Alex Wong / Chet Strange/ Sarah Silbiger / Bloomberg / Getty / The Atlantic
When the polio vaccine was declared safe and effective, the news was met with jubilant celebration. Church bells rang across the nation, and factories blew their whistles. “Polio routed!” newspaper headlines exclaimed. “An historic victory,” “monumental,” “sensational,” newscasters declared. People erupted with joy across the United States. Some danced in the streets; others wept. Kids were sent home from school to celebrate.
One
might have expected the initial approval of the coronavirus vaccines to
spark similar jubilation—especially after a brutal pandemic year. But
that didn’t happen. Instead, the steady drumbeat of good news about the
vaccines has been met with a chorus of relentless pessimism.
The
problem is not that the good news isn’t being reported, or that we
should throw caution to the wind just yet. It’s that neither the
reporting nor the public-health messaging has reflected the truly
amazing reality of these vaccines. There is nothing wrong with realism
and caution, but effective communication requires a sense of
proportion—distinguishing between due alarm and alarmism; warranted,
measured caution and doombait; worst-case scenarios and claims of
impending catastrophe. We need to be able to celebrate profoundly
positive news while noting the work that still lies ahead. However,
instead of balanced optimism since the launch of the vaccines, the
public has been offered a lot of misguided fretting over new virus variants, subjected to misleading debates about the inferiority of certain vaccines, and presented with long lists of things vaccinated people still cannot do, while media outlets wonder whether the pandemic will ever end.
This
pessimism is sapping people of energy to get through the winter, and
the rest of this pandemic. Anti-vaccination groups and those opposing
the current public-health measures have been vigorously amplifying the
pessimistic messages—especially the idea that getting vaccinated doesn’t
mean being able to do more—telling their audiences that there is no
point in compliance, or in eventual vaccination, because it will not
lead to any positive changes. They are using the moment and the
messaging to deepen mistrust of public-health authorities, accusing them
of moving the goalposts and implying that we’re being conned. Either
the vaccines aren’t as good as claimed, they suggest, or the real goal
of pandemic-safety measures is to control the public, not the virus.
Five
key fallacies and pitfalls have affected public-health messaging, as
well as media coverage, and have played an outsize role in derailing an
effective pandemic response. These problems were deepened by the ways
that we—the public—developed to cope with a dreadful situation under
great uncertainty. And now, even as vaccines offer brilliant hope, and
even though, at least in the United States, we no longer have to deal
with the problem of a misinformer in chief, some officials and media
outlets are repeating many of the same mistakes in handling the vaccine
rollout.
The
pandemic has given us an unwelcome societal stress test, revealing the
cracks and weaknesses in our institutions and our systems. Some of these
are common to many contemporary problems, including political
dysfunction and the way our public sphere operates. Others are more
particular, though not exclusive, to the current challenge—including a
gap between how academic research operates and how the public
understands that research, and the ways in which the psychology of
coping with the pandemic have distorted our response to it.
Recognizing
all these dynamics is important, not only for seeing us through this
pandemic—yes, it is going to end—but also to understand how our society
functions, and how it fails. We need to start shoring up our defenses,
not just against future pandemics but against all the myriad challenges
we face—political, environmental, societal, and technological. None of
these problems is impossible to remedy, but first we have to acknowledge
them and start working to fix them—and we’re running out of time.
The past 12 months
were incredibly challenging for almost everyone. Public-health
officials were fighting a devastating pandemic and, at least in this
country, an administration hell-bent on undermining them. The World
Health Organization was not structured or funded for independence or
agility, but still worked hard to contain the disease. Many researchers
and experts noted the absence of timely and trustworthy guidelines from
authorities, and tried to fill the void by communicating their findings
directly to the public on social media. Reporters tried to keep the
public informed under time and knowledge constraints, which were made
more severe by the worsening media landscape. And the rest of us were
trying to survive as best we could, looking for guidance where we could,
and sharing information when we could, but always under difficult,
murky conditions.
