"Throughout this book, six principles of effective crisis and risk communication are emphasized:
1. Be First: Crises are time-sensitive. Communicating information quickly is almost always important. For members of the public, the first source of information often becomes the preferred source.
2. Be Right: Accuracy establishes credibility. Information can include what is known, what is not known, and what is being done to fill in the gaps.
3. Be Credible: Honesty and truthfulness should not be compromised during crises.
4. Express Empathy: Crises create harm, and the suffering should be acknowledged in words. Addressing what people are feeling, and the challenges they face, builds trust and rapport.
5. Promote Action: Giving people meaningful things to do calms anxiety, helps restore order, and promotes a restored sense of control.
6. Show Respect: Respectful communication is particularly important when people feel vulnerable. Respectful communication promotes cooperation and rapport."
> 1. Be First: Crises are time-sensitive. Communicating information quickly is almost always important. For members of the public, the first source of information often becomes the preferred source.
Fauci saying masks don’t work before he said the opposite.
> 2. Be Right: Accuracy establishes credibility. Information can include what is known, what is not known, and what is being done to fill in the gaps.
Instead of saying they didn’t have enough information about outdoor transmission, they threw out the 10% number as a random CYA. See above about the first number being sticky.
> 3. Be Credible: Honesty and truthfulness should not be compromised during crises.
Fauci saying masks don’t work, and also the 10% number being thrown out there without caveating that it’s a wild ass guess.
> 4. Express Empathy: Crises create harm, and the suffering should be acknowledged in words. Addressing what people are feeling, and the challenges they face, builds trust and rapport.
Fauci berating people for being upset that their lives are being shut down by government orders.
> 6. Show Respect: Respectful communication is particularly important when people feel vulnerable. Respectful communication promotes cooperation and rapport.
Instead of respect, we got demonization of half the country.
A significant and vocal portion of the country thinks its okay to bully and berate officials.
Anna Maria Barry-Jester: "People are not willing to be governed," at least not by officials who ask them to make sacrifices for their neighbors. And as a result, the officials, trying to govern us are quitting in droves. Since the beginning of the pandemic, nearly 250 public health officials working in communities all over the US have left their jobs, many because of threats and political pushback.
Nearly one in six Americans now lives in a community that has lost its local health department leader during the pandemic, officials like Mimi and Gail. It's the largest exodus of health officials in US history.
I think that partly has to do with CDC overreach. For instance, CDC mandated an eviction moratorium. You can agree with the moratorium, but is that really something the Center for Disease Control should be involved in?
Also, some nursing schools have seen record applications, suggesting people actually want to help. You provide no scale for that 250 public health officials.
I listened to that TAL recently and how they were treated was outrageous.
But NPR reveals some bias in a couple of instances. For example, they describe how the health officials had to rescind the order prohibiting people from being on the beach because it was impossible to enforce. An unasked question is whether an order to close beaches might have engendered skepticism of public health officials' judgement.
It's okay to be skeptical. I think we look at how officieals closed the beaches, know now that outdoor spread is rare, and say that it was an obvious misjudgment. But this ignores the practical reality of what happens when the beaches are open, which is this sort of thing:
> “We don’t want people from higher-impact counties who maybe haven’t done as good a job as Santa Cruz has to come in and spread that virus,” Hart said. “In ordinary times, we love people coming in, right? Our economy is driven on tourism and agriculture. We want people here during normal times. This is not a normal time. So we don’t want those folks here from Sacramento or other areas,” Hart said.
> The law breakers have been all ages, but a few whom deputies caught were teens who gathered in a car near the beach and passed around a bong, Hart said.
Maybe the officials should have left the beaches open and tried a message like "it's okay for Santa Cruz locals to go to the beach, but this thing spreads through the air in enclosed spaces, so please everyone take your own cars or drive with the windows open, and we don't want people from outside communities coming here and spreading the virus."
I believe health officials were generally operating in good faith. That doesn't mean they were always correct. I'd like to ask what they were thinking when they closed the beaches, but I don't think it was a simple calculation.
I think the calculation was wrong. It's not a question of whether being outdoors was safe or not, it's about whether or not it's safer than gathering indoors. Instead, they naively thought that closing outdoor gathering spaces would leave people with no option besides privately quarantining rather than--predictably--gathering indoors away from regulators. And while we didn't know precisely how much safer it was to be outdoors than indoors, we certainly knew that it was quite a lot safer.
Anyone who paid attention in high school biology knew that the beach is close to the safest place you could be during a respiratory pandemic. The literature on fresh air and sunshine improving tuberculosis outcomes is a century old.
>> Instead of respect, we got demonization of half the country.
> I don't think this is entirely fair. I'd invite you to at least listen to what local public health officials were dealing with...
~Half the country was ~demonized (or more importantly: perceive themselves to have been demonized), or they were not. Whether it was ~justified is certainly relevant, but it has no bearing on the fact, and more importantly: the second order behavior that will result from that fact, perhaps for several years.
The CDC guidelines seem to have been written in a way that is mindful of this complexity, but it seems they were not followed for some reason (do you point your critical eye at these shortcomings, and with the same enthusiasm and scrutiny as you point it at the members of your outgroup?), which will likely have some negative consequences, most of which we will be completely oblivious to (not to worry though: we'll imagine plenty of others, and consider these imaginations to be reality).
> A significant and vocal portion of the country thinks its okay to bully and berate officials.
And whose fault is that, comprehensively and accurately? Is the suboptimal behavior of black people in inner city ghettos purely their fault? Should they just work hard and pull themselves up by their bootstraps? INB4: That's different! That's whataboutism! That is not comparable! Mother nature decides how reality unfolds, based on recursive causality far beyond our ability even conceive of, let alone measure and understand. You and I can only decide (to whatever degree we have free will) how we shall conceptualize the situation, and then how we shall act. One can perceive it simply, with a high level of confidence in the correctness of one's biased guesses, or one can exert effort to perceive it more accurately, closer to how it really is: unknown. Just as the people in the article have chosen a way to perceive reality (my guess: low complexity, high confidence), so too do you and I choose a way - and based on such choices, reality unfolds according to the laws of the universe - our respective agreement with how this is, is not a requirement.
