{"id":184304,"date":"2021-05-10T12:01:36","date_gmt":"2021-05-10T11:01:36","guid":{"rendered":"https:\/\/www.transcend.org\/tms\/?p=184304"},"modified":"2021-05-07T08:44:23","modified_gmt":"2021-05-07T07:44:23","slug":"usa-more-than-a-year-into-the-pandemic-were-still-figuring-out-what-risks-were-willing-to-take","status":"publish","type":"post","link":"https:\/\/www.transcend.org\/tms\/2021\/05\/usa-more-than-a-year-into-the-pandemic-were-still-figuring-out-what-risks-were-willing-to-take\/","title":{"rendered":"USA: More Than a Year into the Pandemic, We\u2019re Still Figuring out What Risks We\u2019re Willing to Take"},"content":{"rendered":"

3 May 2021 – <\/em>When the Centers for Disease Control and Prevention last week issued guidelines for what vaccinated people can safely do, the agency employed the word \u201crisk\u201d 43 times.<\/p>\n

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The word often carried a modifier, like so: increased risk, residual risk, low risk, potential risk, minimal risk, higher risk. The CDC did not define \u201clow,\u201d \u201cminimal\u201d or \u201chigher,\u201d instead using broad brushstrokes to paint a picture of post-vaccination life.<\/p>\n<\/div>\n<\/div>\n<\/section>\n<\/div>\n

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For example: \u201cIndoor visits or small gatherings likely represent minimal risk to fully vaccinated people.\u201d<\/p>\n<\/div>\n<\/div>\n

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On Wednesday, CDC director Rochelle Walensky said she could not give a definitive answer to what a \u201csmall\u201d gathering is, because there are too many variables.<\/p>\n<\/div>\n<\/div>\n

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\u201cIf we define a small- and medium-sized gathering, we actually also have to define the size of the space that it\u2019s in, the ventilation that is occurring, the space between people. And so, I think we should get back to the the general concepts,\u201d Walensky said.<\/p>\n<\/div>\n<\/div>\n

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The situation has left people where they\u2019ve been since the start of the pandemic: forced to play the role of amateur epidemiologist.<\/p>\n<\/div>\n<\/div>\n

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In the early days of the pandemic, we wondered if we could catch the coronavirus from a passing jogger and if our groceries, fresh from the store and resting on the kitchen counter, threatened to kill us. Science has attenuated some of our earliest fears. But more than a year into this crisis, we\u2019re still trying to perform complicated risk calculations while relying on contradictory research and shifting CDC guidance.<\/p>\n<\/div>\n<\/div>\n

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Risk analysis is not something humans are necessarily good at. We rely on anecdotes more than scientific data. The questions we ask rarely have a simple yes or no answer. Risk tends to be on a sliding scale. Outside of self-isolation, there is no obvious way to drive the risk of viral transmission to zero, nor is risky behavior guaranteed to result in a dire outcome. We have no choice but to live probabilistically.<\/p>\n<\/div>\n<\/div>\n

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\"Image<\/div>
People with resumes in hand wait to apply for jobs during an outdoor hiring event April 27 in Las Vegas. (John Locher\/AP)<\/figcaption><\/figure>\n<\/div>\n<\/div>\n
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The risk landscape keeps changing as well. The virus is mutating, and there are many different variants in circulation. Many people are now fully vaccinated, some only partially vaccinated (in between shots, for example), some unvaccinated and some armored with a level of immunity through natural infection. Add the extreme variation in disease severity because of age and underlying conditions, and the risk equations get so long we may run out of chalkboard.<\/p>\n<\/div>\n<\/div>\n

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The restrictions imposed by governments have sometimes made little sense. Casinos were open before schools in some states. Mask mandates outdoors remained in place even when indoor dining became permitted.<\/p>\n<\/div>\n<\/div>\n

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\u201cIt seems to me if we are going to have indoor dining, we should have mask-free jogging,\u201d Harvard epidemiologist Marc Lipsitch said in an email.<\/p>\n<\/div>\n<\/div>\n

