I like to think that I’m plugged into social media, at least about the topics that I care about, such as medicine, quackery, vaccines, and, for the last couple of years, COVID-19. Occasionally, however, I realize that I’m not, which is what happened over a week ago, when I saw this Tweet from outspoken Yale epidemiologist Gregg Gonsalves Tweeted a link to an article by Dr. Lucy McBride:
It didn’t take long for me to learn why Dr. McBride’s article had started making the rounds again over a year after its publication. Dr. McBride herself had Tweeted it again on Saturday, in essence doubling down on her year-old words:
So basically, Dr. Social Media hadn’t noticed that Dr. McBride herself was responsible for the reappearance of her old article. Mea culpa.
I also was pointed to another article by her that was published in The Washington Post only a week later titled “I’ve been yearning for an end to the pandemic. Now that it’s here, I’m a little afraid“. One can’t help but note how, just as Dr. Marty Makary prematurely (and very confidently) declared that the pandemic would be over in April 2021 due to natural herd immunity and so many other contrarian physicians kept predicting throughout 2020-21, Dr. McBride’s expression of being “afraid” now that the end of the pandemic was imminent (in March 2021!) has not aged very well. More importantly, her labeling her patients afraid of the virus as having “coronaphobia” or, in the WaPo article “fear of normal” (or FONO), has also not aged very well. It was also particularly vile in its time because by the beginning of March 2021, most of her patients had not been vaccinated, but, as Gonsalves noted:
Remember, the EUA for the Pfizer COVID-19 vaccine was issued in December. After that, healthcare and other frontline workers were first in line for the vaccine, followed by those over 65, and then the rest of the population. March 2021 was less than three months after the first frontline workers started receiving their first dose of the Pfizer vaccine, and most of the US population was still not vaccinated.
The reappearance of this article provided me with a convenient excuse to address yet another example of how, during the pandemic, everything old is new again and antivaccine talking points keep popping up again and again from pandemic minimizers and COVID-19 contrarians like Dr. McBride. In this case, it’s the pathologizing of the fear of infectious disease, representing it as an anxiety disorder, specifically a phobia, that might even need treatment. In other words, according to Dr. McBride, if you are afraid of a COVID, you could be mentally ill.
It is not my intention to deny that there are people out there suffering from anxiety and depression due to the consequences of the COVID-19 pandemic, some of whom might even require treatment. There are. What I am going to point out is how the messaging that Dr. McBride is doubling down on a year after she first promoted it is very similar to messaging that I’ve been encountering for many years coming from the antivaccine movement. Although Dr. McBride probably doesn’t realize it, she is echoing an old antivax trope that does exactly the same thing: Seeks to shame those who fear vaccine-preventable diseases. She denies up and down that that’s what she’s doing. For instance, in her HuffPo article, she wrote:
When anxiety takes on a life of its own — that is, when the cognitive, emotional, physical and behavioral manifestations of anxiety are rooted in reality but out of proportion to the actual threat — it’s time to see a doctor. After all, mental health isn’t something that we can opt out of like we can a feature on our iPhone.
Not coincidentally, her message was (and apparently still is) that anything that she doesn’t consider to be a rational fear is potentially pathological, a phobia, and her messaging has been consistent about this. As Jonathan Howard mentioned in February, her public appearances at least since those editorials have been all about minimizing the threat of COVID-19 and “helping” patients deal with their “anxiety” (coronaphobia in the HuffPo article, FONO in the WaPo article).
Let’s go back to a time before the pandemic, as much as that seems like ancient history now.
“It’s just a childhood illness”
I realize that I’ve referenced this before, but it’s time to do so again. Back before the pandemic, when fear of the MMR vaccine and thimerosal-containing vaccines, rather than COVID-19 vaccines, was the main terror being stoked by the antivaccine movement, I liked to divide antivaccine messaging into two broad categories. (There are more, obviously, but for purposes of messaging about vaccines and the pathogens targeted by the vaccines, there are two.) The first was to portray the vaccine as dangerous and/or ineffective, and the second was to portray the disease being vaccinated against as not dangerous—or even normal, a necessary experience to achieve that vaunted “natural immunity“. (Never mind that measles is actually more dangerous than had been commonly thought.) Obviously, as I’ve written many times before, these same two messages are being applied to COVID-19 and the vaccines against it, but back in the day these messages were mainly about measles, chickenpox, mumps, and other childhood illnesses.