> Since the beginning of the pandemic, nearly 250 public health officials working in communities all over the US have left their jobs, many because of threats and political pushback.
Or, “I’ll do the job when it’s easy but when it’s hard, gosh I’m trying my best why won’t people just do what I say.”
They’re continuing this bad streak with saying things like people that have had COVID should be immunized.
The reason they’re saying it is pretty obvious to me - a lot of people that just had a cold in the past year think they had COVID. I had a friend that thought he had it twice before he actually did. Also if you didn’t get very sick you might not have had enough of an immune response to get all that immune.
If they explained that, it would be fine. Instead they’re basically doing misinformation of their own. My mother-in-law is concerned that I’m not getting the vaccine. I had COVID bad in December, and I have autoimmune issues so I’m not going to poke the proverbial bear unless I need to.
She also thinks that you’re only immune for three months if you actually got infected, but that’s the media’s fault. They ran all those stories about antibodies only lasting a few months without going in to details about memory T cells or the like.
> She also thinks that you’re only immune for three months if you actually got infected, but that’s the media’s fault. They ran all those stories about antibodies only lasting a few months without going in to details about memory T cells or the like.
It's also wrong regardless. "Three months" came from studies that only lasted three months / were early in the pandemic, and actually meant "at least three months".
There are newer ones now that say "at least 8 months", and even that is several-months old news.
Donald Trump had Covid19 and was later vaccinated and has the best medical care in the world. Do you think his doctors would have done so if they didn’t believe it was medically justified?
Trump has political reasons for wanting to be seen having taken the vaccine. If his doctors felt it wasn't the best treatment but wasn't particularly harmful, would they deny him the vaccine? Right or wrong, doctors write scripts all the time that are a limited to no value because the patient wants it and if there is little to no harm from it.
Everybody's got a different risk profile for Covid-19, and their own risk profile for vaccinations. You shouldn't expect that an answer balancing those for one person is at all applicable to a different person.
The fact that a confirmed natural infection confers immunity equal to or greater than the vaccines is well established at this point. There are something like 80 documented reinfections worldwide. For previously infected people with autoimmune issues there is miniscule upside and some potentially significant downside to getting the shots.
Donald Trump is about the last person on earth I would point to as someone whose actions and motivations should be viewed as straightforward. He's been pumping the vaccines and trying to take credit for them ever since they were approved, and his making a big show of getting the vaccine can easily be viewed in that light.
>The fact that a confirmed natural infection confers immunity equal to or greater than the vaccines is well established at this point. There are something like 80 documented reinfections worldwide.
There is definitely a lot more than 80. My impression is that the mRNA vaccines are more effective than natural immunity.
It doesn't make sense to compare a study where asymptomatic people were being mass tested for the presence of SARS-CoV-2 RNA with the vaccine trials or the CDC's existing tracking of breakthrough infections, both of which require the presence of symptoms before running any tests. The CDC has even set a lower CT threshold (i.e. higher amount of viral RNA must be present) in order to consider a positive test to be an actual breakthrough infection.
> For previously infected people with autoimmune issues there is miniscule upside and some potentially significant downside to getting the shots.
I wasn't addressing that portion of AuryGlenz's comment. Obviously if you have an underlying condition, you should take that into account. The C.D.C. addresses autoimmune conditions here:
> Donald Trump is about the last person on earth I would point to as someone whose actions and motivations should be viewed as straightforward. He's been pumping the vaccines and trying to take credit for them ever since they were approved, and his making a big show of getting the vaccine can easily be viewed in that light.
He didn't make a big show of it. He made no show of it at all. I'm not appealing to his judgement. I'm appealing to the judgement of his doctors.
None of those links really support that the vaccine is better than a “natural” immunity. It sounds about as effective as the Pfizer vaccine, and that’s when you count the whole population of people that tested positive for COVID. A good portion of those were probably mild or even asymptotic. I had a raging infection where I could barely get up out of a chair for a few days, high fever, etc.
Also, I’m far from an expert but wouldn’t the vaccines only produce antibodies for the spike protein as opposed to an actual infection producing antibodies for the spike protein and the virus itself?
The claim was "confirmed natural infection confers immunity equal to or greater than the vaccines is well established."
I don't think that's true, certainly not to the point of “well established.”
Here's another source:
Which produces a stronger immune response: a natural infection or a vaccine?
The short answer: We don’t know. But Covid-19 vaccines have predictably prevented illness, and they are a far safer bet, experts said.
Vaccines for some pathogens, like pneumococcal bacteria, induce better immunity than the natural infection does. Early evidence suggests that the Covid-19 vaccines may fall into this category. Volunteers who received the Moderna shot had more antibodies — one marker of immune response — in their blood than did people who had been sick with Covid-19.
In other cases, however, a natural infection is more powerful than a vaccine. For example, having mumps — which can, in rare cases, cause fertility problems in men — generates lifelong immunity, but some people who have received one or two doses of the vaccine still get the disease.
I am also not an expert, so my first link is to someone who is (an immunologist). She cites various sources for why she recommends still being vaccinated. Of course, while she is A doctor, she isn't your doctor.
What I think is that a lot of people posting here are certain they are right, while what most doctors seem to be saying is: "we're not certain, but vaccination is low risk and provides reliable immunity."
Now, those doctors aren't your doctors. They're making a general recommendation. Your doctor, knowing your specific health history, will likely be able to make a more informed recommendation.
