Reopening as COVID-19 fades is not a science

The accelerating reopening of businesses in the U.S. doesn’t violate “the science” of covid-19. Some individual scientists are warning of increased virus deaths associated with these choices, but there’s no science that can tell us precisely how to balance public health with other human needs. Some people want to minimize covid-19 cases at all costs – but that’s a moral stance. It’s not “the science.”

Yet as tension grows over governors’ decisions to reopen restaurants, gyms and other venues, CDC director Rochelle Walensky not only warned that the U.S. could see a surge in new cases, but pleaded with Americans to continue with public health measures like masks, solitude and avoiding travel. This sort of public health advice conflates science, morality, values and partisan politics. We’ve seen too much of it in the past 12 months.

Risk communication consultant Peter Sandman made the distinction this way: “I am simply not interested in an epidemiologist’s opinion on whether schools should be reopened. I’m interested in an epidemiologist’s opinion on how much more the virus will spread if schools are reopened. Whether schools should be reopened – that’s not their field. It bothers me when they try to pretend that it is.”

UCSF physician Vinay Prasad took a similar view. “Science can only articulate our best estimate of what would happen if we did something or if we did something else. But science can’t tell you how to value those things. Those will always be decisions for the body politic.”

At this point most people know the vaccines aren’t perfect, but the signs are everywhere that many people think they’re good enough to return to travel, restaurants and other activities. That means public health officials need to be more specific and less draconian.

Sandman says he thinks the public health community is still compensating for the early 2020 blunders downplaying covid’s risks. “I think when they realized their mistake they overcompensated and became excessively pessimistic instead,” he wrote me in an email this week. He sees this in the way they’re still recommending that fully vaccinated people shouldn’t travel, and the long months it took to allow public schools to open with a more realistic three-foot social distancing rule.

When I asked him whether this pessimism is related to any conflict between science and people’s needs, he said public health officials’ excessive caution “is much less grounded in ‘the science’ than they would have us believe.”

Prasad admits there has been a lot of educated guessing about which restrictions to impose. “How many things did we do to fight SARS-CoV-2? I conservatively estimate ten thousand to a hundred thousand different interventions,” he says. Those ran the gamut from closing national borders to removing basketball hoops. “You’ll never know if that if that one basketball rim was the culprit. You just won’t have enough data to tease that out.”

It’s fine to warn people that the crisis isn’t over; we don’t know whether the new, more transmissible variants will cause a new wave. But we’re seeing a more dysfunctional relationship in which scientists suggest untenable rules and people get called selfish for failing to follow them. It could be driving people toward indifference, fatigue, distrust and suspicion that rules are being imposed with ulterior motives.

Whatever the CDC says, Sandman says he suspects even many compliant Americans will go back to normal after vaccines are widely available. “All along, they have assumed that vaccines, if and when they became available, would replace this menu of burdensome non-pharmaceutical interventions with a much less burdensome pharmaceutical one: a shot, or maybe a couple of shots,” he says. “Now they’re told that after they’re vaccinated they should nonetheless keep taking most of the precautions they’ve been taking for a year already. That doesn’t just feel like a betrayal. It feels like an exercise in futility.”

There’s a lot science can tell us about relative risks of returning to normal activities, and it’s important for public health officials to keep people informed on any risks that might persist post-vaccine. But it’s time to stop disguising their preferred goals and trade-offs as “the science.”