Making Sense of Pandemic Restrictions

(Or Why Thanksgiving Dinner is Cancelled But Schools Are Not)

Last week the Governor of Vermont announced a ban on multi-household gatherings and other temporary mitigation measures in response to a rise in community transmission of COVID-19 and a surge in case numbers. These restrictions are intended to limit activities that are known to lead to viral transmission in order to preserve essential services, like in-person learning. For many Vermonters, this was a much-appreciated measure. For others, this led to confusion, resentment, and fear. How is it not ok to have family or friends over for dinner but ok for kids to still go to school? Is that safe? Is it fair?

So here we go — a quick look at epidemiology, risk perception, and equity to make sense of the new guidelines.

Epidemiology

We are fortunate to have a robust and thorough contact tracing program through the Vermont Department of Health (VDH). The contact tracing investigations have revealed that recent viral transmission has occurred during private events and social gatherings like house parties, baby showers, tailgating, and other social events. The virus has mostly spread via adults in informal settings who are not wearing masks or following guidelines. So if we want to stop the virus from spreading, it makes sense to stop doing the activities that we know lead to transmission. Notably, schools and workplaces are not leading to significant transmission of the virus.

The in-person learning environment is not one of the main drivers of transmission.

Low rates of school-based transmission were predicted early on in the pandemic when it was observed that children are not as effective at transmitting the virus as adults. As the months have gone by and child care, summer camps, and now schools have shown very little viral transmission, we have even more evidence to support the idea that the in-person learning environment is not one of the main drivers of transmission. And there’s no evidence that making schools fully remote would lower case rates in the community. But still, for some, schools remaining open feels potentially scary. Which leads me to the next point…

Risk perception

We humans are bad at understanding risk. Our brains are just not wired in a way that allows us to be objective all the time. We tend to overestimate the risk of activities that are rare, unusual, or out of our control. And we underestimate the risk associated with activities that are familiar to us and in our control. For example, back in the day when air travel was a thing, how many of us got nervous stepping onto an airplane? And how many of us were told, “you’re more likely to die in a car crash on the way to the airport than in a plane crash”? Was this fact comforting? Did it change how you felt or behaved? Probably not. Most of us understand this fact to be objectively true but it still doesn’t completely quell the fear and anxiety. Facts don’t always FEEL right.

These emotions lead us to make decisions that don’t always align with true risk. In this case, if our brains allowed us to assess risk more objectively, we would all relax a little more on airplanes but would be more careful driving our cars. And that might lead to better outcomes overall with fewer car crashes and less in-flight alcohol consumption.

Ok, back to pandemic behavior. Our inability to assess risk properly is exactly what has led to the epidemiological trends above. We’re careful when we go to work, and school, and the grocery store. In Vermont there is reasonably good compliance with the mask mandate in public spaces and schools have done a ton of work to minimize the chance of viral spread. From the beginning of the pandemic, we have viewed schools and public places as potentially risky — full of strangers and events out of our control. So we’re careful. And that’s been great because we haven’t seen transmission in these public settings. But then we go home and relax and let our guard down. Our homes and the homes of our friends are familiar and comforting. We put the masks away and share space and food and celebrate and commiserate. We feel comfortable doing these things even though that’s where viral spread is happening. It’s as if we’re driving home from the airport too fast in bad weather, distractedly flipping through the radio stations, feeling relieved that we survived the flight. Our assessment of risk is off and it’s leading to unintentionally risky behavior.

The hopeful part? We can turn this thing around. We just need to reframe our perception of risk to align with what the evidence is telling us. This means cancelling plans with anyone outside of your home over the holidays. No non-essential travel or visitors. Cancel it all now. Parents should cancel playdates or interactions with others outside the home unless it’s related to child care. If you share a home with a student or someone who is an essential worker like a teacher, childcare provider, or healthcare worker, please know that your behavior affects their ability to work and go to school.

We just need to reframe our perception of risk to align with what the evidence is telling us. This means cancelling plans with anyone outside of your home over the holidays.

So we’ve established that settings with preventive measures in place, like schools, have lower viral transmission than informal social events, even though this may run counterintuitive to our feelings about these situations. That should be enough to understand the newest restrictions on gatherings. But wait — there’s another factor…

Equity

Although COVID-19 presents a risk to all of us, it does not do so equally. We know that there are great disparities in how the virus directly and indirectly affects our population. Knowing that the virus discriminates, we should all make decisions about our own activity through an equity lens. Ask yourself, does this activity minimize or exacerbate inequity?

As an example, holiday travel and gatherings are activities that require resources that are not available to all Vermonters. Travel requires a place to stay, a reliable form of transportation, and time off from work. Hosting visitors requires a home with space and food to share. Vermonters struggling with housing or food insecurity are not able to participate in these activities. Holiday gatherings are not equally accessible and by increasing the risk of COVID-19 transmission in the community, they threaten the ability of schools to stay open — a place that does address and minimize inequity. Keeping our schools and early childhood centers open should be a priority.

This is crucial because kids need consistent in-person learning. Childhood and adolescence moves at an accelerated pace compared to adulthood. Growth and development is measured in weeks and months, not years. Development is rapid and exciting but that also means that when opportunity is missed or delayed, that lost time can be unforgiving to children. We saw this in the spring, when school closures led to regression of developmental milestones for our children with special health needs who missed out on much-needed services. Educators have been racing against the clock too, trying to catch students up and re-engage learners who have fallen behind. There are critical time periods for motor and sensory development, for social emotional learning, and for academic progress. Kids can’t afford to lose more time.

So there it is. How epidemiology, risk perception, and equity factor into the new restrictions.

Lastly, a note about trust. Our behavior is influenced by our social circle and by the information we consume. In the midst of a novel global pandemic, information is ever-evolving. Guidance can change over time, leading to a sense of uncertainty and mistrust. And let’s face it, the federal government has done a lousy job containing the virus and promoting evidence-based practices. In the absence of credible national leadership, who do we trust?

For me, personally, I trust VDH and the leaders in Vermont who have guided us through the pandemic with consistency and appropriate caution. Week after week, we have had the lowest, or close to the lowest, prevalence and case positivity rates in the country. Governor Scott and Dr. Levine stand in front of Vermonters twice a week and report the newest data and guidance and then answer questions for hours (no exaggeration — these press conferences are long). Behind them, invisible, is a network of people working tirelessly to collect and analyze data and make recommendations. They are the public health experts among us — our friends and neighbors who care about keeping Vermont safe. These are the people I trust.

To recap VDH guidance: wear a mask, keep six feet apart, get your flu shot, stay home when sick, get tested if you’ve been in a social setting. And the hard part: cancel upcoming travel and gatherings. Share your change of holiday plans with others in your social circle. This will create a sense of community and shared sacrifice. And in this season of gratitude, consider sending messages of thanks to your local schools, early childhood centers, and child care hubs. They are holding our communities together right now.