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It’s Time to Reevaluate How We Talk about COVID Risk

SCIENCE

It’s Time to Reevaluate How We Talk about COVID Risk



I have never had as much suicidal ideation as I’ve had over the last year and a half, during this pandemic.

I have not been in any particular physical danger. Thinking about ending one’s life can be an understandable coping mechanism to survive adverse conditions, such as living alone through a pandemic and going without touch or indoor companionship for months on end. I have a good therapist, and my ideas about suicide never progressed beyond thoughts towards making any plans to actually go through with it.

The “logic” to these thoughts happened in a cycle like this.

After eating 21 meals alone week, week after week, I craved being close to other people.

But if I gave in to such urges, I feared, based on a no-risk mentality, that I might unwittingly set off a COVID infection chain that would kill people.

Feeling like I couldn’t take another 21, 42, 63 or 84 meals alone, I’d think to myself at times, “Well, if you’ve got to kill someone, it might as well be you, Steven.”

“Better just to erase myself from the equation,” I’d think, lest my desires inadvertently kill someone else.

While not lethal, these thoughts caused me great emotional pain and mental anguish. And when I felt my first vaccine shot punctuate my left arm recently, I felt a palpable sense of relief as those excruciating thoughts drifted out of mind and body—hopefully for good.

When COVID first began to shut down the United States, I feared how single people who live alone like me would be expected to just suck it up and deal with a purely solitary life. (I also feared how domestic violence would affect families.) Yet while I often tell other people that risk lies on a spectrum, that it’s not absolute, I had a hard time granting myself any leeway with thinking I could put anyone else at any risk. And so, I have been painfully alone for almost all of the time I’ve spent indoors over the past year.

Now, as increasing numbers of Americans are getting vaccinated, the risk of many activities is mercifully plummeting. If it ever was, I believe it is no longer excusable to attempt an impossible no-risk approach to life in an ongoing pandemic that may well become endemic. As we fight for a more just world, we must also learn to live with a spectrum of risk.

A key to doing this is for those of us who are researchers, journalists or both to better narrate the concept of risk. Let us consider three examples of how news media could do a better job.

On April 25, a New York Times headline irresponsibly screamed that “Millions Are Skipping Their Second Doses of Covid Vaccines.” While technically true, the headline’s framing obscured something more exciting and newsworthy: out of more than 60 million people, it was only a scant “8 percent of those who got initial Pfizer or Moderna shots” who had “missed their second doses.” The real news was that 92 percent of people who’d gotten their first shot had shown up for their second.

The U.S. COVID vaccination follow-through has been an unmitigated, historic success. In previous multidose vaccine campaigns, it has been far lower. In 2018, for example, a study of 350,240 Medicare and 12,599 Medicaid enrollees receiving multidose vaccines for hepatitis A and hepatitis B found completion rates could be as low as 19 percent, and only went as high as 48.9 percent. And a campaign completed between 2017 and 2019 that sought to vaccinate approximately seven million people against shingles—previously cited as one of the most successful multidose campaigns ever undertaken in the U.S.—found that 70 percent and 80 percent “completed the two-dose series within six and 12 months post initial dose, respectively.” That over 92 percent showed up for their second COVID shot, and the rest still got the 80 percent protection of a single jab, is a wildly successful campaign. And yet, the Times narrated it as cause for concern—because if it had to be all or nothing, it fell short. 

Journalists and social media users similarly struggled to properly frame the potential risks of the Johnson & Johnson vaccine when the Food and Drug Administration put it on pause last month. The FDA reported in early April that there had been six cases of blood clots possibly linked to some 6.8 million administered doses of Johnson & Johnson’s one-shot vaccine. That’s less than one per million, and only one was fatal. At the same time, about 562,000 of approximately 331 million Americans had died of COVID—about one out of every 588 people living in the United States. This meant that even if one in a million people were getting blood clots from the Johnson & Johnson vaccine, the risk of not taking it would be much higher than the risk of taking it.

A reader wrote to me on the night of the pause, despondent and asking for advice, having just secured funding and created outreach materials that included J&J information to get vaccines to hard-to-reach populations. If you do some math, if another 6.8 million people who might have gotten J&J went unvaccinated altogether, some 11,564 of them might die of COVID— to stop one one possible death. Yet because narratives often focus on single stories of individuals and the holy grail of zero risk, the idea of six people getting blood clots can register more in our collective consciousness than the broadly mitigating effects of a single-dose vaccine with minimal risk.

Finally, the CDC recently recommended that people who are vaccinated do not need to wear masks outside unless in crowds. This was prudent and sensible. SARS-CoV-2 has long been known to transmit overwhelmingly more easily indoors; a study of 381 outbreaks in China could only trace one to outdoor transmission. For that reason, outdoor mask mandates (in the hopes people will then also use them inside) have always been dubious. As Harvard epidemiologist Julia Marcus once put it, requiring masks outside is “a bit like saying we’re going to ask people to wear condoms when they’re masturbating, because we think it’s going to get them to wear a condom when they’re with another person.”

The risk is even more dubious as the U.S. population becomes vaccinated. Yet the idea that perhaps, maybe, there could be a single transmission outside is driving many to scold the idea of doffing masks outside. (Curiously, the CDC’s guidance advising people who are vaccinated that it was okay to gather indoors with others who are also vaccinated caused much less conflict, even though indoor transmission is far more risky.)

There’s a lot of activism still to be done to get vaccines to the most affected in the U.S. and abroad. But we can’t do that work well from a place of panic or needless pain or suffering. For instance, the high COVID mortality of line cooks has nothing to do with wearing masks outside, and everything to do with getting line cooks vaccines, stronger ventilation and better working conditions overall. Yet unnecessary panic about the former can cloud our judgment about acting on the latter.

As my body builds up COVID protection in the coming weeks, I am looking forward to how a far lower risk of infection or transmission will improve my mental health and make life more pleasurable. I am happy to let go of fears of harming others or myself by engaging in normative life activities. I look forward to hugging, kissing and eating with other people again, and to sharing more unmasked smiles in various settings. And I welcome this boost of happiness as fuel to keep fighting against viral stigma and for vaccine equity.

The trauma of the past 15 months or so will mean that many of us will have to be socialized into unmasking and being intimate with one another again. That socialization can be better aided if news media organizations reassess risk, narrate risk with more nuance and do not frame this next stage of the pandemic in all-or-nothing terms.

This is an opinion and analysis article.





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