The CDC and Misinformation Within The Parameters of Truth

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The New York Times’ Dave Leonhardt reports on a misleading statistic being reported by the CDC:

When the Centers for Disease Control and Prevention released new guidelines last month for mask wearing, it announced that “less than 10 percent” of Covid-19 transmission was occurring outdoors. Media organizations repeated the statistic, and it quickly became a standard description of the frequency of outdoor transmission.

But the number is almost certainly misleading.

It appears to be based partly on a misclassification of some Covid transmission that actually took place in enclosed spaces (as I explain below). An even bigger issue is the extreme caution of C.D.C. officials, who picked a benchmark — 10 percent — so high that nobody could reasonably dispute it.

It is a good report, but I take issue with this part:

This isn’t just a gotcha math issue. It is an example of how the C.D.C. is struggling to communicate effectively, and leaving many people confused about what’s truly risky. C.D.C. officials have placed such a high priority on caution that many Americans are bewildered by the agency’s long list of recommendations. Zeynep Tufekci of the University of North Carolina, writing in The Atlantic, called those recommendations “simultaneously too timid and too complicated.”

I don’t believe they are “struggling” to communicate anything, and I believe that their communication is effective for what they are trying to accomplish. It just so happens that the transmission of useful information is not it.

Since the beginning of the pandemic (and before, but we’ll get to that) the CDC has managed to project this image of ineffectual communicators whose nerdspeak is poorly conveyed by a scientifically illiterate media. Then, when it becomes revealed that everybody got the wrong idea, it’s not their fault you see. So, we need to continue to “trust the science” and such. Now, the part about the media is true. It is often the case that the media misconstrues and then misreports something. But it’s also true that they not only hide behind this, but rely on it.

There have been numerous “communication failures” over the past year, and one of the big things they tend to have in common is that misunderstanding would, should, or does lead people to behave in ways that the CDC would prefer that they do.

“There is no proof that masks are effective against Covid,” they say. It is reported and understood as masks being ineffective. People don’t wear masks and therefore more masks are available to front-line healthcare workers who need them. Then it turns out masks are effective against Covid, and you see we all misunderstood because “no proof” means just that they weren’t actually saying that people shouldn’t wear masks or that they do no good. (Except where they were.) There are people to this day who argue that we simply misunderstood about masks, even as Fauci admitted that PPE for health care workers played a role in delaying the correction of the “misunderstanding” for a couple weeks. Similarly, Fauci admitted that his estimate of what vaccination levels would be needed to get herd immunity was based not on a real scientific estimate (he had no idea what was needed) but a number high enough to potentially work but low enough to be achievable. Once again, about getting people to behave the way they wanted¹.

Another example is the J&J Pause, which many justified on the basis that they needed to pause it so that people would have faith in the efficacy of the drug. It was, as much as anything, an exercise in public communication and behavioral science. Others argue that they shouldn’t have paused it specifically for fear of the lack of confidence in the drug conveys, which in my view falls into pretty much the same trap in the other direction. I understand the temptation and it was one of the first things I thought about, but short of knowing how people will respond with great confidence, perhaps the decision should have been made based on the potential health consequences of offering it or not, and informed consent towards those who would take it. Compare the dangers of pausing to learn more about the scope of the problem and slow vaccinations down versus the dangers of continuing with more adverse outcomes. While they paused it out of a sense of caution, they also misled people about the dangers. They cited the “one in a million” and relayed that young women were at greater risk leading a lot of people to believe that women were at one-in-a-million risk while men had none, when in fact men having near-none meant fiddling with the denominator and in fact female risk was substantially higher than one in a million. But at the same time that they paused the vaccine to communicate that they were diligent watchdogs, they also underplayed the dangers in certain demographics to reduce the number of people who refuse that particular vaccine.

To be clear, this isn’t about what they did or did not decide to do with the vaccine. I have my opinions on that, but that’s beside the point except to say that I came to mine primarily by way of a focus on informed consent. Emphasis “informed”. Can we trust people to make these judgments wisely? Not really. But neither can we trust public health experts to successfully manipulate behavior for the public good. They’ve not demonstrated that they are very good at it. While it is to some extent unavoidable when it comes to trying to figure out what people can actually do (to make sure recommendations are achievable), it goes awry when it enters the realm of reverse psychology or trying to figure out what they need to believe in order to do what you want.

This brings us back to today’s revelation, that they are misleading people into believing a percentage of outdoor transmission that is a rate 100x (not 100%, but 100x) higher than it is. Why did they do it? Well, not because they are nerds at the mercy of a scientifically illiterate media. Some of it is CYA by picking a number that cannot possibly be wrong. Some of it is, I think, a belief in the scientific community that it is important not to give anybody the impression that they can afford not to be vigilant at any time in any place. They fear – not wrongly – that some would take the .1% figure as an excuse not to be vigilant outdoors. The same reason that they drug their feet so long on wearing masks outdoors if vaccinated. It wasn’t necessarily that they cared about people wearing masks in that context, but that they are very concerned about people getting the idea that they no longer need to worry when they still do (or might, anyway).

As is obvious from my tone, I am not a fan of this thinking. Until somewhat recently (specifically the vaping issue, and the pandemic) I was sympathetic to it. I may be one of relatively few people whose view of people in general has actually gone up during this pandemic. If 24 months ago you would have told me that people would be willing to do what they have done over the past 18 months, I would not have believed it. While our political leaders have gravitated towards advocating licking doorknobs for fun and profit on one side and cancelling Halloween on the other, the people found their middle ground with very poor guidance. I have been very frustrated with public opinion on multiple issues throughout this pandemic, but for the most part the failures I see have been failures of leadership.

Maybe you disagree. Maybe you think this is the way it just has to be because people are gonna people and people are the worst. C’est la vie. But whether we believe what they are doing is good or bad, we should at least be clear about what they are doing.

1. To be clear, Fauci doesn’t work for the CDC, but he is a voice for the public health community and though unfortunately I can’t find it, he did say he looked for a number based on how he thought people would respond to it.