Indeed, back in the day (e.g., in 2015), I used to refer to what I liked to call the Brady Bunch gambit, in which old sitcoms from the 1950s and 1960s where kids getting measles was played for laughs, with measles portrayed as “just a childhood illness that we all got”, were weaponized to argue that measles isn’t dangerous. I named the gambit after an episode of the classic sitcom The Brady Bunch that antivaxxers were widely referencing. The episode first aired in 1969 and featured hijinks that ensued when all the Brady kids caught the measles in rapid succession, a situation that was mostly handled humorously. It’s worth noting that this 52 year old Brady Bunch episode also features “natural immunity”. When Mike Brady (the father) and Alice (the maid) catch the measles near the end of the episode, it is revealed that they had never had measles as kids but that Mike’s wife Carol had and was therefore immune to it as an adult.
The reality was, of course, different from the fuzzy-headed nostalgic thinking of comedy writers in the 1960s, all of whom likely suffered from survivorship bias; i.e., that they had the measles and it wasn’t so bad for them, which led them to believe that it wasn’t bad for anyone. In fact—as I like to point out—according to the CDC, before the vaccine, 48,000 people a year were hospitalized for the measles; 4,000 developed measles-associated encephalitis; and 400 to 500 people died. By any stretch of the imagination that was a significant public health problem, and the introduction of the measles vaccine in 1963, followed by the MMR in 1971, made it much less so. As Dr. John Snyder reminded us nearly 13 years ago in his response to Dr. Sears making the same arguments in his vaccine book that touted an “alternative vaccination schedule”, measles is not a benign disease, regardless of what popular culture thought of it 50 or 60 years ago. (More recent data show that a severe complication of measles, subacute sclerosing panencephalitis (SSPE), is more common than we used to think.) Meanwhile, over 13 years ago, Dr. Sears was claiming that “the risk of fatality from measles is “as close to zero as you can get without actually being zero”, or “one in many thousands”, in other words practically a rounding error.
Measles “phobia”: A precursor of “coronaphobia”
While it is obvious how such tropes might contribute to a message that you should be more afraid of the MMR vaccine (which, antivaxxers proclaimed, caused autism), let’s show some examples more directly related to Dr. McBride’s argument. For example, in 2017 in the comments section of an antivaccine blog that I’ve often referred to as a “wretched hive of scum and antivaccine quackery”, a pro-vaccine commenter named Curt Watkins (an allergist and immunologist who had apparently made the mistake of thinking that he could persuade anyone on this blog) pointed out that measles is dangerous and can kill children. He then realized the futility but still left the door open:
I guess I’m tilting at windmills by posting here, but it really gets my goat when someone claims that measles is this benign illness, shrugging off a one in 3,000 (or 1 in 10,000) case fatality rate for developed countries. In the third world the fatality rate is far higher. I challenge you to find a pediatrician with pre-vaccine experience and ask them about treating measles. If anyone cares to argue that measles is not occasionally a very serious disease, then I would be happy to engage in a discussion. I’ll check back.
A commenter named Grace Green promptly portrayed Dr. Watkins as having a phobia:
Curt Watkins, I’m very sorry for your phobia of risk-taking. I have survived measles, mumps. rubella, chickenpox and even scarlet fever! I must have been at much greater risk walking out of my front door, as a slate could have fallen on my head, and as for getting into a vehicle, the risk is huge. Come to think of it, most accidents happen in the home, so it’s not even safe to stay there! I have on the other hand lived with “mild” vaccine injury for 64 years, and it’s total misery, prevented me from working, or socializing. So I’ve seen both sides of this debate, including my sons having measles, chickenpox (twice) and whooping cough. People who haven’t had these experiences are being lead astray by fear-mongering into needlessly poisoning their children. The writers here are simply trying to warn others, from our own experiences.
The idea, of course, is that if you’re “irrationally” afraid of something as normal and not dangerous as measles, you must have a phobia, while the antivaxxer is, by comparison, the one who is rationally and carefully weighing risks and benefits. Indeed, another antivaxxer explicitly says this:
From the 1950 Merck manual on Diseases:
Measles usually is a benign infection with a low mortality rate and one attack apparently confers lifelong immunity. However, the disease may be followed, particularly in infants, by bronchopneumonia and other bacterial infections which may be fatal. Postmeaslcs encephalitis, which also may be fatal, occurs only about once in 1,200 to 1,500 cas
Benign doesn’t imply innocuous. Most parents I know who have elected by informed consent to decline the MMR vaccine, have an alternative medical philosophy in place on how they would support a child’s immune system, as they succumb to measles and other infections.
