Make Nuance Great Again
It’s funny. After I appeared yesterday on MSNBC's Morning Joe to talk about my recent Op-Ed on the physical health toll of mental health issues, I was publicly accused of being a “hope monger.”
To that I say: BRING IT!!
We have every reason for optimism. With three stunningly effective vaccines that essentially take death and severe disease off the table, dramatically reduce the risk of COVID-19 in any form, AND drop the risk of transmission — even with the variants dominant in the US — it’s safe to say that hope is alive and well.
Just yesterday and today, the New England Journal of Medicine published FOUR new articles that should be BALMS for our COVID anxiety:
This study revealed powerful coverage against the B1341 (South Africa) and B1429 (California) variants by the Moderna and Novavax vaccines (the latter likely to be out later this spring). UPSHOT: More evidence that the vaccines work well against the variants.
And for people who have recovered from COVID-19:
This study showed that patients previously infected with SARS-CoV-2 who received Pfizer’s vaccine had dramatically increased neutralizing antibody activity against ALL variants.
This study showed that blood taken from people who recovered from an infection with SARS-CoV-2 variant B1351 (UK) showed potent neutralization of D614G (the “original” coronavirus), as well as variants B1351 (South Africa) AND the P1 (Brazil) variants. UPSHOT: Booster vaccines may just seal the deal if needed!
This study showed that people who have recovered from previous COVID infection and then received ONE dose of either the Pfizer-BioNTech or the Moderna vaccine had TEN to FORTY-FIVE times the amount of neutralizing antibody in their blood compared to people who got one dose of vaccine who did not have previous immunity from past infection. UPSHOT: Having had COVID in the past seems to “prime” our immune system. (For now, though, the recommendation is still for recovered COVID patients to get both of the Pfizer or Moderna shots — or one of the J & J — as soon as possible).
That said, ongoing caution is warranted.
Just look at Brazil. Or Michigan. The situations there are tragic. It’s also not a mystery whatsoever as to why cases are surging overseas and at home. We know exactly how to control outbreaks: with widespread and equitably-distributed vaccination; aggressive risk mitigation particularly in unvaccinated people; clear, nuanced public health messaging; and strong, science-backed leadership.
To be clear: the variants are indeed worrisome and will contribute to even more cases until — and even after— we vaccinate everyone who wants it.
We also can expect that a small percentage of vaccinated people will get COVID-19. Even though it’s highly unlikely, we shouldn’t be shocked when this happens. Particularly as the more contagious variants circulate, even vaccinated people can and will get COVID-19.
But the crucial point is this: vaccinated people won’t die. They won’t get that sick. If a vaccinated person is in the unlucky small percentage that gets COVID-19, they’ll have a mild illness like a cold or mild flu. Will there be exceptions? SURE THING.
We've never been promised a risk-free existence, and the vaccines are not 100%. But they are pretty darn close. Let's not make amazing the enemy of the perfect (especially when perfect isn't on the menu). Let’s also try to take fear out of the driver’s seat when we recognize our anxiety is out of proportion to reality.
As I wrote about earlier this week, hope and caution are not mutually exclusive. We can exercise caution AND liberalize our behaviors to enjoy the benefits of vaccination. We are capable of doing both.
In other words, there's an OCEAN OF GRAY between public discourse that dismisses the variants and the ongoing devastation from COVID-19 and the dialogue that promotes fear and behavioral paralysis when vaccination is the obvious ticket to safety and sanity.
The problem with the gray? Navigating it is the source of most of my patients’ anxiety and stress.
The complex decisions around risk and risk tolerance are driving fear and frustration, family discord, and — in many of my patients — COVID-19 itself.
Mixing unvaccinated and vaccinated people together is where risk and risk tolerance meet.
To help you make hard decisions about how to mitigate risk in new situations — as put your big toe into new situations, I offer three tools for you today:
Talk to your doctor. Our job, particularly in primary care, is to marry broad public health advice with your unique health situation. It’s to help you make hard decisions putting your medical data into context. It’s to help keep you safe AND sane.
Check out this handy-dandy risk calculator created by my friend and Brown University Professor, Emily Oster, PhD. Here she elegantly acknowledges that there’s no algorithm — no one-size-fits-all prescription — for human behavior (hence buttressing my job security!) yet aims to use accumulated data on COVID-19 risks to help guide complex decision-making.
Read this article by science journalist Tara Haelle about risk and making hard decisions. She nicely asked me to help with the piece, and it boiled down to this: it’s complicated! At the same time, let’s not lose sight of the big picture: our risk goes down with every shot in every arm around the country and around the world. The real-world data shows that vaccination is our ticket to the future.
The UPSHOT OF THE UPSHOT? Data without context isn’t useful. Nuance is everything. (In fact, I’d love to make a T-shirt that says “Make Nuance Great Again.”) Life is complicated, so is COVID. The road to recovery is long, but we’re getting there.
(Oh — and for the love of all things good, please stop wiping down your groceries!)
I will see you next week. Until then, be well.