What Leviticus knows about COVID, Fauci, and measles in Lancaster County
When I lecture or write about infectious disease and the policy questions they raise, I often try and find historical references or precedents to broaden understanding of the concept. In a few lectures I use the bible, particularly the book of Leviticus (I was a token atheist at a K-8 Catholic school, so I have some standing). Leviticus 13 is particularly important for these purposes as it contains directives for dealing with a “defiling” skin disease (sometimes thought to be leprosy). In such cases, the priest is to examine individuals and isolate them for 7 days after which a re-examination is warranted and there are secondary steps to take enumerated for various reasons. It seems, to me, to be a laborious process but one that is premised on asking questions, observations, and attempting to discern what the condition is and what contagiousness level it represents, if any.
Contrast this to Leviticus 16, in which Aaron performs the annual rite of atonement for the people. He takes two goats and casts lots over them. One is sacrificed. Over the head of the other he lays both hands and confesses the sins of the whole population, transferring them onto the animal, which is then driven into the wilderness. Importantly, that goat is chosen by lot — there’s no examination or observation akin to the process of Leviticus 13. It is chosen by availability and chance, not deliberation.
These are, on their face, two different problems. Leviticus 13 concerns an affliction of the body. Leviticus 16 concerns transgression against a deity. But both are impurity, both threaten the population, and both are the same leader’s responsibility. What Leviticus offers is not a theory of disease but a system for handling contamination — and that system has exactly two operations. Examine the afflicted, at length, and reach a determination about what they actually have. Or gather the pollution onto a designated carrier — a scapegoat — and drive it out. The second method is fast and requires no real objectivity.
This biblical context has been active in my mind for some reason (I blame the nuns) as I think about the controversies that have engulfed the field of infectious disease since the COVID-19 pandemic. What we witnessed — what we are still witnessing — is a society that increasingly cannot perform the first ritual, and reflexively performs the second. The examination is laborious and yields answers that differ from person to person, satisfying no faction. The goat is fast and yields unanimity. When the pandemic demanded an examination, one camp inflated every danger and another denied them, and when it ended neither camp reckoned with what it had gotten wrong. Both went looking for a carrier instead. The carriers have accumulated. First the officials, then the agencies, then the countermeasures themselves, and now the discipline as such — the proposition that infectious disease medicine is a body of knowledge rather than an instrument of control.
Four Questions
When any infectious disease emergency, outbreak, or issue arises that becomes a subject for government in the form of health departments or more there are four questions (among many others) that arise. For this piece, I am going to use these four to frame the discussion.
1. How dangerous is the disease (does it cause death, hospitalization, healthcare utilization?) and to whom?
2. How well do the medical countermeasures (treatments, vaccines, post-exposure prophylaxis) work, if any are available? And for whom?
3. What does the medical countermeasure strategy cost?
4. What is the cost of inaction?
The answers to these questions are not going to be one-size-fits-all but stratified. For example, a measles outbreak poses a wholly different threat to a newborn too young to be vaccinated versus a 40-year-old who has had 2 doses of the MMR. What does a school closure policy cost a tenured college professor vs. a single mother? This distribution of answers is why policy is complicated and why adept, principled thinkers could conclude a unified policy isn’t possible and that a stratified policy is best.
The last question — the cost of inaction — is one that is frequently skipped. For example, while it is easy to find people warning of the alleged danger of the use of genetically modified mosquitoes to combat malaria, how many times is there active discussion of the risks and costs of not doing it? The quantification of a counterfactual is difficult but is a mark of a thorough analysis.
The errors run in a direction, and often the direction is set by the conclusion someone seeks. Deny the danger and you don’t have to act. Inflate it and you never have to stop. This is the same failure with different destinations. Every factor gets pushed whichever way protects a conclusion already reached.
I argued in The Hill in December of 2021 that abstinence-only messaging had crowded out harm reduction, and that the abandoned middle was where the honest answers were.
An examination that produces nuance or different answers for different persons is unusable to anyone who needs a mandate or a grievance. So, both groups skipped it, and both summoned Leviticus’ goat.
