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All major indicators of COVID-19 transmission in the United States continued to fall this week. Nationally, cases have been falling for six weeks, hospitalizations have been dropping sharply for five weeks, and deaths have been declining for four weeks. The average number of people in the hospital with COVID-19 this week was just under the average we saw during the high points of the April and July hospitalization surges. States and territories reported 14,463 COVID-19 deaths in the past seven days, the first weekly total under 15,000 we’ve seen so far in 2021.
The decline in cases and deaths appears to have slowed this week. After so many weeks of very rapid improvements in reported cases and deaths, a slowing of those declines was inevitable. But we don’t think that a true plateau is the only or even likeliest explanation for what we’re seeing this week. Instead, we think we’re once again seeing the equivalent of a holiday-reporting effect.
Two confounding events that occurred last week—Presidents’ Day and the beginning of a major winter storm that knocked out power for millions of Americans—resulted in slowdowns in case reporting. As we’ve seen with other holidays and storms, these kinds of disruptions produce a predictable series of reporting artifacts: first an artificial drop, then an artificial rise. We should always look for confounding factors before interpreting the data as suggesting a change in the direction of the pandemic—and in this week’s data, we found them. Artificially low numbers from last week’s disruptions make this week’s case and death declines look smaller by contrast, and make the daily numbers look as though they’re reversing direction, especially as backlogs roll in.
The death-reporting process was also affected by the federal holiday and the storm, producing similar artifacts in the data. Even hospitalization numbers appear to have wobbled in a similar way, probably as a result of both small reductions in reporting and small reductions in the number of people who sought care at hospitals over the three-day weekend and during major regional storms.
We’ve also seen large numbers of deaths from much earlier periods reported this month, including a backlog of more than 1,500 deaths in Indiana reported on February 4, nearly 4,500 old but previously unreported deaths in Ohio reported from February 11 to 13, plus a smaller addition of deaths in Virginia (total size still unknown), which the state notes is due to processing death certificates from the postholiday (January) surge.
This brings us to a crucial point that news summaries frequently get wrong: The deaths that states and territories report on a given day do not represent people who died on that day. Reported deaths lag behind cases by two to three weeks on average, and many reported deaths actually took place substantially earlier. When reported cases rose during previous surges, deaths lagged weeks behind. The same is true now, as cases decline.
Why this matters: We have every reason to believe that far fewer people actually died of COVID-19 this week than in previous weeks, because cases and hospitalizations continue to drop. But we won’t see those smaller death numbers for weeks to come—probably for more than two or three weeks, as previously overwhelmed public-health officials are able to catch up on processing death certificates.
The backlogs in reported deaths have also affected our numbers for nursing homes and other long-term-care facilities: Indiana added 659 historical resident deaths and one staff death to its cumulative total for the week ending February 17, and Ohio added 1,150 historical resident deaths. We can chart a national trajectory of deaths in long-term-care facilities despite these and other recent large additions by working with the data from the 52 jurisdictions that have not included major backlogs or reassignments in recent months.
The resulting visualization is an incomplete representation of deaths in LTC facilities in absolute numbers, but it allows us to understand the national trend: Weekly deaths in long-term-care facilities continue to decline.
If we view deaths in long-term-care facilities in these 52 jurisdictions as a share of COVID-19 deaths in the U.S., we see that the percentage of the country’s COVID-19 deaths that are occurring in these facilities also continues to decline.
When our project ceases data compilation on March 7, the only comparable, public federal data set will be the CDC/Centers for Medicare and Medicaid Services data set on COVID-19—which is only partially comparable, as it includes only nursing homes and not other long-term-care facilities, such as assisted-living and independent-living facilities. These nursing-home data have been reported weekly by facilities to CMS since May 17 through the CDC’s National Healthcare Safety Network. Cases and deaths are reported as cumulative and weekly totals, and some facilities include cumulative data dating back to January 1, 2020. We’ll be writing more about that in next week’s additions to our series of trainings on federal COVID-19 data.
Although COVID-19 has disproportionately harmed Black, Latino, and Indigenous people in many areas of the U.S., it appears that vaccinations are not being proportionately administered to many of these communities. The Vergevisualized vaccine administration in Chicago, New York City, and Washington, D.C., and found substantial mismatches between areas with the highest case or death rates and areas with the highest vaccine administration. A Los Angeles Times investigation likewise found that the areas hardest hit by COVID-19 in and around Los Angeles currently have the lowest vaccination rates. Inequities in vaccine distribution and administration result from many factors, including inaccessible systems, state-level decisions, fixed age cutoffs, and problems with people actively circumventing the processes established.
Federal vaccine data include race and ethnicity for slightly more than half of all reported doses, but aren’t broken down by state and don’t allow for crucial age-race cross-comparison. Data from the 40 states that publicly report race and ethnicity data for vaccinations, compiled by KFF and others, track vaccinations by race and ethnicity, but most states do not include age breakdowns, and some are missing race and ethnicity data for more than 30 percent of vaccinations. Reporting at the metro level and rough analysis within states have given us plentiful warning that vaccine rollouts are currently missing many of the communities at the greatest risk from COVID-19. Without better data about who has been vaccinated across all U.S. jurisdictions, we will not be able to identify and address the full range of inequities in the rollout.
Mandy Brown, Artis Curiskis, Alice Goldfarb, Erin Kissane, Kara Oehler, Jessica Malaty Rivera, and Peter Walker contributed to this report.
If you’re like me, you know that getting rid of your car is one of the best things you can do for the climate, and also that you will never do it. This is a car-oriented country, and a car-oriented time. But in 2019, the private cars and light trucks that ordinary people drive for work and shopping and leisure were responsible for about 15 percent of U.S. fossil-fuel-energy use. Electric vehicles get a lot of press, but less than 1 percent of energy used for transportation came from electricity. Personal transportation is a large contributor to carbon emissions in America; it’s also the hardest to give up.
But trading a gasoline automobile for an electric one (or for a bus or train) isn’t the only way ordinary citizens can contribute to fossil-fuel reduction. Decarbonization has two pillars: First, generate electricity from energy that does not emit carbon—renewable sources such as wind, solar, and geothermal instead of fossil fuels. That requires legislative and regulatory change. Second, use electricity to run as much of your personal life as possible.
