Thread by @ASlavitt

COVID Update: I’ve interviewed well over 100 experts now. With omicron, the graphs & opinions are many but the truths are muddled.

There are plenty of contradictions including 8 important ones. In that muddy world, 2022 will be shaped by differing circumstances & 3 attitudes. 1/

1. Some of the scientists I respect the most, like @DrTomFrieden & @Farzad_MD are expressing doubts that with omicron, efforts to prevent contagion are realistic.

Yet, there are many of us who have worked hard to avoid COVID & don’t want to stop now. 2/

2. Omicron, either because of our T cell response, vaccination rates, inherent challenges in spreading to the lungs, or some combination is less likely to put any one of us in the hospital.

Yet hospitals will be swamped because enough people will still get sick. 3/

3. The number one thing you can do to protect yourself is to get boosted.

Yet even with 3 shots, there will be plenty of breakthrough infections— that generally don’t lead to being hospitalized or that some label “mild.” 4/

4. The very definition of mild is problematic & in the eye of the beholder.

Potential loss of smell/taste, symptoms that linger (as my son can attest a year later) & the ability for anyone to spread COVID make “mild” a problematic description. 5/

5. A population where many feel personally safer— say there turns out to be a 50-75% reduction in hospitalizations— would cause many to let their guard down & increase spread.

Yet that reduction still adds up to a horrible number of deaths— hundreds of thousands/year. 6/

6. The very nature of a variant that is so easily spread leads many to feel like we must enter a more sustainable state of lower restrictions.

Yet this perpetuates the lax response & drives down the use of low-hassle measures like mask wearing. 7/

7. Public health guidance changes as the science does. Incubation periods, vaccine recommendations, boosters, type of masks get thrown up in the air with time & viral evolution.

These changes cause some to lack trust in guidance & others to see it as hopelessly behind. 8/

8. And we can’t know the future: will omicron infection protect against new variants (or delta)? How often will vaccinations be recommended?

We have to make decisions & policy with this real uncertainty. 9/

The very nature of these contradictions requires more nuance than most public health communicators are capable of.

There are few absolutes.

As a result, we’re all processing things through our own individual circumstances & attitudes. 10/

An example: Many people will know dozens more people positive with COVID than very sick from COVID & particularly for many younger ones, it’s not a surprise that many are ready to move on.

Yet if you have a family with an organ transplant that indifference is lethal. 11/

Personal circumstances— young/old, vaxxed/unvaxxed, immunocompromised, salaried v front line, already touched by COVID, in school or apart from family— have as much to say about how these contradictions are interpreted as some absolute truth. 12/

And attitudes— towards science, government, faith, what you believe to be your obligation to others in society— even more sharply define how people interpret the data they hear about omicron. This accounts for the presence of 3 prevailing sentiments. 13/

There are 2 near absolute views present both on Twitter & to some degree IRL.

One is “it’s inevitable.”

The other is “zero COVID.”

While in conflict, both can find a basis in fact and both promote different prescriptions.14/

This “it’s rainy” & “it’s sunny” could persist if we end up with a virus that doesn’t end up killing in high percentages but is not a common cold. The more who feel safe, the less safe for those who aren’t.

Policy decisions become increasingly challenging. 15/

The “it’s inevitable” thinking isn’t the 2020 “herd immunity” crowd that discouraged interventions & destined many to die.

People in this camp view delta & omicron as nearly impossible to contain & high unvaxxed rate as immutable. Policies in SA post-omicron reflect this. 16/

Policy approaches here call for a lighter touch. For example, recommend boosters only for those at highest risk & when they prevent hospitalization, but not to prevent infection.

But critics view this as “giving up” & damning people to die.
17/

Zero COVID was a prevailing 2020 view to aim for complete containment. With a slower growing virus, lack of tools & hope of a coming vaccine, aggressive action seemed both time limited & achievable.

Many still see this as the right, most humane answer.18/

Those who do can point to the outrageously high death count, many who can’t be protected & long COVID— as evidence for a much sharper policy response on masks & mandates.

But critics ask “for how long” & how realistic it is at preventing spread. 19/

Many feel in between, accepting some level of uneasy ambiguity & deciding day to day.

-take calculated risks for priorities like school & family
-test frequently so as not to expose others
-wear masks in crowds
-check local conditions & adjust

20/

This approach respects that data is evolving & also that the virus appears fit enough to last but it can feel like extended limbo.

It makes policy responses more uncertain. Recommend boosters whenever they wane? Require vaccinations? Masks? Travel? 21/

Any approach for addressing COVID is open to criticism because the pandemic doesn’t present the opportunity for perfect answers.

Criticism is often warranted— particularly of people like me in the public arena. But attacks on those with honest disagreements are too common. 22/

It’s easier to find a graph or a study to retweet that reenforces a view than it is to grant the nuance to at validates opposing views.

As of today, those who see omicron as milder are just as right as people who see it as potentially more dangerous. 23/

For me, my baseline is to advocate for policies that favor those with the fewest choices—

-Require vaccines when in crowds
-Preserve best anti-virals for immunocompromised
-Support frontline health care workers by reducing spread. 24/

2022 will have twists & turns but we have many tools we should use to both minimize death & maximize living.

Certainty seems like the only sure mistake. /end