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When the coronavirus first surfaced last year, no one was prepared for it to invade all aspects of daily life for so long, so insidiously. The pandemic has forced Americans to grapple with life and death choices every day for the past 18 months – and there is no end in sight.
Scientific understanding of the virus is changing hour by hour, it seems. The virus is spread only through close contact or on contaminated surfaces, and then turns out to be airborne. The virus mutates slowly, but then appears in a series of dangerous new forms. Americans don’t need to wear masks. Wait, they do.
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At no point in this ordeal has the ground beneath our feet felt so uncertain. As recently as last week, federal health officials said they would begin offering booster shots to all Americans in the coming months. A few days earlier, those officials had assured the public that the vaccines were holding up against the delta variant of the virus and that boosters would not be necessary.
As of Monday, the Food and Drug Administration is expected to officially approve the Pfizer-BioNTech vaccine, which has already been administered to tens of millions of Americans. Some holdouts have found it suspicious that the vaccine was not formally approved but somehow widely distributed. To them, “emergency clearance” never seemed enough.
Americans live with science as it unfolds in real time. The process has always been fluid, unpredictable. But it has rarely moved at this speed, leaving citizens confronted with search results as soon as they land at the front door, a flood of deliveries that no one has ordered and that no one wants.
Is a visit to my sick relative too dangerous? Do the benefits of in-person schooling outweigh the possibility of physical harm to my child? Will our family reunion turn into a superspreader event?
Living with a finicky enemy has been unsettling even for researchers, public health officials, and journalists accustomed to the mutable nature of science. They too have often agonized over how best to protect themselves and their loved ones.
But for frustrated Americans unfamiliar with the roundabout and often controversial path of scientific discovery, public health officials have at times seemed to move the goalposts and turn around, or mislead, even lie, at home. .
Most of the time, scientists “move forward in a very gradual fashion,” said Richard Sever, deputy director of Cold Spring Harbor Laboratory Press and founder of two popular websites, bioRxiv and medRxiv, where scientists publish new research.
“There are dead ends that people go down, and most of the time you don’t know what you don’t know.”
Biology and medicine are particularly demanding fields. Ideas are evaluated for years, sometimes decades, before they are accepted.
Researchers first formulate the hypothesis, then design experiments to test it. Data from hundreds of studies, often carried out by competing teams, are analyzed before the community of experts makes a decision.
In the meantime, scientists present the results to their peers, often at specialized conferences closed to journalists and the general public, and refine their ideas based on the feedback they receive. It’s not uncommon to see participants in these meetings point out – sometimes harshly – every flaw in a study’s methods or conclusions, sending the author back to the lab for further experiments.
Fifteen years have passed between the description of the first cases of HIV and the identification of two proteins that the virus needs to infect cells, a discovery that is crucial in the search for a cure. Even after a study has reached a satisfactory conclusion, it must undergo rigorous review in a scientific journal, which can add a year or more before the results are made public.
Measured at this scale, scientists have become familiar with the coronavirus at lightning speed, in part by accelerating the changes already underway in this process.
Treatment outcomes, epidemiological models, virological findings – research on all aspects of the pandemic is coming online almost as quickly as authors can complete their manuscripts. “Preprint” studies are analyzed online, especially on Twitter, or in emails between experts.
What the researchers haven’t done is explain, in a way the average person can understand, that this is how science has always worked.
Disagreements and public debates that take place in public, instead of obscure lectures, give the false impression that science is arbitrary or that scientists make things up as they go.
“What a non-scientist or a layman doesn’t realize is that there is a huge bowl of information and a consensus that the two people arguing will agree to,” Sever said.
Is it really so surprising, then, that Americans feel bewildered and duped, even enraged, by rapidly changing rules that have profound implications for their lives?
Federal agencies have an unenviable task: to create the guidelines necessary to live with an unknown virus that spreads quickly. But health officials have not clearly or often enough recognized that their recommendations could – and very likely change – as the virus and their knowledge of it evolve.
“Since the start of this pandemic, it has been a pathetic job, to put it in the nicest way,” said Dr Syra Madad, infectious disease epidemiologist at the Belfer Center for Science and International Affairs at Harvard University. .
The leaders of the United States and Britain promised too much too soon and had to back down. Health officials have failed to change advice if necessary when scientists learn more about the virus.
And officials haven’t really defined the end of the pandemic – for example, that the virus will finally loosen its grip once infections drop below a certain threshold.
Without a clearly defined goal, it may appear that the authorities are asking people to relinquish their freedoms indefinitely.
A shocking flashback has been the orientation of masks by the Centers for Disease Control and Prevention. The agency said in May that those vaccinated can drop their masks, advice that has paved the way for a nationwide reopening. Officials have not emphasized, or at least not enough, that the masks may be needed again. Now, with a new wave of infections, they are.
“It can be very difficult for public perception and understanding when these large organizations seem to turn the tide in a way that is really not clear,” said Ellie Murray, science communicator and public health expert at the Boston University.
It doesn’t help that the CDC and the World Health Organization, the two major public health agencies, disagree as often as they have over the past 18 months – over what a pandemic, on the frequency of asymptomatic infections, on the safety of COVID-19 vaccines for pregnant women.
Most Americans have a good grasp of basic health concepts – exercise is good, junk food is bad. But many never learn how science progresses.
In 2018, 15-year-olds in the United States ranked 18th for their ability to explain scientific concepts, behind their peers not only in China, Singapore and the United Kingdom, but also in Poland and Slovenia.
In a 2019 survey by the Pew Research Center, many Americans correctly identified fossil fuels and the threat of antibiotic resistance, but they were less familiar with the scientific process.
And the fundamentals of public health are often even more mysterious: How does my behavior affect the health of others? Why should I get the vaccine if I consider myself to be low risk?
“People weren’t prepared until they understood a lot of these concepts,” Madad said. “We should have known that we couldn’t expect audiences to change their behavior in no time. “
Information and misinformation about COVID-19 is surfacing online, especially on social media, much more now than in previous public health crises. This represents a powerful opportunity to fill knowledge gaps for many Americans.
But health officials have not taken full advantage of it. The CDC’s Twitter feed is a robotic stream of announcements. Experts at the agency must not only convey messages, but also answer questions about how the evolving facts apply to American life.
And health officials need to be more nimble, so bad actors don’t define the narrative while real advice is held up by a traditionally heavy bureaucracy.
“They are not moving at the rate at which this pandemic is evolving,” Murray said. “This obviously creates a perception among the public that you cannot just rely on these more official sources of information.”
In the midst of a pandemic, health officials have some responsibility to counter the many spurious voices on Twitter and Facebook that are spreading everything from pseudoscience to lies. Risk communication during a public health crisis is a special skill, and Americans right now need the balm.
“There are people whose confidence trumps their knowledge, and they are happy to say things that are wrong,” said Helen Jenkins, an infectious disease expert at Boston University. “And then there are other people who probably have all the knowledge but keep quiet because they’re afraid to say things, which is a shame too, or just aren’t good communicators.”
Health officials could start now with 2 minute videos explaining the basic concepts; information hotlines and public forums at local, state and federal levels; and a responsive social media presence to counter disinformation.
The road ahead will be difficult. The virus has other surprises in store, and myths that have already taken hold will be difficult to erase. But it’s no exaggeration to hope that the lessons learned from this pandemic will help experts explain future disease outbreaks, as well as other pressing issues, like climate change, in which individual actions are contributing to the disease. together.
The first step in educating the public and gaining their trust is to make plans, and then communicate them honestly – flaws, uncertainty and all.
© 2021 The New York Times Company
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