Despite
all these good intentions, much of the public-health messaging has been
profoundly counterproductive. In five specific ways, the assumptions
made by public officials, the choices made by traditional media, the way
our digital public sphere operates, and communication patterns between
academic communities and the public proved flawed.
Risk Compensation
One of the most important problems undermining the pandemic response has been the mistrust and paternalism that some public-health agencies and experts have exhibited toward the public. A key reason for this stance seems to be that some experts feared that people would respond to something that increased their safety—such as masks, rapid tests, or vaccines—by behaving recklessly.
They worried that a heightened sense of safety would lead members of
the public to take risks that would not just undermine any gains, but
reverse them.
The
theory that things that improve our safety might provide a false sense
of security and lead to reckless behavior is attractive—it’s contrarian
and clever, and fits the “here’s something surprising we smart folks
thought about” mold that appeals to, well, people who think of
themselves as smart. Unsurprisingly, such fears have greeted efforts to
persuade the public to adopt almost every advance in safety, including
seat belts, helmets, and condoms.
But time and again, the numbers tell a different story: Even if safety improvements cause a few people to behave recklessly, the benefitsoverwhelmthe ill effects.
In any case, most people are already interested in staying safe from a
dangerous pathogen. Further, even at the beginning of the pandemic,
sociological theory predictedthat wearing masks would be associated with increased adherence to other precautionary measures—people interested in staying safe are interested in staying safe—and empirical research quickly confirmedexactly that.
Unfortunately, though, the theory of risk compensation—and its implicit
assumptions—continue to haunt our approach, in part because there
hasn’t been a reckoning with the initial missteps.
Rules in Place of Mechanisms and Intuitions
Much
of the public messaging focused on offering a series of clear rules to
ordinary people, instead of explaining in detail the mechanisms of viral
transmission for this pathogen. A focus on explaining transmission
mechanisms, and updating our understanding over time, would have helped
empower people to make informed calculations about risk in different
settings. Instead, both the CDC and the WHO chose to offer fixed
guidelines that lent a false sense of precision.
In
the United States, the public was initially told that “close contact”
meant coming within six feet of an infected individual, for 15 minutes
or more. This messaging led to ridiculous gaming of the rules; some
establishments moved
people around at the 14th minute to avoid passing the threshold. It
also led to situations in which people working indoors with others, but
just outside the cutoff of six feet, felt that they could take their
mask off. None of this made any practical sense. What happened at minute
16? Was seven feet okay? Faux precision isn’t more informative; it’s
misleading.
All
of this was complicated by the fact that key public-health agencies
like the CDC and the WHO were late to acknowledge the importance of some
key infection mechanisms, such as aerosol transmission. Even when they
did so, the shift happened without a proportional change in the
guidelines or the messaging—it was easy for the general public to miss
its significance.
Frustrated by the lack of public communication from health authorities, I wrote an article
last July on what we then knew about the transmission of this
pathogen—including how it could be spread via aerosols that can float
and accumulate, especially in poorly ventilated indoor spaces. To this
day, I’m contacted by people who describe workplaces that are following
the formal guidelines, but in ways that defy reason: They’ve installed
plexiglass, but barred workers from opening their windows; they’ve
mandated masks, but only when workers are within six feet of one
another, while permitting them to be taken off indoors during breaks.
Perhaps
worst of all, our messaging and guidelines elided the difference
between outdoor and indoor spaces, where, given the importance of
aerosol transmission, the same precautions should not apply. This is
especially important because this pathogen is overdispersed: Much of the
spread is driven by a few people infecting many others at once, while
most people do not transmit the virus at all.
After I wrote an article explaining how overdispersion
and super-spreading were driving the pandemic, I discovered that this
mechanism had also been poorly explained. I was inundated by messages
from people, including elected officials around the world, saying they
had no idea that this was the case. None of it was secret—numerous
academic papers and articles had been written about it—but it had not
been integrated into our messaging or our guidelines despite its great
importance.
Crucially, super-spreading isn’t equally distributed;
poorly ventilated indoor spaces can facilitate the spread of the virus
over longer distances, and in shorter periods of time, than the
guidelines suggested, and help fuel the pandemic.
