Trust Science
Tonight I have the distinct honor of interviewing Dr. Monica Gandhi, Professor of Medicine and Infectious Diseases and Global Medicine specialist at UCSF/San Francisco. (Details at the end.)
Since the pandemic hit, Dr. Gandhi has had her finger on the pulse of COVID-19. She has provided a wealth of scientific information and public health guidance to a wide audience through academic journals and on Twitter.
(I’m now addicted to Twitter thanks to her and other physicians like Julia Marcus, MD, at Harvard Medical School, Sapna Kudchadkar, MD, at Johns Hopkins, and Ashish Jha, MD, at Brown University School of Public Health, etc.)
Dr. Gandhi has been a consistent voice of rational thinking and decision-making rooted in public health while considering broader, complex human needs.
Specifically, she shares my evidence-based optimism about the vaccines—even with the new variants bearing down on us. Last week she published this MUST-READ article about the vaccines and new variants: “Want to Motivate Vaccination? Message Optimism, Not Doom.”
I completely agree with her: widespread vaccination is the path toward resuming normalcy. And when hope is rooted in science, medical folks should dispense it. Just as false hope can do harm, so can negative messaging and fear mongering.
For example: the new variants are worrisome. But the sky is not falling as the headlines might suggest. Indeed, just like the J & J vaccine, the Oxford-AstraZeneca vaccine has been found to be less effective against mild-to-moderate disease due to the South African variant (B.1.351), but that does not mean that the AZ vaccine doesn’t prevent severe disease and death from this variant of coronavirus. In fact, the J & J vaccine still completely (aka 100%) prevented hospitalizations and death from COVID-19. (In other words, there’s still a chance you could get a flu-like illness even after vaccination, but you won't get terribly sick or die.)
Indeed, the current data show that the available Pfizer and Moderna vaccines also offer protection against the new variants. To remind you: two weeks after the second dose of the Pfizer or Moderna vaccine, we are 95% protected against COVID-19 and 100% protected against death and severe disease.
That's astoundingly good. But what exactly does protection even mean? And how does that translate into real life? She and I will discuss exactly these very issues tonight.
And will the vaccines always offer protection against every variant? Probably not. The virus will continue to mutate and, ultimately, the variants may outsmart the vaccines. What do we do then? We simply adjust the vaccines like we do the flu shot every year. The scientific community and vaccine manufacturers already are on the case.
In other words, we needn’t assume the fetal position with every headline. Science has our back. Our jobs?
Continue to mask up, distance, hand wash, and avoid crowded indoor spaces.
Get vaccinated (try screaming into a pillow if you’re eligible and can’t yet access it).
Trust science.
Maintain hope.
Hopefulness not only motivates people to get vaccinated; it also can fortify those of us who actually want the damn shot but can’t get our hands on it.
Adding insult to injury for anyone frustrated with the bungled vaccine rollout is the somber messaging from many public health experts that, when together, vaccinated people should continue to wear masks, distance, and avoid indoor spaces. This does not make sense. Nor does it make sitting on hold for hours with your Health Department any more pleasant.
As above, the current vaccines are ridiculously effective. The odds of two vaccinated people sickening one another is essentially zero—even with the new variants upon us.
Dr. Gandhi wrote last week, “Although it is prudent for those who are vaccinated to wear masks around the unvaccinated in case a slight risk of transmission remains, two fully vaccinated people can comfortably abandon masking around each other.”
(We’re also seeing early data showing what we already suspect: that vaccination likely also prevents transmission of the virus. When that pot of gold is proven, friends, it will be a whole new ballgame!)
But many public health officials would still say that two vaccinated people unmasking is unsafe and not recommended—that we need to wait until we’ve achieved herd immunity for anyone to unmask. To me and many of my medical colleagues, this kind of heavy-handed and coarse public health advice that ignores our broad human needs (and our universal desire to connect with others) is the quickest way to erode people’s trust.
Here is where we need to understand public health guidance and personal decision-making. Here is where tiered messaging matters. Here is where we need to invoke “harm reduction,” which, when applied to preventing infectious diseases, is the principle of advising individuals on risk mitigation, while acknowledging the real-world conditions that may lead individuals to take some risks.
“The public will be more inclined to trust health officials if those officials communicate with nuanced messages backed up by evidence, rather than with broad brushstrokes that shame” says Dr. Gandhi.
You and I are smart enough to understand context and nuance. We know to mask, distance, handwash, and avoid indoor spaces when we are not yet immune or in the company of non-immune people (although not everyone chooses to agree). With guidance and facts, most of us are capable of weighing risk and reward and making reasonable decisions. We all want the same things: health, safety, and human connection. Fortunately, vaccination can offer us all three.
I hope you will join us on Facebook live tonight at 4:45 pm PT/7:45 pm ET. (I will send out the recording later this week.)