That’s where ordinary people like you and me can contribute. At least 7 percent of U.S. fossil-fuel energy is used for something fairly banal: residential space and water heating. Put differently, making relatively smaller, cheaper, and easy changes to home heating in America could reduce fossil-fuel use nearly as much as taking half of all private vehicles off the roads. If you want to do the most immediate good for the planet, replace your aging gas furnace with a new, electric appliance.
You can heat a building in many ways. A boiler heats water and cycles it through radiators that heat rooms. A furnace transfers heat to air, which it then pushes through vents into living spaces.
Most American homes run these devices by burning fossil fuels. Depending on your geographic location and the age of your home and its systems, those fuels might include distillate fuel oil (mostly still used in the Northeast), propane (common in rural areas), or natural gas (common everywhere else). Every one of these releases carbon dioxide into the atmosphere when burned.
But boilers and furnaces aren’t your only options. Instead of heating the air, heat pumps move heat from one place to another by converting a substance called refrigerant between its liquid and gas forms. Your refrigerator is a heat pump. So is an air conditioner. Both of those devices pump heat in reverse: Warm air is absorbed by the refrigerant coils and pumped out. Your fridge and AC unit move heat in only one direction. But a heat pump can do both, meaning that the same appliance can heat in the winter—even in very cold climates—and cool in the summer. (“Heat pump” is a terrible, confusing name for these gadgets.)
Heat pumps have been around for decades, but they didn’t used to be very efficient, especially in extremely cold weather. That’s changing. Now some cold-climate heat pumps can transfer heat effectively in subzero temperatures. An oil- or gas-fueled furnace (or other backup heat sources) might be required on the coldest days, but on all the others, your heat can be electric.
In Maine, the lack of natural-gas infrastructure made it easy for the state to encourage electrification of home heating. Central air is uncommon in the state, and installing a heat pump adds cool air-conditioning for free. Maine’s electricity grid is already very clean, and these new heat-pump devices are much more efficient than window AC units.
Michael Stoddard, the executive director of the Efficiency Maine Trust, the state’s energy-efficiency organization, told me that more than 60,000 heat pumps have been sold to Mainers in the past seven years. Some Mainers have been burned by the high cost of heating oil, a commodity whose price fluctuates. State-sponsored consumer-rebate programs, including one that offers up to $1,500 back on purchases of heat pumps, has also driven recent adoption of the devices. Stoddard worried that participation in the state’s incentive programs might dry up because people wouldn’t want to spend the money during the pandemic. “Instead, participation has doubled,” he said. People were stuck at home, some with extra money to spare, given their stimulus benefits and reduced spending. And parts of Maine can still reach 90 degrees Fahrenheit in the summer.
Does carbon reduction itself motivate Mainers to adopt heat pumps? “I’m confident the answer is that it is evolving,” Stoddard hedged. But even if residents aren’t making green-energy choices with decarbonization in mind, the success of incentive programs such as the Efficiency Maine Trust’s have helped the state advance more aggressive policy proposals. In the weeks prior to our conversation, Stoddard told me, Maine had just completed a new climate action plan, and decarbonizing heating systems was among its top three mitigation recommendations. “Now you have everybody talking about this as if it’s just a thing we have to get going on,” he said.
Elsewhere, switching to a heat pump is a tougher sell. Natural gas pollutes less than distillate, and it doesn’t suffer the commodity-price fluctuations that have helped shift homeowners off heating oil in the Northeast. And more than 60 percent of the U.S. residential market already has air-conditioning, according to Paul Camuti, the chief technology and strategy officer at Trane Technologies, which manufactures HVAC systems. That means the benefit of added air-conditioning from a heat-pump switchover doesn’t apply to many American homeowners.
Even so, electric utilities have strong incentives to move homeowners to electric heat: They can sell them more electricity, for one thing. And they can realize their own decarbonization goals more rapidly. For both of these reasons, the Sacramento Municipal Utility District (SMUD) in central California has adopted some of the country’s most aggressive rebate incentives for heat pumps, as much as $3,000 on heat-pump space heaters and $2,500 on heat-pump water heaters. According to Scott Blunk, SMUD’s strategic business planner of electrification and energy efficiency, the incentives can make the payback almost immediate.
The water-heating program has been the most popular, probably because the incentive provides the most benefit at the lowest cost to homeowners and contractors. Electrifying water and space heating is still unfamiliar to many people, and Blunk speculated that giving them a reason to try the technology might warm them up, as it were, to other gas-to-electric conversions. Heat-pump space heating is entirely viable in central California, where the temperature doesn’t drop below freezing that often. Even without the incentives, replacing an air-conditioning unit and a furnace with one heat pump can save a lot of money in the long run, since the heat pump can do the job of both.
As was the case in Maine, Sacramento is leveraging the success of its electrification programs to shift corporate strategy and state policy. The energy code for 2023 is currently being developed in California, and it is making the rollout of electric devices easier. Adjusting the baselines of reasonable energy need can make room for electrifying more home devices. And making electric-appliance installations easier for builders encourages them to recommend cleaner appliances. In addition to reducing carbon emissions directly, every heat-pump installation has an incremental effect on the viability of policy changes.
You don’t have to get rid of your old appliances right away, either. “To hit our decarbonization goals, we don’t need to take out someone’s perfectly good water heater,” Blunk told me. “We just need to replace it with an electric one when it goes out.” That’s an easier pill to swallow for homeowners, who can think of the incremental cost of electric conversions as a small premium over the money they were going to spend on a replacement device anyway. Rebates and incentives sweeten the deal.
Sacramento power burns no coal, and runs roughly 50 percent carbon-free, thanks in large part to hydroelectric power. Blunk calculates that a new-construction home on the grid might reduce its carbon output from 2.5 to 1.1 tons of carbon a year, and a 1978 home’s could drop from 5.2 to 2.5 tons. Because 80 percent of the region uses natural gas for space and water heating, electrification could substantially reduce fossil-fuel use there.
