The Covid-19 pandemic has exposed two competing views of how society should consider the risk-benefit ratio in formulating public-health policy. One view is that our policy, guided by experts, can and must eliminate risk; any benefits are worth deferring until the risk is eliminated. The other view is that risks are to be expected, and that experts have only a limited ability to mitigate them; proponents of this view more readily recognize the need to balance risks and benefits, including the benefit of personal choice. These competing views of risk have revealed themselves in public attitudes toward policies like mask mandates and school closures. It’s convenient to write off these differences of opinion to politics, but on matters of public health, individuals may be governed more by their own views on the risk-benefit ratio.
Over time, the balance of power between those contrasting views has shifted. At the start of the pandemic, when the elderly and other vulnerable populations were dying at unacceptable rates, hospital intensive care beds were filled, and few effective clinical practices or pharmaceutical treatments were available, the United States, like many other countries, went into lockdown to stop transmission and slow the growth of new cases. Public-health discussions focused on how to achieve herd immunity. The zero-risk perspective, along with relatively widespread support for a limited lockdown, seemed to rule the day.
Today, the situation is different. It is unlikely that we will achieve herd immunity, even with the vaccines. And as the highly contagious Omicron variant spreads, we have seen public-health policymakers begin to shift from a focus on eliminating Covid to an acceptance of its endemic nature and a more balanced approach to risks and benefits. We also have new treatment options—and, though vaccines don’t seem very effective in blocking transmission of the Omicron variant, they do appear to protect against severe illness. As Omicron surges, advocates for mask and vaccine mandates and restrictions on large gatherings argue that a rapid rise in severe illness could overwhelm hospitals and health-care personnel. On the other side of the ledger, the costs of these mandates and restrictions are the loss of personal choice, economic hardship, and additional educational and developmental losses for children.
Notably, public-health policy has shifted to align with these new facts, but the opposing zero-risk and balanced risk-benefit views remain. The CDC’s move in late December to reduce the recommended length of the Covid isolation and quarantine period from ten days to five days is a sign that the decisional calculus is slowly moving toward a more balanced perspective, weighing the need for people to go back to work against the reality that some small percentage of the returning workforce may still be infectious. One need only consult Twitter to see this debate raging among public-health professionals and government officials.
The point of contrasting these two viewpoints on public-health policy is not to impugn one group or the other but to recognize that those arguing for a risk-benefit view are being just as rational and considerate in their concerns as are those who hold to the zero-risk view. The differences are less about politics than they are about individual judgments of what we should be willing to sacrifice to eliminate risk in our lives.
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