Post and The Atlantic.
- March 2, 2021: COVID-19 cases are dropping, but anxiety is everywhere.
- March 9, 2021: I’ve been yearning for an end to the pandemic. Now that it’s here, I’m a little afraid…The pandemic will end. With dropping case rates and three incredible vaccines robustly protecting us from COVID-19, soon we’ll be able to relax the restrictions of pandemic life.
- March 10, 2021: I see it every day: ambivalence & #anxiety about reentry. After a year of #trauma, it’s normal. Let’s name, normalize, & navigate it. I was honored to speak about #FONO & my @washingtonpost opinion piece on @Morning_Joe today!
“I’ve been yearning for an end to the pandemic. Now that it’s here, I’m a little afraid.”
- March 16, 2021: Enjoyed talking with @ryanegorman of @iHeartRadio podcast about my @washingtonpost Op-Ed & how to safely and sanely navigate our post-pandemic transition to normalcy. I hope you take a listen!
- March 26, 2021: Further evidence that the variants are infinitely less scary than the lack of nuanced messaging about them. So many of my vaccinated patients – particularly the elderly – are PARALYZED by fear of the variants.
- April 3, 2021: Wired and tired after months of COVID-19 distress, it’s time to recover our mental health. To fully bounce back from COVID, we need a dose of reassurance and a plan for recovery. We need science under our feet and doctors at our back…The first steps toward post-pandemic health are seemingly simple yet vexingly hard for most of us…We have every reason to be hopeful. COVID-related deaths and hospitalizations are falling fast.
- April 3, 2021: But as you know, once you’ve been vaccinated, your risk of death & severe disease essentially goes away. The risk is of getting milder illness. And even that risk goes down as herd immunity takes hold.
- April 3, 2021: Post-pandemic health: To fully bounce back from #COVID, we need a dose of reassurance and a plan for recovery. We need science under our feet and doctors at our back.
- April 3, 2021: The first steps toward post-pandemic health are seemingly simple yet vexingly hard for most of us…We have every reason to be hopeful. COVID-related deaths and hospitalizations are falling fast, and real world data confirms the stunning efficacy of our vaccines. The medical community has its hands on the science we need for reentry. To fully recoup from COVID, we now need our arms around our patients. The doctor is in; are you?
- April 6, 2021: The risks of getting #COVID19 and transmitting #SARSCoV2 both drop significantly after #vaccination. Neither risk is zero (zero isn’t even on the menu). As we approach herd immunity, these risks will get even smaller than they already are.
- April 19, 2021: I’ve been using the “off-ramp” analogy with patients — both for how restrictions should END & how we can expect our brains to adjust post-pandemic. There’s no on/off switch for either. #FactsNotFear #Nuance #Context
- April 19, 2021: I’ve been using the “off-ramp” analogy with patients — both for how restrictions should END & how we can expect our brains to adjust post-pandemic. There’s no on/off switch for either.
- April 21, 2021: I made these points on @MSNBC @Morning_Joe today: #vaccines 1) essentially take death/severe dz off table; 2) drop risk of #COVID19 to 0.0005% (@CDC data), 3) reduce transmission (94% per Israeli data), 4) are powerful against all current variants. #FactsNotFear#ThisIsOurShot
- April 21, 2021 : Vaccines aren’t 100% effective (though these are close!), but we don’t need them to be 100% to gradually resume regular life as we head toward herd immunity.
- April 22, 2021: My (humble) impression is this: nothing in life is risk-free. Certainly the risk of COVID transmission is higher w/ the circulating variants, but as we edge toward herd immunity, outdoor masking is less important (if at all) unless in a crowded space like a rally w/ shouting etc.
- May 1, 2021: People need to know, for example, that the risk of two vaccinated people sickening one another with Covid-19 is vanishingly small…Vaccinated grandparents should be reassured, for example, that seeing their unvaccinated grandchildren poses very little risk to themselves and that, in general, the risks of Covid-19 in kids are small.
- May 1, 2021: The #vaccines are so effective at preventing #COVID & reducing transmission it can be hard to believe. Remember when we thought we might never get a #vaccine? Well, here we are with a near-perfect vaccine. Reminder: perfect isn’t on the menu.
- May 4, 2021: The reason you would need booster shots is if the virus mutates in a way that escapes the immune protection conferred by the vaccines. That has not happened yet. Nor do we expect that to happen, given how quickly we are crushing the curve and how robust we know the immune response to be from these vaccines. It’s just not anything that anybody should be worried about.
- May 4, 2021: Why all the negative news about variants when it’s just not important?… If you’re in that tiny category of people that does get COVID after vaccination, you’re going to get a cold or a mild illness, most likely. Are there exceptions? Yes. But the vaccines are stunningly effective against the virus. They take death and severe disease off the table. They prevent transmission and they cover all the variants.
