Comment by newacct583 | Hacker News Reader

Comment by newacct583 | Hacker News Reader

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> it's almost amusing that the WHO was recommending not to use it

Why is everyone picking on the WHO constantly? It's like it's a reflex at this point, as far as I can tell designed to shift "blame" off of... other parties who got lots of stuff wrong.

In this case you're spinning really hard. The WHO guidance you're quoting, quoted in the article you link, was really mild: "“Given lack of effectiveness and possible harm, routine corticosteroids should be avoided unless they are indicated for another reason,” WHO authors wrote." Is that really unreasonable? In January they didn't have evidence of effectiveness, and drugs have side effects. Sounds like correct reasoning to me. Do you actually disagree?

And in any case that quote is from a document in January, the current version (from March, also linked from the article) is here, and makes a bunch of complicated points about steroid use, citing contemporary research which was inconsistent about effect: https://www.who.int/docs/default-source/coronaviruse/clinica...

>Why is everyone picking on the WHO constantly?

Because they've made multiple avoidable bad calls.

>In this case you're spinning really hard.

'WHO was recommending not to use it' is a quick summary of statements like "routine corticosteroids should be avoided unless they are indicated for another reason,”. How is this not a recommendation against it and 'spinning really hard'?

At any rate, I didn't dig into that part much (WHO recommendations are much much less important than medical trials), I just found it interesting enough to mention.

> Because they've made multiple avoidable bad calls.

Could you say more about this ?

It all comes down to politics. Some people want covid to be the "fault" of someone else. The WHO is a good target, because they did indeed have some really bad communication work in the early days of the infection:

1. They stated, more assertively than they probably should, that they believed the virus was contained in Wuhan and not spreading in the community (that's the "no human-to-human transmission" quote that gets taken out of context).

2. Their statements that people should not try to acquire PPE masks were poorly phrased and seemed to imply that masks don't work (obviously they do).

3. There was that one incident, not related to the outbreak really, where a WHO official hung up the phone rather than take questions about Taiwan (for geopolitical reasons, Taiwan is not a member of the WHO). This led to a thousand "WHO is in China's pocket" takes.

I mean, just in general the WHO has not comported themselves well here. There's been plenty of routine incompetence to complain about, and frankly they haven't really don't much to help.

But the political vitriol you hear about them is 100% blame shifting. Most of the people yelling loudest about the WHO failing to give good advice about this dangerous disease tend to argue in other contexts that the disease isn't so dangerous, we shouldn't be forced to wear masks, the economic damage is too great, liberty is at stake, etc...

Honestly I don't think it's true to say it's about politics. The WHO tweet from 14 January was very misleading and no doubt caused things to get worse:

> Preliminary investigations conducted by the Chinese authorities have found no clear evidence of human-to-human transmission of the novel #coronavirus (2019-nCoV) identified in #Wuhan, #China🇨🇳.

As far as the WHO was aware, and at the time of posting, that tweet was entirely accurate.

They're not the CIA. They don't have an adversarial spy arm. They rely enormously on member nations' self-reporting, and they rely on those reports being honest. That clear evidence came later on doesn't mean the WHO had clear evidence at the time.

(And, as the saying goes, absence of evidence isn't evidence of absence. Nothing in that tweet says "it can't spread"; it says "we can't solidly confirm it has been yet".)

Sure, and a lot of misleading stuff is true.

Consider this imaginary scenario. Imagine a dead body is found in the street in front of your house. The dead person has multiple stab wounds, and there is a knife 20 feet away from the body.

Imagine you inform the police, but they come 2 hours later, and announce that they'll investigate the death. Then 2 days later they come and announce that they had no evidence that this was a murder. They also announced that staying in and locking your doors had shown to not stop serial killers and was counter productive.

Do you want such an investigative agency?

I would prefer if the police said something like this within 1 hours of arriving at the crime scene "the stab wound and a bloody knife indicate that this might be a murder. In order to stay safe, the residents should stay in, take precautions and lock their doors"

In case you didn't get what I referred to, there is no reason to doubt via a SARS like virus with respiratory sickness may be transmitted via air. Their default reaction should have been to assume the worst. Further, saying that travel restrictions do not stop a disease is a stupid statement to make. Specially when we see South Korea, Taiwan, Vietnam, Hong Kong, NZ etc exterminate the virus.

WHO is to blame as much as individual governments.

Per https://www.washingtonpost.com/politics/2020/04/17/trumps-fa..., on the same day, the WHO said this:

> Van Kerkhove added, however, that human-to-human transmission would not be surprising given the WHO’s experience with SARS, MERS and other respiratory pathogens.

> Van Kerkhove’s message was not lost on reporters. The Telegraph in Britain headlined its article on the news conference: “WHO refuses to rule out human-to-human spread in China’s mystery coronavirus outbreak.”

Within a week (Jan 20) they'd confirmed the human-to-human transmission, too.

