Templeton, Steve

Steve Templeton | Indiana University School of Medicine-Terre Haute

Politicians, school and public health officials are under a lot of pressure again.

They are under a lot of pressure because SARS-CoV-2 is doing what many viruses do, mutating and following the path of least resistance. Vaccines enhance antiviral immunity, but they don’t do it perfectly. They reduce the risk of severe disease, but they don’t eliminate all risk, and they don’t prevent vaccinated people from getting a mild infection and transmitting the virus to others.

Many people, having been subjected to a steady stream of sensationalized media stories for a year and a half, are scared yet again because of reports of the increased infectivity of the delta variant. They are expecting that something be done to make them safer, and they believe that all the things they have done so far have worked as promised. Many have been willing to comply with lockdowns, remote schooling, and mask mandates, and really want to see evidence that it was worth their sacrifices.

Scientists find themselves under great pressure to deliver that evidence. Imagine if you were a scientist, and knew that a favorable conclusion of your study would lead to instant recognition by The New York Times, CNN and other international outlets, while an unfavorable result would lead to withering criticism from your peers, personal attacks and censorship on social media, and difficulty publishing your results. How would anyone respond to that?

Yet, despite this stratospheric publication bias in support of mitigation measures, real-world evidence of their effects on the pandemic seem underwhelming. A randomized controlled trial of masking in Denmark published last December found no significant difference in cases between masked and unmasked groups. This is still the only randomized controlled trial of mask usage for prevention of COVID-19 transmission, and these types of studies are considered a gold standard in research. In a separate editorial, the editor of the journal wrote an apologetic piece defending her decision to allow the study to even be published. The study wasn’t perfect, but the hostile response highlights just how politicized universal masking has become.

More recently, Dr. Emily Oster of Brown University, a health economist and proponent of COVID prevention measures in schools, created the National COVID-19 School Response Dashboard in order to examine the relationship between preventative measures in schools and cases among students and staff in schools in New York, Massachusetts, and Florida. The results were remarkable in that no significant difference in cases could be found with mask requirements in Florida (the only state of the three where requirements were left to local districts). Even more surprising — low student density was correlated with higher rates of infection among students. This study has yet to be peer-reviewed, and will likely be subjected to intense criticism from reviewers. This is as it should be, although it is easy to imagine a quicker path to publication and public recognition if the results were different.

The CDC’s record of disseminating accurate information and recommendations without political interference has unfortunately been dismal. Their school reopening guidance, released in February, placed such a draconian restriction on the level of community cases required for reopening that most schools open for months would have been forced to close had they actually followed that guidance. Worse yet, parts of their reopening document were revealed to have been edited by officials from the American Federation of Teachers. Other recommendations by the CDC, like masking children above age 2, continue to remain controversial and unsupported by evidence. Their own study of the effect of statewide mask mandates, published in February, only considered a period from March through October 2020, completely ignoring the effects of fall surges on cases in mandated vs. non-mandated sites. Unfortunately, questions about potential conflicts of interest and biases only make the CDC’s mission more difficult, causing a loss of trust from the public with resulting increased reliance on less reputable sources.

One major challenge has been to convince young and healthy individuals with a low risk of developing severe COVID to get vaccinated. As a result, promises were made that restrictions and mandates would be lifted for vaccinated individuals. With rising cases in individuals despite vaccination status, those promises have been broken. Replacing promises with shaming and threats of loss of employment and vaccine passport requirements are likely to backfire and erode any remaining trust in government institutions.

Two things are necessary for the pandemic to end. The first is the development of a sufficient level of community immunity, through some combination of vaccination and natural infection. When this happens, and it will happen no matter what we do, the virus will lose its epidemic potential and become “endemic”, much like other cold and flu viruses. The second is for the public to cease demanding the elimination of risk of infection from leaders that are incapable of delivering it.

In other words, the pandemic will end when people lose the illusion of control and decide to stop being afraid.

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