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One thing that is incontrovertibly true: The coronavirus vaccines are remarkably safe and effective, and people should get vaccinated if possible.<\/p>\n<\/div>\n<\/div>\n

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\u201cThese are off-the-scale good,\u201d said Amesh Adalja, an infectious-disease doctor and senior scholar at the Johns Hopkins Center for Health Security. \u201cThese are much better than vaccines that we rely on every year, like the flu vaccine.\u201d<\/p>\n<\/div>\n<\/div>\n

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Even for people sold on vaccines, there remain lingering questions about what is and isn\u2019t safe, and what is and isn\u2019t the proper way to go about daily life in an increasingly vaccinated society. Here, we present some answers, with the caveat that our knowledge of the coronavirus, SARS-CoV-2, is still evolving, as is the virus itself.<\/p>\n<\/div>\n<\/div>\n

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Q:\u2009<\/b>Why do I still need to wear a mask after I\u2019m fully vaccinated?<\/p>\n<\/div>\n<\/div>\n

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A:\u2009<\/b>You don\u2019t need to wear a mask outdoors when fully vaccinated, except in crowds (such as at a sports stadium or a concert), nor do you have to wear one indoors among other vaccinated people or members of your own household.<\/p>\n<\/div>\n<\/div>\n

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But there are situations where you still need to mask up. You could still get infected with the coronavirus, and although it would most likely be mild or asymptomatic, you could transmit the virus to another person. Again, the odds of that happening are low, and there is encouraging data from Israel that suggests vaccinations dramatically reduce community spread.<\/p>\n<\/div>\n<\/div>\n

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But remember: A vaccination campaign is not simply about protecting the vaccinated individual. The goal is to build immunity broadly. Moreover, many communities still require masks in public settings \u2014 so it\u2019s the law. It\u2019s also polite \u2014 you don\u2019t want to make people guess if you\u2019ve been vaccinated or not. That probably will change when infection rates plummet and vaccinations are far more widespread.<\/p>\n<\/div>\n<\/div>\n

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\u201cIt is also a show of solidarity that we are still in this together,\u201d said Maria Van Kerkhove, technical lead for the World Health Organization\u2019s covid-19 response. \u201cIt\u2019s about you and your community, your family, your friends, your workplace, your loved ones. It\u2019s not just about you.\u201d<\/p>\n<\/div>\n<\/div>\n

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At some point, viral transmission will plummet. We\u2019re a long way from that point. As long as the virus is circulating in our communities, we need to use what we can to limit the spread and drive down the infection rate.<\/p>\n<\/div>\n<\/div>\n

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\u201cBecause [the vaccines] are not perfect, that\u2019s precisely why we are urging people to be cautious,\u201d Surgeon General Vivek H. Murthy said in a recent White House covid-19 task force news briefing. \u201cWe have great confidence in vaccines. We understood they are not perfect.\u201d<\/p>\n<\/div>\n<\/div>\n

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\"Image<\/div>
Updated CDC guidelines say fully vaccinated people can go without masks outdoors when walking, jogging or biking or dining with friends at outdoor restaurants.
\n(Nicholas Kamm\/AFP\/Getty Images)<\/figcaption><\/figure>\n<\/div>\n<\/div>\n
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Q:\u2009<\/b>If you\u2019re vaccinated, are you definitely protected against the coronavirus?<\/p>\n<\/div>\n<\/div>\n

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A:\u2009<\/b>You\u2019re very likely protected from symptomatic illness. That\u2019s why Adalja, echoing the consensus, said, \u201cThese vaccines are something that will change your life.\u201d<\/p>\n<\/div>\n<\/div>\n

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In clinical trials, the Pfizer and Moderna vaccines were about 95\u00a0percent effective in blocking symptomatic illness after two shots. The one-shot Johnson & Johnson vaccine was not quite as effective but just as good at preventing severe illness and death \u2014 which is the highest public health priority in a pandemic like this.<\/p>\n<\/div>\n<\/div>\n

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Q:\u2009<\/b>But aren\u2019t there also breakthrough infections?<\/p>\n<\/div>\n<\/div>\n