Ultimately this is a cost/benefit analysis. There seems to be less benefit to being vaccinated for people who have previously been infected vs those who haven't. You need to weigh that smaller benefit against the risk of vaccination. If the risk of harm from vaccination is smaller than the risk of re-infection, isn't it still worth getting vaccinated?
Anyway, hacker news comments aren't medical advice and I am highly skeptical of folks posting here with such certainty about matters outside their expertise, especially about an emerging disease.
> 1. Be First: Crises are time-sensitive. Communicating information quickly is almost always important.
An I correct in remembering the CDC taking its talking points from the Chinese officials who had a vested interest in spreading disinformation and falsehoods about where and how the virus started?
They left out one possible recommendation: Tell the whole truth. Failure to do that was a big mistake by the powers that were during the 1918 flu unpleasantness. The lesson has been lost.
Value #1 seems pretty at odds with 2 and 3, and dangerous with #5. I wonder how the CDC reconciles this... surely Be Right is more important than Be First. A spammy news site could claim most of these values in this order.
No, 2 includes "what is not known, and what is being done to fill in the gaps". Being honest about "we don't have an answer to this yet but are working on it" helps with the others.
The CDC had a special way of being dishonest here: They claimed and continue to claim there is zero knowledge available unless there are a dozen studies from the right institutions confirming it. This led them to be months behind on realizing that COVID was airborne.
To me it seems like something has fundamentally changed in the world in the past decade. If you are an information worker and want to have credibility, you need to put things on git. Otherwise you lose credibility. It's sort of like the difference between hearsay and the written word. Anything not backed by git nowadays I consider as hearsay.
Yeah, it was rushed writing on my part. Basically there's an OOM difference in the credibility between things published with a backing git repo and those where just the artifacts are published.
I mean, their whole raison d'etre is to manage disease outbreaks, and at the start of the outbreak they were caught with neither basic supplies (PPE, respirators, etc) nor plans for provisioning the same. They also tried to roll their own tests which proved faulty and labor-intensive rather than using the WHO standard tests (though as luck would have it, testing capacity doesn't seem to have been a strong predictor of success in combatting the virus). So I'm not entirely surprised that the CDC is struggling to communicate effectively during this outbreak.
I have the board game "pandemic" which came out some years before COVID, and I remember thinking about how cool the CDC was, as though it was one of the few agencies that had its shit somewhat together (the only other which springs to mind is NASA though no doubt NASA also has its share of mismanagement). Boy was I wrong.
A charitable take:
They didn't read their own manuals, which is extremely common in US Federal Government agencies, and really any large bureaucracies.
A less charitable/borderline hostile take:
Biden is extremely likely to not run for re-election (due to his health), and has some extremely ambitious legislation he is pushing which will cement his legacy. He and his advisers don't believe they will maintain control of the House of Representatives in 2022, and are justifying many of these changes with the crisis of the pandemic. If the pandemic doesn't appear to be a crisis, the odds of this legislation being passed are lower.
Probably the most frustrating part of all of this is the fact that the April job's numbers (1 million jobs predicted, actual was a 1/4 of that) were hand-waved away with "people can't work when their kid's schools are shut", as if the administration hasn't helped justify schools remaining closed in certain states. (I live in Colorado, a blue state, and our schools have been open since January with no issues, as opposed to Oregon, where they are still closed.)
My comment had absolutely nothing to do with Trump or previous CDC policy. I thought he was a terrible president and a horrifically inept manager.
But his presidency broke so many people's brains that folks like yourself immediately read into any criticism of Biden as being motivated due to somebody being 'on the other side'.
I really don't care for the childish game of red blue sectarianism.
Complex topics require nuanced discussion. But instead it turns into the most base instinct form of information filtering, where folks look at who you are friends with or who you follow on Twitter and immediately dismiss any opinion you have based on that. It's incredibly low brow and anti-intellectual and I can't believe it's become such a popular form of debate on the left, like it already was on the right.
No, we haven't. Failing to shut down the CDC power grab was Trump's biggest failure. Not firing Fauci changed me from an enthusiastic Trump supporter into a reluctant one.
Trump did far worse than simply not fire Fauci. Trump made Fauci a living martyr (yes, sorry, I can't think of a better phrase).
The things Trump did and said regarding the pandemic were so consistently and profoundly idiotic, they made the bumbling bureaucrats around him look like sages. And his empty threats and blustering emboldened them, and amplified the worst of the covid scolds in opposition.
Everything we can fault Fauci for is equally on Trump's head.
I would have preferred that Trump (or any president) ignore Covid altogether. I'm of the view that viruses are none of the federal government's concern.
> as opposed to Oregon, where they are still closed
This is false. I live in Oregon and my kid's school has been open since February. Both our elementary school and middle school are dealing with a minor COVID-19 outbreak too and they're small schools in a very wealthy city (median household income is over 110k), so I question the authenticity of your "no issues" comment regarding Colorado schools.
EDIT: just checked, our local high school has more than double the cases of our elementary and middle school combined. Yeah I'm really doubting the "no issues" part, but I guess "issue" is relative
I'm sorry, but this is part of the misinformation. Of course there are positive cases of COVID in schools, and of course high schools (my son is a freshman) have higher rates. This is explained by the science, which clearly shows that high school age groups have dramatically higher rates of transmission.
It's more about the risks. All of the teachers in Colorado were prioritized for vaccines. They are all vaccinated in my county (Jefferson County, which has almost 600,000 residents). Which leaves the bigger question: What's the risk to the students, and to the people they can spread it to?
To the students, the data clearly shows that it's minimal, unless they have comorbidities.
350 people between ages 5-17 have died of COVID in the US. This age group represents 16.3 percent of the US population, or roughly 56 million people.