I must admit that I laughed, because benign actually does imply innocuous. If a disease is not innocuous, then how can it be benign?
Another common antivax message was that the fear of measles was due to physicians, public health officials, and the media “hyping” the fear and exaggerating the danger, for instance, in this antivaccine article, A Very Brady Measles, which invoked the Brady Bunch gambit:
Things are so different today. Illness is a bad word. What used to be called a common childhood disease is now viewed as impending doom. Fevers, rashes and sicknesses that last longer than a few hours are treated like the plague. Anything that can be passed from one person to another is a death sentence. These types of exaggerations fill many news stories.
Catching a disease can be scary. But as we saw in the clip, the Bradys survived the measles in America. In that clip, we’re given a peek at how a TV family, likely modeled after hundreds of real-life families, treated and managed the measles with common sense. Instead falling for scare tactics and being filled with doom and gloom, we saw that the parents used good judgment. We saw that the kids rode out the illness. They rested, they got better, and they survived. And God love her, Alice did too.
Sure, in a fictional idealized late 1960s suburban Los Angeles upper middle class white neighborhood, the kids all did fine when they got the measles, as did the two adults who had somehow never had it. Unfortunately, such was not the case for many thousands of others every year before the vaccine, at which time approximately 500 per year would die.
Dr. Bob Sears and Dr. Lucy McBride: Compare and contrast
It wasn’t just antivaxxers, either. It was some physicians, too, who portrayed the fear of measles as irrational and stoked by the media. For example, in 2014, Dr. Bob Sears, author of The Vaccine Book: Making the Right Decision for Your Child, which was the original “alternative vaccine schedule” for antivaxxers, actually complained about parents asking him if they should be worried about measles, to the point where he got a bit…testy and basically told his patients’ parents to stop bothering him with their panicked questions about measles:
No doubt that Dr. McBride, should she even see this, will bristle at the comparison. She, after all, has advocated that adults be vaccinated. On the other hand, she also helped to found the “Urgency of Normal” astroturf effort to open up schools, in which she argued:
In addition to ending mask mandates in schools, she [Dr. McBride] told me, she wants required quarantines to end, as well as testing for asymptomatic children. “The problem right now is we’re isolating and quarantining healthy kids,” she said, arguing that the decision to quarantine a child who is exposed to the virus should be up to parents and pediatricians. (Public health experts have told me this policy would likely lead to further spread, since people are highly infectious before they ever show symptoms. This could be particularly problematic if masks are not required in classrooms.)
In fairness, though, Dr. Sears comes off as a prat complaining about his patients’ parents—whose children, of course, were mostly unvaccinated because, after all, this was Dr. Sears’ practice—being too fearful and anxious about measles outbreaks, to the point of being dismissive in the final part of his Facebook post above:
This year there will be more than usual, the way it’s looking so far, but it’s not a reason to panic. Make your choice – do vaccine, or don’t do the vaccine.
So, when SHOULD someone worry? If an actual direct exposure has occurred from a known case, then you might be at risk. This doesn’t mean a case in the county in which you live: it means that you’ve actually been in the same room with someone who has had measles. Or, at the most, maybe the same building. But transmission almost always requires close proximity (same room). There have been a handful of cases over the decades in which someone sitting across a stadium has caught it, but that is almost unheard of. You have to be in the same room, people. If THAT happens, call me. If not, then just relax and go about your life as usual.
IF we see more cases, I’ll let you know. Actually, just to give you a heads up, we probably WILL see a few more cases. But virtually all measles outbreaks are limited to 10 to 20 cases in any given county. So, the chance that any one of your unvaccinated children is going to be a case is very very very very very small. I love you all, and love caring for you all. But just chill out. Measles will never go away – it’s always going to be a very small risk. If you aren’t comfortable with that, get the vaccine. If you don’t want the vaccine, accept the risk.
Even eight years later, one can’t help but observe the reason why most measles outbreaks were small back then. Can you guess what it was? Obviously, it was because of generally high vaccine uptake in the communities in which the outbreaks occurred that tended to limit such outbreaks to the pockets of unvaccinated children living there.
From the perspective of 2022 compared to 2014, Dr. Sears’ message actually still sounds more than a little like the message that Dr. McBride and other COVID-19 pandemic minimizers have been promoting: COVID-19 will never go away. It’s on you how much risk you’re willing to accept. Vaccinate and mask if you’re worried, but don’t expect anyone else to do the same (or even to isolate if exposed or be quarantined if symptomatic). Chill out.
