Public Health and January 6th

State Representative Steve Carra has submitted a bill in the Michigan legislature to make the anniversary of the insurrection in Washington, DC on January 6^th, 2021 into a “Day of Remembrance” for the “heinous and tyrannical actions levied on society by an unhinged and politically motivated ruling elite”, specifically the “manmade” Coronavirus pandemic. He was also one of the most ardent backers of the so-called Refuse to Obey tour, a series of demonstrations that were a direct offshoot of the earlier armed invasion of the Michigan Capitol on April 30^th, 2020. The Refuse to Obey Tour brought maskless anti-public health rallies to communities across Michigan, and Carra was one of the first Michigan elected officials to campaign against COVID vaccination. Because of Carra and others like him, opposition to COVID safety measures like masking, vaccination and closures left red and rural counties with much higher rates of COVID mortality than other areas, and Carra’s home county of St. Joseph has a COVID mortality rate well above the State average.

There are many similarities and connections between April 30^th in Michigan and January 6^th in Washington. April 30^th was ostensibly about overturning Michigan’s COVID public health orders and January 6^th was an attempt to overturn the 2020 presidential election results, but US Rep. Jamie Raskin who helped manage the first impeachment trial of then President Donald Trump, called April 30^th a “state level dress rehearsal” for January 6^th. And the people and organizations behind April 30 quickly pivoted to “stop the steal” within a few months. Similarities between the two events include extensive organizing on the extremist web, collaboration with public officials, boogaloo style paramilitaries entering the Capitol and in Michigan, the subsequent hunt for Governor Whitmer by the Wolverine Watchmen, like the hunt for Vice President Pence by the Proud Boys in Washington. Connecting the two events were prominent Michigan officials, like Matt and Meshawn Maddock, who helped fund and build anti-public health organizations like Stand Up and Unlock Michigan and later arranged for Michigan to be well represented among the rioters assaulting Congress on January 6^th.

Here I don’t want to talk about all the connections between April 30^th and January 6^th. I want to focus on one connection: the public health connection. Why was public health the dress rehearsal for an attempt to overturn an election?

First, I want to say that there is nothing about being rural or “red” that makes a person anti-public health. The people I know in central Michigan are smart, kind, hard working and courageous. More times than I can count, I saw folks make deep personal sacrifices for the welfare of their community. It would take some pretty weird politics to get such good people to spread disease to one another. But weird is what we got.

One reason attacks on public health were precursors to January 6^th is chance. Then President Trump was looking for ways to mobilize his base and COVID provided an opportunity. He had observed the beginning of opposition to COVID lock down policies being organized by some of the same people who were responsible for Charlottesville and his advisors Mark Meadows and Stephen Miller told him it would benefit him politically to take an anti-public health position.

It wasn’t obvious that COVID would get so out of control. At the beginning of the pandemic almost all governors followed tough lock-down policies as their pandemic preparedness plans said they should. They all thought about 9-11, Katrina and the Flint water crisis, and none of them wanted to fail their people. They talked regularly, shared information and copied each other’s successful practices. Even Ron DeSantis. Then, on April 17, 2020, President Trump infamously tweeted “Liberate Michigan”, “Liberate Minnesota”, and “Liberate Virginia”, targeting three democratic governors (Gretchen Whitmer, Tim Walz, and Ralph Northam, respectively). Republicans Mike DeWine of Ohio and Eric Holcomb of Indiana didn’t get tweets, even though their state’s policies were almost exactly like the others’. The national pandemic preparedness plan called upon Trump to lead the nation in sticking to safety protocols until the vaccine arrived, but seeing a chance to weaken Democrats he took it. Encouraged by Trump’s tweets Michigan was hit by an armed demonstration on April 30^th, and Minnesota and Virginia on May 1^st. Republican governors took note, and began to turn away from fighting COVID.

Meshawn Maddock leads a maskless rally.