Outdoors? It’s the opposite.
There
is a solid scientific reason for the fact that there are relatively few
documented cases of transmission outdoors, even after a year of
epidemiological work: The open air dilutes the virus very quickly, and
the sun helps deactivate it, providing further protection. And
super-spreading—the biggest driver of the pandemic— appears to be an
exclusively indoor phenomenon. I’ve been tracking every report I can
find for the past year, and have yet to find a confirmed super-spreading
event that occurred solely outdoors. Such events might well have taken
place, but if the risk were great enough to justify altering our lives, I
would expect at least a few to have been documented by now.
And
yet our guidelines do not reflect these differences, and our messaging
has not helped people understand these facts so that they can make
better choices. I published my first article pleading for parks to be kept open on April 7, 2020—but outdoor activities are still banned by some authorities today, a full year after this dreaded virus began to spread globally.
We’d
have been much better off if we gave people a realistic intuition about
this virus’s transmission mechanisms. Our public guidelines should have
been more like Japan’s, which emphasize avoiding the three C’s—closed spaces, crowded places, and close contact—that are driving the pandemic.
Scolding and Shaming
Throughout
the past year, traditional and social media have been caught up in a
cycle of shaming—made worse by being so unscientific and misguided. How dare you go to the beach? newspapers have scolded us for months,
despite lacking evidence that this posed any significant threat to
public health. It wasn’t just talk: Many cities closed parks and outdoor
recreational spaces, even as they kept open indoor dining and gyms.
Just this month, UC Berkeley and the University of Massachusetts at
Amherst both banned students from taking even solitary walks outdoors.
Even
when authorities relax the rules a bit, they do not always follow
through in a sensible manner. In the United Kingdom, after some locales
finally started allowing children to play on playgrounds—something that
was already way overdue—they quickly ruled that parents must not socialize while their kids have a normal moment. Why not? Who knows?
On social media, meanwhile, pictures of people outdoors without masks draw reprimands, insults, and confident predictions of super-spreading—and yet few note when super-spreading fails to follow.
While
visible but low-risk activities attract the scolds, other actual
risks—in workplaces and crowded households, exacerbated by the lack of
testing or paid sick leave—are not as easily accessible to
photographers. Stefan Baral, an associate epidemiology professor at the
Johns Hopkins Bloomberg School of Public Health, says that it’s almost
as if we’ve “designed a public-health response most suitable for
higher-income” groups and the “Twitter generation”—stay home; have your
groceries delivered; focus on the behaviors you can photograph and shame
online—rather than provide the support and conditionsnecessary for more people to keep themselves safe.
And
the viral videos shaming people for failing to take sensible
precautions, such as wearing masks indoors, do not necessarily help. For
one thing, fretting over the occasional person throwing a tantrum while going unmasked in a supermarket distorts the reality: Most
of the public has been complying with mask wearing. Worse, shaming is
often an ineffective way of getting people to change their behavior, and
it entrenches polarization and discourages disclosure, making it harder
to fight the virus. Instead, we should be emphasizing safer behavior
and stressing how many people are doing their part, while encouraging
others to do the same.
Harm Reduction
Amidst all the mistrust and the scolding, a crucial public-health concept fell by the wayside. Harm reduction
is the recognition that if there is an unmet and yet crucial human
need, we cannot simply wish it away; we need to advise people on how to
do what they seek to do more safely. Risk can never be completely
eliminated; life requires more than futile attempts to bring risk down
to zero. Pretending we can will away complexities and trade-offs with
absolutism is counterproductive. Consider abstinence-only education: Not
letting teenagers know about ways to have safer sex results in more of
them having sex with no protections.
As Julia Marcus, an
epidemiologist and associate professor at Harvard Medical School, told
me, “When officials assume that risks can be easily eliminated, they
might neglect the other things that matter to people: staying fed and
housed, being close to loved ones, or just enjoying their lives. Public
health works best when it helps people find safer ways to get what they
need and want.”
