Like it or not, the pandemic’s choose-your-own-adventure period is upon us.
The mask mandate has fallen. Some free trial sites have closed. Whatever parts of the United States were still trying to collectively end the pandemic, they have largely turned their attention away from community advice.
Now, even as case numbers begin to climb again and more infections go unreported, it’s up to individual Americans to decide how much risk they and their neighbors face from the coronavirus. has to be done – and what, if anything, is to be done about it.
For many, the threats posed by COVID have reduced dramatically in the two years since the pandemic. Vaccines reduce the risk of being hospitalized or dying. Powerful new antiviral pills may help protect vulnerable people from getting worse.
But not all Americans can count on equal protection. Millions of people with weakened immune systems do not get the full benefits from vaccines. Two-thirds of Americans, and more than one-third of those 65 and older, have not received the critical protection of a booster shot, with the most worrying rates among black and Hispanic people. And patients who are poor or live far from doctors and pharmacies face huge hurdles in taking antiviral pills.
These vulnerabilities have made computing the risks posed by the virus a difficult exercise. The recent suggestion from federal health officials that most Americans may stop wearing masks because hospitalization numbers were low has led to confusion in some quarters as to whether the odds of getting infected have changed, scientists said.
“We’re doing an awful job of communicating risk,” said Caitlin Jetelina, a public health researcher at the University of Texas Health Science Center in Houston. “I think that’s why people are throwing their hands up in the air and saying, ‘Screw this.’ They are desperate for some kind of guidance.”
To fill that void, scientists are rethinking how to discuss COVID risks. Some researchers are working on tools to compare the risks of infection to the risks of a wider range of activities, for example, finding that the average 43-year-old who was vaccinated last year, almost as much as a bull rider. Infection is likely to result in hospitalization after the ride. Others have studied when people could unmask indoors not only to keep hospitals from being overrun, but to protect immunocompromised people.
But many scientists said they are also concerned about this latest phase of the pandemic, which is placing too much burden on individuals about keeping themselves and others safe, especially when tools to fight COVID are within reach of few Americans. are beyond.
“As much as we might not want to believe it,” said Anne Sosin, who studies health equity at Dartmouth College, “we still need a society-wide approach to the pandemic, especially to protect those who Can’t take full advantage. vaccination.”
While COVID is far from America’s only health threat, it is one of its most significant. In March, even as deaths from the first omicron surge declined, the virus was the third leading cause of death in the United States after only heart disease and cancer.
More Americans are dying than usual, indicating the virus’s wider toll. By the end of February, 7% more Americans were dying based on previous years – a stark contrast with Western European countries such as the UK, where total deaths have been lower than expected recently.
How much the virus is spreading in a population is one of the most important measures for those trying to assess their risk, the scientists said. This is true, even though case numbers are now outpacing true infections by a large margin because so many Americans are testing at home or not getting tested, he said.
Even after many cases have been missed, the Centers for Disease Control and Prevention now places most of the Northeast at “high” levels of viral transmission. In some parts of the region, case numbers, while much lower than during winter, are close to peak rates of the autumn delta variant increase.
Most of the country has what the CDC describes as “moderate” levels of transmission.
Scientists said the amount of virus circulating is important because it decides how likely someone is to encounter the virus and, in turn, roll the dice on a bad outcome.
That’s part of what makes COVID so different from the flu, the scientists said: Coronavirus can infect many more people at once, and with people more likely to catch it, the overall chance of a bad outcome increases.
“We’ve never seen the spread of flu — how much of it is in the community — we’ve seen with COVID,” said Wake Forest University biostatistician Lucy D’Agostino McGowan.
COVID vs Driving
Scientists said that even two years into the pandemic, the coronavirus remains fairly new, and its long-term effects are quite unpredictable, making measuring the threat posed by infection a thorny problem.
Some unknown number of infected people will develop COVID for a long time, leaving them severely debilitated. And the risk of getting COVID spreads to others, potentially in poor health, who may be exposed as a result.
Nevertheless, in populations with far greater immunity than previously thought, some public health researchers have sought to make risk calculations more accessible by comparing the virus to daily threats.
The comparisons are particularly knotty in the United States: the country does not conduct the random swabbing studies needed to estimate infection levels, which makes it difficult to know exactly what portion of those infected are dying.
Jetelina, who has published a set of comparisons in her newspaper, Your Local Epidemiologist, said the practice highlights how difficult it is to calculate risk for everyone, public health researchers included.
