Approximately a million people have died from Covid-19 in the US. The country now faces a new surge in BA.2 and BA.2.12.1; other variants are likely to follow. Yet Americans are now packing into restaurants, parties and exercise classes as if it’s 2019.
It’s easy to blame Covid fatigue, but that may not be the problem. People are confused, badly informed, and cynical for good reason — the public health establishment has let us down many times, underplaying the risk early, making rules that were geared as much for show as for our protection, and blaming us for their failures.
Now mandates are becoming less popular, and people are being left to make more of their own choices, or as the New Yorker phrased it: “Americans knew what was allowed and what wasn’t. We’re now reverting to the Wild West phase.”
But the problem isn’t the shift to personal choice. It’s that our public health establishment wasn’t very good at making effective mandates or giving people the information needed to calculate our own risks. “What was allowed and what wasn’t” often didn’t make sense — or much of a difference. Over the last two years, Covid rules were formed with many motives in mind beyond public safety; politicians and business owners wanted to be seen as taking strong action to protect voters and customers. But indoor restaurants were never safe despite extra cleaning and mask mandates, and parks were unlikely sources of disease. Nonetheless, the rules imposed around them rarely reflected current scientific understanding.
The only time Americans were under any sort of lockdown was during the spring of 2020, when restaurants, churches, gyms and schools were forced to shut down. That was never sustainable, although it seemed prudent as a short-term measure to prevent hospitals becoming overrun. But why did so many governors put checkpoints at state borders or impose quarantine rules for border crossers? There was never much of an explanation. By then it was already clear that Covid had spread across the country.
Public health measures for the rest of the pandemic were equally confusing and often not science-based. Things like plexiglass dividers and supermarket one-way arrows probably didn’t save any lives. Mask mandates were the centerpiece of all rules, and there’s good evidence that N-95 and KN95 masks are protective — but the efficacy of the cloth and surgical masks most people use remains in question. It was a mostly empty gesture to require people to wear them to and from restaurant tables. Even the rapid tests that were a centerpiece of President Joe Biden’s policy lacked useful information about how to interpret the results.
The messages the public got on pandemic safety were often “contradictory, incomprehensible, sanctimonious and disrespectful,” according to Carnegie Mellon University public policy professor Baruch Fischhoff, in an essay for Foreign Policy magazine last fall. I saw this attitude play out as well; occasionally in my interviews and often on social media, experts accused the public of being too “selfish,” “irrational” or “science illiterate” to absorb honest messages.
When I interviewed Fischhoff for a column this spring, he said that years of research in risk communication demonstrates the benefit of showing people the scientific underpinnings of new policies and rules. Failing to do that will leave some people “feeling that their lives were disrupted for no good reason and other people feeling they were left needlessly exposed to risk,” as he put it in his article.
The CDC and WHO both owe the public an apology for being too slow to accept evidence that Covid-19 is primarily transmitted through small airborne particles that can infect people over long distances indoors. Their slowness to admit Covid was airborne made it harder for public health officials to give the public credible advice. Yet even now, public health advice remains hung up on the disproven notion that you’re safe as long as you stay six feet away from unmasked people. For example, quarantine recommendations from the CDC still define exposure as spending more than 15 minutes within six feet of an infected person. But the risk of being in the same room at all with an infected person is much higher than being within six feet outside.
At this point, smart, well-targeted recommendations might be more life-saving than muddled mandates. We need better data about the relative risk of eating in restaurants outdoors and indoors, the risk associated with different kinds of shops, hair parlors and gyms, as well as public transportation and gatherings at home. When cases start to climb, the CDC could save lives by issuing clear warnings about the riskiest places and activities — even if it is bad for the restaurant industry or other businesses.
The agency could also do better at informing us how to protect others while still getting back into the swing of life. That would include up-to-date information on how to decide if you’ve been exposed based on the latest understanding of airborne transmission and incubation time, which is usually shorter than originally thought.
Why not create a new category of possible exposure — something that might encompass going to a large indoor event such as the Gridiron Dinner, or eating indoors in a crowded restaurant during a surge? Many cases could be avoided if people in those categories took at least a few extra precautions for a few days afterward, such as avoiding people who remain vulnerable.
Some people are acting as if they are done with precautions and ready to accept the risk of catching Covid, but many others just want to get back into life while still making reasonable choices. Public health owes it to us to make that easier.
Bloomberg