The Emergency That Cannot End
In 2022 I published an essay in Areo arguing that the pandemic’s end would be settled by a moral question rather than a virological one. The position I was arguing against held that the emergency could not be declared over while anyone remained vulnerable. Commentators called the CDC’s revised isolation guidance grotesque; the immunocompromised were defined as the population whose existence should govern everyone else’s behavior. The premise was that a countermeasure which leaves anyone at residual risk has not done enough, and that until it does, the restrictions should stay.
It is true that in the pre-vaccine period, SARS-CoV-2 was dangerous enough that ordinary implied consent did not cover it. Temporary, metric-directed measures aimed at protecting hospital capacity were justified after the government squandered 2 ½ months doing nothing except the wrong things.
But run this position through the four questions and the failures are systematic. Question one is inflated and, more importantly, frozen — the disease was treated as equally dangerous to everyone, forever, as though a 30-year-old with three doses and hybrid immunity occupies the same position as an unvaccinated transplant recipient in 2020. Question two is where the real damage happens. Vaccines worked. Antivirals worked. Home tests worked. Monoclonal antibodies worked. Those who will not let countermeasures change their conclusion have stopped examining anything, because the entire purpose of a countermeasure is to alter the calculus. Question four went largely unasked by this group.
The refusal to consider risk stratification, risk calculation, and harm reduction was a failure. The honest answer to COVID-19 would produce different guidance for different people — and different guidance is unusable to anyone who needs a universal rule. The immunocompromised patient deserved a real conversation about their specific residual risk and the additional tools available to them. What they got instead was conscription into an argument about everyone else’s behavior.
The Emergency That Never Was
The mirror image runs the other way. The disease is no worse than the flu. The vaccine does not work, or works so briefly it doesn’t count. The vaccine’s harms are catastrophic and concealed. And doing nothing costs nothing at all.
This is not inquiry, which would be welcome. What happened instead was that every one of the four questions above was answered in advance by a conclusion already held, and the answers moved as needed to protect it.
The vaccine-risk claims should be considered seriously. Myocarditis after mRNA vaccination in young males was a real but rare phenomenon. The Cutter incident was real. The 1976 swine flu GBS signal was real. What makes the modern claim insidious is decoupling — an adverse event severed from its magnitude, from its base rate, and from question four. Myocarditis is more common after COVID infection than after vaccination. Guillain-Barré is more common after influenza than after influenza vaccine. The events are real; the ledger is invalidated by leaving the other columns blank.
And this pattern predates COVID entirely. Wakefield published in 1998. The MMR panic ran its full course — inflated countermeasure risk, denied disease risk, uncounted cost of inaction — twenty-two years before anyone closed a school. All that transpired in 2020 did not create this. It just changed who held the position.
There is something else that has never been adequately explained.
In March and April of 2020, nineteen of the twenty-six Republican governors issued stay-at-home orders. Ron DeSantis signed Florida’s on April 1st and the state did not fully reopen until September 25th. Two weeks before he signed it, the White House task force had told governors that in states with evidence of community transmission, schools should close, and so should bars, restaurants, food courts, and gyms. His own campaign book barely acknowledges that he was the one who signed the order. The President whose task force issued that guidance later ran advertisements against the tyranny it produced. Greg Abbott told Texans that together they would heal their state. Kay Ivey brought a preacher to the podium. President Trump criticized Governor Kemp for reopening his state earlier than he wanted him to.
None of this is contested. It is all on the record, in their own words, in their own orders.
Then it vanished. Not repudiated, not defended, not explained — simply removed from the account. The men who had signed the orders then became the leading voices arguing that the emergency had been a fabrication from the beginning.
That requires an explanation.
Why It Worked
The explanation is not that they were lying. It is that they were shamed, and the shame worked because they shared the premise of the people shaming them.
That premise is close to universal and rarely stated: you answer for deaths traceable to your decision, and you do not answer for harms nobody can trace to you. It fails under one specific condition — when the untraceable harms are as large as the traceable ones. March 2020 was that condition, in its most extreme form. Deaths from acting too little would be counted, dated, photographed, and attributed to a named person. Harms from acting too much — the closed business, the missed screening, the interrupted childhood — were diffuse, delayed, statistical, and belonged to no one.
