The Future Of COVID: Confronting The Twists And Turns Of Scientific Uncertainty
More news in the fight against COVID-19 this week, with the FDA’s approval of the Pfizer vaccine.
In addition to that, corporations, cities, schools, and even the U.S. military are laying down the law on tests and vaccines.
Here’s medical reporter Jonathan Cohn:
“We talk about following the science. But this is a new pandemic. We are still learning about it and it’s changing in real time,” he says. “We are now dealing with a version of COVID that looks different than the version of COVID we were dealing with a year ago. And suddenly things we thought we knew, we don’t know anymore.”
Dr. Nirav Shah, epidemiologist and director of the Maine CDC. (@nirav_mainecdc)
Dr. Preeti Malani, chief health officer and professor of infectious diseases at the University of Michigan. (@PreetiNMalani)
There was excitement when the vaccines came, and all of a sudden this backslide into uncertainty. Are you seeing confusion from people?
Dr. Nirav Shah: “As I talk to my counterparts across the country at state health departments, as well as my colleagues and friends in academia and elsewhere, we too are seeing the same concerning science and the data. One of the jobs of state health officials is to take those data and then translate it into what it means for the individuals who reside in our various states and cities and jurisdictions. And when I do that, I attempt to acknowledge that this summer was not what any of us thought it was going to be.
“And moreover, it seems like every day we learn or hear something that in some senses contradicts what we were told just a couple of days or weeks ago. And that feeling of being whipsawed from one thing to another is, I think, part of the reason why there’s more than just confusion, there’s outright fatigue. And I think it’s fair to say a lot of people are done with the pandemic in every way possible. So that’s what we’re hearing.
“The goal right now is to keep folks with us, because we’re not through this yet. And it could be weeks, if not months before things start subsiding. The goal that my colleagues and I across the state are trying to effectuate is how do we keep people on board with best public health recommendations, as well as to urge folks who are on the fence to get vaccinated.”
Is encouraging people to get vaccinated the ultimate goal?
Dr. Nirav Shah: “It certainly is the ultimate goal. And I think many of these favorable pieces of news that we’ve heard just this past week will have the effect of bringing some folks who are on the fence off that fence and ultimately prompt them to go get vaccinated. There are open and good questions about what the magnitude of that effect will be. Will it be just a few percentage points of those who have not been vaccinated, or will it be sizable? And that’s an interesting and important question. It’s ultimately an empirical one.
“And soon in the near future, we’ll have better data based on what folks response to these pieces of good news have been. I’m optimistic. Generally speaking, in particularly here. At a minimum, the approval, the full approval of the Pfizer vaccine for many people removes an obstacle that they had. Even for those who said that they would get the vaccine, but used that as a pretext. The approval gives clinicians, public health officials an opportunity to dig a layer deeper. If it wasn’t that you were waiting for the FDA approval, then what was it, in fact, that is hesitating you to get a vaccine? So either way, we’ll learn more. And in particular, we’ll learn about the magnitude of this effect.”
How do you deal with this uncertainty yourself as a health official?
Dr. Preeti Malani: “Cases are going up, but they’re not going up uniformly. And if you look at at least the U.S. maps, there’s a inverse likelihood of how many cases and particularly severe cases. Again, cases are going to go up, I think, especially as kids and college students and others get back to things. I try to message not just about the vaccine protects you. It protects everyone around you. It helps, even if vaccine effectiveness is less. It’s very, very effective still for severe infection, hospitalizations and deaths.
“But what I find is that there’s two groups. One, that they feel like they can’t really get back to normal activity, because of their perceived risk is being very high. And then there’s others who feel like, well, I’m not really worried about COVID. I’m not going to let it ruin my life. So I’m not getting vaccinated. I’m not going to wear a mask. My difficulty is trying to get everyone to the middle. … But what I also message on our risks that we can manage, we can’t manage every risk.