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A:\u2009<\/b>As of April 26, the CDC had documented 9,245 breakthrough infections<\/a> among fully vaccinated people. But look at the denominator: Those cases were among more than 95\u00a0million people. That\u2019s fewer than 1 in 10,000 people vaccinated. (The agency noted that this is probably an undercount because of lack of testing and surveillance.) Of those rare breakthrough cases known to the CDC, 27\u00a0percent were asymptomatic and only 9\u00a0percent required hospitalization.<\/p>\n<\/div>\n<\/div>\n

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Adalja said people need to focus on probabilities and not anecdotes.<\/p>\n<\/div>\n<\/div>\n

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\u201cThis is kind of a cognitive bias that people have with many kinds of risk. It\u2019s just like when there\u2019s a shark attack in Australia. How much coverage does that get?\u201d he said.<\/p>\n<\/div>\n<\/div>\n

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Q:\u2009<\/b>Should people who got the Johnson & Johnson vaccine worry about blood clots?<\/p>\n<\/div>\n<\/div>\n

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A:\u2009<\/b>If you notice unusual and serious side effects, such as severe headaches, contact your doctor. But the risk is extremely low. Federal regulators reauthorized the use of the vaccine after a 10-day pause, having found 15 cases of a serious clotting disorder among the 7 million people who had received the vaccine at that time. By any calculation, the risk of a bad vaccine reaction is much less than the risk of getting a serious case of covid-19.<\/p>\n<\/div>\n<\/div>\n

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Paul A. Offit, a pediatrician at Children\u2019s Hospital of Philadelphia who is an expert on vaccination, suggests that the Johnson & Johnson coronavirus vaccine suffers from bad timing. Had it been approved first, before the Pfizer and Moderna vaccines, its many virtues would have been celebrated and the rare side effects minimized.<\/p>\n<\/div>\n<\/div>\n

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He noted that the Johnson & Johnson vaccine is \u201crefrigerator stable\u201d for up to five weeks. The vaccine is appealing to public health officials because it\u2019s one-and-done and can be more easily deployed <\/a>in remote locations and in places where recipients are homebound.<\/p>\n<\/div>\n<\/div>\n

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Q:\u2009<\/b>How long will natural or vaccine-induced immunity last?<\/p>\n<\/div>\n<\/div>\n

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A:\u2009<\/b>No one knows, but the initial evidence is encouraging, said Alessandro Sette, a professor of immunology at the La Jolla Institute for Immunology. A research paper published by Sette and fellow researchers in January showed that 90\u00a0percent of people who recovered from a coronavirus infection had robust levels of immunity <\/a>eight months after they became sick. Immunity did not suddenly drop after eight months \u2014 that was merely the limit of the research period.<\/p>\n<\/div>\n<\/div>\n

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\u201cNinety percent having a good immune response also means 10\u00a0percent don\u2019t. That is a reason for vaccinating and being careful even if you had the disease,\u201d Sette said.<\/p>\n<\/div>\n<\/div>\n

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Immunity post-vaccination also appears durable, and there is less variability in levels of antibodies and other immune system cells following a vaccination than following a natural infection, Sette said.<\/p>\n<\/div>\n<\/div>\n

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Because this is a novel disease, and vaccines have not been widely deployed for very long, it is too soon to know how long antibodies will last. But Sette pointed out that the immune system has other weapons against invasive viruses, including \u201ckiller T-cells,\u201d which continue to be able to recognize infected cells and kill them, preventing viral replication.<\/p>\n<\/div>\n<\/div>\n

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Q:\u2009<\/b>Do the vaccines work against these new virus variants? And shouldn\u2019t we be worried about a new variant that has even scarier, vaccine-evading mutations?<\/p>\n<\/div>\n<\/div>\n

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A:\u2009<\/b>The immune response generated by vaccines is sufficiently protective against coronavirus variants to prevent most people from getting seriously ill.<\/p>\n<\/div>\n<\/div>\n

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Infectious-disease experts do worry about future mutations that could allow the virus to exhibit vaccine evasion. That said, there are limits to how much the virus can mutate \u2014 how much it can change its structure \u2014 and still function, according to Sette.<\/p>\n<\/div>\n<\/div>\n

