by Mike Critelli
Unfortunately, lawmakers, public health authorities, as well as the media and some scientists have found it difficult to acknowledge that “following the science” means we must become comfortable with uncertainty on some key points:
- How likely will the virus spread in indoor spaces?
- How effective is mask-wearing in reducing the spread?
- How effective are vaccines?
- Who is likely to be hospitalized or at risk of “long Covid” or death?
Last year, lawmakers decided to make a big bet on the assumption that a massive global lockdown could contain the virus within a relatively short period of time, after which normal life could resume. Vaccines would be broadly distributed and herd immunity would be achieved.
We are now into the second year of the crisis. The virus is not contained. Vaccines, along with the antibodies created from surviving the virus, have not produced herd immunity. The virus is mutating faster than the vaccines designed to stop it.
Drawing on their experience with other viruses and bacterial pathogens, scientists assumed early on that the virus spread through contact with contaminated surfaces. We now know the virus spreads through droplets or aerosols from an infected person’s nose or mouth, and that contaminated surface transmission is extremely rare. (This could yet still change with a new strain of the virus far better able to live and multiply on surfaces.)
To “follow the science,” we need rigorous and continuous research which takes into account the prevalence of the virus, its probable effects on a total population, and the speed with which it mutates. But we have not created a data gathering system that enables us to do this.
The question is “why didn’t we create a system to achieve these goals?”
There are several reasons, some of which are deeply imbedded in our cultural values:
1. We designed our COVID-19 testing protocols primarily to detect the presence of the virus in those who presented themselves with symptoms. Eventually, we developed exceptions to this:
- To enable professional sporting events to be staged for public benefit, we made mandatory Covid-19 testing a core part of the process of allowing athletes to compete in close proximity to other athletes.
- We created testing protocols for film, TV and theater production casts and crews.
- We required testing for people leaving one state or country and entering another.
But we did not go as far as we could have in mandating testing and vaccinations for those who are in close proximity to others. And we never implemented random testing for surveillance purposes. Today, we require mask-wearing to compensate partially for the risk that asymptomatic, infectious individuals are allowed to move freely among us without us knowing who they are.
2. We made the primary goal of our Covid testing the management of populations that needed hospitalization. The goal of our testing was diagnostic, not preventive.
This is consistent with how we approach health and healthcare more generally. Many Americans are walking time bombs with asymptomatic and, in some cases, life-threatening conditions like hypertension, Type 2 diabetes, and coronary artery disease. We make no effort to prevent these conditions from becoming life-threatening and fatal before patients present themselves as needing care. Even when they are diagnosed as life-threatening chronic diseases, we do nothing to force individuals to get treated.
3. We know that some parts of our population are at far higher risk than others, but lack the tools to be sufficiently precise in risk assessment to intelligently segregate those at highest risk. We lack these tools because our concerns about privacy have pushed us so far away from legitimate privacy concerns that we cannot aggregate anonymous health data for research adequate to developing a robust risk management tool.
As someone who is in a “vulnerable” age bracket, the notion that I should be segregated as a “high risk” patient is ludicrous, because not enough else is known by or about me to convince me that I am at high risk. I know individuals in their 80’s or 90’s who came through the process of getting infected without noticeable symptoms.
Within age cohorts of people in particular communities, even among those who are over 80 or 90, there are outcome variations. Why some individuals over 90 have no serious consequences from being infected and others do not is still unclear. Is it because they have a lower viral load or because they have a superior immune system or a combination of both? We also know that younger people with no known risk factors have ended up hospitalized or dead, but we do not yet know why.
We also know that individuals with “comorbidities,” that is, chronic diseases that weaken the immune system, are more susceptible to needing hospitalization, having long Covid, or dying. Our health records, however, are not sufficiently complete or integrated to enable us to assess the probabilities of incurring more serious consequences.
There are some isolated studies which indicate that individuals with higher levels of Vitamin D do not have as serious infections as those with lower levels, but few people are regularly tested for Vitamin D.
4. The conclusions we drew about the most prevalent strain of the SARS CoV-2 virus a year ago are not as useful in assessing risks from the Delta variant, today’s most dominant strain. “The science” works best when we are assessing the contagiousness and health consequences of a relatively stable pathogen, not one that evolves enough in a short enough period of time that its behaviors are less predictable.
What does all this mean? The “science” we are asked to “follow” is an uncertain, moving, changing target. We feel most comfortable with scientific guidance that is clear, standardized, and stable.
Our elected officials believe that we look to them for confident, clear direction. For Americans of my generation and many who followed us, the model for political leadership was President Kennedy’s 1961 ambitious and inspiring statement that we would put a man on the moon by the end of the decade. That was a clear and unchanging goal.
We do not even know what “success” would be in this case, because viruses mutate. The vaccines which worked so well early in 2021 now appear to require booster shots. There will undoubtedly be another pathogen that befuddles our researchers and other public health experts. This is not a single campaign that will end at a certain point, but an endless battle that we will need to incorporate in the flow of our lives and work.
Psychology professor Adam Grant, in his recently published book Rethink, discusses the need for all of us to internalize a learning culture. “Following the science" is ultimately about adhering to a discipline in which we learn and adapt continually in addressing major societal challenges. It is not about passive adherence to a fixed set of guidelines by so-called “experts.”
We are most likely to grow and improve our wellbeing in response to this crisis if we learn to “think like scientists,” as opposed to trying to adhere rigidly to guidelines that are likely to have an increasingly short shelf life.