This is why the Imperial College model mattered so much more than its assumptions warranted. It converted future statistical deaths into a specific number that could be assigned, in advance, to whichever official failed to act. And it is why “if it saves just one life” became an unanswerable argument. Consider two sentences a governor might have said that spring:
I closed the schools to save lives.
I kept the schools open because closing them would cause greater harm.
Both are empirical claims. Both could be checked. Only one could be said aloud. The difference is only the first is framed as costing the speaker something.
What that asymmetry reveals is a moral standard operating underneath the policy argument, one that measures an act’s goodness by what it costs the actor rather than by what it accomplishes. Acting to protect what you value is one thing. Treating the cost to yourself as the thing that makes the act right is another, and the second is what made the argument unwinnable.
Blame asymmetry helps explain why politicians feared the visible consequences of underreacting, but it does not explain why bearing personal or societal costs came to serve as evidence of moral seriousness. That requires a deeper moral premise: that sacrifice itself confers moral credit, regardless of whether the sacrifice actually improves the outcome. Philosopher Benjamin Bayer of the Ayn Rand Institute has developed this in detail. Under a standard that equates virtue with sacrifice, risk stratification cannot even be proposed. A recommendation with no sacrifice in it offers nothing to be credited and does not register as a moral position at all.
The governors accepted a bill they could not pay, using a premise they could not repudiate. There is only one exit from that position: deny the deaths were ever coming. Which requires denying the danger. Which requires denying the science that established it.
The conspiracy theories, which partly represent a reversion to some pre-modern credulity in which disease and a lower standard of living are embraced, are actually load-bearing.
The evidence for this is documentary. The campaign book that omits its author’s own order, the advertisement that campaigns against its author’s own guidance. People do not delete what they are not ashamed of.
Custody of the Victim
I have written elsewhere about where the anti-vaccine movement’s epistemology came from — the postmodern critique of scientific authority, the flattening of expertise, the treatment of consensus as a species of power. That genealogy explains how people acquired the confidence to disbelieve expert claims. It does not explain why vaccines became the object. Nobody organizes against statins. Nobody holds rallies about dialysis.
The answer, I think, is that vaccination is the one medical intervention routinely justified to the patient as an obligation to other people. Get it to protect the immunocompromised. Get it for your grandmother. Get it for herd immunity. Every other intervention in medicine is offered on the grounds that it will help you. This one, uniquely, is pitched as something you owe.
That framing is well-intentioned and largely true. It is also precisely what made vaccination available to a critique about bodies being conscripted for collective ends. When a field argues its case in the language of what you owe the collective, it should not be surprised when someone predisposed to see medicine as social control finds the evidence in its own words. And there is a second cost: by making the case in terms of what you owe others, public health left the benefit to you underemphasized for decades.
The obvious inference is wrong. It is tempting to read the anti-vaccine movement as resisting a demand for sacrifice — as a kind of frustrated individualism. It is nothing of the sort. The thinkers it borrowed from were never opposed to sacrifice; they objected to who was benefiting from it. And the movement itself is relentlessly, conspicuously altruistic. They say they are protecting children. They say they are defending the injured. They are bringing pharma and biotech to heel. They describe careers ruined and reputations destroyed in service of a warning nobody wants to hear. Robert F. Kennedy Jr.’s entire public posture is martyrdom on behalf of harmed kids.
The standard is fully intact. Only the beneficiary has moved.
Which is why the argument cannot be settled with evidence. Both sides agree that moral authority comes from bearing a cost on behalf of a victim. The dispute is over custody of the victim.
The Goat
A ritual has an advantage no examination can offer: it settles the account without itemizing it.
If one man deceived the country into lockdowns, then nothing requires assessment. Not the nineteen governors. Not President Trump. Not the question of what you yourself believed in April of 2020, or why. The sins were real and they were collectively owned — that is what makes the ritual work. There is nothing to transfer if nobody did anything.
I said in July, after the Senate hearing, that the proceeding was performative — that it was not a venue for examining pandemic policy but an occasion for scapegoating Anthony Fauci for failures that were never his alone.