For example, it estimated that the average vaccinated and raised person who was at least 65 years old after a COVID infection compared to the risk of dying during a year of military service in Afghanistan in 2011 The risk of dying was slightly higher. He used a standard unit of risk known as a micromort, which represented a one-millionth chance of dying.
But his count, in one way or another, only included reported cases, not unreported and generally minor infections. And looking at the figures for a week in January, it did not account for the gap between cases and deaths. Risk was predictable in each of those variables.
“All these nuances underscore how difficult it is for individuals to calculate risk,” she said. “Epidemiologists are having a challenge with this as well.”
For children under the age of 5, they found that the risk of dying after a COVID infection was almost the same as the risk of mothers dying during childbirth in the United States. This comparison, however, highlights other difficulties in describing risk: the mean number may hide large differences between groups. For example, black women are nearly three times more likely to die during childbirth than white women, a reflection in part of differences in the quality of medical care and racial bias within the health system.
Cameron Byerley, assistant professor in math education at the University of Georgia, created an online tool called COVID-Taser, which allowed people to adjust for age, vaccine status and health background to predict virus risks. His team used earlier estimates of the proportion of infections in the epidemic that led to poor results.
His research has shown that people have trouble interpreting percentages, Byerle said. She recalled her 69-year-old mother-in-law following a news program earlier in the pandemic to worry that people her age had a 10% risk of dying from the infection.
Byerly suggests her mother-in-law imagine that if she uses the toilet once out of every 10 times a day, she will die. “Oh, 10% is terrible,” she recalled saying to her mother-in-law.
For example, Byerley’s estimates show that an average 40-year-old who was vaccinated six months earlier had almost the same chance of being hospitalized after infection as someone who took a car during 170 cross-country road trips. Had to die in an accident. , (More recent vaccine shots seem to offer better protection than older ones, complicating these predictions.)
For people with compromised immunity, the risks are higher. A 61-year-old man with an organ transplant, Byerley estimates, is three times as likely to die after an infection as someone who dies within five years of receiving a diagnosis of stage 1 breast cancer. And that transplant recipient is twice as likely to die of COVID as someone is likely to die while climbing Mount Everest.
Considering the most vulnerable, Dr. M., an emergency physician at Brigham and Women’s Hospital in Boston. Jeremy Faust set out last month to determine how fewer cases would fall to prevent indoor masking of people without endangering those with extremely weakened immunity. system
He imagined an imaginary person who drew no benefit from vaccines, wore a nice mask, barely took prophylactic medication, attended occasional gatherings and shopping but didn’t work out in person. He set his sight on keeping the chances of vulnerable people getting infected at less than 1% over a four-month period.
To achieve that limit, they found, the country would have to keep masking indoors until transmission fell to less than 50 weekly cases per 100,000 people — a stricter limit than the CDC is currently using. but one said it offered a benchmark for the target.
“If you just say, ‘We’ll take off the mask when things get better’ – that’s true, I hope – but it’s not really helpful because people don’t know what ‘better’ means,” said Faust. said.
For those with immune deficiencies, collective efforts to reduce the level of infection have been disappointing.
“There’s all the layered protection we’re talking about throughout the pandemic, each one of them being stripped down,” said Marnie White, a professor of public health at Yale University. She said that families in her local school district were encouraging each other not to report COVID cases. “It is impossible to calculate the risk in these situations,” she said.
White House COVID Response Coordinator Dr. Ashish K. Jha said the administration has helped reduce people’s risks by making it easier to obtain rapid tests and masks, and by partnering with clinics to quickly prescribe antiviral pills. He said there is a need for better communication to distribute preventive medicine to people with weakened immunity.
“We need a system that can provide therapeutics for them very easily,” he said. “It is a huge responsibility of the government.”
Scientists said the current boom and better preparedness for the future could make people’s risks more manageable, even if it doesn’t eliminate them. By ventilating indoor spaces, guaranteeing paid sick leave, delivering booster shots to people’s doorsteps and making it easier to treat, the government can help people make choices with less fear of devastation, he said. .
“We must set up the infrastructure that allows us to respond rapidly when the next wave occurs,” said David Downey, a public health researcher at Johns Hopkins University.
“We must train people that, when those waves hit, there are things we have to do,” he said, such as enforcing a short-term mask mandate. “Then you can live your life in relation to that possibility – but not in fear that it could happen at any moment.”