This is when Steve Carra and others like him came into their own. Instead of doing the difficult but responsible thing and calling on their constituents to be brave, like they were during the Great Depression or World War II, local politicians leaped at the opportunity to agitate their political base. With coordination from the Maddocks and others like Garrett Soldano, who started out selling bogus COVID cures, PAC dollars began flowing from GOP campaign war chests into operations aimed at overturning public health orders and weakening public health leadership. An entire class of paid political operatives focused on undermining public health sprang up, including political fixer Ron Armstrong, to whom prominent GOP donors funneled cash, and lawyer David Kalman, who built a business breaking public health orders. By fall, public health was effectively paralyzed, unable to persuade sufficient numbers of people in the red parts of the state to mask or get vaccinated and unable to gain cooperation for contact tracing. We were on our way to 40,000 Michigan deaths. The blueprint for attacking public health became the blueprint for attacking our democracy.

But there is a deeper connection between public health and democracy. I’ve been groping for a word to describe that connection and I’ll try one out here: Courage. It takes courage to defend public health just like it takes courage to defend democracy. In both cases we are defending the institutions we have built together, based on the hard lessons of history, that exist to maintain the integrity and well-being of our people.

To defend public health you have to tell people things they don’t want to hear: you have been exposed to a disease; your community needs you to make a sacrifice for the health of others. You also have to tell elected officials things they don’t want to hear: more needs to be done to protect the public; you must defend the workers defending community health.

That’s the same kind of courage it takes to defend democracy. Today, to defend democracy, you have to tell people the election was fair; you have to tell elected leaders they must count all the votes; you must tell them they may not prevent people from voting. If you defend public health, just as if you defend democracy, you see yourself called a “nazi” on the media and your kids and coworkers wonder “Why”? You have to keep going while people threaten you, dox you, threaten your family.

Public health and democracy are fundamentally two different aspects of one thing: they are both built upon the promises we have made to one another, and committed to law, about how we will treat each other, how we will care for each other, even when it is unpopular. We understand as we rebuild the public health system that we are renewing true democracy—the ability of a free people to control their destiny. Let us have the courage to continue that work. 

NOTES: This article was extensively researched and sources and citations can be found in the "Bibliography and Citations" linked in the right-hand column of this website. Much of the material comes from Michigan regional media. Most relevant material is in the "Michigan Case Study" notes in the second half of that bibliography.

COVID Health Disparities Don't Mean What You Think

Epidemiology is the science that proves shit flows downhill. Stated a little less baldly, one of the most important insights from epidemiology is that disease and premature death are often concentrated in low income, minority and other vulnerable populations. This insight leads to the single most important strategy for improving population health, which is to focus on the health of those vulnerable populations. Applying this strategy to a pandemic we find that to save the most lives we must ensure that vulnerable people, most of all, understand the risks and have the tools to protect themselves. Sadly, because of structural inequities, public health isn’t as good at protecting the vulnerable as we need to be. We know this and are constantly trying to improve. This is reflected in how we communicate about our mission. For example, on top of health equity and social justice components baked into national accreditation, our leading local public health association (NACCHO) embraces and promotes five “Compass” principles for ensuring health equity during the pandemic.  

Another reflection of public health’s concern about inequality is how we tell the story of the pandemic. In particular, when public health talks about COVID mortality we emphasize higher rates of death among populations of color. During the first month of the pandemic, April 2020, COVID mortality in the African-American community was nearly three times higher than in the White community. Public health held itself accountable for this disparity. One public health official I spoke with said the disparity was because the public health response was “dripping with racism”. I think the word “dripping” is over the top, but that attitude illustrates how seriously many took those deaths.

As I think about this, though, I wonder if this telling of the story of COVID stops us from really understanding what happened—both the bad and the good. I think taking a longer look at COVID health disparities can help us see both why we were so ineffective, and also what the possibilities are for the future.  

