How should we think about the risk from Covid now?
When it comes to public health emergencies like the pandemic, if people fail to be safe enough, or the danger and uncertainty are just too great to rely on individual decisions, then the government must act, as it did with stay-at-home orders and mask mandates last year. But as the country emerges from the pandemic, it’s going to fall increasingly on each of us to figure out what to do ourselves.
In normal times, warnings from health officials and mandates about what not to do often fall on deaf ears. Did you know that the Centers for Disease Control and Prevention says that women should not drink alcohol if they are of childbearing age and are not on birth control and that people shouldn’t eat raw cookie dough and should consume only about a teaspoon of salt a day? Probably not — and even if you have heard the advice, there’s a good chance you nodded and then ignored it.
The Covid-19 pandemic has been different. The last time the world faced a disease this infectious and this dangerous and for which there were no vaccines was the 1918 flu outbreak. Covid was a new crisis that needed extraordinary leadership, and many turned to the C.D.C.
That’s entirely appropriate, because what the C.D.C. is good at is protecting Americans from health threats (though yes, the C.D.C. could have communicated messages more clearly and early on, without political interference).
But there were good reasons for Americans to rely on the C.D.C. Almost no states had a public health infrastructure up to figuring out guidelines for the pandemic.
Many people also began looking to the C.D.C. to tell them what to do in everyday situations. This was also the reasonable thing to do in a state of emergency, but we should acknowledge how exceptional this state of affairs was.
Today, as the risk of Covid decreases with vaccinations, C.D.C. experts are still inundated with questions as to what is “safe.” Is it safe to travel and see other vaccinated members of the family in their home? What if one of them is unvaccinated? What if that unvaccinated person is a child? What if we want to see friends who are vaccinated, except for their children, but they’re sheltering in place and seeing no one else? What if they have a baby?
Many people, including experts, are angry that the C.D.C. isn’t clear on all of the answers. They’re upset when the C.D.C. makes recommendations too slowly, and they’re upset when the C.D.C. makes decisions too quickly. No one is there to tell us exactly what is safe and what is not.
There are a few problems with this way of thinking. The first is that safety is not binary; things are not either “safe” or “unsafe.” What people really need to understand is how risky or safe activities are, not to be told what’s forbidden or permitted. They need to know the amount of risk that comes with various activities so they can compare them. In addition, people need to interpret this information in the context of their own lives, understanding that what might be too risky for some may not be too risky for others.
The C.D.C. cannot know the nuances of every situation. So it’s no wonder that when it issues detailed advice, it often winds up confusing people instead of comforting them.
The C.D.C.’s recent change in policy on masks for those who are vaccinated is a good case in point. In an effort to attempt to address every possible scenario, the agency published a pretty complicated document that tried to tell people whether they needed to mask in a wide variety of situations.
Instead, it could have said this: When you’re vaccinated, your personal risk is substantially lower than ever before. You are significantly less likely to be infected. You’re much less likely to get sick in the unlikely event that you are infected. You’re even less likely to spread infection. Given that, masks likely provide limited benefit in most settings, so you really don’t need to wear one.
However, if you’re in a large group of people indoors for an extended period (flying on a plane, being in a classroom, shopping in Costco) then masking might still be a good idea. Additionally, you may live in areas where outbreaks are occurring, or you might have a chronic illness that places you at higher risk, and organizations or individuals may feel safer continuing to mask in certain conditions until transmission slows further.
Because the C.D.C. didn’t frame it this way, many people took its advice to mean they needed to worry whether others were following the rules, and that they might be at risk if the people around them were unvaccinated and unmasked. But the real danger in those situations is for the unvaccinated, not the vaccinated. They’re the ones who need to worry.
Better guidelines would give us a sense of how much risk comes with certain activities, not whether risk exists. Knowing the amount of risk would allow people to make decisions about what they are willing to accept for themselves and others.
The C.D.C. is typically a very conservative voice when it comes to health. People should know that if they’re waiting for a notice from C.D.C. experts that the pandemic is over and it’s safe to go back to normal, they will likely be disappointed. Instead, they will once again need to make their own choices as to what advice to follow, and what to ignore. When my daughter and I make cookies, we taste the raw dough. Until she’s fully vaccinated in a couple of weeks, she’s still masking inside and being pretty careful around others.
Aaron E. Carroll (@aaronecarroll) is a professor of pediatrics at Indiana University School of Medicine and the vice president for faculty development at the Regenstrief Institute. He writes about health research and policy at The Incidental Economist.
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