You were correct that I was wrong about Oregon. My brother's kids are still out of school because his wife is terrified of them catching covid, and she kept them remote. They are ages 5 and 7, respectively. She's been one of the most extreme overreacters in the pandemic. She lived like a shut in for 8 months, and she's healthy and in her 30s.
Now onto the question of the danger the kids pose to the public by spreading covid to their families or vulnerable people.
At this point, the majority of Americans over 60 are vaccinated. Vulnerable people were prioritized. Which is why you aren't seeing news reports of droves of people dying in Colorado as a result of schools being opened.
All of these decisions represent trade-offs, but too many in the US public seem to not understand relative risk. I am safer if I wear a helmet when I drive my car than otherwise, but I'm not going to, for the same reason you don't.
Perhaps this happened because we had an entire political leadership calling it a "liberal hoax" shibboleth at the same time that the CDC was trying to ring alarm bells?
"Falsehood flies, and truth comes limping after it."
"We understand we will constantly make mistakes and bad actors will constantly try to influence us. To counter that, we will make it painless for people to fork and correct. Every change will be open, attributable and signed."
During the Obama administration, he put out an executive order for Federal Gov't agencies to open up their datasets. There were hardcore standards set, APIs, certain formats, etc. This is the same initiative that created data.gov. It was revolutionary and groundbreaking, and the various federal agencies essentially ignored it, and were allowed to.
I'm talking about a full executive order, and I had a lot of expertise and was being tasked with helping agencies, including the VA and DOE, open up their data. HHS was also part of this.
I was immediately blocked in all of these agencies with foot-dragging, and a complacent, "I couldn't give a fuck" attitude. They didn't care about enacting the order, because unlike me, they all knew that there would be no consequences for not doing so. They didn't do it, and there were no consequences.
I voted for Obama twice, but one of the things I noticed about his administration was that they weren't willing to strike fear into the hearts of bureaucrats who undermined their objectives. Another executive program he pushed, for properly integrating military health systems with the VA's health systems, was also actively ignored by the VA, with zero consequences. That experience was the final straw for me to leave and join the private sector, and get out of DC permanently.
That sounds very accurate. Thanks for your efforts, and I bet you actually had a bigger long term impact than you realized. In my past experience with big orgs, it takes people like you to get the ball rolling, and eventually it does pick up momentum, just takes a long long time (not sure what the best way to forecast timeframes is).
I would imagine you do so indirectly -- you threaten the income sources (e.g. federal funding to the departments/tax allocation, or killing loopholes), the politics (you publicly advocate for the other guy, or lobby against their prioritized initiatives), or the system itself (advocate for new laws/rulings/governing bodies that would make their lives more painful/goals more difficult to achieve)
It's the presidency -- just playing favorites carries a lot of weight. Or even threatening to cockblock anything they're looking to do for the next 8 years, by swinging party support.
The CDC's advice has been focused on one thing since the start of the pandemic: keeping the amount of PPE and infrastructure resources required down to the attainable for hospitals. It has never been about protection of the public at large.
It's why they waited so long to acknowledge aerosol spread and still stick to droplet based modeling of indoor spaces despite acknowledging aerosol spread being dominant. It's why they say 6ft still re: droplets even though aersols don't care about 6ft. It's why they (and states) still let people use ineffective unfit "masks" instead of requiring (and supplying) everyone with N95 or better.
I just don't understand what exaggerating outside spread does to help them with this. If anything it suggests that outdoors we'd need to use more N95 masks. It seems to go against all their past behavior.
Austria[0] and Germany[1, edit: this seems to only be true for Bavaria and Berlin, see comments below] have mandated the use of FFP2 masks since the end of January. Their neighboring countries didn't[2].
If you look at the data, there does not appear to be a decrease in infection numbers relative to their neighbors after the switch to FFP2[3].
Germany requires FFP2 masks OR op masks. Public transportation requires FFP2, vouchers for FFP2 masks have been issued (huge cash grab for pharmacies, but thats a different story). They are ubiquitous. I just went shopping and all customers wore a ffp2 mask. The cashier was behind totally useless (see: aerosols) plastic shielding and didn't wear any mask thou.
Apropos of very little, I was in Tennessee recently and at nearly every establishment, the personnel wore their facemasks around their chin, presumably to nominally satisfy some corporate mandate. I say this more as an amusing observation than an implicit judgment one way or another.
Not right, in Berlin FFP2 is required in supermarkets, on the train and so on. This may be because the individual state not the federal government set up the rule, but there you go.
To play along: The CIA receives its funding based on perceived threat - the more there is, the better funded they need to be to defend against it. The less threat, the less the CIA needs to exist.
The CDC is the same: the importance of their organization is perversely tied to medical danger present in the world, and the population’s perceived danger from it (as long as the CDC ensures they’re not at fault, or rather, no one believes them to be).
That is, no one cares about the CDC when there’s no pandemic.
TB: this is also the basis of nier:automata’s plot, taken to the extreme. The equivalent for the CDC is that they would intentionally preserve pandemics despite ability to eliminate them altogether, in order to preserve their own existence
Simple conclusion: "Masks make a huge difference indoors and rarely matter outdoors." The 10% estimate in question is perhaps orders of magnitude too conservative. Why would the CDC employ such a weak numeric argument? They could have left it at something like we see no strong evidence for outdoor transmission. Does there have to be a number attached to public health advice?
>Simple conclusion: "Masks make a huge difference indoors and rarely matter outdoors."
Also: For a disease that we now know is airborne/aerosol spread rather than airborne/droplet, N95 and KN95 masks are highly effective, a two layer cloth mask fit tightly over a surgical mask is moderately effective, and a cloth mask by itself is largely for show. I still see people saying you should NOT use N95 masks (they're cheaply and widely available now) while donning a neck gaiter pulled up over their mouth. It's another area where the initial messaging was terrible (in this case out of the good intention of reserving them for healthcare workers) and unfortunately has persisted.