Unfortunately, many Americans still don’t trust electric and renewable sources for heating. Some blamed Texas’s widespread outages during a severe storm this month on the failure of wind turbines, but that’s not right: The state still relies largely on natural-gas energy for electricity. And even gas-burning furnaces require electricity to work, making those appliances no less unreliable if the power goes out for an extended time, as it did across much of the state. Amid climate change, gas isn’t an answer so much as just another problem. “Electrifying buildings and vehicles while switching to climate-safe clean electricity while adapting our infrastructure to a changing climate will be deeply challenging,” David Pomerantz, the executive director of the Energy and Policy Institute, told me. “But relying on gas in a changing climate would also be deeply challenging.” Electric power is fundamental to everything we do, making widespread reform of the grid and the tools that use it even more urgent.
Instead, we expend energy glorifying electric cars. For this year’s Super Bowl, General Motors spent millions on a star-studded ad celebrating its ambitious electric-vehicle plans. It was surprising, but not out of place. Less surprisingly, no heat-pump ads aired during the big game. Even if trust in the grid can be improved, electric heat faces one big problem: Transitioning off natural gas just isn’t as sexy as solar panels or electric cars. Unless you’re a contractor or an HVAC nerd, you probably don’t think much about your heating and cooling systems. They are hidden in attics and basements and utility closets, tucked away on roofs or in side yards. These machines go almost entirely unconsidered unless they break down. Nobody shows off their new water heater when friends come over the way they might show off a Tesla in the garage.
Unlike solar panels, clean upgrades to home appliances also don’t produce social-signaling benefits—the neighbors can’t gawk at your greener home, and you can’t take pride in passersby noticing it. How do you make a heat pump sexy? “I don’t know,” Blunk admitted. “I think the closest we have is cooking.” He means the blue flame of a stove, the only place in the home where a resident can see and hear and feel natural gas at work. Stove-top cooking is so essential to justifying home gas service, the fossil-fuel industry has poured resources into preserving the appliances’ appeal.
Even SMUD’s executives felt protective of kitchen gas. “You’re never going to get rid of my gas stove,” Blunk recalled them saying. So he bought them portable induction-cooking units (a kind of electric stove that transfers heat directly to cookware) to demonstrate that modern electric cooking heat wasn’t like the old wire coils they might remember from the 1950s.
Natural-gas cooking is responsible for only 2 percent of residential natural-gas use—far less than space and water heating. Still, converting from a gas cooktop to an electric-induction one can have a substantial, if different, impact. For one part, there are health benefits: Igniting open-gas fires in your home produces pollution that can exacerbate asthma. But from a sustainability perspective, the kitchen is the place where people develop an emotional relationship to natural gas. The blue flame lapping over the sturdy cast-iron grates imparts a sense of power and control to cooking, just as the rumble of a carburetor on a muscle car does to driving.
That makes the induction cooktop the Tesla of the natural-gas-decarbonization movement. It’s the device you can brag about while also showing your friends and family that electricity is just as good as gas for cooking, if not better. “When I first got my induction,” Blunk told me, “I had a party and invited all my friends over.”
Brian Keane has built a whole organization around that idea. SmartPower, a nonprofit renewable-energy outreach and marketing company, helps municipalities and utilities get their citizens and customers interested in clean energy. “Americans listen to what friends and co-workers are doing. That’s the pressure point,” Keane told me. And when it comes to energy, once you’ve taken action, whether that be installing a smart thermostat or replacing a combustion furnace, the best thing to do is tell a friend or colleague that you’ve done it. This is particularly important for renewable energy in the home, Keane said, because no brand name is associated with it. Nobody knows what furnace or water heater they have. “There’s no Coca Cola, no Pepsi.”
SmartPower has run a series of marketing campaigns for solar adoption around the country, many of which amount to better-funded and more-formal versions of Blunk’s induction-stove house party. Sometimes they hold block parties when the panels go up on the first roof in a neighborhood, or host house parties with a utility-bill reveal (really!). People used to want to wait for a technology to be widespread, but Keane thinks that lifestyle-technology turnover has entered the home. “Apple is always coming out with a new iPhone,” he tells homeowners; a water heater is no different. “You could keep waiting, or just buy this one. It’ll work for 20 years.” Averaging across campaigns, SmartPower’s solar programs were found to increase the rate of solar adoptions in a municipality by nearly 1,000 percent.
Camuti, the Trane HVAC-equipment executive, agrees that the change in perception about heating and cooling in the past decade has been dramatic. “I relate this directly to the availability of online information,” he told me. People still ask dealers, tradespeople, or contractors what they should buy, which makes upstream incentives from states and utilities to those agents extremely important. “But people go online and ask if there is a better choice,” Camuti said. “We are starting to have a relationship with them.”
There are some lessons for homeowners. First, there is benefit in advocating for home upgrades on your block, at your workplace, and in your family. Some people are interested in clean energy for its own sake, but many more are motivated by doing something beneficial for their communities. And emissions reductions positively impact a local environment before the global one. Second, lower-impact but more-visible upgrades, such as induction cooktops or solar water heaters, might become the gateway to abandoning natural gas. Nobody thought they wanted or needed an internet-connected thermostat before Nest came on the scene, after all. But it was stylish and functional, and many smart-home rollouts began from that unlikely start.
If you’re building a new home, it’s easier to skip natural gas entirely. Not running a gas line will save thousands of dollars, and it will prevent you from ever installing gas-burning appliances. But for existing homes, you should abandon the idea that a solar roof or an electric car is the only path forward. Replace your gas cooktop and show it off to friends, or on Instagram. Blog or podcast or post on Facebook about it, so that human experiences will come up in search results when people go hunting for their own products. If your gas furnace or air conditioner or water heater is near the end of its lifespan, replace it with a heat pump. And if not, plan to do so when it conks out. If you live in a large population center, do these things sooner, because your action will send faster signals to utilities and governments that the tide is turning. If you want to do your part to reduce carbon emissions, do what you can to wean yourself off the gas you use in your home, not just the kind you put in your car.
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.
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.
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.
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!”
