Like it or not, the period of pandemic adventures is ahead of us. The mandates for masks have fallen. Some free test sites are closed. Whichever part of the United States was still trying to collectively quell the pandemic, it has largely shifted its focus from community-wide councils.
Now, even as the number of cases begins to rise again and more infections remain unaccounted for, the burden has fallen on individual Americans to decide how much risk they and their coronavirus neighbors face – and what, if anything, to do about it.
For many people, the threats posed by COVID have dropped dramatically in the two years of the pandemic. Vaccines reduce the risk of hospitalization or death. Powerful new antiviral pills can help protect vulnerable people from getting worse.
But not all Americans can count on the same protection. Millions of people with weakened immune systems do not fully benefit from vaccines. Two-thirds of Americans and more than one-third of those aged 65 and over have not received critical security for booster injections, with blacks and Spaniards at the most alarming rates. And patients who are poorer or live farther away from doctors and pharmacies face steep barriers to receiving antiviral pills.
These vulnerabilities have made calculating the risks posed by the virus a difficult exercise. A recent suggestion by federal health officials that most Americans could stop wearing masks because the number of hospitalizations is small has created confusion in some circles as to whether the likelihood of being infected has changed, scientists said.
“We’re doing a really terrible job of communicating risk,” said Caitlin Jetelina, a public health researcher at the University of Texas Health Center in Houston. “I think that’s why people raise their hands in the air and say, ‘Fuck.’ They desperately need some kind of guidance. ”
To fill this gap, scientists are rethinking how to discuss the risks of COVID. Some have studied when people can expose themselves indoors if the goal was not only to protect hospitals from overcrowding, but also to protect immunocompromised people.
Others are working on tools to compare the risks of infection with the dangers of a wide range of activities, finding, for example, that the average unvaccinated person aged 65 and over is approximately as likely to die from omicron infection as someone dying from heroin use. for 18 months.
But how people perceive risk is subjective; no two people have the same chance of dying from a year and a half of heroin use (about 3%, according to one estimate).
And besides, many scientists have said they are also worried about this latest phase of the pandemic, which is placing too much weight on people to make choices to keep themselves and others safe, especially while COVID’s tools remain out. the reach of some Americans.
“As much as we don’t want to believe that,” said Anne Sosin, who studies health justice at Dartmouth College, “we still need a public approach to the pandemic, especially to protect those who can’t take full advantage of it.” vaccination. ”
Collective indicators
Although COVID is far from the only threat to America’s health, it remains one of the most significant. In March, even as deaths from the first omicron jump declined, the virus was still the third leading cause of death in the United States, after only heart disease and cancer.
In general, more Americans have died than they would have in normal times, a sign of the virus’s widespread use. By the end of February, 7% more Americans were dying than would have been expected in previous years, in contrast to Western European nations such as Britain, where overall deaths have recently been lower than expected.
How much virus is circulating among the population is one of the most important measures for people trying to assess their risks, scientists said. This remains true, although the number of cases now underestimates real infections by a large margin, because so many Americans test at home or do not test at all, they said.
Although many cases have been missed, the Centers for Disease Control and Prevention now puts most of the northeast at “high” levels of viral transmission. In parts of the region, the number of cases, although far lower than in winter, is approaching the peak growth rate of the autumn version of the delta.
Much of the rest of the country has what the CDC describes as “moderate” transmission levels.
The amount of circulating virus is critical because it dictates how likely someone is to encounter the virus and in turn roll the dice in a bad outcome, scientists said.
That’s part of what makes COVID so different from the flu, scientists said: The coronavirus can infect many more people at once, and the more likely people are to catch it, the greater the chance of a bad outcome.
“We’ve never seen the spread of the flu – how many there are in the community – in the numbers we’ve seen with COVID,” said Lucy D’Agostino McGowan, a biostatistician at Wake Forest University.
COVID against driving
Even two years after the pandemic, the coronavirus remains new enough, and its long-term effects are unpredictable enough that measuring the threat posed by infection is a difficult problem, scientists said.
An unknown number of infected people will develop prolonged COVID, which will leave them very exhausted. And the risks of getting COVID extend to others, potentially in poor health, who may be exposed.
However, with much greater immunity in the population than ever before, some public health researchers are seeking to make risk calculations more accessible by comparing the virus to everyday dangers.
The comparisons are particularly complex in the United States: the country does not conduct random swab tests needed to assess levels of infection, making it difficult to know what proportion of infected people die.
Jetelina, who published a set of comparisons in her newsletter, Your Local Epidemiologist, said the exercise highlights how difficult risk calculations remain for everyone, including public health researchers.
For example, she estimated that the average vaccinated and reinforced person who was at least 65 years old had a risk of dying from a COVID infection, slightly higher than the risk of dying during a year of military service in Afghanistan in 2011. It uses a standard unit of risk, known as micromort, which represents one in a million chances of death.
But her calculations, however rough, included only registered cases, not undeclared and generally milder infections. And she did not report a backlog between cases and deaths, looking at data from a week in January. Each of these variables can change risk assessments.
“All of these nuances underscore how difficult it is for people to calculate risk,” she said. “Epidemiologists also have a challenge with this.”
For children under 5 years of age, she found that the risk of death after COVID infection was approximately the same as the risk of mothers dying in childbirth in the United States. However, this comparison highlights other difficulties in describing the risk: averages can hide large differences between groups. Black women, for example, are almost three times more likely than white women to die in childbirth, which is partly a reflection of differences in the quality of health care and racial bias in the health care system.
Cameron Beyrle, an assistant professor of mathematics at the University of Georgia, has built an online tool called COVID-Taser that allows people to adjust age, vaccine status and health to predict the risks of the virus. Her team used earlier estimates in the pandemic of the share of infections that led to poor results.
Her research shows that people have trouble interpreting percentages, Beyrle said. She recalled that her 69-year-old mother-in-law was unsure whether to worry earlier in the pandemic after a news program said people her age had a 10% risk of dying from an infection.
Beyrle suggested to her mother-in-law that if she died once every 10 times when she used the toilet on a given day. “Oh, 10% are awful,” she recalled her mother-in-law’s words.
Beyrle’s estimates show, for example, that an average 40-year-old vaccinated more than six months ago faces about the same chance of being hospitalized after an infection as someone dying in a car accident on 170 trips across the country. . (More recent vaccines provide better protection than older ones, which complicates these predictions.)
In immunocompromised people, the risks are higher. An unvaccinated 61-year-old with an organ transplant, according to Beyrle, is three times more likely to die after an infection than someone to die within five years of being diagnosed with stage 1 breast cancer. And this transplant recipient is two times more likely to die from COVID than someone to die while climbing Mount Everest.
With the most vulnerable in mind, Dr. Jeremy Faust, an emergency physician at Brigham and Women’s Hospital in Boston, worked last month to determine how low cases would have to fall for people to stop masquerading indoors. without compromising those with extremely weakened immune systems.
He imagined a hypothetical man who did not benefit from vaccines, wore a good mask, took hard-to-reach prophylactics, attended occasional gatherings, and shopped, but did not work in person. It seeks to keep the chances of vulnerable people being infected below 1% over a four-month period.
To reach that threshold, he found, the country will have to continue to disguise itself indoors until the show falls below 50 weekly cases per 100,000 people – a stricter limit than the one the CDC currently uses, but says offers a benchmark to strive for.
If you just say “We’ll take off the masks when things get better” – that’s true, I …
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