“And frankly, the risk of COVID is one of the few that we can manage. And I don’t just talk about health. I talk about disruptions. Family disruptions with kids getting sick, and classes being canceled, but also economic disruption. And I think the economic piece is one that I’m talking about a lot, because public health is economic.”
Hospitalizations are high in the United States. Why?
Dr. Nirav Shah: “People are looking around saying, wait a minute, vaccination rates are going up, but cases are going up. And how do we reconcile those two? Well, here in Maine and as I talk to my colleagues across the country, my counterparts, what we’re finding is that it’s largely the unvaccinated individuals who are experiencing new cases and finding themselves in the hospital.
“For example, one of the largest hospitals here in Maine based in Portland … as of yesterday, every single one of their patients in the ICU was someone who was unvaccinated. So what we are seeing right now is this heterogeneity where individuals who are fully vaccinated are uncommonly experiencing breakthrough cases, but they’re not driving the pandemic. What’s driving the pandemic is the Delta variant wreaking havoc among unvaccinated individuals.”
On how to be a trusted source without being preachy
Dr. Preeti Malani: “I actually think that a lot of people in public health have been good messengers since the beginning. And have said, Listen, this is a short-term thing. But whether people wanted to hear that or not is difficult. And of course, I do think that the notion that, Well, once we hit 70% vaccination we’re going to be done was certainly a message that was out there. And again, turned out to not be correct. But I do think people want to hear optimism and the fact that we can do a lot of things. We just have to adjust, and be flexible and we need to take care of each other. And make good decisions and really think about that in terms of the health of our community, of our state, of our nation.
“Some of the things that are very practical are getting information out there regularly. And if you have a website like a lot of state agencies do, or in our case, the University of Michigan, we have this campus website, is making sure that that information has good timestamps and that it’s up to date. And that’s a full-time job. We actually have phenomenal communications partners who are fielding questions and trying to keep things up to date. Because there is such a demand for good information. But, you know, ultimately this is imperfect because what we’re doing is so difficult. But I think if you can continue to say, This is what we know, this is what we don’t know, next week, it might be a little different. But we’re moving in the right direction. And I believe we are moving in the right direction. I think it’s a world different from last year, but there’s a long way to go. And frankly, we may be having some of these same conversations a year from now.”
Next steps: On what health officials should be doing now
Dr. Nirav Shah: “Everything that we say, and all the advice that we give, is based on what we know today, which could very much change. And that was the case for prior pandemics, whether it was Ebola, Zika virus, etc. … In COVID, though, there seems to have been this notion that what we know, and say today will be eternally true and you will be held against what you say forever and ever. And we see that when it comes to things like masking, et cetera. I concur … that public health officials ought to do a better job providing guardrails around what it is that they know and indicating, for example, what the magnitude of an effect is or what the degree of uncertainty is in any pronouncement they make. Now, I get why public health officials don’t do that all the time.
“No one really wants to get up there and say, Hey, here’s what I think you should do. But there is a 70% chance I could be wrong. That’s not exactly the thing that spurs people to action or to follow you, but that is what we’ve got to do. The other thing I think public health officials and perhaps anyone out there needs to do a better job of is being straight when it comes to what we know and what we don’t know. And acknowledging what we don’t know. And couple that with what we’re trying to do to get an answer. All too often when we are asked questions in public health, we obfuscate. And my cardinal rule I tried to stick with, which is: if someone asks me what time it is, I don’t tell them how to build a clock. I just try to tell people what time it is, even if it’s not what they wanted to hear.”
From The Reading List
JAMA Network: “Confronting the Delta Variant of SARS-CoV-2, Summer 2021” — “Availability of safe and highly effective SARS-CoV-2 vaccines increased the possibility of durable control of COVID-19 both in the US and worldwide.”
New York Times: “The U.S. Is Getting a Crash Course in Scientific Uncertainty” — “When the coronavirus surfaced last year, no one was prepared for it to invade every aspect of daily life for so long, so insidiously.”
This article was originally published on WBUR.org.
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