How best to assess actual risk and personal responsibility?

The Quarantine Zone
1

My cousin has three kids that are too young to get vaccinated. Her pediatrician has told her that they’ve seen “a lot” of reports from parents of other patients who’ve gotten the delta variant while fully vaccinated. She’s concluded from this that fully immunized people can get that variant “fairly easily.”

From what I’ve read casually, this seems incorrect, but I don’t think I’m sure enough in my info to argue (and I’m not sure I’d want to regardless). But this got me thinking: am I, a fully vaccinated individual, being irresponsible or dangerous by, say, going to my Friday game night (six people max in the room, all vaccinated also)? Going to see my cousin’s kids if I’ve gone to the mall eight days previous? If I were to stop wearing my mask in public in the next two months (I haven’t yet, just a hypothetical)? Am I being a danger to myself and others if I don’t take precautions? To what level (for either side)?

So basically, I was wondering how you all came to conclusions about questions like this. Who did you listen to and trust? How did you deal with the moral questions? I’m especially interested in those of you who are otherwise healthy, as having risk factors (or having them close to you) definitely changes the equation quite a bit. (I live alone, FWIW, which alone makes my thinking different from my cousin’s.)

Just trying to sort through my conflicting feelings and doubts. Thanks!

2

I wouldn’t worry about a ‘conclusion’ of a cousin who is concluding something from information repeated from four degrees away. Theys and heard and been told.

Seek out and listen to your local public health authorities, follow their recommendations. Follow the CDC announcements. Read the NYT Covid coverage, it’s free.

Don’t be guided by the game of telephone.

3

Your cousin’s pediatrician is correct that an increase in breakthrough infections (symptomatic infections in people inoculated by vaccination or prior infection) has been observed with the B.1.167 variants (‘Kappa’ and ‘Delta’). However, vaccination, and in particular the mRNA vaccines (Pfizer/BioNTech, Moderna) still seem to offer good protection against severe illness and death based on trends where it is spreading in vaccinated populations compared to unvaccinated people. How much the newer variants compromise immune response is unknown because nobody is really doing comprehensive population sample testing and the virus often presents no symptoms in otherwise healthy people (although there has been an increase in severe infections in younger people compared to the original ‘wild type’ SARS-CoV-2 virus) but virologists and immunologists have suspected from the beginning that this virus would adapt and become endemic in the population.

The rate at which it has adapted and the pathology of the virus has been surprising because of the original perception of this being ‘just’ a respiratory virus, but that just reinforces the need for a comprehensive vaccination campaign as well as continued development of therapeutics and treatments for those who do get a severe presentation of the disease. What I’ve seen of the B.1.167.2 variant is worrisome although more for what it will do to the nearly half of the US population who apparently refuse vaccination, or to populations around the world that don’t have ready access to good vaccines; provided that we can get vaccines and booster shots in arms, this is far more manageable of a pathogen than the potential that many others have.

It is unfortunate that the guidance on vaccination status and preventative measures has been so muddled and politicized. If you are fully vaccinated and meeting with other fully vaccinated people, none of whom have had contact with someone suspected or known to be infectious, you have basically done all due diligence, and the question boils down to whether or not to continue to wear masks. Although a lot of emphasis has been put on masks as the primary prophylactic measure, there is still surprisingly little definitive data or studies on the effectiveness of non-respirator masks in confined spaces; it is, however, clear that little transmission occurs in outdoor and well-ventilated areas. I would personally emphasize ventilation over the wearing of masks in a group setting, particularly if you’re going to be taking them on and off to talk, drink, and eat.

As far as who to listen to and trust, I would refer to medical authorities knowledgeable in infectious disease who are independent of political agendas and vested interests. They may not always have complete answers for questions of risk because there is not enough information to produce definitive guidance, and they may hedge toward the more conservative response in absence of such data, but you can trust that they are at least being honest about what is known and unknown. I think if you apply that yardstick to the information and guidance you receive you’ll be able to suss out facts from speculation and nonsense, and are certainly way ahead of the people getting their information diet straight from social media.