Scapegoating is not the same as criticism, and I have done the second. I objected publicly when the CDC reversed its masking guidance for vaccinated people on the basis of the Provincetown outbreak, because the data did not support the reversal and the reversal cost the agency credibility it could not spare. I objected when the eight-month booster interval was announced from the White House podium before the advisory committee had met, because the sequence inverted the process that gives such recommendations their authority. Those were criticisms of specific decisions, made on specific grounds, and each could have been answered.The difference is that criticism is an examination. It has to identify what was done, on what evidence, and what should have been done instead. It can be wrong. It can be rebutted. It produces findings about particular decisions. It produces exactly the kind of differentiated, unsatisfying answer that the first ritual always produces.
The goat is chosen by lot. Nothing about it is examined, because examination is not the point — the point is that the pollution leaves with it, and everyone else goes home clean.
The Carrier Keeps Growing
The trouble with expulsion is that it doesn’t work. Leviticus prescribes the rite annually for a reason — the sins come back. Infectious diseases keep arriving, which means a larger carrier is required each time.
So, the carrier has grown. First the officials. Then the agencies that employed them. Then the countermeasures themselves — not this vaccine or that recommendation, but vaccination as a category. And now, increasingly, the discipline: the proposition that infectious disease medicine is a body of knowledge rather than an instrument for managing populations.
This last step is different in kind. Someone who disputes a myocarditis rate is working inside the field. They have accepted that the question has an answer and that evidence bears on it, and they can be met with evidence. Someone who understands infectious disease medicine as a control narrative has not made a claim about any finding. They have rejected the field’s standing to produce findings. You cannot answer that with data.
The position did not arrive from nowhere. Public health supplied a great deal of the material. The CDC’s remit expanded well past communicable disease control. Population health was elevated over individual health as a matter of doctrine. Emergency authority was sometimes used to move policy that had nothing to do with the emergency. I have been making this argument for years, and I was making it before it became useful to people I disagree with. A field that claims authority over everything begins to look like the thing it now stands accused of being.
The overreach is real. The conclusion drawn from it is not. Those two ideas have to be held at once even though almost nobody is willing to.
Lancaster County
Measles is where the argument runs out of alibis.
There is no novel pathogen here. No emergency authority, no modeling uncertainty, no evolving guidance. The vaccine is sixty years old. The disease was eliminated from this country in 2000. A generation of American physicians completed training without seeing a case. Whatever one believes about 2020 — about the closures, the mandates, the officials, the reversals — none of it is in play. There is nothing here to resist.
Run those four questions and the answers are not close. The disease is dangerous, and dangerous in a way that is well characterized and stratified by age and immune status. The countermeasure works, with sixty years of evidence behind it. Its costs are small, known, and quantified. And the cost of inaction is being paid right now, in Pennsylvania, by children.
This is what tells you the accusation was never really about any particular policy. The ritual has outlived the thing it was performed over. It was supposed to be about lockdowns, about mandates, about a government that overreached in a genuine emergency. Those are arguments worth having, and I have engaged in them. But the goat is still being sent out, and there is no emergency left to justify it — only a vaccine that has worked since before most of the people refusing it were born.
Clean and Unclean
The priest in Leviticus 13 examines a spot on the skin. He waits seven days. He looks again.
The procedure, in this context, was right. Observe. Wait. Observe again. Reach a determination about this case and be willing for the determination to differ from the last one. Three thousand years later we have better instruments and the same procedure, and the procedure is what matters. It is the only method anyone has ever found for telling what is actually there. Despite its biblical provenance, it is an ancestor of the scientific method.
What it will never do is produce unanimity. It yields answers that differ by person and by circumstance, satisfying no faction and vindicating no side. That is not a defect in the method.
The other ritual asks nothing. It requires no findings, no waiting, no revision. It is available at all times, to anyone, and it feels like justice.
Consider what you lose when you decide the method is corrupt. You do not lose an official, or an agency, or a set of recommendations you disliked. You lose the examination itself. There is no one left with standing or a method to say what is clean and what is not — and the spot on the skin is still there.