Another
problem with absolutism is the “abstinence violation” effect, Joshua
Barocas, an assistant professor at the Boston University School of
Medicine and Infectious Diseases, told me. When we set perfection as the
only option, it can cause people who fall short of that standard in one
small, particular way to decide that they’ve already failed, and might
as well give up entirely. Most people who have attempted a diet or a new
exercise regimen are familiar with this psychological state. The better
approach is encouraging risk reduction and layered
mitigation—emphasizing that every little bit helps—while also
recognizing that a risk-free life is neither possible nor desirable.
Socializing is not a luxury—kids need to play with one another, and adults need to interact. Your kids can play together outdoors, and outdoor time is the best chance to catch up with your neighbors
is not just a sensible message; it’s a way to decrease transmission
risks. Some kids will play and some adults will socialize no matter what
the scolds say or public-health officials decree, and they’ll do it
indoors, out of sight of the scolding.
And
if they don’t? Then kids will be deprived of an essential activity, and
adults will be deprived of human companionship. Socializing is perhaps
the most important predictor of health and longevity, after not smoking
and perhaps exercise and a healthy diet. We need to help people
socialize more safely, not encourage them to stop socializing entirely.
The Balance Between Knowledge And Action
Last but not least, the pandemic response has been distorted by a poor balance between knowledge, risk, certainty, and action.
Sometimes,
public-health authorities insisted that we did not know enough to act,
when the preponderance of evidence already justified precautionary
action. Wearing masks, for example, posed few downsides, and held the
prospect of mitigating the exponential threat we faced. The wait for
certainty hampered our response to airborne transmission, even though
there was almost no evidence for—and increasing evidence against—the
importance of fomites, or objects that can carry infection. And yet, we
emphasized the risk of surface transmission while refusing to properly
address the risk of airborne transmission, despite increasing evidence.
The difference lay not in the level of evidence and scientific support
for either theory—which, if anything, quickly tilted in favor of
airborne transmission, and not fomites, being crucial—but in the fact
that fomite transmission had been a key part of the medical canon, and
airborne transmission had not.
Sometimes,
experts and the public discussion failed to emphasize that we were
balancing risks, as in the recurring cycles of debate over lockdowns or
school openings. We should have done more to acknowledge that there were
no good options, only trade-offs between different downsides. As a
result, instead of recognizing the difficulty of the situation, too many
people accused those on the other side of being callous and uncaring.
And
sometimes, the way that academics communicate clashed with how the
public constructs knowledge. In academia, publishing is the coin of the
realm, and it is often done through rejecting the null
hypothesis—meaning that many papers do not seek to prove something
conclusively, but instead, to reject the possibility that a variable has
no relationship with the effect they are measuring (beyond chance). If
that sounds convoluted, it is—there are historical reasons for this
methodology and big arguments within academia about its merits, but for
the moment, this remains standard practice.
At
crucial points during the pandemic, though, this resulted in
mistranslations and fueled misunderstandings, which were further muddled
by differing stances toward prior scientific knowledge and theory. Yes,
we faced a novel coronavirus, but we should have started by assuming
that we could make some reasonable projections from prior knowledge,
while looking out for anything that might prove different. That prior experience
should have made us mindful of seasonality, the key role of
overdispersion, and aerosol transmission. A keen eye for what was
different from the past would have alerted us earlier to the importance of presymptomatic transmission.
Thus, on January 14, 2020, the WHO stated
that there was “no clear evidence of human-to-human transmission.” It
should have said, “There is increasing likelihood that human-to-human
transmission is taking place, but we haven’t yet proven this, because we
have no access to Wuhan, China.” (Cases were already popping up
around the world at that point.) Acting as if there was human-to-human
transmission during the early weeks of the pandemic would have been wise
and preventive.
Later that spring, WHO officials stated
that there was “currently no evidence that people who have recovered
from COVID-19 and have antibodies are protected from a second
infection,” producing many articles laden with panic and despair.
Instead, it should have said: “We expect the immune system to function
against this virus, and to provide some immunity for some period of
time, but it is still hard to know specifics because it is so early.”