The past year of COVID-19 has been so terrible that many people struggle to imagine any return to normalcy. More than 500,000 Americans have died. The continued shutdown of schools has led to rising rates of depression and anxiety, unhealthy weight gain, and self-harm among students. Now, because of the rapid development and distribution of highly effective vaccines against COVID-19, a long period of devastation for American families—including the children who have been out of classrooms for so long—is coming to an end. Despite the amazing solution of vaccines, however, many educators, government officials, and media commentators cannot seem to permit themselves any optimism yet about when school closures and other emergency restrictions might be eased.
Officials across the United States had to err on the side of caution last March and shut almost everything down, including schools. Too much about the novel coronavirus was unknown. Scientists quickly came to conclusions about which mitigation procedures worked to minimize risk. When measures including masks, physical distancing, and better ventilation were put into practice, people performing essential jobs did not get sick. But many schools remained closed. Vaccines were then rapidly developed, and are starting to be distributed more nimbly in the U.S. At this point, the end of the pandemic is not just a glimmer in our eye, but a reality coming closer and closer for countries with a brisk vaccine rollout. But the public narrative in the United States seems to still be swirling around three depressing themes: (1) alarm about more infectious variants of the coronavirus; (2) uncertainty about whether vaccines will stop asymptomatic as well as symptomatic infection; and (3) disagreement about whether schools can safely reopen when not everyone is vaccinated. Regrettably, unwarranted pessimism about the first two issues will complicate the third—despite an emerging consensus among health experts that opening schools is paramount for student learning and mental health.
Millions of people in the U.S. have already received one of the two mRNA vaccines that have proved highly effective against the coronavirus. A one-dose adenovirus-DNA vaccine from Johnson & Johnson is on the verge of authorization. Phase 3 clinical-trial data for five other vaccines deploying different technologies show promising results. Since the peak of the third surge this winter, the number of new cases and hospitalizations has been falling dramatically across the United States. The sharpness of the decline suggeststhat partial immunity, likely from both natural infection and vaccinations, has started to kick in. In countries with a more rapid mass- vaccination rollout than the U.S., specifically Israel and the United Kingdom, the decline in hospitalizations and cases from vaccines has been even more precipitous.
In response to that good news, skeptics point to several major variants of the virus now circulating in the world: B.1.1.7 (the “U.K. variant”), B.1.351 (the “South Africa variant”), P.1 and P.2 (the “Brazil variants”), B.1.427/B.1.429 (the “California variant”), and B.1.526 (the “New York City variant”). These variants are suspected of being more easily spread from person to person, and conflicting data leave open the possibility that some may be more dangerous to each infected individual.
All of the approved vaccines and major vaccine candidates provide nearly 100 percent protection from severe COVID-19 disease that requires hospitalization or medical treatment, even when tested in countries where variants are circulating. For instance, the Johnson & Johnson single-dose vaccine prevented 100 percent of hospitalizations and deaths across the three sites in which it was tested (the United States, Latin America, and South Africa), despite 95 percent of the viral strains in South Africa at the time being the B.1.351 variant and 69 percent of the strains in Brazil being of the P.2-variant lineage. Protection from mild disease from the variants with the current vaccines is more variable.
Vaccines can work in multiple ways, most familiarly by inducing antibodies that usually provide more short-term protection or protection from mild illness. The COVID-19 vaccines also generate strong T-cell immunity, which not only is more enduring, but works against numerous parts of the virus (including different parts of the spike protein produced by the vaccine), making them more resistant to variants. The astounding protection that the vaccines provide against becoming ill from the coronavirus is likely due to generating a complex T-cell response that makes the disease less severe. In fact, re infection with variants leading to a symptomatic infection is rare following the development of T-cell immunity to an initial infection. Moreover, vaccines have been shown to generate T-cell immune responses directed against multiple regions of the virus—responses that remain potent across variants. Once vaccinated, an individual should be protected against severe disease from any variant.
Despite considerable data to that effect, frequent predictions of deadly fourth waves of infection because of the variants are generating anxiety among the public, including teachers. Constant speculation that the variants will infect even people who have antibodies to the coronavirus—despite immunity being more than just a matter of antibody production—is distorting the discussion about schools.
Another problem is the frequent confusion of the idea We don’t know from the clinical trials whether COVID-19 vaccines prevent asymptomatic infection with the idea COVID-19 vaccines don’t stop transmission. Beyond the sheer biological plausibility that a vaccine-mediated immune response would block viral replication in your nose—through which you are most likely to spread the virus—as effectively as it blocks replication elsewhere in the body, researchers now have powerful data from the real-world vaccine rollout indicating that vaccination will reduce spread (from asymptomatic infection), as well as symptomatic disease. A recent article in The Lancet showed that health-care workers in the United Kingdom who were swabbed every two weeks after vaccination demonstrated an 86 percent reduction in asymptomatic infection compared with unvaccinated individuals. Other data, from health-care workers based in Israel and across the Mayo Clinic system, show a similar result: a massive reduction in both symptomatic disease and asymptomatic infection after vaccination. A study from Israel across a more general population during an early vaccine rollout confirms that 89.4 percent of infections are prevented with vaccination (including asymptomatic). In clinical trials, the Johnson & Johnson vaccine was 74.2 percent effective in preventing asymptomatic infection. Furthermore, nasal viral loads from post-vaccination exposures are low and likely noninfectious because of the body’s immune defenses rushing in to halt viral replication. With every passing week, vaccines will prevent more disease transmission, and our messaging can change accordingly. However, the number of stories lamenting whether vaccinated grandparents can hug their unvaccinated grandchildren speaks to our failure to absorb this data and move forward with optimism.
Finally, the debate over school openings—which shouldn’t be a debate at all—does not incorporate what scientists have learned about the pandemic. Despite a wealth of data from the CDC and other countries suggesting that opening schools is safe for teachers and students with mitigation procedures applied, many districts across the country, especially on the West Coast, have failed to reopen. Oregon and California have no clear path in sight for schools to return to in-person learning. The latter has maintained more stringent and prolonged lockdowns during COVID-19 than any other state in the U.S. and, like many other places, has expressed panic regarding variants. Furthermore, most states have not told their residents that life could pivot towardnormalcy for the vaccinated. Oregon teachers recently indicated that they would not return to in-person instruction even after vaccination. Continued fear-based messaging and policies in certain states are likely creating needless anxiety for students, parents, and teachers.
