Slavitt: For Omicron, ‘Only Sure Mistake Seems to Be Certainty’

In this video, Andy Slavitt, former White House Senior Advisor for COVID Response, discusses common COVID contradictions, public opinion, and their effects on public health policy.

The following is a transcript of his remarks:

I’ve interviewed a lot of experts, and there’s a lot of opinions. And with omicron in particular, there’s plenty of graphs and plenty of data points, but the truth is muddled. There’s a lot of contradictions, and at the end of the day, we’re gonna be shaped much more by the circumstances people live in and the attitudes that they develop.

I mean, these contradictions are everywhere. We’re hearing people say that it’s no longer realistic to prevent the spread of COVID. Yet so many people have worked hard to avoid COVID and don’t wanna stop now. We’ve heard that Omicron will make it much less likely for us individually to end up in the hospital. Yet hospitals are gonna be swamped because enough people will still get sick. We hear how important it is to get boosted, and yet even with three shots, there’s plenty of breakthrough infections.

The very definition of “mild itself” – when people say a mild infection, it’s challenging and it’s really in the eye of the beholder. Even cases that seem mild can have symptoms that linger and a virus that lingers. So it’s very tough to say that an infection is mild or not mild. And then there’s the contradiction that even as we feel personally safer, that itself causes us to let our guard down. And even with reductions, we’re still living with hundreds of thousands of deaths every year. A variant that just spreads so rapidly becomes a bit of a self-fulfilling prophecy, because people believe that they can’t live with higher restrictions, and that itself causes people to stop doing things like wearing masks.

Public health guidance changes along the way and will change along the way. Even recently, when we saw the new recommendations for how long people should quarantine – masks, boosters, all of those changes. They cause half of the people to say they really don’t trust the guidance they are getting and the other half of people see the guidance as hopelessly behind.

We just can’t know the future. We can’t know how to make policies given all these contradictions. And the truth is there are few absolutes as a result. We’re all processing things much more through our own individual circumstances and attitudes than we are any solid facts. A lot of people will see the same events very differently. If you’re young and you know a lot of people who have become positive with COVID, but aren’t particularly sick, COVID looks one way. If you have someone in your family with an organ transplant, that looks different. So these personal circumstances – whether you’re old or young, whether you’ve been vaccinated or not, if you’re immunocompromised, if you’ve been touched by COVID already, if you work on the front line, if you get paid a salary, if you haven’t seen your family in a while – all those things have as much to say about how you interpret these contradictions as the absolute truth.

Then your broader attitudes — about science, government, faith, what you believe to be your obligation to others in society — even more sharply define how people interpret the data that they hear about Omicron. And in the end, you’ve got three wildly diverging sentiments. At one extreme is this sentiment of “it’s inevitable,” because Delta and Omicron are impossible to contain and we have a very high unvaccinated rate that’s gonna be very hard to change. And that’s a very legitimate perspective that points to the same data as the opposite view, which is this view you might call “zero COVID.” This was the prevailing view in 2020, that you could really contain COVID. And, you know, people who take that view would point very rightly to thousands of people dying every week.

You come to different policy responses if you believe one versus the other. Do you give people a booster if it helps prevent them from getting infected but not hospitalized? Depending on what you believe in these two theories, that’s where you might land. We’re gonna be living with this kind of rain and sunny at the same time because we have a virus that may not kill in high percentages, but it’s also not the common cold. That means the more people who feel safe, the less safe it is for those who aren’t. Policy responses will become much, much harder.

There’s also a third zone, and that third zone is people who are in between this “it’s inevitable” and “zero COVID.” And this is sort of the day-to-day management people who wake up every day and decide whether they’re gonna take calculated risks and what their priorities are, whether for school or for family. People who will just test frequently so they don’t expose others, people that wear masks in crowds, but every day they’ll check local conditions and adjust. This approach acknowledges that the data changes, but it also can leave you in an extended limbo.

It also makes policy decisions very uncertain, because it’s not grounded to any of those perspectives. Any approach to addressing COVID is going to be open to criticism for the very simple reason that the pandemic doesn’t present the opportunity for perfect answers. Now, criticism is often warranted, particularly for people like me who are in the public arena, but attacks on those with honest disagreements are too common, particularly because there aren’t a lot of absolute truths here. It’s been much easier to find a graph or a study or data point that reinforces your view than it is to grant the nuance that validates someone else’s view. As of today, those who see omicron, for example, as milder are just as right as people who see it as potentially more dangerous.

For me, my baseline is to advocate for policies in favor of those with the fewest choices. Require vaccines for those who are going to be in crowds of people, preserve the best antivirals for the immunocompromised, support frontline healthcare workers by reducing spread. 2022 is gonna have a lot of twists and turns, but we do have the tools we could use to both minimize death and maximize living.

The only sure mistake seems to be certainty.