Similarly,
since the vaccines were announced, too many statements have emphasized
that we don’t yet know if vaccines prevent transmission. Instead,
public-health authorities should have said that we have many reasons to
expect, and increasing amounts of data to suggest, that vaccines will
blunt infectiousness, but that we’re waiting for additional data to be
more precise about it. That’s been unfortunate, because while many, many
things have gone wrong during this pandemic, the vaccines are one thing
that has gone very, very right.
As late as April 2020, Anthony Fauci was slammed
for being too optimistic for suggesting we might plausibly have
vaccines in a year to 18 months. We had vaccines much, much sooner than
that: The first two vaccine trials concluded a mere eight months after
the WHO declared a pandemic in March 2020.
Moreover, they have delivered spectacular results. In June 2020, the FDA said
a vaccine that was merely 50 percent efficacious in preventing
symptomatic COVID-19 would receive emergency approval—that such a
benefit would be sufficient to justify shipping it out immediately. Just
a few months after that, the trials of the Moderna and Pfizer vaccines
concluded by reporting not just a stunning 95 percent efficacy,
but also a complete elimination of hospitalization or death among the
vaccinated. Even severe disease was practically gone: The lone case
classified as “severe” among 30,000 vaccinated individuals in the trials
was so mild that the patient needed no medical care, and her case would
not have been considered severe if her oxygen saturation had been a
single percent higher.
These are exhilarating developments,
because global, widespread, and rapid vaccination is our way out of this
pandemic. Vaccines that drastically reduce hospitalizations and deaths,
and that diminish even severe disease to a rare event, are the closest
things we have had in this pandemic to a miracle—though of course they
are the product of scientific research, creativity, and hard work. They
are going to be the panacea and the endgame.
And
yet, two months into an accelerating vaccination campaign in the United
States, it would be hard to blame people if they missed the news that
things are getting better.
Yes, there are new variants of the
virus, which may eventually require booster shots, but at least so far,
the existing vaccines are standing up to them well—very, very well.
Manufacturers are already working on new vaccines or variant-focused
booster versions, in case they prove necessary, and the authorizing
agencies are ready for a quick turnaround
if and when updates are needed. Reports from places that have
vaccinated large numbers of individuals, and even trials in places where
variants are widespread, are exceedingly encouraging, with dramatic
reductions in cases and, crucially, hospitalizations and deaths among
the vaccinated. Global equity and access to vaccines remain crucial
concerns, but the supply is increasing.
Here in the United States,
despite the rocky rollout and the need to smooth access and ensure
equity, it’s become clear that toward the end of spring 2021, supply
will be more than sufficient. It may sound hard to believe today, as
many who are desperate for vaccinations await their turn, but in the
near future, we may have to discuss what to do with excess doses.
So why isn’t this story more widely appreciated?
Part
of the problem with the vaccines was the timing—the trials concluded
immediately after the U.S. election, and their results got overshadowed
in the weeks of political turmoil. The first, modest headline announcing
the Pfizer-BioNTech results in The New York Times was a single column, “Vaccine Is Over 90% Effective, Pfizer’s Early Data Says,” below a banner headline spanning the page: “BIDEN CALLS FOR UNITED FRONT AS VIRUS RAGES.” That was both understandable—the nation was weary—and a loss for the public.
Just
a few days later, Moderna reported a similar 94.5 percent efficacy. If
anything, that provided even more cause for celebration, because it
confirmed that the stunning numbers coming out of Pfizer weren’t a
fluke. But, still amid the political turmoil, the Moderna report got a mere two columns on The New York Times’ front page with an equally modest headline: “Another Vaccine Appears to Work Against the Virus.”
So we didn’t get our initial vaccine jubilation.
But
as soon as we began vaccinating people, articles started warning the
newly vaccinated about all they could not do. “COVID-19 Vaccine Doesn’t
Mean You Can Party Like It’s 1999,” one headline admonished.
And the buzzkill has continued right up to the present. “You’re fully
vaccinated against the coronavirus—now what? Don’t expect to shed your
mask and get back to normal activities right away,” began a recent Associated Press story.
