How researchers get heard

A Number Isn’t an Answer

I’m a season ticket holder for the Major League Soccer club DC United. After a couple of horrible, painful years, the team has a new young coach and (this just in) the second female general manager in league history. Saturday night is the season’s opener.

It’s been a year — a heIluva year. I’m a little scared, but I want to go.

So when the DC government announced in March it would permit United to host up to 2,000 fans for matches at the team’s 20,000-seat stadium. I asked my soccer buddy (who’s north of age 70 but fully vaccinated) if he’d like to go with me (who just got my second shot). He said yes enthusiastically. Ten percent capacity seemed safe to us. So I bought two tickets.

Then the DC government announced late last week that it would now allow DC United to admit 5,000 fans to matches this season — and DC United announced, yes, it would take advantage by selling 3,000 more tickets for Saturday night.

What does science say about whether it’s still safe for my buddy and I to go?

The salient answers include:

1) There’s one study that kind of has an answer.

2) Lots of science authorities have opinions — wildly differing. Authorities disagree. Fauci says avoid crowds, as does the CDC. Others say the CDC recommendations are far too strict. Pick your authority.

3) Wrong question. The vaccine was our finish line, and we (my buddy and I) crossed it. We want our lives back, at least in non-reckless ways. We get to make our own decision.

That one study: this MedRxiv pre-print looking at whether, in the 14 days after NFL and NCAA football games with spectators were held in cities and towns, COVID rates increased in those places. Not much, except for crowds over 20,000 (which happened in Tampa — why?). Based on the study, it seems as if attendance under 5,000 is safe, although it doesn’t discuss whether smaller stadia might increase one’s risk.

But even if we had a hard number, it increasingly wouldn’t be an answer — not in the way it was last year, when at least some of us were “listening to the science.”

Economist and ParentData author Emily Oster, who has been writing cogently about the pandemic since it began, put forward last week what Oster called two simplifications: 1) Vaccinated people can start to return to their normal lives. 2) We should assume that vaccinated people are safe.

Oster wrote:

The COVID-19 vaccines are really, really good. Our latest numbers suggest something close to 100% (it cannot really be 100%) protection against serious illness and death. This includes known variants. Protection against any illness also looks like it is running around 90% in the latest data. This latter fact — combined with the fact that any post-vaccine infections are likely to be asymptomatic — means vaccinated people are also extremely well protected against transmitting the virus.

Oster also came up with a calculator to try to more flexibly capture the risk of indoors scenarios with different combinations of vaccinated and unvaccinated people. To me, it redefines user unfriendliness, and I gave up trying to use it after about 30 seconds. I felt better about that cart abandonment after I read her closing line on the limits of the calculator:

Most importantly: even if this did capture every number, it wouldn’t give you an answer, because no two people will have the same reaction to a given number. The key, as always, is to look at the risks, look at them in context, and think about how they feel to you.

The number is no longer the answer, everywhere in the United States.

Scientists might not like it, but we are entering the stage of the pandemic (at least in the United States) in which vaccination is allowing people to make decisions about what the numbers mean for them, rather than the other way around.

Which is how it should be, as I’ve written previously. Even if we “listen to the science,” we always make up our own minds.

That dynamic even applies to scientists. Science Insider asked Fauci what additional activities he feels comfortable engaging in, now that he’s vaccinated. Not many more than before vaccination, it turns out — but that’s because, as he admits, he doesn’t have time for them. “I’m a very unusual person,” he says.

The article exposes a frequent contradiction in science communications: We turn to an authority figure as an embodiment of “science,” to listen to what “science” says — because we trust people, not institutions. We turn to that authority, only to find out their personality is what’s driving their recommendations and framing.

Science communications needs to admit that it’s not only vaccines that have ushered in a normalized rebalancing between scientific, political and citizen authority. Science and public health communications and policy haven’t helped matters with spectacular misses.

As Joe Nocera and Faye Flam discuss in a recent column for Bloomberg Opinion (“The Pandemic Isn’t Over, But We’re Over It”), Florida never really closed — and yet its cumulative death rate is far less than many states that, at least on paper, have played by the epidemiological rules. Indeed, the top 10 states with the most cases per capita over the last week are all states with strict COVID controls. And while science can’t explain why US COVID cases fell precipitously from mid-January to late February —prominent experts like Michael Osterholm and Eric Topol continued to predict a catastrophic new wave of infections. (And still do, in the case of Osterholm.) This list is by no means exhaustive, of course.

Nocera, who has been fully vaccinated for a month, tells Flam he feels liberated. “I’m ready to go back to the office, eat in a crowded restaurant, hear some live music and visit a museum,” he says.

Vaccine optimism is going to overwhelm any and all cautionary advice. Which I think is fine. In the end it is the role of the scientist to tell us what the risks are and how to mitigate them. But it is the role of the politician to make the risk-reward calculus, to decide how much risk is worth taking to keep a society functioning. At this point, even if there is a fourth or fifth or sixth wave, no governor is going to call for a lockdown. The citizens have made their own risk-reward calculation.

Flam quotes an email from risk communication consultant Peter Sandman to explain this attitude:

“(People) have spent the year complying as best they can with recommended precautions: wearing masks, staying six feet away from others, avoiding indoor events and crowds, canceling travel plans. All along, they have assumed that vaccines … would replace this menu of burdensome non-pharmaceutical interventions … 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.”

Takeaway: At this point in the COVID science communication cycle, science cannot drive the policy or public behavior buses. Risk as individual decision has reasserted itself.