Wed. Jan 19th, 2022
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Masks are another example. If you can have only the best, you’ll focus on N95 masks, see they are in short supply at the start of the crisis and tell most people they shouldn’t wear masks at all because only certain ones provide the best protection, and we have to save them for those at highest risk. A population-level view argues that cloth or surgical masks — which aren’t anywhere near as good as N95s but were easier to get — would lower the risk for everyone when the pandemic was beginning, and therefore would be helpful. It took until April 2020 — many weeks into the pandemic — for the C.D.C. to recommend mask wearing for the general public.

When better masks are more available (as they are now), then of course everyone should be encouraged to use them, even if not everyone will wear one — but the C.D.C. is still sticking to “any mask is better than no mask.” While true, fearing that some individual might not wear any mask if you strongly recommend a better one misses a chance to potentially raise overall safety.

It’s not just doctors who focus on individual risk; it’s also patients. For example, any parent might reason that the risk to their child from Covid (and other vaccine-preventable diseases) in the United States is very low, so why take on any risk of a vaccine at all? But from the perspective of the public health system, only with herd immunity, or something close to it, can we begin to see an end to this pandemic — and that requires near-universal vaccination. Over-focusing on encouraging people to vaccinate to protect themselves, which is what every chart comparing curves of hospitalization among the vaccinated and unvaccinated tries to do, misses opportunities to explain that the biggest reason to vaccinate is often to protect others, especially those who cannot protect themselves.

The response to Covid is just one way this dichotomy expresses itself. Much of the way medicine discusses screening for diseases in general focuses on the individual. Diagnosing cancer often feels like failure and leads to an unrelenting push for earlier and earlier detection. This is how medicine ends up recommending mammograms sooner and more often. If you pull back to the population, you may see that screening mammograms in young, healthy women have done little to reduce their mortality, and much to worry them.

So what can be done about this? A start would be for those making decisions to explicitly define their goals when deciding what lens to use.

If we’re trying to prevent Covid surges and end the pandemic, then we need to center the population in our thinking. Health authorities need to get tools like rapid tests and better masks to as many people as possible, especially those who are more likely to spread disease, even if they’re at low risk themselves. People need to be persuaded or incentivized to vaccinate to protect others.

If you are sick, even with severe Covid, you want someone with a doctor’s viewpoint caring for you. America, however, is not a patient. And we’d all be better off, as a society and as individuals, if those in control of our country’s health stopped thinking of it that way.

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