People
might well want to party after being vaccinated. Those shots will
expand what we can do, first in our private lives and among other
vaccinated people, and then, gradually, in our public lives as well. But
once again, the authorities and the media seem more worried about
potentially reckless behavior among the vaccinated, and about telling
them what not to do, than with providing nuanced guidance reflecting
trade-offs, uncertainty, and a recognition that vaccination can change
behavior. No guideline can cover every situation, but careful, accurate,
and updated information can empower everyone.
Take the messaging
and public conversation around transmission risks from vaccinated
people. It is, of course, important to be alert to such considerations:
Many vaccines are “leaky” in that they prevent disease or severe
disease, but not infection and transmission. In fact, completely
blocking all infection—what’s often called “sterilizing immunity”—is a
difficult goal, and something even many highly effective vaccines don’t
attain, but that doesn’t stop them from being extremely useful.
As
Paul Sax, an infectious-disease doctor at Boston’s Brigham &
Women’s Hospital, put it in early December, it would be enormously
surprising “if these highly effective vaccines didn’t also make people
less likely to transmit.” From multiple studies, we already knew that
asymptomatic individuals—those who never developed COVID-19 despite
being infected—were much less likely to transmit the virus. The vaccine
trials were reporting 95 percent reductions in any form of symptomatic
disease. In December, we learned that Moderna had swabbed some portion
of trial participants to detect asymptomatic, silent infections, and
found an almost two-thirds reduction even in such cases. The good news kept pouring in. Multiple studies
found that, even in those few cases where breakthrough disease occurred
in vaccinated people, their viral loads were lower—which correlates
with lower rates of transmission. Data from vaccinated populations
further confirmed what many experts expected all along: Of course these
vaccines reduce transmission.
And yet, from the beginning, a good chunk of the public-facing messaging and news articles implied or claimed that vaccines won’t protect you against infecting other people or that we didn’t know
if they would, when both were false. I found myself trying to convince
people in my own social network that vaccines weren’t useless against
transmission, and being bombarded on social media with claims that they
were.
What went wrong? The same thing that’s going wrong right now
with the reporting on whether vaccines will protect recipients against
the new viral variants. Some outlets emphasize the worst or misinterpret
the research. Some public-health officials are wary of encouraging the
relaxation of any precautions. Some prominent experts on social
media—even those with seemingly solid credentials—tend to respond to
everything with alarm and sirens. So the message that got heard
was that vaccines will not prevent transmission, or that they won’t
work against new variants, or that we don’t know if they will. What the
public needs to hear, though, is that based on existing data, we expect
them to work fairly well—but we’ll learn more about precisely how
effective they’ll be over time, and that tweaks may make them even
better.
A year into the pandemic, we’re still repeating the same mistakes.
The top-down
messaging is not the only problem. The scolding, the strictness, the
inability to discuss trade-offs, and the accusations of not caring about
people dying not only have an enthusiastic audience, but portions of
the public engage in these behaviors themselves. Maybe that’s partly
because proclaiming the importance of individual actions makes us feel
as if we are in the driver’s seat, despite all the uncertainty.
Psychologists
talk about the “locus of control”—the strength of belief in control
over your own destiny. They distinguish between people with more of an
internal-control orientation—who believe that they are the primary
actors—and those with an external one, who believe that society, fate,
and other factors beyond their control greatly influence what happens to
us. This focus on individual control goes along with something called
the “fundamental attribution error”—when
bad things happen to other people, we’re more likely to believe that
they are personally at fault, but when they happen to us, we are more
likely to blame the situation and circumstances beyond our control.
An
individualistic locus of control is forged in the U.S. mythos—that we
are a nation of strivers and people who pull ourselves up by our
bootstraps. An internal-control orientation isn’t necessarily negative;
it can facilitate resilience, rather than fatalism, by shifting the
focus to what we can do as individuals even as things fall
apart around us. This orientation seems to be common among children who
not only survive but sometimes thrive
in terrible situations—they take charge and have a go at it, and with
some luck, pull through. It is probably even more attractive to
educated, well-off people who feel that they have succeeded through
their own actions.
