The CDC's Big Surprise!

The CDC opted to lift all restrictions for the vaccinated. That it was a surprise is a really bad thing

Welcome to Plugging the Gap (my email newsletter about Covid-19 and its economics). In case you don’t know me, I’m an economist and professor at the University of Toronto. I have written lots of books including, most recently, on Covid-19. You can follow me on Twitter (@joshgans) or subscribe to this email newsletter here. (I am also part of the CDL Rapid Screening Consortium. The views expressed here are my own and should not be taken as representing organisations I work for.)

“I don’t understand the CDC.” This is a different and more damning statement than the usual “I disagree with the CDC.” But this week’s announcement that the CDC was changing its guidelines to allow all fully vaccinated people to live life (mostly) without restrictions seemingly came out of nowhere. Contrast it with its, albeit poorly messaged, the announcement that vaccinated people (and perhaps others) don’t have to wear masks outdoors. I understood that one because the driver was the scientific consensus that the outdoor spread of Covid-19 wasn’t a thing. I can critique the decision for being too late, etc., but coupled with some precautionary motives I could understand it. The decision last week, by contrast, is hard to understand.

By hard to understand, I mean that it is hard to see what triggered it. To be sure, there had been a running criticism that there was an inconsistency between the CDC’s messaging that the vaccines worked and that the vaccinated had restrictions on them. But you could understand the CDC being cautious because there were new variants and there were things we didn’t know. Besides, it wasn’t as if the US had achieved the low prevalence of Israel and the UK. As I said, you could disagree with how the CDC weighed the various trade-offs but you could understand where they were coming from.

Last week’s announcement came as a surprise. That is the first clue that something is amiss. No decision based on the science or evidence should come as a surprise. We, and I mean experts not me, would have seen the evidence and so when the CDC announced a change, been able to point to it and say, “see.” What it seemed to be is that the CDC has moved from overly cautious to overly optimistic in a single bound. So I don’t understand the CDC now because they have seemingly changed who they are.

Why is understanding important?

Understanding is important because how we process information depends on our views regarding where someone is coming from. If you talk to someone who tends to be overly cautious and they say they are going to act in a less risky manner (e.g., “wait and see” etc), you can process that and think to yourself, am I as cautious as them and act accordingly. On the other hand, if that same person says they are going to do the nominally risky thing, you can say, well I am not as cautious as them so if they are happy to do this, then I should be too.

Prior to May 13, the CDC, for all their other issues, could be relied upon to be overly cautious. They shared that with pretty much every other public health agency. You could critique their decisions but you could understand them — they are placing too much weight on this rather than that. This was why when the CDC suddenly decided vaccinated people could go maskless, many were thrilled because the CDC had a reputation for being cautious and they were pretty much declaring the pandemic over.

But it wasn’t that. The less cautious experts were saying, “hang on a minute.” This wasn’t the CDC being finally pried out of its reticence to let people go back to normal. This was the CDC being ahead of that and jumping the gun. Surprise! How am I supposed to process that one? If I believed that the CDC was still cautious in its nature, then I could act. If not, then I am just confused and don’t really know what to do.

Their surprise landed like a big dollop of doubt on businesses and states. Previously, the CDC was cover for them. Now the CDC was either cover for them to just let it all rip or to be faced with greater challenges in pandemic management. Given the differences between the states in terms of the outbreaks they are still experiencing, no one needs challenges right now.

The issue is that this now makes it confusing for all subsequent decisions. What is going to happen if the CDC changes back to needing to impose restrictions? Does the CDC have a new, “we are only advocating this because we really mean it” reputation or do they have no reputation? My guess is the latter.

OK, what about this decision?

Of course, what about the decision itself? Is it is a good one? One problem with the issue of understanding is that we don’t know what the criteria for the decision were. The most likely criteria are that the US vaccination rates have stalled and the CDC is trying to speed them up. The way they have chosen — which is something many argued for — is to provide greater benefits — in terms of freedom — if you are vaccinated. That makes sense. But as many have pointed out, the flipside of that is that unvaccinated people can mimic themselves as vaccinated people and enjoy those benefits too but, at the same time, posing a greater risk to other people.

On that broad trade-off, I don’t know if this is the right call. But for a place where prevalence is low and with summer coming, I think there is merit to removing restrictions for vaccinated people to boost vaccinated rates (and also second dose takeup) prior to the fall which could be very rough. I also think that, when asked, people do find it hard to lie. Not all people (and we tend to focus on that) but most people. So I am less worried about unscrupulous unvaccinated people. But there is no concrete evidence for any of this. I guess we are about to find out.

This doesn’t quite get to the issue of whether this decision was right. It almost certainly was not the right one for a national health agency in a large and diverse country. Look at the difference in vaccination rates:

Maine is not Idaho. (And what’s with the missing data!) And that matters when we look at case rates:

This is a country with more than 30,000 cases and 600 deaths per day. But it is concentrated in some places which means that, in those places, there are real risks in relaxing restrictions.

But the big issue is that this “just happened.” There was no, “if you get to 75% vaccinated in your county, you can relax” type plan which some states were already trying to do. That would have made some sense and given local authorities and businesses the cover they needed. And there was no timeline such as, “if things keep going the way they are, then on June 1, you can relax,” type arrangement. Instead, it was, “we are changing our mind, today.”

There is still a global pandemic. We are not at the stage where we can do anything that looks like declaring victory. So this bad policy in my opinion. It sends one right signal — there are good reasons to be vaccinated — at the cost of a whole bunch of wrong and unnecessary signals.

Anyhow, I’ll leave it here and just recommend again that everyone reads Michael Lewis’s book on the subject.