As for “moral questions” of putting yourself and others at risk, that is something that everyone has to decide for themselves, but that you are even thinking about it puts you in the select category of people who even give enough of a damn to consider it. Given that this virus will become endemic, it isn’t realistic to avoid social and occupational contact indefinitely even if you have the means and privilege to do so, and if you and your friends are vaccinated, aware of the general status in your area (e.g. ICUs aren’t packed to capacity), and otherwise making a reasonable effort to mitigate possible transmission, you have done a reasonable amount of risk mitigation. I personally err toward the more cautious approach to returning to some kind of normal , meaning that I still don’t eat inside of restaurants, wear a mask (N95 and a cloth mask on top of it) at work and stores, and don’t plan to do any air travel for the foreseeable future, but I wouldn’t hesitate to meet with a small group of vaccinated and asymptomatic people who I trust to play games for a few hours.

Stranger

4

I would like to agree with that sentiment but I’ve frankly been shocked and dismayed about how guidance from many public health authorities has been inconsistent, unclear, out of date, or clearly driving by political agendas rather than proven science and empirical data, and how often epidemiologists speaking the ugly truth of what is known and unknown have been sidelined or ignored. There are a select few infectious disease experts in public facing roles such as Dr. Anthony Fauci who I generally trust to offer the best possible guidance and acknowledge what they do not know but so many seem either willing to bend to political pressure (and not just from the denialist side, either) or actually appear to not be well-informed and competent when it comes to infectious disease.

This is particularly shocking because the CDC has an entire service (the Epidemic Intelligence Service) which exists primarily to aid state and local health department response on dealing with infectious disease, and yet many states completely failed to utilize the EIS or follow any guidance offered by it. It would be good if state and local health authorities could be trusted as a whole to provide accurate and useful guidance but that has certainly not been demonstrated in this pandemic. But that is hardly limited to the US; the same is true in many other nations, with few actually implementing sensible measures to reduce contagion and then using objective metrics to assess when it was appropriate to ease restrictions.

In this era of data science and the ability to break down complex data and tease out obscure trends, it is inexcusable to be running public health assessment by seat-of-the-pants judgment. If a dilettante ‘data scientist’ like me can take publicly accessible data and render more accurate predictions and trends than the supposed experts in government, something is seriously wrong with the current system of public health surveillance and assessment.

Stranger

5

Covid has demonstrated once again that humans are NOT rational creatures. Viruses exploit this for their own benefit.

“What should I do as a moral person during this pandemic?” is a moving target.

I’m fully vaccinated and, at this point, since my employee is not requiring masks at work at the moment I’m not wearing one. The customers are a mixed bag - some do, some don’t. But if Delta starts running amok in my area we might well mask up again.

Are masks effective? Well, they help and if, like me, you’re coming into close proximity to 200-300 people in a shift every bit of help is worthwhile. All the precautions add up.

My current understanding is that I am less likely to get infected with Delta, and if I do, it will almost certainly be a mild illness. I don’t want to get covid again, but current science says if I do I should get through it OK. My risk is lower now than it was a year ago, but I’m still going to work and even starting to socialize a bit more now so I don’t go crazy.

The biggest problem isn’t those of us vaccinated. The big problem will be all the millions who aren’t vaccinated.

6

My wife and I are both fully vaccinated.

We have two pre-teen children who cannot yet receive the vaccine.

The risk calculus for us, therefore, is not about our personal danger, but potential transmission to our kids.

While evidence is increasingly solid that the vaccines make a major difference as far as the severity of the illness when a vaccinated person catches the virus, that’s not the key question for us. We’re looking for information on whether or not being vaccinated reduces communicability. And while data are starting to accumulate to suggest that having the vaccine makes it less likely to pass on the virus once acquired, it’s still preliminary and inconclusive.

Hence, my wife and I continue to mask in all appropriate situations, because we take responsibility for our children’s safety.

We look forward to the end of masking. But until we know that our vaccines create a meaningful bubble of safety for our kids, or until the vaccines are approved for younger recipients, we will mask.

7

I’ve kinda-sorta gotten accustomed to wearing a mask in indoor public places. I almost feel naked without it.