The Bay Area was a model of cooperation during the early years of the COVID pandemic, as residents sheltered in place, lined up for vaccines and wore masks in public. Many residents have watched in dismay at the politicization of health precautions in other parts of the country.
Yet even in this conscientious region, vigilance did not last. As another winter surge of COVID grips the region, large numbers of people are forgoing masks and skipping the latest booster – an essential tool to prevent serious illness as immunity from previous injections or infection decreases.
Since the emergence of vaccines and better COVID treatments — and the lifting of heavy-handed government measures such as mask mandates — the public approach to the coronavirus has become more laissez-faire. Some are calling this approach the “find it out yourself” era of the pandemic. But individual choices still weigh heavily on vulnerable populations, such as the elderly and immunocompromised, some of whom are once again withdrawing from the public square.
Added to widespread apathy over the latest surge is considerable confusion about how to behave at this stage of the crisis. Experts say, in particular, that the rollout of the new bivalent vaccine booster – the first to target both the original coronavirus and the omicron family of variants – has been lukewarm. Without a strong marketing push and government resources devoted to distribution, many Americans are unaware of the benefits of the booster, or even its existence.
“The situation is that people have to decide as individuals,” said Denise Herd, a behavioral science professor at UC Berkeley in the School of Public Health. “Without a lot of information, without a lot of support for some of these public health measures, we’re going to see what we do now.”
To date, only 20.5% of eligible Californians have received the bivalent vaccine, leaving the majority more vulnerable to serious illness. California’s uptake is higher than the national average of 14.6%, but still only a fraction of the 72.5% of people who received the initial two-dose vaccine series. The bivalent vaccine is licensed for Californians over 6 months of age, depending on when someone completed their initial two-dose series and when they last received the old “monovalent” booster.
Bay Area counties lead the California average in reminder usage, but the proportion is still relatively low, ranging from 23% to 38% of the eligible population. This may contribute to the sharp rise in local COVID cases over the past month and the rise in hospitalizations that further tax a medical system already strained with outbreaks of influenza and respiratory syncytial virus, or RSV.
“Pandemic fatigue fatigue” and confusion
Some pandemic fatigue is “natural, expected and real,” said Marin County public health officer Matt Willis. He noted that the term has been in use since 2020. Perhaps now “we’re feeling pandemic fatigue,” Willis said.
After all, the ability to self-regulate “is like a muscle that gets tired,” said Benjamin Rosenberg, professor of psychology at Dominican University of California. “Doing this risk calculation every time you go out is exhausting,” he said.
A recent Chronicle survey found that fewer Bay Area residents were wearing masks to go to the supermarket, despite the current resurgence of COVID. Although not a scientific study, the comments offered to reporters – maskless people said they had ‘given up’ and wanted to ‘move on’ – underscored the public health challenge encourage voluntary compliance.
It’s easier to make healthy decisions when people have clear, credible and accessible information, and the decision itself is relatively easy to make, said Stanford professor of medicine Kevin Schulman, who has made research on marketing campaigns for the first vaccines in 2021. But in the current pandemic landscape, Schulman said, it’s hard to find those attributes.
“It’s no longer a scientific endeavor that we all follow every week,” Schulman said.
Indeed, Rosenberg added, other “big ticket items have replaced COVID at the top of the list of things people are looking to read,” whether it’s inflation, layoffs, Ukraine, abortion rights, the Warriors or the weather. And there’s only so much bad news that’s healthy to take in: Psychologists have actually measured an increase in news-related stress, according to the American Psychological Association.
“Some people are literally turning away from information about COVID. It’s almost like an ‘ignorance is bliss’ instinct,” Rosenberg said.
Diminishing attention diminishes cooperation with public health efforts. A September poll found, for example, that half of the American public had heard “little or nothing” about the bivalent vaccine.
But lukewarm messaging and the lack of a mass marketing campaign share the blame, Schulman said. “We don’t put as much effort into it as we put into getting people to vote for someone,” he said, referring to political ads during the midterm elections.
Information isn’t reaching the people who need it most, added Debbie Toth, CEO of the Pleasant Hill-based nonprofit Choice in Aging. Older people get their news mainly from radio and television, and sometimes from the local newspaper. “I can tell you that older people don’t go to public health websites looking for information,” she said.
Lack of federal funding, mobilization
The White House acknowledged the confusion to some extent. But he also faulted Congress for not authorizing additional funding to support the coronavirus response.
Meanwhile, the Centers for Disease Control has delegated much of the pandemic response to state and local public health departments, which in turn say they are looking to the CDC for guidance, a said Stanford professor of medicine Seema Yasmin, an expert in science communication.
“In the midst of that, you have hundreds of millions of Americans thinking, ‘Who’s responsible for what’s going on and what should I do? ‘” Yasmin said.
Resources are “really limited,” with no additional federal funding to do mass vaccination sites or other big campaigns, said San Francisco health officer Susan Philip.
Programs such as those that sent teams of people to nursing homes to vaccinate the elderly in 2021 have been reduced or eliminated.
“It’s the people with health insurance, with computers, with transportation options that can still really choose whether or not to get vaccinated,” said UC Berkeley’s Herd.
Some elderly and disabled people affected
The urge to resume a “normal” life may be stronger in young people, but they are also less at risk. More than half of California’s confirmed COVID cases are in people between the ages of 18 and 49, according to the most recent data from the state’s COVID-19 dashboard. Still, Californians over the age of 65 — who make up one-sixth of the population — account for nearly three-quarters of confirmed deaths in the state.
Another group at increased risk for serious illness and hospitalization are people with weakened immune systems. As masks come off and precautions fade, writer, speaker and disabled model Charis Hill, who has the inflammatory disease of ankylosing spondylitis, has self-isolated to protect himself.
“The fatigue of a lot of able-bodied people is that they want to travel again,” Hill said. “My fatigue is that I just want autonomy over my own life and activities of daily living.”
A return to normal ignores that “normal has never been good for people with disabilities,” Hill said.
Some jurisdictions are now moving to reinstate limited regulations. Last week, the Oakland City Council reimposed a mask mandate inside public buildings after lobbying from groups such as Senior & Disability Action.
Senior & Disability Action director Jessica Lehman despaired of the mindset that COVID isn’t serious if most elderly and disabled people go to hospital and die. This reinforces the idea that “older people and people with disabilities are less important, less valued in society,” she said.
But most public health officials remain reluctant to enact mask mandates. “We won’t enforce behaviors unless there’s a major change in the virus,” such as a more virulent strain that’s highly contagious, Willis said.
Possible solutions
In the absence of blanket mandates or costly marketing and incentive campaigns, health experts see how the general public could once again be engaged to help slow the virus and protect themselves.
“You’re changing the environment to make the healthy choice the easy choice,” said Santa Clara County Public Health Officer Dr. Sara Cody.
Simple measures can go a long way: offering free masks at the entrance to buildings, or suggesting that patients get a bivalent vaccine when they consult their doctor or go to the pharmacy to pick up a prescription. The key is to grab their attention “in the fleeting moment” when they become motivated, Rosenberg said of The Dominican.
It may also involve a rebranding of the vaccine: if part of the pandemic fatigue stems from feeling uncertain, then “the vaccine itself is actually the cure because it makes you safer in every way”, said Willis of Marin County.
Philip from San Francisco added, “We need to reinforce the message that…it’s very effective in keeping people out of the hospital.”
Claire Hao is a staff writer for the San Francisco Chronicle. Email: claire.hao@sfchronicle.com Twitter: @clairehao_
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