People no longer know what to do about the Covid pandemic. Part of the problem is the very language we use to talk about it. Words such as “breakthrough,” “booster” and even “sick” mean different things to different people — and to experts and the general public. The solution is for experts to be mindful of words that have various popular meanings, and to avoid others altogether. Public health officials who wonder why the public is ignoring them — or who blame scientific illiteracy for their own muddy communication — should consider adopting a new glossary for the pandemic’s third year.
The language problem really hit me when Paul Offit, director of the Vaccine Education Center at the Children’s Hospital of Philadelphia, said in a video talk that he wished experts had never used the term “breakthrough infection.” This descriptor makes it sound as if the Covid vaccines failed. But in other diseases, asymptomatic or mild infections often coexist with vaccination.
Offit also suggested jettisoning the term “booster” and redefining fully vaccinated simply as two, three or four shots, depending on various risk factors and age. That might encourage people to get the additional shots they need. Last winter, the critical care physician Roger Seheult told me that most patients he was seeing in the intensive-care unit during the omicron surge had serious health conditions (one was a kidney transplant recipient) but had not gotten that third dose of vaccine. Thirty percent of Americans over 65 never got a booster, though they are vastly more likely to be hospitalized or die from Covid than younger people.
Even very basic terms can highlight a disconnect between the public and public health. Take the word “sick.” “A recent CDC announcement regarding international travel advised travelers to ‘get tested for current infection … and not travel if they are sick,’” notes risk communication consultant Peter Sandman. But does “sick” mean having symptoms or just testing positive? When scientists estimate that a quarter or even half of Americans have been infected with omicron, do they mean tested positive or got symptoms? Does this include people who didn’t test but would have been positive if they had?
“Airborne” is another term Sandman considers confusing. Most people think of airborne as any transmission via air, in contrast with transmission via infected surfaces. But the World Health Organization and the US Centers for Disease Control and Prevention differentiate between airborne and droplets, which also travel through the air but are larger and less likely to travel more than six feet. The distinction is critical. With a droplet-borne disease, even cloth masks are likely to help, and staying six feet apart keeps people safer. If a virus is technically airborne, then being outside, having good ventilation and wearing respirator masks make more sense.
Even the term “mask” has lost some meaning. Masks encompass everything from a bandana tied bank robber-style around the face to an N-95. The former hasn’t been shown to protect the wearer or others, while the latter does both. So when we talk about “wearing masks” or say “masking works,” people have wildly varying interpretations.
“Long Covid” also encompasses too much, lumping together any lingering symptoms with a disabling neurological syndrome. This makes it hard to judge the risk of severe long Covid. To understand the difference, think about skin cancer. There are many kinds of skin cancer, and the common ones are the least deadly. There’s a good reason that most of us who’ve had something zapped off our skin don’t consider ourselves cancer survivors.
The word “emergency” also highlights the growing gulf between the public and public health, since most people no longer see the pandemic as an emergency and haven’t for some time. “To qualify as an emergency, an event normally should be important, bad, sudden and short-term,” Sandman wrote to me.
The pandemic is still an official public health emergency, which gives drug companies the ability to fast-track drugs and vaccines through emergency use authorizations. But the situation is no longer sudden or short-term. “It’s not surprising that much of the public is highly motivated to “get over” COVID and return to normal life, while many public health professionals are inclined to stay focused (and want the public to stay focused) on the biggest public health emergency of their careers,” Sandman wrote.
Finally, the word “pandemic,” when contrasted with “endemic,” has unleashed a new wave of confusion. People think of a pandemic as something very serious and scary, and endemic as a problem that fades into the background. Oxford University biologist Aris Katzourakis has called “endemic” one of the most misused terms of the pandemic because many endemic diseases, such as malaria, can be extremely deadly and debilitating.
To most of us, however, the idea of a permanent pandemic or a permanent emergency feel oxymoronic. When people say they think the pandemic is over, they’re describing the way things feel now. That might be subjective, but it’s no less real — and public health professionals would be wise to pay attention.