Six years ago, the United States declared a national emergency in response to COVID-19, a turning point that reshaped public health and daily life across the globe. Schools, offices, athletic leagues, and public events ground to a halt as communities scrambled to confront the virus. During a recent session of Stanford’s Democracy and Disagreement class, HumBio alumna and former Santa Clara County Director of Public Health and Health Officer, Sara Cody ‘85 returned to campus, joined by Stephen Macedo, the Laurance S. Rockefeller Professor of Politics, for a conversation reflecting on the pivotal decisions made during the pandemic and what we can learn from the experience six years later.
The Democracy and Disagreement series, led by Debra Satz, Dean of the School of Humanities and Sciences, and Paul Brest, Professor Emeritus at Stanford Law School, engages participants in complex topics marked by significant disagreement. Launched to foster critical thinking and open dialogue, the series brings together speakers with differing perspectives to explore complex and often contentious topics through structured dialogue. This session brought together Cody and Macedo, whose insights challenged one another–Cody drawing from her direct experience as a leader during the pandemic, while Macedo assessed the effectiveness of political and institutional response. The discussion reflected many of the interdisciplinary themes central to Human Biology at the intersection of science, public policy, ethics, and community health.
In her talk, Cody provided an insider’s view on the decisions made at the local level during the early months of the pandemic. As a health officer and the Director of Public Health, she faced the daunting responsibility of protecting public health amidst rapidly evolving information. Cody and her colleagues anticipated early activity based on what the county experienced during the SARS-CoV-1 outbreak in 2003. She explained the challenges of acting decisively amid uncertainty and limited resources, particularly given early restrictions in testing capacities and severe shortages of personal protective equipment, most notably masks.
By early March, Santa Clara County had recorded some of the nation’s first cases of community transmission and deaths, and among the highest case rates in California at that time. Faced with alarming data trends and watching the chaos in Italy unfold, she and her Bay Area counterparts decided to shift from simply restricting gathering sizes to issuing shelter-in-place orders. “We realized that SCC was exactly like Italy, just two weeks behind,” Cody recalled. “I didn’t see any other tools to protect the public. [...] [Shelter-in-place] was the only tool that we had to try to prevent death.” This non-pharmaceutical intervention (NPI), the first regional shelter-in-place order issued in the United States, aimed to prevent further infection and loss of life while the world awaited vaccines. Ultimately, Cody highlighted the complexities of decision-making in an ever-changing environment, stating, “the risks changed over time in many ways that we couldn’t anticipate. [...] We were in this constant dance with the virus.” Her experience emphasized the challenges health officials faced and that their choices ultimately came down to prevention and protection until vaccines became available.
While Cody’s remarks highlighted the challenges of real-time decision-making under uncertainty, Macedo offered a broader critique through the lens of his book, In Covid’s Wake, examining how political polarization shaped the pandemic response and what lessons can be drawn moving forward. He argued that deep partisan divisions limited meaningful deliberation and decision-making about public health policies. “Deliberation around COVID was handicapped by the extent of hatred across partisan lines,” he noted, suggesting that this climate stifled effective communication and undermined trust in public health measures.
Within this polarized environment, Macedo argued that the audience should reconsider some of the central policy choices made during the pandemic, particularly the reliance on mask mandates and lockdowns. He cited earlier pandemic planning documents from organizations, including the WHO, ACLU, and Johns Hopkins, to argue for a more limited reliance on these measures. Cody challenged that framing during the discussion, disputing several of Macedo’s conclusions and arguing that the evidence supporting masking and mask mandates is strong; she also noted that some of the guidance often cited in these debates was developed with influenza scenarios in mind. Macedo also emphasized that even where NPIs provide short-term benefits, he believed the long-term costs for education, economic stability, mental and physical health, and the social fabric of society at large were significant. “The one thing that we needed to do was to think about the costs of these measures that were being imposed and not focus simply on the one variable of potential deaths,” he explained.
In his closing thoughts, Macedo called for continued reassessment of the pandemic response and for more room for open discourse and debate. He argued
that “dissent was unwelcome and stigmatized” and that he thought “the debate was cut off prematurely. [...] It’s not that we made mistakes early on, but that we failed to learn from the experience of others.”
As the conversation unfolded, Cody and Macedo emphasized different lessons from pandemic decision-making. Cody stressed adapting to rapidly changing information and operational constraints, while Macedo emphasized how polarization shaped public debate and policy. Responding to questions about tradeoffs, Cody added that broader costs were part of the calculus, but that relevant data were often difficult to access and interpret in real time, highlighting the need to make such data easier to find and use. Both speakers underscored the importance of trust, though they described it in different ways: Cody in terms of community cooperation and public health operations, and Macedo in terms of sustaining open democratic deliberation.
Cody and Macedo’s reflections on the COVID-19 pandemic response left attendees with critical insights and delivered a call for continued open dialogue. Their exchange returned to a central tension of the pandemic: how to act decisively in moments of uncertainty while still leaving room for debate, revision, and trust in moments of crisis.
For those interested in learning more about the Democracy and Disagreement class or watching a recording of the discussion, visit the Democracy and Disagreement homepage.