Shift to personal choice on boosters, masking reflects evolving pandemic response
THE WALL STREET JOURNAL // APR. 17, 2022
In the latest phase of the Covid-19 pandemic, federal and local officials are telling people to decide for themselves how best to protect against the virus.
Health officials are leaving it up to people to assess if they need booster shots, whether to wear a mask and how long to isolate after a positive test. Businesses, schools and other entities are scaling back specific guidelines as they prepare for a return to normal.
The question of when older adults should get a second vaccine booster is the latest example of the government shifting decisions from broad-based community outreach to personal choice. People 50 years and older can get the additional booster at least four months after their first, but health authorities aren’t pushing those eligible to get the shots.
The actions represent a shift from two years ago when government officials responded to the pandemic by shutting down cities, limiting capacity in public places and mandating social distancing. Then, they lacked effective treatments, vaccines and widespread testing to fight the pandemic. Now, as those tools help dent the worst outcomes as the virus continues to spread, the response is becoming more tailored to people’s own health and appetite for risk, according to public-health experts.
“We have many different ways of protecting ourselves at this point,” said Leana Wen, an emergency physician and professor of health policy and management at George Washington University. “People are going to choose different levels of protection based on their own tolerance of risk and how much they want to avoid Covid-19, and at this point, the role of government needs to be to empower people to use the tools that are readily available.”
This new phase of managing the pandemic recalls decades of debate among officials and public-health experts over the best strategies for getting people to buckle up, wear helmets and get vaccinated.
“The history of public health has been a constant tension between individual-level and government or community-level intervention,” said Megan Ranney, an emergency-care doctor and academic dean of the Brown University School of Public Health.
Officials are still watching the virus closely. States and local governments are tracking wastewater data and counting hospitalizations and cases. The federal government is eyeing purchases of vaccines and treatments.
And restrictions could return if Covid-19 cases surge again. Some universities and cities including Philadelphia have restored mask mandates recently.
But many measures are being left more to individuals, including Covid-19 testing and whether to wear masks. On masks, states and employers are largely leaving it up to people to decide whether to wear them.
Ashawn Dabney-Small, a 20-year-old community activist in Boston, said he is limiting socializing to friends and family who are vaccinated and wearing masks regularly. He said it has been tough sometimes to decide when to wear one ever since Boston stopped requiring mask-wearing indoors in public spaces in March.
“People are essentially doing what they want to do, but I will always mask,” Mr. Dabney-Small said.
Mass-testing sites have closed, more people are testing at home and the federal government has stopped covering the costs for the uninsured.
In turn, when you test positive, you don’t need to test negative to stop isolating, per the CDC guidelines, but rather wear a mask and make the determination yourself.
“There’s an acceptance that there is going to be more exposure for everybody to Covid out in the community and that people need to do what they feel like they need to do to protect themselves,” said Walid Gellad, a health-policy professor at the University of Pittsburgh.
When health regulators opened the door for people 50 and older to get another booster in late March, the Centers for Disease Control and Prevention stopped short of the full-throated endorsement it had lent to previous doses. Health officials have said it is up to people to decide on their own whether to get another shot.
When demand for Covid-19 vaccines was higher, health authorities made them available based on broad risk groups. They also typically strongly backed their use for certain groups. A debate over how to recommend initial boosters was largely settled when research showed an additional dose for eligible people increased protection against Omicron.
Some experts said the government forgoing a strong endorsement on the second booster is smart given the limited data available. Whether to get a second booster is more of an individual decision than with earlier shots in part because medical experts and federal officials don’t agree on whether the goal of Covid-19 vaccination is to reduce severe disease or prevent infections, said Dr. Wen.
“Because there is that discrepancy, there needs to be a conversation with the patients about what matters to them,” she said.
Physicians and public-health experts also said the benefit of a second booster is much less pronounced than deciding between your first dose and no vaccine, and is likely to be influenced by someone’s health. Yet many people—including physicians—in the U.S. are left confused about whether a second booster shot should be given immediately or if they should wait, possibly for an Omicron-specific vaccine.
Sumana Reddy, a family physician in Salinas, Calif., said the CDC should provide more details on what constitutes high risk, how much risk is lowered after vaccinations and treatments.
“Individuals are having to make their own decisions based on their own feelings of how protected they want to be,” she said. “I’m not sure people really recognize their risk. There’s a huge gray area where people don’t understand if they’re at high risk.”
Dr. Reddy administered second boosters even before the clearance by the government because of concerns about her patients’ protection.
“I’m also telling people to be strategic about it,” she said. “If they’re really truly limited in their interaction but know they’re going to be taking a trip in two months, I’m telling them to get that fourth dose.”
Some public-health experts said they are concerned that increasing the burden on individuals could jeopardize people who have weakened or compromised immune systems, or people who aren’t eligible to get vaccinated, such as children under 5.
They said leaving it to people to decide for themselves could exacerbate healthcare disparities around race and income, given hurdles in accessing healthcare. While the government has tried to increase access to easy-to-use antiviral pills such as Pfizer Inc.’s Paxlovid, the so-called test-and-treat program is limited to certain pharmacies.
“There is an element of, ‘We’ve had the training wheels on, we’ve helped you learn how to balance and now we expect you to understand the way that this works,’” said Dr. Ranney. “The error is I’m not actually convinced that all of society has learned how to balance on two wheels.”
Renée Onque contributed to this article.