You
can see the attraction of an individualized, internal locus of control
in a pandemic, as a pathogen without a cure spreads globally, interrupts
our lives, makes us sick, and could prove fatal.
There have been
very few things we could do at an individual level to reduce our risk
beyond wearing masks, distancing, and disinfecting. The desire to
exercise personal control against an invisible, pervasive enemy is
likely why we’ve continued to emphasize scrubbing and cleaning surfaces,
in what’s appropriately called “hygiene theater,” long after it became clear that fomites were not a key driver of the pandemic. Obsessive cleaning gave us something to do, and
we weren’t about to give it up, even if it turned out to be useless. No
wonder there was so much focus on telling others to stay home—even
though it’s not a choice available to those who cannot work remotely—and
so much scolding of those who dared to socialize or enjoy a moment
outdoors.
And perhaps it was too much to expect a nation unwilling
to release its tight grip on the bottle of bleach to greet the arrival
of vaccines—however spectacular—by imagining the day we might start to
let go of our masks.
The focus on individual
actions has had its upsides, but it has also led to a sizable portion
of pandemic victims being erased from public conversation. If our own
actions drive everything, then some other individuals must be to blame
when things go wrong for them. And throughout this pandemic, the mantra
many of us kept repeating—“Wear a mask, stay home; wear a mask, stay
home”—hid many of the real victims.
Study
after study, in country after country, confirms that this disease has
disproportionately hit the poor and minority groups, along with the
elderly, who are particularly vulnerable to severe disease. Even among
the elderly, though, those who are wealthier and enjoy greater access to
health care have fared better.
The poor and minority groups are
dying in disproportionately large numbers for the same reasons that they
suffer from many other diseases: a lifetime of disadvantages, lack of
access to health care, inferior working conditions, unsafe housing, and
limited financial resources.
Many lacked the option of staying
home precisely because they were working hard to enable others to do
what they could not, by packing boxes, delivering groceries, producing
food. And even those who could stay home faced other problems born of
inequality: Crowded housing is associatedwith
higher rates of COVID-19 infection and worse outcomes, likely because
many of the essential workers who live in such housing bring the virus
home to elderly relatives.
Individual responsibility certainly had
a large role to play in fighting the pandemic, but many victims had
little choice in what happened to them. By disproportionately focusing
on individual choices, not only did we hide the real problem, but we
failed to do more to provide safe working and living conditions for
everyone.
For
example, there has been a lot of consternation about indoor dining, an
activity I certainly wouldn’t recommend. But even takeout and delivery
can impose a terrible cost: One study
of California found that line cooks are the highest-risk occupation for
dying of COVID-19. Unless we provide restaurants with funds so they can
stay closed, or provide restaurant workers with high-filtration masks,
better ventilation, paid sick leave, frequent rapid testing, and other
protections so that they can safely work, getting food to go can simply
shift the risk to the most vulnerable. Unsafe workplaces may be low on
our agenda, but they do pose a real danger. Bill Hanage, associate
professor of epidemiology at Harvard, pointed me to a paper
he co-authored: Workplace-safety complaints to OSHA—which oversees
occupational-safety regulations—during the pandemic were predictive of
increases in deaths 16 days later.
New data highlight the terrible toll of inequality: Life expectancy has decreased dramatically over the past year, with Black people losing the most from this disease, followed by members of the Hispanic community. Minorities are also more likely to die of COVID-19 at a younger age. But when the new CDC director, Rochelle Walensky, noted
this terrible statistic, she immediately followed up by urging people
to “continue to use proven prevention steps to slow the spread—wear a
well-fitting mask, stay 6 ft away from those you do not live with, avoid
crowds and poorly ventilated places, and wash hands often.”
Those
recommendations aren’t wrong, but they are incomplete. None of these
individual acts do enough to protect those to whom such choices aren’t
available—and the CDC has yet to issue sufficient guidelines for
workplace ventilation or to make higher-filtration masks mandatory, or
even available, for essential workers. Nor are these proscriptions
paired frequently enough with prescriptions: Socialize outdoors, keep
parks open, and let children play with one another outdoors.