- May 26, 2021: Parents need to role model confidence and optimism about the end of the pandemic.
- May 26, 2021: As covid-19 cases continue to fall and vaccines demonstrate vigor against even the most concerning variants, it’s time to evaluate which pandemic restrictions are worth keeping in place…This low risk for children nearly vanishes as cases plummet. As we saw in Israel and Britain, vaccinating adults indirectly protects children. The same trend is evident here in the United States: Adult vaccination has lowered COVID-19 incidence among children by 50 percent in the past four weeks.
- June 2, 2021: What I’m telling you is I’m following the science and seeing the very low risk that COVID-19 poses to kids, and it’s lower and lower every day. And then we also see that kids are really protected by the vaccination status of the staff, and faculty, and teachers at the schools. And so by the time fall rolls around, of course, depending on the local situation of COVID in the particular region we’re talking about, it just isn’t going to make sense for most schools to restrict kids. Now, there’s lots of nuance here, right? Because I don’t have a crystal ball and because could things change? Could case rates go up? They could. It’s just very, very unlikely. Again, if you look at the UK and Israel as the seniors and we’re the sophomores, we’re going to be in so much better shape even next week than we are today, and in the fall, it should be a lot different…the vaccines that we currently have are so stunningly effective against all of the circulating variants…worst case scenario, we need boosters and Pfizer and Moderna will crank them out.
All this from a doctor who said on April 16, 2021 “As physicians, dispensing false hope is dangerous & unethical.”
“I’m A Doctor Seeing Patients with Coronaphobia. Here’s What You Need to Know.”
While Dr. McBride announced we were “post-pandemic” as early as March 2021 and that variants were nothing to worry about, she was very concerned that strangers were trying too hard to avoid the virus. She had dozens of Tweets using the hashtag #FactsNotFear and encouraged her audience to “abandon irrational fear.”
She even used several new medical terms to pathologize cautious people, and Dr. David Gorski previously discussed how she parroted pre-pandemic anti-vaccine talking points about diseases such as measles. For example, in her article, “I’m A Doctor Seeing Patients with Coronaphobia. Here’s What You Need to Know” from March 2, 2021, she wrote:
“Coronaphobia” can be defined as an exaggerated fear of COVID-19 that is rooted in rational anxiety about the very real threat of COVID…Not dying is important (and is essentially guaranteed with COVID-19 vaccination); but what about living?…COVID-19 cases are dropping, but anxiety is everywhere.
A week later, Dr. McBride wrote an article titled “I’ve Been Yearning for an End to the Pandemic. Now That it’s Here, I’m a Little Afraid,” in which she coined yet another term- Fear of Normal- to further stigmatize people who didn’t agree that the pandemic was over. She elaborated on these articles in an interview from May 4, 2021:
I wrote an article for The Huffington Post about what I call “coronaphobia,” and I also wrote a piece for The Washington Post about what I call “fear of normal,” or FONO. What I’m seeing is an epidemic of unbridled fear that is basically the reverberations of the anxiety that we all experienced when the pandemic was happening in full force. As the pandemic comes under much better control, we need to shift our thinking and then our behaviors to reflect reality.
COVID has since injured millions of Americans, killing over 600,000 of them. Perhaps some might still be alive if they had a bit more coronaphobia, which has likely never appeared on a death certificate.
Once the Delta variant arrived, invalidating Dr. McBride’s optimistic declarations that we were edging “toward herd immunity”, she continued to be afraid of fear. In August 2021, as the Delta variant spiked pediatric hospitalizations, she authored an article titled “Fear of COVID-19 in Kids is Getting Ahead of the Data“, as if it were this was necessarily a bad thing. Pediatricians with actual responsibility for treating sick children weren’t so blasé. “This is different,” one said. “What we’re seeing now is previously healthy kids coming in with symptomatic infection.” Another said that “we’re not only seeing more children now with acute SARS-CoV2 in the hospital, we’re starting also to see an uptick of MISC – or Multisystem Inflammatory Syndrome in Children.” Less than a month after Dr. McBride published her essay, the CDC reported that Delta variant had caused a 5-fold increase in pediatric hospitalizations. Dr. McBride got her data, though it was too late for many children. They were the data.
Having used “coronaphobia” and “Fear of Normal” in 2021, Dr. McBride needed a new term to pathologize people in 2022. In March that year, she wrote an article titled “Dealing With ‘Post-Pandemic
Stress’: A Doctor’s Guide”, in which she said:
It’s what some medical professionals, including myself, are calling “post-pandemic stress” which
is not an official diagnosis (nor does it mean that COVID is gone!) but is characterized by anxiety,
mood instability, and mental exhaustion that is interfering with quality of life.
Fortunately, Dr. McBride knew the cure for “post-pandemic stress.” In May 2022, she said, “I’m finding that the ‘cure’ for some of my patients’ outsize fear of COVID is … COVID.”
