Mixed messages on travel, variants causing confusion
To anyone following along the thrill ride of the pandemic from day to day, one thing is clear: There is a lot of uncertainty about the state of the coronavirus in the United States right now.
With national vaccination efforts picking up speed and a large swath of the U.S. population fully immunized, it’s both a hopeful and precarious time, public health experts say. The end is in sight — but there’s plenty of time to screw it up and needlessly prolong the pandemic.
The country has entered a “twilight” stage of the pandemic, said Dr. Monica Gandhi, an infectious disease expert at UCSF. Guidance on what’s safe and what’s not, and how grim
the situation is in California or any other state, sometimes seems to change hourly, and is often dependent on who’s talking.
And as more people become vaccinated, the burden of responsible decisionmaking is shifting, too. For the past year, health officers and other scientific and medical experts have been telling people what to do or not do, in short, pointed messages. Now, individuals increasingly are having to figure that out for themselves.
“It’s like your teenager just got their license, and you want to message both caution and optimism at the same time,” Gandhi said. “So you’re like, ‘Of course you can go out and drive and meet your friends, just don’t speed. You may die, but you can go.’ ”
That dynamic played out starkly Friday, when the Centers for Disease Control and Prevention released new travel guidance that stated people who were fully vaccinated can fly freely about the country. An hour later, the head of the agency was telling Americans not to travel, because it’s too risky with hot spots emerging around the U.S.
California issued similarly cloudy travel advice last week, when it lifted its local advisory against traveling more than 120 miles from home — but at the same time reminded people not to travel and recommended “staycations.” Indoor dining is now allowed in almost every county in California, but several local health officers have told peo
ple they shouldn’t do it anyway.
Meanwhile, the state hasn’t yet adopted CDC guidance on what is safe for vaccinated people to do, such as visiting lowrisk grandchildren or meeting indoors without masks with other people who are immunized.
In fact, what’s safe for people who are vaccinated has become an especially complex conversation, as public health experts try to balance two sometimes contradictory statements: that people should get vaccinated so they can prevent illness and return to their normal lives, but once fully immunized they should continue practicing protective behaviors like wearing masks and not gathering in large groups.
“At some point it becomes very, very difficult to justify these restrictions,” said Dr. Bela Matyas, the Solano County health officer, who has been
one of the few Bay Area authorities to push back against the region’s generally conservative guidance.
Mixed messaging has at times defined the pandemic — the most notorious example may be the early advice not to wear masks, later revoked when public health officials decided face coverings were one of their most useful tools to prevent the spread of the disease. But in some ways it’s more blatant now than ever before.
And that’s understandable, many experts say. There are good reasons for the lack of cohesion. Different rules apply to those who are vaccinated versus those who are not, for starters. And the vaccines themselves are still so new that there’s a lot scientists don’t yet know about how protective they are. One outstanding question is whether people who are vaccinated can still spread the virus — studies increasingly suggest that’s unlikely, but many public health officials remain concerned.
In addition, the coronavirus variants pose an uncertain threat that’s hard to convey to the public.
“Humans like to have intellectual scaffolding to hang things on. Faced with uncertainty and existential dread, we like to have a framework,” said Dr. Robert Wachter, head of the Department of Medicine at UCSF. The country spent the past year developing such a framework to COVID19 that most people adapted to. But vaccinations and variants have required an adjustment.
“We have to now take a step back and say here is a new scaffolding, here is a new framework. It’s a transitional time,” he said.
The current state of the pandemic — specifically, the emergence of what seems to be a fourth surge in parts of the country — further muddies the national and even local messaging. In some states the virus is spreading far and fast, perhaps fueled by more infectious variants. California, though, is still looking relatively well protected, though there are some signs of small upticks in cases.
But that means that people can get wildly different viewpoints about the pandemic depending on when, where and from whom they’re getting their updates. Bay Area public health officials in general have been far more conservative in how they talk about the pandemic and how people should protect themselves than in most other parts of the country — and that mostly remains the case.
Even as the Bay Area continues to stand out as having much lower case rates and hospitalizations than many other parts of the country, it’s not surprising that the local public health officers are sticking with a more cautious thread of guidance, said Dr. Stephen Shortell, former dean of the UC Berkeley School of Public Health.
When Dr. Sara Cody, the Santa Clara County health officer, warns people not to dine indoors at restaurants, even though it’s allowed, “she is expressing her conservatism to some extent, as a health officer and as an individual,” Shortell said. “She’s feeling responsibility for everyone in the county. And maybe with her experience, that the pandemic broke out first down there, it’s understandable she’s more cautious.”
Gandhi said that she also recognized a regional hesitancy among Bay Area health officers that has resulted in some statements that don’t quite align with the state or national picture.
“I think people are traumatized by surges one, two and three. And they sometimes forget we have this lovely protective veneer of vaccines being put down as we’re lifting restrictions slowly,” Gandhi said. “They forget to check their messaging.”