Some parents and teachers felt strongly about keeping schools closed because everyone’s personal level of risk acceptance is different. However, as millions of Americans receive vaccines and community spread slows, we will be able to open schools while mass vaccination is under way. Overcaution and overcautious messaging kept our schools closed earlier in the pandemic, but experts and public officials need not emphasize caution when touting the incredible efficacy of the new vaccines and their ability to return life to normal. Telling people that their lives won’t change after vaccination is tantamount to telling schools to remain closed.
At this point in the pandemic, Americans know how to keep businesses and schools safe for reopening, and we have highly effective vaccines that protect against severe disease, even from variants of the virus. Children and their families have suffered enormous collateral damage from the failure to open schools. Data point after data point shows that countries with a rapid vaccine rollout are seeing the expected, but still thrilling, decline in cases and hospitalizations. Fear was warranted at the outset by the severity of infection that can occur with COVID-19, and fear dies slowly. But public-health messengers and Americans as a whole must allow remarkable scientific progress to help assuage the misery of the pandemic. At this point, the power of these vaccines is undimmed by variants, and Americans, their public officials, and especially their schools must allow this optimism to now dominate.
On this episode of the podcast Social Distance, listeners with mild COVID-19 cases call in with their questions. James Hamblin explains why he thinks the summer could be wonderful. And Maeve Higgins shares nun news from Ireland.
Listen to their conversation here:
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What follows is a transcript of the episode, edited and condensed for clarity:
Maeve Higgins: I’ve been dying to tell you about the latest Irish news. Ireland is under pretty severe lockdown at the moment. You’re not allowed to move from county to county. But some nuns put this video online of them performing an exorcism in Dublin, and they’re not from Dublin.
James Hamblin: Oh, and you’re not allowed to … do exorcisms outside of your locality?
Higgins: I mean, you’re allowed to, but you’re just not allowed to break COVID guidelines to go and do an exorcism.
Hamblin: What happened to them? Are they in trouble?
Higgins: Nothing’s happened to them. The government was already keeping an eye on them. It’s just these two nuns. They’re in a group called the Carmelite Sisters of the Holy Face of Jesus. And they got in trouble just before the Christmas holidays too, because they were selling potions online, so the nuns were, like, known to the authorities and then they broke the COVID rules and came and did an exorcism.
Hamblin: Speaking of religion and COVID, when we talk about people forgoing vaccines, religious exemptions have been a huge thing here in the United States for kids going to school unvaccinated. I’m foreseeing some pretty big debates in the coming months and maybe years about requirements for vaccination and religious beliefs. There’s going to be a lot to unpack there.
Higgins: There is. And Jim, I read your piece about how a COVID-vaccinated summer could be wonderful. And I want to ask you about population-level immunity. You wrote that “no other country has endured so much death and illness. But for all the failures that led to this point, the U.S. does finally seem to be experiencing some protective effects of population-level immunity.” Could you tell me more about that?
Hamblin: The numbers in the U.S. look really promising. Cases are going down really quickly and deaths are plummeting because, among those cases, the high-risk people are being vaccinated or have been vaccinated. Add to that the effects of places that have already been hit really hard, where the virus seemed to be kind of burning out, at least temporarily, on its own.
And you’ve got warm weather on the horizon where people could be outside. It’s a coalescing moment, and I don’t know that it’ll last, but things are looking really promising for the summer. And I’ve been trying to deal with how you genuinely let yourself be pulled forward by the hope and joy in being able to do things that we couldn’t do for a long time, while not getting complacent and declaring things “over” or repeating the same mistakes we’ve been making for the last year.
Higgins: So many people are still catching and experiencing COVID. And we get so many brilliant messages from listeners, so I thought it could be really fun to hear from them today.
Hamblin: Yeah, that would be great. Honestly, the voicemails we get are my favorite part of this whole podcast.
Higgins: The first caller is a 68-year-old in central Pennsylvania. His name is Patrick. And he recently got a mild COVID case and wanted to talk about his immunity—and if and when he needs to schedule a vaccination appointment.
Hamblin: Hello, Patrick. How are you feeling?
Patrick: Not too bad, actually. I had a fairly mild run of this, and the only symptom left over is sort of a foggy-headed lightness. I can give you a pretty concise timeline [of my illness]. In the vaccine rollout here in this area, my wife was entitled to a first shot. She got her first Moderna shot on January 23 and showed her first symptoms of COVID on the 29th. On the 31st, she tested positive and went through a 10-day period where she had mild symptoms. I tested twice negative during that period. On the 13th of February, I started showing symptoms and tested positive on the 14th.
Higgins: You tested positive on Valentine’s Day?
Patrick: I did.
Higgins: And you got it from your wife?
Patrick: (Laughs.) I did.
Higgins: Patrick, I’m sorry. What a gift.
Hamblin: Well, I’m glad you’re both doing okay now. I hope things continue to improve for you. And so you’re specifically wondering about vaccination now, after having gone through this?
Patrick: Yes. For both of us. My wife’s already had her first shot. She’s due for her second. Should she get it? And I actually have an appointment scheduled for March 3 that I haven’t canceled yet. And I’ve heard several things from primary-care doctors. And I’m just curious to see what your take is.
Hamblin: Well, I never want to contradict anyone’s own doctor, because everyone has unique considerations. What’s the gist of what you’re hearing?
Patrick: [That I should wait] three months. And the reason given to me is: “because you would have the immunity, and that is the current guideline.” So at least part of that answer has to do with current distribution protocol, I suppose.
Hamblin: So with a lot of diseases, you don’t want to get vaccinated right after you’ve had it, because there can be an increased rate of side effects. If you already have high levels of this acute immune reaction going on, and then you get vaccinated, your body could react more strongly than it would otherwise. We don’t know a lot yet about how that would work with this vaccine, because it’s so new, and I think it’s very reasonable to wait that amount of time.
