Public Health Professionals Should Be Saying THIS about the
Public’s COVID-19 Risk Choices

Hundreds of years ago, doctors believed that the pure-in-heart were protected from getting sick. No infectious disease expert believes that today. The COVID-19 virus doesn’t care about your motives. What you do is as safe or dangerous as it is, regardless of why you do it.

The job of public health professionals is to try to figure out and then communicate how safe or dangerous that is. It is a difficult job, and we haven’t done it very well.

• We were slow to realize and say that the surfaces you touch matter way less than how close you let yourself get to other people.
• We were slow to realize and say that people wearing a mask, any kind of mask, are way less likely to infect others than people not wearing a mask.
• We were slow to realize and say that outdoor activities are way less likely to lead to the spread of the virus than indoor activities.

Even now, we can’t fully quantify these differences, and there are a few experts who think we’re wrong about one or another of them. But we have made real progress in understanding COVID-19 risk factors.

The question of when a COVID-19 risk is worth taking and when it’s foolish is not a public health question or a science question. Governments make those decisions; and within the range governments permit, individuals make those decisions. As a citizen, a public health expert may believe that one activity is worth the risk and a different activity is not. That is never a scientific opinion, and we should never pretend that it is. We should never try to harness the credibility of public health on behalf of our judgments as citizens.

Racial inequality is an important public health issue. Economic privation is also an important public health issue. Everyone is entitled to believe as a citizen that one of these issues is more important than the other. No one is entitled to claim as a public health professional that demonstrating on behalf of one of these issues is more important – or somehow safer – than demonstrating on behalf of the other. To the extent that we have done that, we were wrong.

For the foreseeable future, our society will be living with the COVID-19 virus. Some priorities are obvious: We need to protect the most vulnerable among us; we need to pay attention to congregate settings; we need to identify infected people and trace their contacts; we need to keep hospitals from being overwhelmed. Other questions are debatable: Is K–12 education important enough to take the risk? Is religious worship important enough to take the risk? Is being at a dying loved one’s bedside important enough to take the risk?

Some of these decisions will be made by governments, some by individuals. The job of public health experts is to inform these decisions and respect these decisions – not to make them or tell people how to make them.