Vaccines are the tool
that will end the pandemic. The story of their rollout combines some of
our strengths and our weaknesses, revealing the limitations of the way
we think and evaluate evidence, provide guidelines, and absorb and react
to an uncertain and difficult situation.
But also, after a weary
year, maybe it’s hard for everyone—including scientists, journalists,
and public-health officials—to imagine the end, to have hope. We adjust
to new conditions fairly quickly, even terrible new conditions. During
this pandemic, we’ve adjusted to things many of us never thought were
possible. Billions of people have led dramatically smaller,
circumscribed lives, and dealt with closed schools, the inability to see
loved ones, the loss of jobs, the absence of communal activities, and
the threat and reality of illness and death.
Hope
nourishes us during the worst times, but it is also dangerous. It
upsets the delicate balance of survival—where we stop hoping and focus
on getting by—and opens us up to crushing disappointment if things don’t
pan out. After a terrible year, many things are understandably making
it harder for us to dare to hope. But, especially in the United States,
everything looks better by the day. Tragically, at least 28 million
Americans have been confirmed to have been infected, but the real number
is certainly much higher. By one estimate,
as many as 80 million have already been infected with COVID-19, and
many of those people now have some level of immunity. Another 46 million
people have already received at least one dose of a vaccine, and we’re
vaccinating millions more each day as the supply constraints ease. The
vaccines are poised to reduce or nearly eliminate the things we worry
most about—severe disease, hospitalization, and death.
Not all our
problems are solved. We need to get through the next few months, as we
race to vaccinate against more transmissible variants. We need to do
more to address equity in the United States—because it is the right
thing to do, and because failing to vaccinate the highest-risk people
will slow the population impact. We need to make sure that vaccines
don’t remain inaccessible to poorer countries. We need to keep up our
epidemiological surveillance so that if we do notice something that
looks like it may threaten our progress, we can respond swiftly.
And
the public behavior of the vaccinated cannot change overnight—even if
they are at much lower risk, it’s not reasonable to expect a grocery
store to try to verify who’s vaccinated, or to have two classes of
people with different rules. For now, it’s courteous and prudent for
everyone to obey the same guidelines in many public places. Still,
vaccinated people can feel more confident in doing things they may have
avoided, just in case—getting a haircut, taking a trip to see a loved
one, browsing for nonessential purchases in a store.
But it is
time to imagine a better future, not just because it’s drawing nearer
but because that’s how we get through what remains and keep our guard up
as necessary. It’s also realistic—reflecting the genuine increased
safety for the vaccinated.
Public-health agencies should immediately
start providing expanded information to vaccinated people so they can
make informed decisions about private behavior. This is justified by the
encouraging data, and a great way to get the word out on how wonderful
these vaccines really are. The delay itself has great human costs,
especially for those among the elderly who have been isolated for so
long.
Public-health authorities should also be louder and more
explicit about the next steps, giving us guidelines for when we can
expect easing in rules for public behavior as well. We need the exit
strategy spelled out—but with graduated, targeted measures rather than a
one-size-fits-all message. We need to let people know that getting a
vaccine will almost immediately change their lives for the better, and
why, and also when and how increased vaccination will change more than
their individual risks and opportunities, and see us out of this
pandemic.
We
should encourage people to dream about the end of this pandemic by
talking about it more, and more concretely: the numbers, hows, and whys.
Offering clear guidance on how this will end can help strengthen
people’s resolve to endure whatever is necessary for the moment—even if
they are still unvaccinated—by building warranted and realistic
anticipation of the pandemic’s end.
Hope will get us through this.
And one day soon, you’ll be able to hop off the subway on your way to a
concert, pick up a newspaper, and find the triumphant headline: “COVID
Routed!”
Zeynep Tufekci is a contributing writer at The Atlantic and
an associate professor at the University of North Carolina. She studies
the interaction between digital technology, artificial intelligence,
and society.
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