Cloth masks are largely for show in protecting you from other people. They are still highly effective in preventing your aerosols from getting out into the air. Even though COVID is airborne, it comes out of your mouth and nose in liquid droplets that then dehydrate and become airborne. If they hit a cloth mask on the way out, they'll be trapped.
> For a disease that we now know is airborne/aerosol spread rather than airborne/droplet, N95 and KN95 masks are highly effective, a two layer cloth mask fit tightly over a surgical mask is moderately effective, and a cloth mask by itself is largely for show.
I mean, who's "we"? I knew this back in January 2020.
Actually, and just for the record, a N95 properly fitted works very, very well.
But usually you cannot wear (properly) a N95 for more than two/three hours without having your face with deep signs (and of course you need to be clean shaven).
A "generic" N95 used by untrained people and loosely worn, isn't that much better a protection for the person wearing it than a surgical mask, while both are quite good at protecting other people from the "emissions" of the person wearing the mask (of course only if it is valveless).
I've had a box of the former out in the garage for a couple of years; before 2020, if you looked for an "N95" mask, that's what you would find. But they're not terribly useful in a medical situation.
I can sympathize with that, that would probably have been much more truthful.
But the CDC recommendations have been so poorly thought out so far, it's hard to blame anyone who would say "screw your judgment of evidence, give us a number"
This seems like pointless pedantry that the article itself seems to admit.
The CDC set the bar really high (10%), so that they could provide public health guidance without getting caught in bickering about error-rate or statistical anomaly traps. The CDC tried to avoid pedantry and are now getting pedant-ed for that too.
Ultimately this is a distinction without a difference, since "less than 1%" is included in "less than 10%." The CDC covered their back, and the public health guidance was identical.
Absolutely not a distinction without a difference. "Less than 10%" implies, in the vernacular, that they didn't have confidence stating another round bound. That almost certainly it is greater than 1%, probably greater than 2%, and there's a good chance it's greater than 5%. That's how folks read numbers like this. And then they will correctly conclude they should not listen to the CDC because the CDC's numbers seem made up.
If you need more nuance to avoid miscommunicating but you do not give it, you have miscommunicated.
What percentage of the American public understand what a confidence interval is? I have 95% confidence that this number is under 0.1% using the methodology of pulling numbers out of my butt.
I have been in college level stat classes where many people didn't truly grasp confidence interval. While I would love the data, I think it's not really the most important thing during a crisis.
They don't have to say its a confidence interval. Just say something like: "Though outdoor infections are uncommon, how uncommon is uncertain. Based on the limited data available, we estimate outdoor infections to make up anywhere between 0.1% and 10% of total infections". That is honest, transparent, and doesn't require understanding any statistical theory like confidence intervals.
No - but a lot of people by now work with someone or know someone who does understand stats. So people could talk about these things and start to understand it.
If the larger public could read and understanding the underlying data in the way you're proposing then the CDC's guidance isn't of importance. Since they won't/can't, the public depend on/trust the CDC's guidance, who were intentionally conservative here for that exact reason.
As far as public health policy goes this is a distinction without a difference. Everything else is just pointless pedantry.
I can read the data. However I also know it is messy (as all data is), and needs a lot of understanding. Give me the data and some time with a computer and I can make sense of it though - I have all the skills. However I also have a day job, and then a family to spend time with. There isn't enough time left to figure out the raw data. Thus I really need trustworthy people to figure it out for me and give me the summary that I can use. Such people should ideally have practice at the job and so can do it faster than me, while also looking for things that I would forget to account for.
They said it is less than 10%, and now we have a bunch of people "correcting" them that it could be actually less than 1%. That correction is unhelpful/pointless/pedantic.
If the statement is still true, and the public health guidance is identical, then what is it we're even discussing? This discussion is pointless and the article itself is pointless.
The CDC cannot win no matter what they do. They say it is "less than 1%" then someone will find a study that shows that they're wrong, if they say "less than 10%" then people will say that isn't precise enough and that they're wrong.
They probably can't actually know the answer any better than that. Think for a moment about this statement from the article: "There is not a single documented Covid infection anywhere in the world from casual outdoor interactions, such as walking past someone on a street or eating at a nearby table." That's probably true, but how would you even find those infections? There's no record of who walked past who on the street, no way to contract trace every stranger that passes by an infected person, and generally countries don't even try. So the fact that this form of infection hasn't been documented to happen says very little when it's so much harder to detect than indoor transmission. Ultimately, where you draw the numerical line is going to mostly be a matter of personal judgement, and no matter what choice the CDC make the New York Times will always be able to find experts who back a different conclusion.
(Also, the word "casual" is doing a lot of work in that sentence. There absolutely have been documented examples of outdoor transmission via, for example, people going for walks together or chatting with each other outside. So if people think that this means all outdoor interaction is safe, as the article seems to be inviting them to do, this could cause some real problems.)
In your first paragraph, you say there's no way to contact trace outdoors, and in the second you say there are documented cases of it happening.
There are ways to predict your chances of getting infected from someone outdoors. You back-trace from known cases, identify the people they have interacted with, and from those that later contracted Covid, you note whether the contact was indoors or outdoors. There is plenty of data to do that with.
The instances of outdoor infection that have been documented aren't just random strangers passing each other on the street or sitting near each other - as I recall they involved people who knew each other, which obviously makes contact tracing easier. Also, one of the ones I know of was in New Zealand during the period where every case was headline news and aggressively investigated, and the other was in China which similarly had very few cases that were very aggressively traced. This does not say good things about how well countries with more cases are detecting outdoor transmission.
> That's probably true, but how would you even find those infections?
Well, you could look at the infection rates among people who attended large outdoor gatherings during the pandemic in spite of warnings - like Trump rally attendees or BLM protesters.
