As I wrote in Tuesday’s post, “‘Back to Normal’ isn’t a thing,” there’s a bit of a raging debate in the discourse about what “we” should say people ought to feel free to do after they get a COVID-19 vaccine.
David Leonhardt kicked this into high gear on February 19 with a column arguing that public health messaging about the vaccines has been bad, particularly in terms of not going far enough to tell people they can ease up and party if they get vaccinated.
Due to weird New York Times policies, his colleague Apoorva Mandavilli — who’s one of the paper’s COVID-19 reporters — isn’t allowed to argue with him directly. So instead we got this kind of weird subtweet.
My view of this is that American society is currently suffering from a bit of ambiguity as to who “we” are in terms of delivering messages, and what it means to say something like you “need” to wear a mask.
Because the pandemic is a weird, scary event, a lot of people who are not normally inclined to pay close attention to what the Centers for Disease Control say about things are suddenly tuning in to CDC guidelines — complete with media people echoing those guidelines and some sense that elected officials and non-health government agencies ought to be following what the CDC says. The reality, though, is that while the CDC’s scientists are great if you want to understand CDC guidance about COVID-19 vaccines, you need to contextualize it in the larger universe of CDC guidance about stuff in general.
Once you do that, you’ll see that life getting “back to normal” does not mean that the CDC will tell you that all the things you do in your normal life are okay. It means that you will go back to ignoring CDC guidance about lots of stuff and feeling good about yourself anyway.
The CDC is really underselling the vaccine
If you check out the CDC’s official vaccine factsheet, it’s a real bummer. Not only does it tell you the side effects may “affect your ability to do daily activities” for multiple days, but (in the portion I highlighted) they then go on to caution you against modifying your behavior post-vaccination.
Lame!
I am on Team Leonhardt much more than Team Mandavilli here and think this is a bad message to send to the public. Now what’s true is that with only 10% of the population vaccinated, I think mask mandates indoors are still a good idea. And it’s not really logistically tractable to say “it’s okay for vaccinated people to ditch their mask starting 10 days after receiving their second shot.”
But that’s an enforcement issue. My view is that if you’ve gotten your shots, you should feel free to invite a friend over to your house and breathe all over him. The thing about vaccines is that there are positive externalities associated with getting vaccinated — as the supply of doses keeps increasing, we really want to encourage people to get their shots, which means giving them happy news about the consequences of getting the vaccine.
On the science, though, the CDC is not “wrong.” I recommend Kelsey Piper’s article on the evidence that the vaccines block transmission of the virus. The evidence is very strong! But just as a vaccine that is 95% effective at blocking symptoms is not 100% effective at blocking symptoms, even a vaccine that is very very very good at blocking transmission is not perfect. The odds that you, after getting vaccinated, will nonetheless contract an asymptomatic case of COVID-19 and then infect your friend by going to his house are extremely low. But not zero!
The CDC doesn’t do cost/benefit
What some people on Team Leonhardt would like is for the CDC to stop being such a Debbie Downer about this and tell vaccinated people to go breathe on their friends.
Noah Rothman, for example, is annoyed that Dr. Fauci says "indoor dining, theaters, places where people congregate” are all examples of things “that you’re not going to be able to do in society” even if you’re vaccinated.
I sympathize with this viewpoint.
But I think people in the media trying to intervene constructively in this debate need to keep two things in mind. One is that Dr. Fauci’s dicta at press conferences or on television interviews do not carry the force of law. Indoor dining is open in most of America. Movie theaters are reopening. As journalists, we are supposed to provide people with accurate information. Fauci is saying that he thinks you shouldn’t do those things — it’s not the case that you can’t do them.
The other is that you need to have an appropriate baseline for how public health agencies behave. It is unlikely that the CDC is going to respond to the COVID-19 vaccine rollout by completely revamping their institutional culture. Instead, we need to understand what that institutional culture is, and cover the CDC’s pronouncements accordingly. And the plain fact is that the CDC is extremely scold-y and conservative with its advice.
Nobody actually listens to the CDC
As I’ve mentioned previously, the CDC’s view is not only that pregnant women should abstain from alcohol, but that all women who aren’t on birth control should abstain from alcohol lest they accidentally have a night out drinking without being aware that they are pregnant.
And the context for that, in turn, is that the CDC thinks a man should never have more than two drinks in a day and a woman should never have more than one.
And to be clear, they are quite strict about this — “one drink” equals 12 ounces of 5% ABV beer or one glass of 12% ABV wine. I don’t know anything about wine, but this Real Simple article says that a normal chardonnay, pinot gris, or sauvignon blanc from California has ABV in the 13.5-14.5% range. So a woman who drinks a single glass of white wine is violating CDC guidelines. A Lagunitas IPA is 6.2% ABV, so a woman who drinks one is violating CDC guidelines. If a couple of guys split a six-pack while watching a football game, they are blowing through the guidelines.
I’m not here to say the guidelines are wrong. My understanding is that alcohol is in fact very hazardous to human health.
