The case for caring less about the public’s understanding of policy

Last week, CDC updated its recommendations for masking and distancing. Dumping on those recommendations is not a fresh take. Even Trevor Noah has taken a shot.

So yes, the new CDC guidance is lousy because it garbles its own message, making it more or less useless. Unfortunately, everyone seems to want CDC to speak more clearly, or produce a policy that is simpler and easier to understand.

For CDC to try to simplify its message would be a mistake. In fact, in trying to build guidance that it can communicate directly to the public, CDC is doing the wrong job.

The first problem is that no simple policy exists.

So far, vaccination data have been uniformly encouraging. Vaccinated people have nothing to fear from SARS-CoV-2, and they appear quite unlikely to transmit the disease. From a simple infectious disease perspective, it sure looks like vaccinated people could do as they please, with negligible risk to anyone around them.

But CDC can’t say, “If you’re vaccinated, do what you please.” There’s no reliable way to tell whether people have been vaccinated. If I’m vaccinated and I feel like singing unmasked in a subway car, what’s everyone else supposed to do?

CDC also can’t say that vaccination shouldn’t change your behavior. If vaccination doesn’t set us free, then why bother?

The hard reality is that people should be doing different things depending on where they are in the country, what environments they’re in, and what other people they’re around. Vaccination sets some people free, in some places, some of the time. There is no simple story. There’s no postcard policy.

CDC shouldn’t be trying to create one.

Instead, CDC could offer guidance designed for governors, mayors, CEOs or plant managers, school principals, and journalists. The guidance could be more nuanced, and more numerate. Rather than offer guidance on how people should behave, it could offer guidance on how to write guidance for how people should behave. It could offer meta-guidance.

In the midst of a once-in-a-century pandemic, anything the CDC publishes will be picked up by the news, or if not, then by a hungry public ready to broadcast the CDC’s perspective on Twitter. It is absolutely appropriate for the CDC to consider how the public will interpret its guidance. That does not mean that it’s always the CDC’s job to advise the public directly.

Here’s a simple model of COVID risk:

• Circumstances (masking, distancing, ventilation)
• Vaccination rate (how many people have been inoculated)
• Incidence rate (how actively the disease is spreading)

Everyone is looking to CDC to tell them what circumstances are safe. But our safety is a function of all three of these variables, and the latter two vary widely as you move around the country, around a given state, or even around town. Incidence and vaccination rates in your house and your job may be very different. Even worse, the vaccination rate at your local grocery store changes moment to moment, depending on who walks in the door. Circumstances that might be safe at home might not be safe at your job, while at your grocery store it’s best to assume these rates reflect, or perhaps even trail, those of your town at large.

So what is CDC to do?

First CDC could define, say, three levels of behavior:

• Basic hygiene: wash your hands, cover your mouth when you cough, and don’t touch your face
• Elevated caution: basic hygiene, plus wear a mask inside or when crowded outdoors
• Extreme caution: elevated caution, choose remote/virtual interaction when possible, move activities outside, or imposing occupancy limits inside to ensure physical distancing.

Next, imagine CDC publishes a plot like this:

It shows what level of behavior is appropriate given the prevailing vaccination and incidence rates. Using this plot, Governors could issue county-by-county rules for behavior in public settings, and guidance for employers. Businesses and schools could track vaccination and incidence in their own communities and adjust the required behavior level accordingly. So if a business reaches 90% vaccination, it drops to “basic hygiene” inside the office, even though the community at large is still subject to “elevated caution.”

Notice, also, that both vaccination rates and incidence are available through public dashboards. NYT and other outlets could use their existing data to publish maps of what kinds of behavior are recommended on a county-by-county basis. Wouldn’t that be more useful than CDC’s unintelligible postcard?

Okay, so my risk model is a toy. I have to assume that the epidemiologists at the CDC could create a much better, more precise model. Perhaps it would be so sophisticated that the average citizen would find it unintelligible.

That’s fine! CDC doesn’t need to tell me whether to wear a mask. The Governor can tell me that. Or my boss. Or my kids’ principal. Or I can hear it from a sign on the door of the grocery store. What matters it that the decision-makers at each of these places have the tools to put a sensible policy in place that makes sense for that place.

Meanwhile, there is one point that CDC needs every American to hear: the higher the vaccination rate, the more we can relax our behavior.

Read that again: the higher the vaccination rate.

Here’s the headline CDC should be broadcasting to every American: We do not act alone.

The infuriating through-line of our pandemic response has been our total refusal to fight this thing as one. Now we have vaccines, and you got yours. Great! Now tell your neighbors and friends to get vaccinated. Tell your co-workers. Tell your kids. Spread the word. Pressure everyone around you. Get vaccinated so we—so I—can get my life back.

We keep asking when we can go back to normal after we get vaccinated. But that’s just it: we all have to get vaccinated. None of us is really done with COVID until we’re all done.