I doubt that it would be a high-risk thing to go ahead and get it. But I also would expect that you have enough protection, having just been sick, that it would be almost impossible for you to get a serious bout of COVID in that time. You are protected, essentially, at least from severe disease. So I don’t think you can go wrong by waiting that period. I certainly wouldn’t wait a year. I wouldn’t expect the immunity that you’re going to have after this infection lasts extremely long or is going to be 100 percent. We’re not seeing people have reinfection cases really shortly after being sick, so I think that should be reassuring.
Patrick: What about my wife’s case of getting a second shot?
Hamblin: People seem to be pretty well protected after the first dose. The second dose is yet another exposure to this spike protein, which you just naturally got. They’re not exactly comparable, but I expect the effect is similar. It’s like your immune system is doing push ups: Is it better if you do 10 or 20? Sure, do 20 if that makes you stronger, but 10 also is nice. I wish I could be more definitive here. And if there were a serious risk in either direction, I would definitely tell you. But I don’t see one.
Patrick: Thank you both for doing this. I’ve followed this podcast since the beginning, and it’s been quite helpful.
Hamblin: That’s great to hear. It’s been a pleasure to do. And it’s great to hear from you.
Higgins: Okay, Jim, now we’re going to hear from Camie in Idaho.
Hamblin: Hi, Camie. How are you feeling?
Camie: As well as can be expected, I guess, under the circumstances. I definitely don’t have it as bad as many people have had it. So we feel very blessed.
My husband was in quarantine for 10 days. I’m actually in quarantine for 21 days because of underlying health conditions. My doctor just wants to be on the very safe side, which I appreciate. And that started me thinking that, when we’re done with this, what does that mean? Should we be just disinfecting when we recover, just like with any cold or flu? How much of this is sticking to surfaces, and what exactly do we have to clean? It made me think also about when the cruise ships came back and they were finding active, live coronavirus weeks and weeks after.
Hamblin: Are there other people in your household?
Camie: No, it’s just my husband and I, but we have a new grandbaby. We want to go see her, and I don’t want to inadvertently infect her when we go see her eventually.
Hamblin: Absolutely. This has been a point of a lot of confusion over the course of the pandemic. I and most other people making recommendations this time last year were much more about surfaces, about hand hygiene, about sterilizing high-touch surfaces. And then, over the course of the year, it’s really turned out that the virus doesn’t linger very long on surfaces. And when it does, it doesn’t seem to happen in infectious doses. You’re just very unlikely to get enough of a viable virus onto your hand after you touch something and then touch your face and infect yourself.
There are other infections that certainly work that way. But just because you are able to detect some RNA of that virus on, say, a cruise-ship doorknob or something, that doesn’t mean that someone who touched that would get sick. It’s kind of a fine distinction, but we had to play it safe at the time. So we sort of overestimated that and didn’t pay enough attention to air. It seems like surface transmission can happen from touching something, but it would have to be within a very short period. Say, someone came into your office right after you’ve been working at a desk for eight hours and then for some reason had to put their face onto your desk.
Briefly touching a handrail as you went down a staircase and then someone coming by an hour later and using that same handrail—that seems like as close to a zero percent possibility as possible. And so the time period in which the virus is persisting on surfaces at all is short enough that once you and your husband are clear of needing to quarantine, the surfaces in your house should not be expected to contain any lingering virus.
Camie: Should we stay away from the grandbaby, even after my 21 days of quarantining?
Hamblin: If you’re going to see people, stay outdoors, wear a mask, don’t have prolonged close contact unless this person is in your tight bubble and you’re all being really vigilant. But no, there’s no reason to expect that you’re at any increased risk of infecting other people in that period.
Higgins: Camie, thanks so much. And I hope you just feel 100 percent really soon.
Camie: Thank you so much. I so appreciate your help. Wonderful to talk with you.
I’m alone now much more than I used to be. I cook alone, work alone, and occasionally walk alone. The pandemic has limited my social life and forced me into a period of isolation, just as it has for so many others. Sometimes this solitude feels like a restorative pause; other times it just feels lonely.
Literature can capture the breadth of these experiences. Some writers explore the nature of solitude by focusing on those living extremely isolated lives. The journalist Michael Finkel profiled a hermit who lived entirely alone for 27 years (excluding one encounter with a passerby) in The Stranger in the Woods. In the fictional The Gradual Disappearance of Jane Ashland, the novelist Nicolai Houm also follows a solitary character—this time a creative-writing professor who ends up isolated in the Norwegian wilderness. In other books, writers explore more uncommon experiences with aloneness. Ruminative works that combine elements of fiction and memoir by writers such as Karl Ove Knausgaard and Chris Kraus feature narrators who emphasize their distance from other people. The novelist Amy Tan says that she writes strong characters by focusing on their uniqueness—all the factors that make them different from others.
Kristen Radtke’s upcoming book Seek You: Essays on American Loneliness covers a broad range of these lonely experiences. In 2018, the author asked people about the loneliest they’d ever felt. The answers, some of which are excerpted in The Atlantic, are quietly sad, showing the emptiness of moments without companionship.
Every Friday in the Books Briefing, we thread together Atlantic stories on books that share similar ideas. This week’s newsletter is written by Kate Cray. The book she’s reading next is How Beautiful We Were, by Imbolo Mbue.
Know other book lovers who might like this guide? Forward them this email.
The current chapter—in which some Americans are fully vaccinated, but not enough to protect the wider population against the coronavirus’s spread—is new territory. The rules of pandemic life are changing once again.
Here are a few things to remember as America takes its next, awkward steps toward normal.
Don’t forget about the global picture.As one expert told James Hamblin, many low-income countries may end up far behind in vaccine distribution. That’s dangerous for the world: “Providing the virus with new places to spread will allow it to linger with us indefinitely. The longer it sticks around, the more time it has to mutate—which is bad news for the entire world, Americans included,” James notes.
One question, answered: Why is Europe doing so much worse than the United States when it comes to vaccine rollout?
