Imagine the Off-Ramp
Yesterday I went on MSNBC’s Morning Joe with a mission to inspire confidence in the vaccines and replace fear with facts. Despite some jitters, I (blessedly!) was able to rattle off the latest data on the extraordinary efficacy of the COVID-19 vaccines:
The vaccines (including J&J) essentially take death and severe disease off the table.
The vaccines reduce our risk of getting COVID-19 to 0.0005% based on the latest CDC data. (In short, it’s hard to get COVID-19 after vaccination. Of course different people will have varying risks depending on their unique medical issues and myriad environmental factors, but let’s face it: the overall risk of getting COVID after vaccination is tiny.)
The vaccines reduce the risk of transmission by 94% based on the most recent data from Israel.
The vaccines are powerful weapons against all of the current circulating variants.
I also put a rather large stake in the ground on national television: that we really don't need to be masking outdoors except, of course, in crowded situations like an outdoor rally with lots of yelling. The vaccines are so effective — and nature so well-ventilated — that outdoor masking doesn’t make sense and isn’t supported by data.
The larger point is this: we need to start lifting restrictions in a gradual way. Indeed, as case rates go down and we edge closer to herd immunity, we can't keep fear in the driver’s seat. We need to use data and evidence to guide our thinking and behaviors — and, of course, policy.
I was feeling a bit high and dry having put my neck out there putting this statement on national TV, so when my bodyguard Monica Gandhi, MD, MPH, went on CNN with Kate Bolduan today to fully explain the robust data on exactly why outdoor masking is unnecessary, I took a deep breath. I didn’t doubt my position; I just feared the blow-back.
Monica also backed me up today on Twitter. PHEW! (As you can tell, this is a new and vulnerable place for me.)
Here’s the thing: neither of us oppose masking. It’s quite the opposite. I actually like wearing my mask outside on a chilly day. And of course masks have been essential for our safety for over a year. Masks are still part of the known risk mitigation strategy (alongside distancing and ventilation), all of which are crucial, particularly for unvaccinated people.
What I do take issue with, however, is the lack of nuanced, tiered guidance to the general public — and not just about masks. In my humble opinion, as the data evolves, as our scientific knowledge increases, and as the public health landscape shifts, so should our thinking, behaviors, and policies.
So many people are struggling with anxiety. I witness it every day. For far too many folks, their internal narrative is stuck in 2020. And when fear overtakes our thinking, we can make decisions that don’t serve our overall health and well-being. For example, some of my patients aren’t getting vaccinated because of fear of vaccine side effects or the (unlikely but) possible need for booster shots. Others are afraid of connecting with loved ones for fear of getting COVID despite vaccination. Worry can also make us sick. (I wrote an article about “Coronaphobia” last month in case you missed it.)
I get it. Trauma does that to us.
Helping patients and the general public take fear out of the driver seat requires entrusting them with facts, nuanced guidance, and tools to protect themselves from disease and despair. And in the case of the pandemic, our goal should be to help prevent COVID and to gradually lift restrictions that keep us from safely meeting our broad human needs.
In other words, not dying is important (and is essentially guaranteed after vaccination), but what about living?
The data is almost so stunningly good that it can be hard to believe. So naturally my patients have lots of questions about what they can and cannot do after vaccination. After all, my job is to put data into context — to marry broad public health advice and scientific evidence with the nuances of my patients’ medical situation.
But here's where my advice is essentially the same for everyone: after vaccination you should start to let go of fear. After all, the goal of vaccination is to put us back in control of our health.
We’ve felt out of control over 14 months. We’ve been marinating in stress hormones for 14 months. I completely understand how hard it is to pivot from fear-based thinking to taking tiny risks. But we just need to do it.
We need to socialize, connect with loved ones, and engage with our communities for our mental and physical health. Once we have been vaccinated, we can. We can feel safe, we can abandon fear, and we can start to rebuild our lives.
You might ask, for example: what about mixing a vaccinated grandparent with an unvaccinated child? Think about it this way: the vaccinated grandparent is very unlikely to get COVID or to transmit coronavirus to the child (see the above data). In the off chance that the grandparent did infect the unvaccinated child, the child is unlikely to get sick or have severe consequences from COVID. Is it possible for children and teens to get severely ill from COVID? Absolutely. Is it likely? No.
Moreover, the risk to unvaccinated people drops as more and more people in their midst are vaccinated. This is the gist of herd immunity. (Side note: the Pfizer-BioNTech vaccine for 12-15 year olds is awaiting FDA approval. I don’t have a crystal ball but am guessing we’ll get approval in May.)
Just as the pandemic doesn't have an on-off switch, neither does fear. Shifting our mindset will be slow and gradual for most. For some people, the trauma of the pandemic will reverberate for decades. For others, the past 14 months has allowed for wisdom and self-reflection. We’ve all heard of post-traumatic stress; you should know about its big sister, post-traumatic growth. Most of us will experience a bit of both. To steer yourself toward the latter, this weekend let’s make sure we get outside, take some deep breaths, and care for our mental health.
I will see you next week. Until then, be well.
P.S. Here is my live conversation with Monica Gandhi last night in case you missed it!