Or you could look at infection rates for people who have a tractable list of possible exposures - interview only people who live alone and work from home, and see if people who only shop for food have a lower infection rate than people who shop for food and also golf once a week.
Or you could run an experiment - get some infected people, have them cough at petri dishes inside and outside, with and without masks, and at different distances.
The CDC is supposed to give the public evidence based guidance, not dictates. If you don’t show your work and simply demand people to confirm, you won’t get compliance. That’s true in myriad real life contexts, from the workplace to pandemics.
In this case technically correct is not the best kind of correct. An N95 mask is about 95% effective in preventing spread indoors. Isn't it critically important to know that being outdoors is apparently roughly as effective as one of the most effective masks? People spend more time inside than outside, so maybe it's not 5x as effective, but outdoors is much, much safer than indoors. If the real number is .1% for outdoors then you are actually better off being outdoors than wearing an N95.
I don't envy the CDC, it is almost impossible to communicate anything even slightly complicated. When they announced that vaccinated people could gather in small groups, at least one person I know interpreted that as saying it was low-risk to go to church in a large gathering with singing.
People keep mistaking cdc, who, and other bureaucracies actions for something other than overcompensating for earlier incompetence and inaction. Bureaucracy is not driven by performance, it is driven by maintaining whatever current acceptable status quo is.
Would it be bad to have the CDC, the WHO, and political figures apologize for the environment of misinformation and division they enabled (and possibly created) through these means?
I feel like a given citizenry can tolerate in-the-moment-incompetence, but they expect to be validated later in turn, and not just in the history books.
I grew up in the ussr. I do not believe in institutional responsibility simply because I have not seen any manifestation of such thing. Federal bureaucrats are too distanced from the voters to suffer any consequences
Now the public has more recommendations from another source, and it also will cause people to doubt the CDC's other advice. That doesn't reduce the complexity or confusion, it adds to it - like the old XKCD about adding another standard to existing standards.
That will hurt people. Wearing a mask too often outdoors will not. It's really major news requiring a special article to say the number of outdoor transmissions may be overstated from 1% to 10%? So what?
> C.D.C. officials have placed such a high priority on caution that many Americans are bewildered by the agency’s long list of recommendations. Zeynep Tufekci of the University of North Carolina, writing in The Atlantic, called those recommendations “simultaneously too timid and too complicated.”
What basis is there for this claim? I find them straightforward, and I find the CDC website clear and well-designed. I just wear a mask when I'll be near other people, and I avoid being near them.
Ranting at an easy target, a government institution, is commonplace, senseless entertainment. It's often harmless - but not in this case.
So people will meet inside rather than outside, not realising what a huge difference it makes, thus increasing infection.
I have family members who still disinfect all their shopping, but don't even open the windows when they have guests round. Prioritisation is essential here, not everybody is going to be perfect, and if they are compromising on the wrong measures due to miscommunication then that's a massive failure.
"That benchmark “seems to be a huge exaggeration,” as Dr. Muge Cevik, a virologist at the University of St. Andrews, said. In truth, the share of transmission that has occurred outdoors seems to be below 1 percent and may be below 0.1 percent, multiple epidemiologists told me. The rare outdoor transmission that has happened almost all seems to have involved crowded places or close conversation."
I'm extremely grateful that the NYT is calling this out. However, they are far too late, and frankly, played a role in misinforming the public on the pandemic.
The audience on HN is pretty strongly aware of the extreme misinformation on COVID pushed out by right-wing news organizations, but doesn't SEEM to be aware of the extreme misinformation that was pushed out by the left-wing news outlets, which successfully skewed the US public's perception of COVID risk.
The partisan divide on THIS specific topic shows that American's on both sides of the political divide grossly overestimate the likelihood of hospitalization from COVID, but that those who consume left-wing media are an order of magnitude more incorrect.
Here's a good breakdown, containing links to the source polling data on the topic.
I wasn't quite aware of how misinformed highly educated colleagues were until I contracted COVID in mid-February. My wife and I couldn't understand why people were acting like I was in so much danger, until we realized that people were grossly overestimating, by massive factors, the danger I was in. I'm a physically fit, active male in my late 30's. But people on my team acted very surprised that I didn't miss any work, and only had a loss of sense of smell as a symptom. They were acting as if I was somewhat of an outlier, instead of being the absolute norm for my age group/health status.
The implications of this fear-mongering results in me being treated like a leper for not wearing a mask on hiking trails in wide open, wind-blown, and sunny open spaces.
It's been a big reminder to me, that no, people on the left aren't actually less prone to misinformation, despite my preconceived notions and biases. Quantitative illiteracy in the majority of the American public has had horrific effects in this pandemic.
I think more than a left-right thing, this is a different axis. Some people are just more fearful in general. I've been surprised by friends of my same political persuasion that have acted in ways I would honestly need to call, not-quite-sane. Such as deciding now to keep their child out of school for the entire 21-22 school year, or leaving deliveries on their porch for 3 days before bringing it inside. These are smart people in many ways, but somehow their brains were hijacked.
Talking to them about the actual risks triggers an emotional response. Even relating the risk level to something they do every day like driving seems to have no effect.
These are people who are educated and consume news from respectable sources.
My brother's wife is one of these folks you talk about, with the "keeping kids out of school" and "leaving deliveries on porch for 3 days".
Very well said!
What I'm very curious about is what makes me perceive risk so much differently than these others. I'm wondering if it's conditioning (I spent a big chunk of my life building houses, and therefore climbing on extension ladders and walking on roof trusses was a daily ritual), childhood (I was in unstable environments a lot), or just brain wiring from birth.
