What Constitutes a Smart Public Guide to Fitness?That’s the verbal exchange I was having with a colleague in her 40s who pointed to the Centers for Disease Control and Prevention’s old rules on alcohol consumption for women of “childbearing age. “These rules, if followed closely, would mean that all women between the ages of 15 and 49 deserve to abstain from alcohol altogether unless they are employing birth control. That’s more than 77 million women in the U. S. alone. U. S. Regardless, the CDC’s rules were shelved last year. , along with a similar proposal from the World Health Organization. For a clever reason: it’s absurd.
In four years of the Covid pandemic, we’ve noticed that many, many instructions change over time. Most recently, the CDC relaxed its isolation recommendations after a positive Covid test.
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People ask: how much guidance does it deserve to be evidence-based compared to what the public is willing to do?But that’s not the right way to think about it. On the other hand, those responsible for public fitness policies deserve to take into account the burden it entails. about other people to replace their behavior, as opposed to the health benefits that replacement can provide to them and those around them.
The CDC’s new rules on what to do after a Covid infection have been moot among some. They say you isolate if you have symptoms, but when your low-grade fever and symptoms improve, you can end isolation. From this attitude of burdens and benefits, the new technique makes much more sense.
Abstinence from alcohol in women between the ages of 15 and 49 (unless contraceptive) is a perfect example of the application of this framework. At first glance, this would possibly make sense: fetal alcohol syndrome (FAS) is a serious problem. Many women don’t know they’re pregnant for a while after conception. If the purpose were to eliminate all cases of APS, ensuring that no woman of childbearing age drinks alcohol would be a moderate recommendation.
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But peak cases of APS are not due to occasional alcohol consumption in early pregnancy. They are largely motivated by excessive alcohol consumption during much of pregnancy. Therefore, ask all women to avoid drinking alcohol during their possible pregnancy. Childbearing years? It’s a very heavy burden. In theory, this would be beneficial, but the absurdly high charge for a minimum profit means it doesn’t make sense.
When we think about other public fitness recommendations that make sense — washing your hands after using the bathroom, putting on your seatbelt in a car, getting a flu or Covid shot if you’re older — those are all minor burdens and superior benefits. . Activities. Even when the burden is moderate or maximum, the benefits can be worth it: quitting smoking, losing weight in case of obesity, restricting the number of sexual partners and/or condoms for sexual activity. None of this is easy. Many other people aren’t willing to perform them, but that doesn’t replace the fact that the benefits of this technique far outweigh the burden, so the public fitness recommendation makes sense.
So how does this framework apply to the new Covid-19 isolation guidelines?In 2020, with vaccines and treatments widely available, Covid-19 infections caused severe illness, hospitalizations, deaths, and even other healthy young people, for a long time. Reducing the spread of infection was vitally important, and the most productive way to do that was to ask other inflamed people to isolate for five to ten days, with masking and negative tests as possible tactics to end isolation a little earlier.
This was a heavy burden. People were taking time off work, and for those who don’t have paid leave for poor health, that loss of source of income can be the difference between paying rent and putting food on the table. Young people skipped school. Single pahirs may simply not take care of their children. These are certainly heavy burdens, but for years the benefits have been very important and useful: keeping other people alive, reducing hospitalizations, reducing long Covid.
But this is no longer the result of Covid. Si well at most everyone in the U. S. If U. S. adults have some degree of immunity to the virus (the CDC estimates that 98% of Americans have either been inflamed or vaccinated, or both), the outcomes of infection in 2024 are simply very different for most. (People who are at maximum risk can still get very sick, especially if they haven’t kept up with their shots. But other people who are at maximum risk can remain safe. )burden on Americans and their families who oppose benefits.
With this in mind, it makes sense to ask other people to isolate when they have symptoms (if they have a fever, the symptoms get worse). They are very contagious. But as the symptoms subside, so does the contagion. So, while a user a week after symptoms may still be contagious, they are much less so. And the threat of spreading the virus a few days after symptoms have disappeared is low. So is the consequence.
But the burden of isolation several days after symptoms have disappeared is very heavy. In 2020, this advice made sense. In 2024? Not so much.
The explosion of public fitness science over the past 50 years has led to the identification of a wide diversity of elements that can contribute to fitness. Some of those things have wonderful advantages, while others are minimal. If we were to adopt an absolutist technique, in which public health officials would consider rules for anything that provides benefits: we’d end up recommending that people never eat bacon, probably avoid all meat, never drink alcohol (no amount is safe!), never drive. hour, and so on. Sure, those things have their advantages, but the advantages of avoiding bacon (technically a Group 1 carcinogen) are minimal, and for bacon lovers, the burden is heavy.
Public fitness consultant lines have been confusing the pandemic. It seems to be constantly evolving, leading other people to wonder: Is science evolving?Sometimes yes, our clinical understanding changes as we learn new things. But this is not the only detail that we deserve to consult our guidelines. As population immunity increases, the benefits of avoiding infection through the use of heavy loads decrease. And as the pandemic progresses, it is imperative that our orientation reflect not only the new science, but also the new realities of burdens and benefits.
Ashish K. Jha is the dean of Brown University’s School of Public Health and a former White House Covid-19 response coordinator.
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