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\u201cThe virus has to walk a tightrope,\u201d he said. The virus can mutate to escape the effect of a specific antibody, but \u201cit can\u2019t change too much.\u201d<\/p>\n<\/div>\n<\/div>\n

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He added, \u201cWhile the virus has surprised us this year in a number of ways, the data we\u2019ve seen so far does not suggest there\u2019s an infinite number of ways the virus can mutate and escape immune recognition and still be as infectious.\u201d<\/p>\n<\/div>\n<\/div>\n

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Q:\u2009<\/b>When will we reach herd immunity?<\/p>\n<\/div>\n<\/div>\n

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A:\u2009<\/b>No one knows what level of immunity would throttle virus transmission, and it probably varies from one environment to another and from one season of the year to another. But in the United States, at least, vaccinations have already had an effect. The virus increasingly is slamming into immune-system walls. Eventually, with enough vaccinations, most of the people who get infected will be dead-end alleys for the virus.<\/p>\n<\/div>\n<\/div>\n

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The virus appears destined to pop up in smaller outbreaks that could be more easily contained. But the virus won\u2019t disappear, especially because it continues to spread at catastrophic rates in many countries that have low levels of vaccination. The only infectious disease-causing virus ever eradicated is smallpox.<\/p>\n<\/div>\n<\/div>\n

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For now, successful navigation of the pandemic may simply mean taking steps to reduce the threat of a serious case of covid-19 (as best as anyone can determine it) to the level of other threats that we typically tolerate, and which don\u2019t tend to keep us awake at night.<\/p>\n

_________________________________________________<\/p>\n

\"HeadshotJoel Achenbach covers science and politics for the National desk. He has been a staff writer for <\/em>The Post since 1990.<\/em><\/span><\/span><\/p>\n<\/div>\n<\/div>\n<\/section>\n<\/div>\n

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Go to Original – washingtonpost.com<\/a><\/p>\n

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\u00a0<\/em><\/span><\/span><\/p>\n<\/div>\n<\/div>\n<\/section>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

3 May 2021 – Risk analysis is not something humans are necessarily good at. We rely on anecdotes more than scientific data. The questions we ask rarely have a simple yes or no answer. Risk tends to be on a sliding scale. Outside of self-isolation, there is no obvious way to drive the risk of viral transmission to zero, nor is risky behavior guaranteed to result in a dire outcome. We have no choice but to live probabilistically.<\/p>\n","protected":false},"author":4,"featured_media":171070,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2236],"tags":[2017,271,1879,1829,1868,289,744,401,710,1937,2428,1864,2186,1102,723,304,1447,1889,2014,1836],"class_list":["post-184304","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-covid19-coronavirus","tag-airborne-contagion","tag-community","tag-compassion","tag-coronavirus","tag-covid-19","tag-economy","tag-empathy","tag-environment","tag-health","tag-lockdown","tag-medical-industrial-complex","tag-pandemic","tag-pcr-tests","tag-public-health","tag-research","tag-science","tag-science-and-medicine","tag-vitamin-c","tag-vitamin-d","tag-who"],"_links":{"self":[{"href":"https:\/\/www.transcend.org\/tms\/wp-json\/wp\/v2\/posts\/184304","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.transcend.org\/tms\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.transcend.org\/tms\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.transcend.org\/tms\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.transcend.org\/tms\/wp-json\/wp\/v2\/comments?post=184304"}],"version-history":[{"count":0,"href":"https:\/\/www.transcend.org\/tms\/wp-json\/wp\/v2\/posts\/184304\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.transcend.org\/tms\/wp-json\/wp\/v2\/media\/171070"}],"wp:attachment":[{"href":"https:\/\/www.transcend.org\/tms\/wp-json\/wp\/v2\/media?parent=184304"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.transcend.org\/tms\/wp-json\/wp\/v2\/categories?post=184304"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.transcend.org\/tms\/wp-json\/wp\/v2\/tags?post=184304"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}