Hey, buddy, wanna know what kind of mask to wear? And how many times you can wear it before you have to throw it away? Do you know where to swab to make sure you find that omicron in your system? Need the hookup on some cool new orifices? When should you test? And how many days in a row?
Don’t worry, pal. I can answer these questions. Just follow me. I got a guy.
This is what COVID-19 advice in the U.S. has come to: a series of meetings with strangers in the dark alleys of the internet, hoping the information we’re getting is the real deal and not just another cheap Rooolex. Two years into the pandemic, it’s infuriating that so many basic facts we need for everyday risk reduction still come from a combination of well-written news stories you just have to hope you can find, Twitter threads of questionable provenance, and something you heard from your friend’s cousin’s doctor. One might argue there could be another source for that information: a large centralized public-health agency that exists to make sure everyone has the crucial facts and to clarify the difference between real, evidence-based advice and garbage speculation. And yet …
The Centers for Disease Control and Prevention exists as a source of official, seal-of-approval safety information. But not only has it become mired in political influence — it’s also failed to address many of the most relevant questions for day-to-day decision-making. Or it’s gotten to them late, long after we all started taking the matter into our own hands.
In this lawless world, we’ve all become public-health vigilantes. And that’s stupid. I’m really not sure how else to say it.
Fumbling around in the back alleys can quickly become a mess. Just look at the confusion around post-infection immunity. Basic biology taught us there are two ways your body can build immune resistance to a virus: You can get a vaccine, or you can catch the virus and recover. It’s less risky to get your immunity from a vaccine, but if you do catch COVID-19 and recover, should you assume you have the same level of immunity as the person who got the shot? It’s a complex question with real-world implications. For example, if you’ve had COVID before and you’re exposed again, how long should you quarantine? Or if you’ve had a breakthrough infection after your primary vaccination, is that as good as having had a booster? Until recently, this wasn’t something the CDC’s guidelines for quarantine and isolation really addressed.
It’s not as though research on these questions was nonexistent. Studies as far back as a year ago were suggesting that infection did reduce the risk of reinfection, at least for several months, and the CDC itself has published some of the more recent work showing that not everyone who has been infected comes away with immunity. My readers knew the question was there. They were writing to me, hoping I would know the answer. Scientists were sharing data on Twitter — both studies from before the delta wave hit the U.S. that found good news for the previously infected, and omicron-era studies that made infection immunity look a lot less useful. Cranks who wanted excuses to claim vaccines were pointless were also aware of these issues and talking about them. But on the website where the nation’s premier public-health agency offered practical guidance for people who had been exposed to COVID, all you could find was the shadow of an unasked question.
That’s changed, thankfully, with a lengthy Jan. 4 update to the guidelines that breaks down in painstaking detail exactly who should be doing precisely what and when. (That this renders the guidelines overwhelmingly dense feels a bit churlish to mention at this point.) Still, it would have been nice to have this information before we started speculating in our living rooms and message boards, swapping cobbled-together pet theories like questionable NFTs. Even an acknowledgment that the question was out there but that a consensus on the answer hadn’t been reached yet would have been helpful — something the CDC did in a topic-specific science brief elsewhere on its site. But without that information making it to the guidelines, the black market moved in to confidently provide multiple, often conflicting, answers that changed over time. Americans are exhausted and overwhelmed, and this kind of situation only makes it worse.
Consider the rise of the scientist Twitter celebrity — credible professionals who share their research, analysis and hot takes in a public forum. These people aren’t stupid and they aren’t trying to mislead, but they’re still part of the black market of COVID information that makes decision-making harder, not easier. How was the average person supposed to understand what choices to make when a Harvard epidemiologist was encouraging the widespread use of rapid at-home tests to reduce the risk of COVID transmission but the FDA was still saying asymptomatic people shouldn’t use them? If one of the best sources of information on the effectiveness of different types of masks is a mechanical engineer from a data-storage company whose credentials don’t appear on his social-media bios, how are most people supposed to know he’s trustworthy — or even to have heard about him at all? Conversely, if a guy with impeccable-sounding credentials and tons of spots on TV news is regarded as a frequently wrong, alarmist self-promoter by a lot of other scientists, how would the general public know that?
Even your own doctor, whom you may trust more than anybody else, could be one of the many M.D.s who don’t actually know a ton about virology, epidemiology or the latest research on a new COVID strain — and maybe shouldn’t even be expected to. I like to think the news media is capable of compiling data, reviewing evidence and sometimes coming up with answers to questions the CDC is ignoring, but which news outlets do you trust to do that?
Through the gaps in the official guidelines, I can see things that I, along with other reporters, have written about — like the CDC’s long, notorious history of risk aversion, which has led it to avoid making statements on questions long after many of the very scientists it’s citing have determined there’s enough evidence to say something about it. Or the tightening vise the agency has found itself in, between that well-meaning tendency and the political pressures placed on it by two presidential administrations. But the lack of leadership has consequences, and one of them is burnout. When we have to get our facts on the black market, every question becomes a moment where my COVID guy and your COVID guy could end up telling us vastly different things. The weight of navigating what we are supposed to do then is crushing us all.
I don’t have a good answer for this. I am frequently finding myself confused, frustrated and angry. I end up feeling like the advice is more convoluted, the opinions more divergent, and the choices harder to make than they really are. I feel like I’m trying to change a tire, in the dark, with a set of instructions only available in a language I don’t read fluently and a person on the sidewalk constantly trying to tell me what he thinks I should do. And I want you to know that if you feel similar, well, you’re not alone. This isn’t your fault, and you aren’t a failure. Instead, it’s the system that has failed you, and you’re doing the best you can in the back alley.