“The risk of COVID-19 is really, really small in kids. It’s a smaller risk than the seasonal flu…If you’re under 11, the risk of getting COVID is teeny.”
Beyond this, Dr. McBride partnered with anti-vaccine doctors in January 2022 to found the group Urgency of Normal (read more here, here, here, here, here) which copied the Great Barrington Declaration by advocating “focused protection for the vulnerable” and spread misinformation to minimize COVID’s risk to children. For example, the Urgency of Normal sought to pacify parents by saying that “COVID is a flu-like risk to unvaccinated children“. They used several statistical gimmicks to make this false claim.
- They compared COVID deaths when mitigation measures were in place to pre-pandemic flu deaths.
- They compared the raw tally of COVID deaths to estimated flu deaths, which inflated the flu death toll relative to COVID.
- They compared the infection fatality rate of COVID to the flu, while ignoring the essential fact that COVID is much more contagious than the flu.
- They made factual errors, claiming that COVID had killed around 400 children, when it fact it had killed around 1,200.
The Urgency of Normal did all they could to obscure the basic fact that from April 2020 to January 2022, when the Urgency of Normal was formed, COVID killed around 1,200 children, while the flu killed 15. A single child died during the 2020-2021 flu season, when mitigation measures were most stringent, while COVID killed several hundred children during that time. However, that didn’t stop Dr. McBride from saying on May 4, 2021:
The risk of COVID-19 is really, really small in kids. It’s a smaller risk than the seasonal flu. We don’t close schools and mask kids in flu season. We have somehow as a society, quote-unquote, “tolerated” the fact that hundreds of kids die from the flu every year. This virus has generally spared children, particularly young children… If you’re under 11, the risk of getting COVID is teeny.
Not only was she wrong about the relative risks of COVID and the flu, schools occasionally closed for the flu before the pandemic, pediatricians vaccinated kids against the flu instead of “tolerating” their death, and babies have by far the highest COVID risk of all children.
The Urgency of Normal also did not mention that children could survive COVID, but be injured by it, and COVID hospitalized many more children than the flu as well. The flu hospitalized just 9 children ages 5-11 years-old in 2020-2021, while COVID hospitalized thousands of children that age during that time.
“The risk of COVID-19 is really, really small in kids. It’s a smaller risk than the seasonal flu…If you’re under 11, the risk of getting COVID is teeny.”
Though Dr. McBride refused to share these basic numbers, to her credit, she vaccinated her teen daughter and shared this publicly. However, she also said that because of rare cases of vaccine-induced myocarditis, which was already known to be mild in 95% of cases, “the risk/benefit ratio for healthy teen boys isn’t yet clear.” This aged almost as poorly as her declaration that we were “post-pandemic”, though again it was too late for some healthy teen boys.
Tyler Black, a child and adolescent psychiatrist and suicidologist at BC Children’s Hospital in Vancouver, hadn’t heard anything about the Urgency of Normal group or its “tool kit” until it came out. But when he saw it go up on Twitter, he was appalled. “Their document was so poor, with so many mistakes, that it required immediate public correction,” he said. He messaged some of the signers directly on Twitter, he said, and when no one responded, he went public, in a detailed Twitter thread that focused on his area of expertise: child mental health. Several other subject-area experts did the same, debunking comparisons to the flu and diving into the dismissal that many kids are fine. The central problem he saw was that the group claimed that masks harm children’s mental health and social development—something he’s seen no evidence for in his own work.
“It was really, really gross to see what they did with the mental health science. It’s a true perversion of what science communication is supposed to be,” Black said. “They had mis-cited the CDC—I’m not talking about they made a mistake, I’m talking about mis-citing. Academic misconduct.” The Centers for Disease Control and Prevention study found that there was no significant increase in child suicide, yet the group used that study to claim the opposite—an increase in suicide. After pushback, the authors edited the tool kit to remove that mention of suicide, he said, without noting what had been revised.
Dr. Black also added, “I consider it ghoulish to wield child suicide statistics inaccurately to make advocacy points.”
“I worry most about peoples’ confusion and resulting anxiety about not knowing who to trust in a global health crisis.”
Let’s return to Dr. McBride’s core concern- peoples’ confusion and resulting anxiety about not knowing who to trust in a global health crisis. I deeply share this concern. This is why I focus on the many sheltered doctors who minimized COVID with bogus statistics, confidently said herd immunity was at hand, that variants were “not anything that anybody should be worried about,” that vaccines were a panacea, and that fear of COVID was pathological.
Amazingly, even as headlines read “Why Are 1,500 Americans Still Dying From COVID Every Week?“, these doctors now feel entitled to lecture everyone else on the importance of trust. Imagine the audacity that takes. They should carefully review their own words. They are the last people who should sanctimoniously sermonize on the “vacuum of trust” in medicine.