The only real difference is that Dr. McBride takes the narrative that people are afraid because of the media and government promoting fear-based messages, and kicks it up a notch by implying that a lot of this is “coronaphobia”, namely an actual, potentially diagnosable phobia, and, even worse, suggesting that the “cure” for this “coronaphobia” is to actually catch COVID-19, although she rapidly pivoted to deny that:
And to argue that we should “name” this fear and anxiety, while cynically invoking Mental Health Awareness Month:
Again, let me emphasize that there is little doubt that the pandemic has caused or exacerbated a lot of anxiety and depression. Also, to be fair, Dr. McBride is correct that some anxiety over a potentially deadly illness circulating through the population is normal and expected. However, by “naming” this anxiety (as she puts it) and calling it “coronaphobia” she is, contrary to what she thinks she’s doing, not making things easier. She’s pathologizing this anxiety while providing no real solution other than her anti-anxiety regimen that she describes:
To mitigate the expected anxiety — rational or irrational — we assemble a kit of coping tools. I commonly recommend breathing techniques, guided meditation, regular exercise, prioritizing sleep and spending time in nature, all of which tamp down stress hormones.
All of this is well and good, but also the sorts of things one would expect a concierge doctor practicing in an affluent DC neighborhood who doesn’t have any contracts with health insurance companies or maintain Medicare assignment to tell not just her patients who have anxiety over COVID-19 but the worried well. There’s also a degree of privilege here, in that her well-off patients can do these sorts of things far more easily than those who are less privileged and well-off.
Also notice how much she harps on “fear-based messaging.” One can’t help but notice that Dr. McBride isn’t above a bit of fear-based messaging herself, not only about mental health and the pandemic, but about the supposedly horrific effects that masks were having on children in schools with mask mandates in an op-ed with at least one…curious…co-author:
Then, of course, as I’ve written before, the entire “Urgency of Normal” campaign co-founded by Dr. McBride to end school mask mandates and oppose COVID-19 vaccine mandates for children to attend school has been associated with the Great Barrington Declaration and right wing astroturf efforts to oppose public health measures against COVID-19.
Perhaps, then, it should not be surprising that Dr. McBride, whether she realizes it or not or will admit it or not, regularly parrots longstanding antivaccine messaging about childhood diseases like measles:
- The disease is not dangerous to children (and most adults).
- The medical, public health, and media response are overblown and fueling panic.
- Fear of the disease is an anxiety disorder, a phobia, that is now doing more harm than the disease (and was doing more harm a year ago).
- People should vaccinate or not depending on their perception of risk.
- Isolation after exposure is unnecessary and an overreaction.
- No quarantines.
- No mandates of any kind, mask or vaccine.
I will, however, admit that, unlike Dr. Bob, she’s smart enough to be self-deprecating, for instance, describing her accepting her first invitation to a gathering thusly:
With a mix of reticence and relief, I click “RSVP YES!” to my colleagues’ party and take my first step toward reentry. The next step? Buttoning my pants.
She also goes out of her way to claim that the reason she’s bringing up mental health issues and describing pandemic anxiety as “coronaphobia” is because of her incredible empathy for her patients:
Dr. Gonsalves had an excellent response:
All of which is true, but hasn’t stopped Dr. McBride from self-deprecatingly portraying herself as just “trying to work it all out”:
Also, I can’t help but cite something that antivaxxer Del Bigtree Tweeted over two years ago, before vaccines and when the virus was new:
I also would argue that “coronaphobia” is not unlike what Bigtree said in another context, either.
The problem is that, regardless of what Dr. McBride actually says to her own patients in the privacy of her clinic exam rooms, her public utterances do amount to a shaming of those who remain, often with very good reason (e.g., chronic health conditions), fearful of COVID-19 as having unreasonable fears out of proportion to reality; i.e., an anxiety disorder, a phobia. Certainly, her “coronaphobia” label contributes to that shaming:
I’ll conclude, as I do too often, by simply reiterating that in the age of the pandemic everything old is new again. Every antivaccine and disease minimizing/denying narrative and trope that I have seen thus far about COVID-19 existed long before the pandemic in one form or another. To this I will add the observation that in the age of the pandemic it has been disturbing to see how many doctors who consider themselves so very reasonable, science-based, and even—dare I say it?—provaccine have found those pre-COVID-19 narratives compelling. Implying that those who have an overwrought fear of a vaccine-preventable disease must have a diagnosable mental health condition, such as an anxiety disorder like a phobia, is just another example.