In February 2022, the U.S. Centers for Disease Control and Prevention (CDC) made a significant change to its COVID-19 community levels map, altering the way the pandemic's impact is visualized and understood across the United States. This adjustment represented more than just a cosmetic change; it was a fundamental shift in how the public's risk of COVID-19 is assessed and conveyed. The consequences of this shift have implications for public perception, behavior, and ultimately, public health outcomes.
The Change in CDC's Color-Coded Map
Before February 2022, the CDC's map predominantly showed red areas, signifying "high" transmission levels across much of the country. However, with the introduction of the new color scale, the map transformed overnight, depicting most of the U.S. in a hypnotically calming shade of teal, symbolizing "low" transmission levels. This change was visually dramatic and had an immediate impact on public perception. The previous red color indicated a sense of urgency and caution, whereas the new green color conveyed a message of safety and normalcy.
Swapping Data Sets: A Shift in Metrics
The key to understanding this change lies in the CDC's decision to swap data sets. Previously, community levels were determined based on the amount of virus spread and the percentage of COVID tests returning positive. These metrics directly reflected the current state of virus transmission within communities. In contrast, under the new guidance, the focus shifted to hospital capacity. This means that the map's color coding now primarily indicates whether local hospitals are overwhelmed, rather than the actual rate of virus spread in the community.
Implications for Mask Guidance
This shift in metrics had immediate practical implications. In counties marked as green or yellow, individuals are advised that they can leave their masks at home. This advice is based on hospital capacity rather than actual virus transmission rates. This change potentially leads to situations where individuals in areas with high virus transmission are not adequately warned or advised to take precautions like mask-wearing, because local hospitals may not yet be overwhelmed. If you think about it, that’s like basing drunk driving rules on ER wait times.
Risk of Adverse Outcomes
One of the significant concerns with this new approach is its potential impact on adverse outcomes such as Long COVID and death. The revised guidance could mean that individuals might not be advised to mask or take other precautions until hospitalization rates increase, which is often a lagging indicator. By the time hospitals start to fill, many people may have already been exposed to the virus, increasing the risk of widespread transmission and the associated long-term health consequences.
Normalization of High Death Toll
Another critical aspect of this change is the normalization of a high death toll. The CDC's category of "high"—the level at which masking indoors is finally recommended—seems to correspond with alarmingly high numbers of COVID deaths per day. If the public health guidelines are being adjusted to accept a certain level of death toll as 'normal' or 'acceptable,' this raises ethical and transparency concerns. The public deserves to be informed if the threshold for what constitutes a public health emergency has been shifted.
Delusional Thinking and the Myth of Pandemic's End
The revision of the CDC's map and the underlying metrics fosters a kind of delusional thinking about the state of the pandemic. With much of the country displayed in green, suggesting low community levels of COVID-19, there's a risk of instilling false confidence among the population. This misperception can lead to reduced vigilance, lower compliance with preventive measures, and consequently, increased virus transmission. Moreover, this change plays into the widespread desire to believe that the pandemic is over, despite evidence to the contrary. The real data, focusing on actual transmission rates, suggest that the virus is still spreading at high levels in many parts of the country.
The CDC's decision to change its data metrics and color-coding system for COVID-19 community levels was not just a technical adjustment; it had profound implications for how the public perceives and responds to the pandemic. By focusing on hospital capacity rather than virus transmission rates, the revised system underplayed the actual risk and contributed to a false sense of security.
This approach not only impacts individual behavior but also influences public policy and resource allocation. We will use this green-mapping as a metaphor, but the actual green map is worth digging in to in a bit of detail, as we did here, because it underscores the sheer slipperiness of scicomms during the current crisis.