But it's NOT misleading. It's correct. They (both the Chinese health care folks and the WHO thought) that all the cases were from that one market and that it wasn't spreading in the community. That's what "human-to-human transmission" means in context. (They were wrong, obviously, but that was a sincerely held belief given the evidence at the time.)

The misleading bit is to try to insist that what the WHO "meant" was something more akin to "it's not contagious, you can't catch it". NO ONE thinks a respiratory virus isn't contagious. The WHO quite clearly did not mean that. And yet we still have this argument months later because people like you steadfastly refuse to assume good faith (and bad writing) on the part of the WHO.

That, sorry, is politics. The WHO isn't your tribe, so they have to be skewered as enemies instead of interpreted as (however confuddled) people just trying to do their job under extreme time pressure and with limited information.

By the time of the tweet, it was pretty well established that there was at least familial spread (aka human to human) in Wuhan. Everyone raised at eyebrow at the tweet because it goes against all observations on the spread, even from official Chinese reports.

The WHO is clearly a very conservative and cautious organization. They won't do anything without really good studies and evidence. In this pandemic, though, this staunch stance gives a perception counter to lot of common sense and comes off as inaction.

There was suspicion. There was not "clear evidence" yet (in the WHO's hands, at least; China may have had evidence they weren't sharing).

Full timeline here: https://www.washingtonpost.com/politics/2020/04/17/trumps-fa...

Later that same day:

> Van Kerkhove added, however, that human-to-human transmission would not be surprising given the WHO’s experience with SARS, MERS and other respiratory pathogens.

> Van Kerkhove’s message was not lost on reporters. The Telegraph in Britain headlined its article on the news conference: “WHO refuses to rule out human-to-human spread in China’s mystery coronavirus outbreak.”

It only took a few more days for the evidence to emerge to the WHO's satisfaction, too. Widespread attempts to justify American officials' inaction in February/March based off the Jan 14 tweet are disingenuous.

> Jan. 19 WHO tweet: “An animal source seems the most likely primary source of this novel #coronavirus (2019-nCoV) outbreak, with some limited human-to-human transmission occurring between close contacts.”

> Jan. 20 WHO tweet: “It is now very clear from the latest information that there is at least some human-to-human transmission of #nCoV2019. Infections among health care workers strengthen the evidence for this.” At the time, there were only 222 confirmed cases in the world, including four deaths.

If it was a foodborne disease that came from a food market, there could have been perceived familial spread that was really just delayed onset and not H2H.

I was personally of the opinion that it was H2H at the time, but taking a few more days and having a complete confirmation was absolutely the right thing to do, given how we wasted that time anyways. There would have been no real upside and many downsides to such a decision for everyone.

> By the time of the tweet, it was pretty well established that there was at least familial spread

That's going to need a cite.

But again, you're trying to ding them on a technicality about wording (you've just moved the goalposts from the usual "they said it wasn't contagious!" line) instead of applying what to most folks seems like the obvious interpretation.

Why was this their fault? As far as everyone was aware all the cases came from a food market, and a few days later when it was clear it was H2H they said it was.

There were some people in local Chinese government that had preliminary indications that it might have transmitted H2H, but that data propagated in under a week after the tweet and it's not the WHO job to run an intelligence agency.

> (obviously they do).

There was legitimate concern early on that misuse of masks by the general public, along with behaviour changes caused by a false sense of security, might have a net negative effect. There's now data that this is not the case, so the recommendation has changed, but the concern wasn't crazy on the absence of data.

I can say, with no politics involved (I'm probably not even in the same country as you) that the WHO messed up to much to have any authority

The potshot upthread wasn't about "giving the WHO any authority" though, it was taking an unrelated subject (corticosteroids for covid), digging an out-of-context statement, and trying to smear the WHO.

That part is politics. Talk about what they actually did wrong, don't drag them in here where they aren't relevant.

Note that those recommendations are made for medical professionals, and in fact that recommendation does not conflict with this study. For people with mild symptoms (not requiring oxygen nor ventilation) it doesn't change the mortality risk, so indeed it shouldn't be used as a routine drug for everyone who is COVID-19 positive. In fact, knowledge of SARS and MERS indicated that corticosteroids could be harmful, so it was absolutely the right call to make: if they aren't indicated for a certain reason, don't use them routinely for most patients.

>> Why is everyone picking on the WHO constantly?

Because they are a political organization first and a medical organization second, and not a particularly effective political group either, combining the worst of bureaucracy with questionable alliance and motives.

In short, they're ineffective and untrustworthy.

> Because they are a political organization first and a medical organization second, and not a particularly effective political group either, combining the worst of bureaucracy with questionable alliance and motives.

Please expand with some sources if you can, because I keep hearing this as a particular political talking point, but have never seen any real backing to these claims.

https://www.theatlantic.com/politics/archive/2020/04/world-h...

Don't forget the Bruce Alyward incident.

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