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A friend invited me to her house for a birthday party. “Ten of us will be there,” she wrote. “I’m pretty sure we’ve all been vaccinated so we should be fine.”
It was the first invitation to an indoor dinner that I had received in almost a year.
Six other friends are planning a tropical vacation and have invited me to join them.
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“Aren’t you worried about Covid? I asked, feeling a little cheesy for raising the question.
“Not really. Two of us got our two shots.”
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“And the others?”
“Two got a shot each, and the other two were very careful.”
And this from another friend: “I feel like I just entered Harvard Law School!” she wrote. “I just received my first vaccine! But is it now okay to fly if I wear a mask all the time? “
These people are grappling with the same safety issues that I struggle with because they have just been vaccinated. We wonder how to change our behaviors and interactions, and understand how protected we and others we meet are – or not.
In early March, the Centers for Disease Control and Prevention released guidelines stating that fully vaccinated people can visit each other or members of a single unvaccinated household indoors without wearing masks or physically distancing themselves. These clarifications, along with the fact that millions of Americans are now being shot, are good news.
But how are the Americans going to react? Over the coming weeks and months, millions of people will be faced with a myriad of nuanced and complex individual choices – which gatherings to attend, with whom, and how certain we need to be sure that we are indeed safe from it. the spread or reception of the virus.
The problem is, humans are not good at assessing risk.
Young people without masks are now flocking to bars. Texas Governor Greg Abbott has decided to fully open his state. As its ruling indicates, many people can now engage in risk compensation, in which they act riskier if they have taken actions they believe are protective. Seat belt use, for example, has failed to reduce fatal car crashes, as seat belt drivers then compensate and drive faster or less safely. Using sunscreen has increased melanoma rates as people feel they can now get more sun.
Vaccines are absolutely essential in stopping Covid-19, but they reduce – not entirely – the chances of getting infected with the virus. The Pfizer and Moderna vaccines are about 95% effective in reducing serious illness, while the Johnson & Johnson vaccine is about 85% effective. These are high figures for vaccines, but not guarantees of safety. For every 20 people who receive the injections of Pfizer or Moderna, one could still acquire Covid-19 and become seriously ill.
Covid-19 and other viruses also mutate, sometimes rapidly. While billions of cells in millions of humans reproduce the virus, its genetic material is constantly changing, sometimes in ways that bypass our defenses and vaccines. At least one vaccine has been shown to be significantly less effective against one of these mutations. Current vaccines may not end up protecting against all of the newer variants.
Scientists are also unsure how long vaccine protections will last and whether vaccinated people can be infected and spread Covid-19, even if they themselves do not get sick.
The human brain has evolved to face simple risks, such as whether a particular plant is safe to eat. But far more complex and nuanced dangers now fill our world. Neurocognitively, we usually assess risk using something called quick thinking, which is basically gut feelings. As anthropologist Mary Douglas wrote in her classic book, “Purity and Danger”, people tend to divide the world into two areas: “risky” and “safe” – which is dangerous and to be avoided in comparison. to what isn’t – or essentially bad versus good. Our brains see these dichotomies in black and white rather than shades of gray. We don’t deal well with ambiguities or notions of relative safety, and we like to think of situations as just totally safe or dangerous, rather than partly or relatively safe.
Public health officials have long recognized such complex realities around harm and safety. To remedy this, they implemented so-called harm reduction strategies. The fight against HIV is one example. Some people who injected opioids or other drugs into their veins shared needles, spreading HIV and hepatitis, which can lead to illness and death. Over the decades, federal and state and local governments have spent hundreds of millions of dollars trying to end addiction, but with limited success. One solution to preventing HIV from spreading was to provide clean needles – a harm reduction approach. Although many states have strongly opposed this tactic, fearing that it will fuel addiction, it helps drastically reduce HIV infections and does not foster addiction.
In the months to come, many people will be faced with complex decisions with no easy answers. While the desire to feel safe from Covid-19 runs deep, we need to accept and adjust to much more complex realities, like how comfortable we are with everyone at a dinner party having in fact been completely vaccinated and did not enter into a relatively crowded subway, bus, store, bar or other area without a mask.
The CDC, the Food and Drug Administration, and other federal, state, and local public health agencies, as well as elected officials, hospitals, physicians, and medical associations, must work urgently to improve public understanding of these questions through appropriate public health messaging campaigns. These messages must convey the complexity of the risks: being vaccinated is not a 100% guarantee of safety.
Each of us must be careful. Research suggests that until the vast majority of people get vaccinated and wearing masks and social distancing when they should, Covid-19 will remain around us in schools, stores and elsewhere.
I had more information about the birthday party and learned that all attendees will be fully vaccinated before the event. So I’m leaving. I also decided to join the beach trip, but I will be driving, not flying, and I will continue to wear a mask and social distancing.
I look forward to more invitations, but I’m not sure how I’m going to respond to them.
Robert Klitzman is a professor of psychiatry at Vagelos College of Doctors & Surgeons and the Joseph Mailman School of Public Health, both of Columbia University, director of the online and in-person masters programs of the university’s bioethics programs, and author of “The Ethics Police ?: The Struggle to Make Human Research Safe ”(Oxford University Presse, 2015).
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