Our staff writer Olga Khazan writes:
Despite lost doses and frustrating vaccine websites, the U.S. is vaccinating its residents faster than any member of the European Union—which may be surprising, given that so many European health-care systems are touted as being more efficient than America’s. …
This story is more about the foibles of the European Union than the triumph of the United States. The EU worried that if it left each of its member countries to acquire vaccines for itself, smaller and poorer nations wouldn’t be able to buy enough. European leaders bet that, by negotiating for vaccines as a bloc, they could match America’s purchasing power.
Listen to the latest episode of The Experiment, our new podcast with WNYC Studios: Filipino nurses have taken some of the hardest jobs in U.S. health care—and they’re dying of COVID-19 at alarming rates. Why?
There’s no place like home—unless you’re Elon Musk. A prototype of SpaceX’s Starship, which may someday send humans to Mars, is, according to Musk, likely to launch soon, possibly within the coming days. But what motivates Musk? Why bother with Mars? A video clip from an interview Musk gave in 2019 seems to sum up Musk’s vision—and everything that’s wrong with it.
In the video, Musk is seen reading a passage from Carl Sagan’s book Pale Blue Dot. The book, published in 1994, was Sagan’s response to the famous image of Earth as a tiny speck of light floating in a sunbeam—a shot he’d begged NASA to have the Voyager 1 spacecraft take in 1990 as it sailed into space, 3.7 billion miles from Earth. Sagan believed that if we had a photo of ourselves from this distance, it would forever alter our perspective of our place in the cosmos.
Musk reads from Sagan’s book: “Our planet is a lonely speck in the great enveloping cosmic dark. In our obscurity, in all this vastness, there is no hint that help will come from elsewhere to save us from ourselves. The Earth is the only world known so far to harbor life. There is nowhere else, at least in the near future, to which our species could migrate.”
But there Musk cuts himself off and begins to laugh. He says with incredulity, “This is not true. This is false––Mars.”
He couldn’t be more wrong. Mars? Mars is a hellhole. The central thing about Mars is that it is not Earth, not even close. In fact, the only things our planet and Mars really have in common is that both are rocky planets with some water ice and both have robots (and Mars doesn’t even have that many).
Mars has a very thin atmosphere; it has no magnetic field to help protect its surface from radiation from the sun or galactic cosmic rays; it has no breathable air and the average surface temperature is a deadly 80 degrees below zero. Musk thinks that Mars is like Earth? For humans to live there in any capacity they would need to build tunnels and live underground, and what is not enticing about living in a tunnel lined with SAD lamps and trying to grow lettuce with UV lights? So long to deep breaths outside and walks without the security of a bulky spacesuit, knowing that if you’re out on an extravehicular activity and something happens, you’ve got an excruciatingly painful 60-second death waiting for you. Granted, walking around on Mars would be a life-changing, amazing, profound experience. But visiting as a proof of technology or to expand the frontier of human possibility is very different from living there. It is not in the realm of hospitable to humans. Mars will kill you.
Musk is not from Mars, but he and Sagan do seem to come from different worlds. Like Sagan, Musk exhibits a religious-like devotion to space, a fervent desire to go there, but their purposes are entirely divergent. Sagan inspired generations of writers, scientists, and engineers who felt compelled to chase the awe that he dug up from the depths of their heart. Everyone who references Sagan as a reason they are in their field connects to the wonder of being human, and marvels at the luck of having grown up and evolved on such a beautiful, rare planet.
The influence Musk is having on a generation of people could not be more different. Musk has used the medium of dreaming and exploration to wrap up a package of entitlement, greed, and ego. He has no longing for scientific discovery, no desire to understand what makes Earth so different from Mars, how we all fit together and relate. Musk is no explorer; he is a flag planter. He seems to have missed one of the other lines from Pale Blue Dot: “There is perhaps no better demonstration of the folly of human conceits than this distant image of our tiny world.”
Sagan did believe in sending humans to Mars to first explore and eventually live there, to ensure humanity’s very long-term survival, but he also said this: “What shall we do with Mars? There are so many examples of human misuse of the Earth that even phrasing the question chills me. If there is life on Mars, I believe we should do nothing with Mars. Mars then belongs to the Martians, even if [they] are only microbes.”
Musk, by contrast, is encouraging a feeling of entitlement to the cosmos—that we can and must colonize space, regardless of who or what might be there, all for a long-shot chance at security.
Legitimate reasons exist to feel concerned for long-term human survival, and, yes, having the ability to travel more efficiently throughout the solar system would be good. But I question anyone among the richest people in the world who sells a story of caring so much for human survival that he must send rockets into space. Someone in his position could do so many things on our little blue dot itself to help those in need.
To laugh at Sagan’s words is to miss the point entirely: There really is only one true home for us—and we’re already here.
A century ago, Russia was enduring a terrible famine, the Irish Free State was created, U.S. President Warren Harding was inaugurated, the Tulsa Race Massacre took place in Oklahoma, a new machine called a “dishwasher” was introduced, New York’s Madison Square Garden was home to “the world’s largest indoor swimming pool,” and much more. Please take a moment to look back at some of the events and sights from around the world 100 years ago.
Editor’s Note:The Atlantic is making vital coverage of the coronavirus available to all readers. Find the collection here.
The past 11 months have been a crash course in a million concepts that you probably wish you knew a whole lot less about. Particle filtration. Ventilation. Epidemiological variables. And, perhaps above all else, interdependence. In forming quarantine bubbles, in donning protective gear just to buy groceries, in boiling our days down to only our most essential interactions, people around the world have been shown exactly how linked their lives and health are. Now, as COVID-19 vaccines rewrite the rules of pandemic life once more, we are due for a new lesson in how each person’s well-being is inextricably tangled with others’.
This odd (and hopefully brief) chapter in which some Americans are fully vaccinated, but not enough of us to shield the wider population against the coronavirus’s spread, brings with it a whole new set of practical and ethical questions. If I’m vaccinated, can I travel freely? Can two vaccinated people from different households eat lunch together? If your parents are vaccinated but you’re not, can you see them inside? What if only one of them got both shots? What if one of them is a nurse on a COVID-19 ward?