From the earliest days of the pandemic, a growing number of researchers found that COVID was starting to gain traction and take off, not in the African-American community, but in mostly White, mostly rural and Republican areas. The Brookings institution began reporting on this in September 2020, and this finding was tested and retested by others like Pew Research. It was one of the most robust epidemiological findings of the pandemic.

COVID deaths started increasing in red areas for three interconnected reasons. The first was that then President Trump’s advisors encouraged his predilection to frame COVID safety measures as an attack on freedom. The second was local politicians in red areas saw an opportunity to align themselves with Trump’s base and took up the cause. The third reason was the rapid emergence of a political machine built to dismantle public health protections. In Michigan, for example, political entrepreneurs like Matt and Meshawn Maddock, Ron Armstrong and David Kalman sought funding from GOP PACs to create Stand Up, Unlock Michigan and other anti-public health organizations. Because of their actions, these people literally spread COVID to others. Their propaganda meant most people living in red areas did not try to protect themselves from COVID by staying home or wearing masks, and only half of them got vaccinated. To this day rates of COVID mortality remain much higher in red areas than in blue.

This point has been made many times already. What I want to do here is contrast this fact with what happened in the African-American community. While rates of COVID mortality in red areas rose, mortality declined in the African-American community. By the end of 2020 when the second wave hit, COVID mortality in the African-American community was less than a third of what it was in the spring of that year. Meanwhile mortality in red communities had exploded to more than double the African-American rate. This fact dramatically demonstrates the importance of good public leadership in a crisis and the deadly consequences that arise when leadership fails.

The reason COVID declined in the African-American community was because of the actions of the community and its leadership. After the horrors of the first wave of COVID the African-American community understood it needed to organize itself to keep people safe. All kinds of people—community organizers, clergy, politicians—put themselves forward to fight COVID. In Detroit, organizations like the Community Health Corps focused on housing and clean water for people sheltering, the Detroit Association of Black Organizations launched the Choose Healthy Life COVID testing and education campaign, and churches like New Mount Moriah aggressively pushed vaccination. In Flint the Greater Flint Health Coalition leveraged neighborhood organizations to fight vaccine misinformation.

I was working in rural central Michigan. I don’t know the names of many of the people doing grass roots organizing in the African-American community. But I do know the names of some public health leaders who supported the community effort and I want to honor them here: Vernice Davis Anthony who came out of retirement, physician and scholar Dr. Abdul El-Sayed, Dr. Joneigh Khaldun who worked from her perch in state government, and Dr. Kanzoni Asabigi who fought for a better response from Detroit government.

It is true that in red and rural areas there were many who understood what was happening and community organizations did all they could to help, just like they did in blue areas. But local politicians who may have wanted to help often felt it was too risky and didn't speak up for them. As one elected leader said to me, “I really want to help you with this but I just don’t know what I can do. My party seems to have lost its mind.” To be clear I am not saying people lost their minds. I know from firsthand experience that everyone was doing what they believed to be right. What I mean is that the consensus that public health was trying “to take our freedom” was so forcefully policed that political leaders feared they would pay too high a price for telling the truth.

It is also true that vaccine hesitancy and misinformation remain a problem in the African-American community. But in contrast to red areas, local leadership was united in working to fight COVID. The result is that today attitudes toward COVID safety and vaccination rates in the African-American community as a whole are similar to White or general community attitudes as a whole. From a deep deficit the African-American community climbed to a better—if not perfect—place. 

In these times when so many things--gun violence, drug overdoses, child health, life expectancy--are moving in the wrong direction, let us lift up this powerful example of how people did the right thing and how they saved lives because of it. 

NOTES: Sources for this article are included in the "Bibliography and Citations" linked in the right-hand column of this website, particularly the data compiled by the WK Kellogg Foundation and Pew Research. African-American COVID mortality in Michigan comes from the tables in the Data and Modeling Updates found at michigan.gov/coronavirus/stats.