A respondent on your comment mentioned a willingness to "outsource judgement to news sources" and even better "outsourcing judgement to political rivals and adopting the opposite viewpoint by default". This is a phenomenon that I anecdotally notice is intensified with educated elites. My brother's wife went to Cornell, never struck me as particularly creative or novel, but just has a great work ethic and follows what books tell her to do. She's a born rule follower, and follows conventional wisdom to the point where it borders on comical and often, defying common sense.
> What I'm very curious about is what makes me perceive risk so much differently than these others. I'm wondering if it's conditioning (I spent a big chunk of my life building houses, and therefore climbing on extension ladders and walking on roof trusses was a daily ritual), childhood (I was in unstable environments a lot), or just brain wiring from birth.
I'm guessing conditioning is a big part of it.
I'd wager the majority or people with more hysterical reactions have lived fairly comfortable lives, without having to face much in the way of dangerous risks. And without that, they also fail to also learn that risks and dangers can be controlled and mitigated. Or that even mild preparedness can mean the difference between recoverable injury and death. So absent this personal experience of a counterpoint to the hysteria on the news, they're more likely to accept prognostications of certain horrible doom uncritically.
Yea I think back to generations past, where you'd find yourself being sent to Normandy or something or stationed on a ship that just got hit by a torpedo. Chance of death - >>1%.
Now healthy people with a fraction of a percent risk of hospitalization, much less death, act like agoraphobes - apparently willing to do so indefinitely.
Far removed from the experience of the world as it is, dependent on the comfort of advanced human technology, people have become debilitated by the mere idea of the challenges that their ancestors overcame and readily coped with.
Courage is gone, and it's perhaps the most important virtue that allows one to get through life and face the insurmountable challenges that all of us will encounter.
> Now healthy people with a fraction of a percent risk of hospitalization, much less death, act like agoraphobes - apparently willing to do so indefinitely.
If someone wants to be an agoraphobe, they can do so. But what bugs me is that these newly-minted agoraphobes seem to treat their agoraphobia with the same fervor and source of moral purity as a religion. To speak the heresy that one might have some control over what existential dangers await beyond one's front door is met with the same screeching panic that would follow suggesting all pre-pubescent children should be required to participate in satanic sex orgies. By refusing to be (as much as) a victim, you are an active threat to all that is good and true in the world.
I like to joke that I don't go outside because the day star is trying to kill me with radiation burns. And then I laugh at my silliness, put on sunscreen, and go outside anyway. But imagine being scolded by someone that, your not-easily-burning darker skin be damned, because you don't think you need sunscreen, you are the reason their dearest grandmother died of skin cancer. All the while recording you with their phone so the whole Internet will know that you, a science-denying anti-sunscreener, are also a killer-of-grandmas.
> seem to treat their agoraphobia with the same fervor and source of moral purity as a religion
Oh yea, I'm gay and it clicked to me recently that the gay clubs I go to are basically just monasteries now. It used to be that gay people were known for unabashedly saying what couldn't be said (the profane) - it's now the complete opposite, gay people largely are enumerating an endless list of what's considered profane. Constant pearl-clutching, tip-toeing, hushed gossip, forced repentance and excommunication.
It's hard not to see the illiberal attitudes on the left (which at least in recent history were concentrated on the right, a consequence of their rigid sense of morality and tradition) as nothing more than rule-book fanatics evangelizing and prescribing a sacred morality.
John McWhorter calls these people The Elect, and I think correctly identified that this is fundamentally a religion. It spans all sorts of topics, but maintains the same character, for instance, in something like anti-racism:
What's really interesting is how many of my comments on this topic have been downvoted to oblivion with absolutely no responses from the people doing the downvoting.
I think a willingness to face temporary discomfort is something that seems to be in decline with specific members of the younger cohort of the millennial generation. This translates to journalism where you have a new generation of journalist who produces clickbait all day but never goes and interviews people in person and certainly doesn't do so over the phone. Think about how many people you know are unwilling to make phone calls and prefer text messages almost exclusively. That's not a huge deal but many of these same people are extremely uncomfortable interacting over a telephone with strangers. It's a really bad recipe for quality journalism.
Any attempt to have nuanced discussions on these topics immediately makes the sectarian politicos come out in droves and assume that you are a supporter of the previous president even if you aren't.
Trying to discuss the extremely plausible scenario of an accidental lab leak makes people assume you're a Trump supporter, for example. My opinion is that if he wasn't so ridiculously ignorant and unwilling to show vulnerability by engaging in topics he knows nothing about and attempting to learn, we would be in a much better place with this pandemic. Instead he didn't want to do that and simply offloaded all thinking to Fauci, but then simultaneously would attack him whenever he was speaking to certain groups.
Yea I largely agree with all the stuff you're saying. Regarding Trump though, I think he did do himself a massive disservice giving space to people like Fauci and Bolton. Although, with a generous interpretation, he certainly seems to be able to listen and platform people he diametrically opposes, which is something I don't know can be said about his opposition.
This has been bothering me for years, long before covid-19. Avoiding risk has become such a huge part of our culture that most of our standard salutations revolve around this: "stay safe", "have a safe trip", "drive safely", and so forth.
I'd much rather that people would wish me a fulfilling life in which I available myself of many rich experiences.
Construction is one of the most dangerous professions, but I’m not sure which direction the risk level is flowing in. Maybe working changed your risk assessment or maybe you wound up in that line of work because you already were more of a risk taker.
I was helping my 60 year old dad fasten some trusses a few months ago for the first time since I was a teen and damn, I was nervous as he walked along the fastened ones to do some fiddling needed in the middle beam. I know I wasn’t nearly as quick to follow instructions when I was 15 and was doing this all the time and it felt normal.
This is an intersection of so many things: politics (outsourcing your judgment to your enemy and effectively just doing the opposite of them), brain-structure propensity for fear, esteem for authorities and experts (fundamentally the tendency towards authoritarianism, whether it's based in expertise or other things), class tendencies that value visible signals of virtue, intelligence and taste, etc.