All I am saying is that we manage as a society to have a situation where these guidelines just kind of exist as a social fact. Libertarians don’t scream at the CDC for advising people to be healthy, and science journalists don’t scream at people for drinking more than this.
All hamburgers should be cooked to at least 160 degrees (i.e., well done)
All steaks should be cooked to at least 145 degrees (i.e., medium)
All eggs should have firm yolks (i.e., no sunny-side up)
I am not a foodie snob who judges people for eating well-done meat. But my personal preference is medium-rare. And lots of people eat medium-rare meat. And restaurants serve it. And recipes call for it. I personally know many people who think that we should “listen to the experts” and “science is real” who enjoy eating eggs with runny yolks.
But beyond cooking temperature, any scientist would tell you that a hamburger is not a very healthy thing to eat! But also the people eating the burgers are not confused about this. Throughout the pandemic, pretty much every Saturday I take my kid out for a hike or nature walk somewhere and then take him to a McDonald’s Drive-Thru. I don’t think the government should try to stop me from buying him his Happy Meal. But I also don’t think the government should try to gaslight me into believing McDonald’s is a healthy lunch.
Normal means ignoring Dr. Fauci
In other words, I actually think we are facing two distinct dangers during the COVID-19 transition.
One is that people will unnecessarily underestimate the benefits of getting vaccinated. The vaccines not only dramatically reduce your personal odds of contracting serious illness; they greatly reduce the chances of you spreading the virus. Precisely because vaccination has large positive externalities — it is an unselfish act that helps your community — we should really be encouraging people to get vaccinated, and that includes giving them a free pass to act a little selfish about it. Get your shots and celebrate a little! Build enthusiasm for the vaccine!
At the same time, we in the media should not encourage public health officials to lie to people.
The government says we should eat more vegetables, for example, which is almost certainly true.
Department of Health and Human Services
Are these recommendations efficacious? I don’t know. But it would be weird for the government to lie and say “nobody’s ever going to eat that many beets and sweet potatoes (I’m trying to think what the red and orange vegetables are), so let’s stop mentioning it.” They should try to recommend scientifically correct things.
One thing I think people don’t realize about the early COVID-19 recommendations that were maniacally focused on cleaning surfaces is that these were just carried over from longstanding flu recommendations.
Here are a few things the CDC has said forever about seasonal flu:
“Routinely clean frequently touched objects and surfaces like doorknobs, keyboards, and phones, to help remove germs.”
“Avoid touching your eyes, nose and mouth.”
“Wash your hands often with soap and water for at least 20 seconds. If soap and water are not available, use an alcohol-based hand rub.”
In other words, if you are hoping to get “back to normal” in the sense that Dr. Fauci will stop lecturing you about hand-washing and face-touching, you are out of luck — he’ll never stop saying that stuff because he’s been saying it for years. You just never noticed, because life getting back to normal means that most people stop paying attention to what infectious disease specialists have to say, just like most people don’t eat as many vegetables as they should.
The big issue, it seems to me, is that Joe Biden is going to have to try to pivot us out of Fauci mode at some point.
Let’s not eat the marshmallow
Unfortunately, the latest COVID-19 case numbers suggest that the post-holiday case decline has now reversed as things started opening up. That’s not great.
“This isn’t over yet,” Derek Thompson says. “Don't eat the marshmallow. We still need masks and distancing. We still need to accelerate vaccinations.”
I agree with all that. But in that sense, I think we are being ill-served by political leadership that has reversed Trump’s flagrant dismissal of public health guidance in favor of the excessive deference of “a woman should never drink a full glass of white wine.”
It’s fine that the public health agencies are going to urge caution essentially indefinitely. But that means we need Joe Biden to clearly say something like:
I anticipate that a vaccine will be available to any adult who wants one around Day X, or at worst Day Y.
That won’t mean the virus magically vanishes, but it does mean that a few weeks after we achieve Vaccination for All Who Want It, the official national emergency will end.
In post-emergency America, it will still be true that virologists recommend washing your hands every time you pet your dog, but personally I’m going to return to my relaxed, no-malarkey lifestyle.
Specifically, I have been wearing a mask in public even though I was vaccinated a while ago because I’m trying to set a good example, but once vaccines are broadly available I will stop doing that.
I understand that everyone is impatient, but I’m asking you all to wait for six more weeks, not seven more months.
Then, I dunno, make a good-hearted joke. Say, “Fauci and Trump disagreed about a lot of stuff, but I read in Washingtonian that way before the pandemic Trump would obsessively hand sanitize before drinking a glass of Diet Coke, and Fauci probably thought that was great. And maybe we should all be more healthy all the time. But right now I’m gonna go get some Jeni’s with Nancy Pelosi.”
The nature of modern social media tends to polarize everything. And throughout the pandemic, the discourse has been pulled between “it’s just the flu” and public health stridency. And for most of the year, stridency has been approximately correct. But the more light there is at the end of the tunnel, the more tempting it becomes to eat the marshmallow, while at the same time the gap between public health stridency and reasonable cost-benefit analysis also grows. It’s not really the job of Fauci or the CDC to strike that balance, but it is the country’s elected leadership’s job, and you can’t just outsource it to them.
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