After asking four experts what the vaccinated can do in as many ways as I could come up with, I’m sorry to report that there are no one-size-fits-all guides to what new freedoms the newly vaccinated should enjoy. Still, there is one principle—if not a black-and-white rule—that can help both the vaccinated and the unvaccinated navigate our once again unfamiliar world: When deciding what you can and can’t do, you should think less about your own vaccination status, and more about whether your neighbors, family, grocery clerks, delivery drivers, and friends are still vulnerable to the virus.
The COVID-19 vaccines are fantastic. The shots that are currently available are tremendously effective at protecting the people who get them from severe illness, hospitalization, and death—all the things we want to avoid if we have any hope of fully reopening society. Even so, advice on what people can do once vaccinated gets complicated. Those who are vaccinated can still be infected by, and test positive for, SARS-CoV-2; they’re just way, way less likely to get sick as a result. The sticky element is whether not-sick-but-still-infected vaccinated people can spread the virus to others and get them sick. So far, the early data have been promising, showing that the vaccines stop at least some transmission, but the matter is not scientifically settled.
This leaves us in an awkward situation. Getting vaccinated means that your choices no longer endanger you much, but they still might make you a risk to everyone else. To put this in more concrete terms: If a vaccinated person goes out to eat, they can’t yet be sure that they’re not carrying the virus and spreading it to their unvaccinated fellow diners and the restaurant staff, or that they won’t pick up the virus at the restaurant and bring it home to their unvaccinated family.
So, first, a very broad guideline for navigating a world in which vaccinations are rising and infections are dropping: Whether you’re vaccinated or not, how much you can safely branch out in your activities and social life depends on the baseline level of virus in your community. You can imagine that, in pandemic life, each of us has been dealt a certain number of risk points that we can spend on seeing friends outside, going to work, sending the kids to day care, and so on. If you or someone you live with is especially vulnerable to the virus, you might choose to spend fewer points by getting groceries delivered; if you live alone in an area where very few people are sick, you might choose to spend more points by forming a bubble with friends. The vaccine delivers you a huge number of bonus points, if you’re lucky enough to get one. And when spread of the virus is low, everyone gets more points.
Saskia Popescu, an infectious-disease epidemiologist at George Mason University, told me that everyone, vaccinated or not, should try to keep track of three metrics in your area: The number of new daily cases per 100,000 people, the rate at which people transmit the virus to one another, and the rate at which people test positive for the virus. Popescu said that there are no magic numbers that would immediately bring the country back to pre-COVID life, but she’ll feel better about reopening when we hit daily case rates of just one to two per 100,000, transmission rates of .5 or less, and test-positivity rates at or below 2 percent. (As of last week, noU.S.state had reached the trifecta, and the country as a whole is still far from it.) Many local public-health departments regularly provide these numbers.
You might be tempted to factor vaccination rates into your safety equation too, but Whitney Robinson, an epidemiologist at the University of North Carolina, told me that those numbers shouldn’t be anyone’s main safety indicator. That’s because vaccine distribution so far has been concentrated in particular social networks (for instance, health-care workers) and demographic groups (notably the white and wealthy), so an entire community won’t necessarily reap the benefits that a local vaccination rate of 15, or even 50, percent might imply.
Knowing the overall risk of infection in your area is at least a first step toward making better decisions about whether you should host that birthday party or take Grandpa out to lunch. Even for people who are vaccinated, all of the public-health experts I spoke with emphasized, it’s still important to not throw caution to the wind. If vaccinated people flock to indoor restaurants or go unmasked in a crowd, they’re not just risking infecting others if they can indeed spread the virus, Popescu said. They’re contributing to a sense that life as we knew it before March 2020 is back, despite the fact that more than 65,000 people are still contracting the virus each day. Simply returning to our old habits would be deadly.
That doesn’t mean that any loosening up is off the table for the vaccinated. Far from it—plenty of public-health experts have argued that vaccinated people safely seeing relatives or returning to the office can benefit everyone, because seeing how much the shot improves life will persuade more people to take it. Downplaying the vaccines’ success could discourage people from getting them, because if it won’t change their lives, they have no incentive.
The best way forward for us all is for vaccinated people to spend their extra risk points in ways that don’t put unvaccinated people in danger. As you consider whether you should do things that you wouldn’t have done before the vaccine, think creatively about how you can make those things safer for everyone involved. “Grandparents really want to be able to go hug their grandchildren,” Tara Kirk Sell, a senior scholar at the Johns Hopkins Center for Health Security, told me. “I don’t have a problem with that.” But consider asking Grandma and Grandpa to wear masks during that hug, or meet you outside, or avoid sleeping over. Throughout the pandemic, we’ve developed an arsenal of strategies to make particular settings and activities safer. The vaccine is an extra-strong weapon against transmission that some people can deploy, but that doesn’t mean they need to discard all of the other ones to use it.
How many of those methods you choose should depend on how many vulnerable people you regularly come into contact with. A vaccinated oncologist who lives with her immunocompromised sister is going to behave differently from a vaccinated retiree who lives alone. That said, there are plenty of settings, such as restaurants and stores, where you don’t know or can’t control how many vulnerable people are around you. For that reason, small private gatherings where you can adjust your anti-spread tactics to accommodate everyone’s risk factors are a safer first step toward normalcy than activities such as concerts, indoor dining, or big weddings. Travel in small groups might be a nearer goal, too: Popescu said she hopes that by the end of the year, she can take a vacation in another state with her husband without worrying that she’s “being a bad steward of public health.”
Playing it safe, even as you loosen up a little, is the best way to ensure that someday, you will again live in a world with bars and birthday parties and movie theaters. It’s also the best way to keep yourself from getting sick with COVID-19 in the future—regardless of whether you’re already vaccinated. No one knowsexactly how long you’ll be protected against serious illness if you get a vaccine (or were previously infected), simply because no one has been vaccinated for more than seven months yet. Given what we do know so far, the most likely way for a vaccinated person to get seriously ill from the coronavirus would be if they encounter a variant that the vaccine they received doesn’t effectively protect against. Such variants are much more likely to emerge if the virus is allowed to rage in particular places or groups before the overwhelming majority of the world’s people can be vaccinated.
As Gregg Gonsalves, an epidemiologist at the Yale School of Public Health, put it, “In the context of epidemiology, we’re all in the same boat.”