There are very different kinds of outdoors. A megacity urban area with packed sidewalks in literal urban canyons is one thing. A suburban town's sidewalks where I pass ~1 other person (on the other side of the street) every 5 blocks is another kind of outdoors. I'd wear an N95 in the former but not in the later.
One of the points that keeps coming up in these conversations- and is cited here as evidence - is that there are no documented cases of casual transmission from being near someone outside. While I don’t on principle dispute the conclusion - citing a lack of evidence of something that would be incredibly hard to find evidence for is not an effective argument. There are a huge number of cases where the actual source of infection is completely unknown and in the cases where tracking and tracing succeeds it is based on asking people who they interacted with, so the set of people you walked near in the street while infectious are almost certainly never going to be found and documented.
The fact is we don’t know - it seems unlikely but there is some amount of existential uncertainty about outdoor transmission and given the fact we want the outbreak to end sooner rather than later being overly cautious doesn’t seem like a terrible idea to me.
There are plenty of friendly gatherings that happen throughout the summer where people who know each other spend significant amounts of time together outdoors.
If outdoor transmission happened, you would see some documented cases. It’s not just all strangers walking past each other on the street.
They've been so circumspect about their advice, their advice is practically useless and even worse: induces society-wide agoraphobia and fear. This does not come without consequence, the health effects of destroying the normal fabric of society are profound. Constant stress and fear ruins a person's health, never mind the effect of it occurring at a global level.
Put together with all of the other mistakes around covid, it all seems rather silly.
- We all know about the WHO and their statement on masks.
- Distinctly remember people saying, "We don't know if antibodies offer protection," (in contrast to every other known sickness afaik). Turns out they do and they are superior to vaccine - Doesn't matter follow the same precautions as
everyone. I know people who have had antibodies for over a year, but nobody would hang-out with them because immunity wasn't explained to the lay-people.
- So much hand-wringing about whether the vaccine prevents transmission. Seemed like a given. Turns out it was a given.
- Still so much hand-wringing about vaccinated people. Given 30% of america is vaccinated, it seems obvious that anybody vaccinated can pretty much go no-mask, no precautions, and if all the vulnerable populations are vaccinated then everybody can go no-mask. Basically America should be 100% open, and the .0001% who are vulnerable but can't get a vaccine can wear masks and quarantine.
It's simply unacceptable for professionsals to say "We don't know X, we'll let you know in 3 months." If you don't know about the India variants and the vaccine, spend 100k to FLY-OUT 1,000 vaccines to India same day, inoculate 1000 volunteers, and track them. You'll have your answer within 40 days. Do this for every variant, it's not rocket-science.
If there's something I'm missing, then they need to explain it about 10x better than they are doing so far. Feels like a bunch of middle-managers.
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tl; dr - CDC needs to be managed by some software engineers apparently.
Edit - Feel free to justify those downvotes if you think you can.
I think your getting downvotes with your 'software engineers should manage everything' comment. That's a comical statement to make and comes off appearing as a 'know-it-all', something the CDC appears to be suffering from
1. We don't (and didn't) know how long antibodies would offer protection. Some viral infections can recur very quickly. Also, all of the data I've seen is that the immunity conferred by the COVID vaccine is more durable than that from an infection.
2. It's not a given that a vaccine prevents transmission. Being an asymptomatic carrier is a real thing.
3. This statement shows a fundamental misunderstanding of how vaccination works. The vaccine is only 90% effective. If vaccinated people are swimming in a sea of COVID, then roughly 10% of them will go on to get COVID. You're also ignoring the fact that as of today children under 16 can't get vaccinated AT ALL, and so beyond whether they die or get critically ill from it, they are contributing to the sea of COVID that can infect vaccinated senior citizens.
3. Studies take time. Knowing how variants perform vs. vaccines is not a matter of people flying on a plane. It's a matter of running a study long enough to see who gets infected and who doesn't. You seem to be completely unaware of the classic project management warning that it takes 9 months to have a baby, 9 mothers can't have one in one month.
On masking in public, you also need to understand that we have to have rules that are manageable. You can't say "oh vaccinated people, you can stop wearing masks in public", because then every storekeeper needs to query every non-masker to ask whether they are vaccinated - and of course they are all going to say yes, and they are even going to carry fake vaccination cards to prove their point. It's just an untenable situation, and additionally as long as COVID is in open spread with tens of thousands of cases per day, vaccinated people are still vulnerable.
This is a shoddy article that serves only to undermine efforts to deal effectively with Covid, in return for some clicks and eyeballs.
Firstly, the entire premise of the article is not grounded in fact, it's based on multiple in-conclusive statements and reports. Just read the language in the first few sentences - "almost certainly", "appears to be partly based on", "seems to be an exaggeration". But the article then proceeds as if that were fact.
It then tries to reach unsupported conclusions that feed into a convenient narrative at the expense of an inconvenient reality.
That outdoor transmission may have been low is inseparable from the fact that the general population HAVE been distancing, cleaning, masking and other responses. So to conclude that since "<10% is too big of an estimate" masks should not be required for any outdoor activity is gross.
It signs off by concluding that Britain's drop in death rate since January is based on Britain being locked down indoors and carefree outdoors completely ignores the fact that vaccinations have been ramping up.
If you have a genuine conclusion then you don't need weasel words and misleading logic to tell your story.
Seems like a rather strong conclusion to be based on guesswork. “CDC didn’t cite their sources for this figure and I don’t believe it” isn’t as catchy a headline though of course.
I don't understand how this happened. The C.D.C. literally has a manual on how to communicate effectively during an outbreak:
https://emergency.cdc.gov/cerc/ppt/cerc_2014edition_Copy.pdf