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 donned masks in public. Many locals looked on with consternation as health precautions became politicized in other parts of the country.
Yet, even in this conscientious region, vigilance hasn’t lasted. As
another winter COVID surge
grips the region, large numbers of people are
forgoing masks
and
skipping the latest booster
— a vital tool in preventing serious illness as immunity from previous shots or infection wanes.
Since the emergence of vaccines and better COVID treatments — and the lifting of blunt governmental measures such as mask mandates — the public approach to the
coronavirus
has become
more laissez-faire.
Some call this approach the
“figure it out yourself”
era of the pandemic. But individual choices still exact a heavy toll on vulnerable populations, such as older and immunocompromised people, some of whom are retreating again from the public square.
Compounding widespread apathy toward the latest surge is considerable confusion over how to behave at this stage in 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 tepid. Without a strong marketing push and government resources put into distribution, many Americans are unaware of the booster’s benefits, or even its existence.
“The situation is that people are left to decide as individuals,” said Denise Herd, a UC Berkeley behavioral sciences professor 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 severe 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 authorized for Californians
older than 6 months,
depending on
when someone completed their initial two-dose series and when they last received the older “monovalent” booster.
Bay Area counties lead the California average in booster uptake, but the proportion is still relatively low, ranging from 23% to 38% of the eligible population. That may be contributing to the
sharp increase in local COVID cases
in the past month and
rising hospitalizations
that further tax a medical system already straining with outbreaks of flu and respiratory syncytial virus, or RSV.
“Pandemic fatigue fatigue” and confusion
Some fatigue with the pandemic is “natural, expected and real,” said Marin County public health officer Matt Willis. He noted that the term
has been used since 2020.
Perhaps now, “we’re getting pandemic fatigue fatigue,” Willis said.
After all, the ability to self-regulate “is like a muscle that gets tired,” said Benjamin Rosenberg, a psychology professor at Dominican University of California. “Making that risk calculation every time you go out, it’s exhausting,” he said.
A
recent Chronicle survey
found fewer Bay Area residents wearing masks to go to the supermarket, despite the current COVID resurgence. While not a scientific study, comments offered to reporters — people without masks said they “gave up” and wanted to “move on with life” — underscored the public health challenge of encouraging voluntary compliance.
It’s easier to make healthy decisions when people have clear, credible and accessible information, and for the decision itself to be relatively easy to make, said Stanford medicine Professor Kevin Schulman, who researched marketing campaigns for the initial vaccines in 2021. But in the current pandemic landscape, Schulman said, it’s hard to find those attributes.
“This is no longer a scientific undertaking that all of us are following every week,” Schulman said.
Indeed, added Rosenberg, other “big-ticket items replaced COVID at the top of the list of things people are seeking to read about,” whether inflation, layoffs, Ukraine, abortion rights, the Warriors or the weather. And there’s only so much bad news that’s healthy to absorb: psychologists have actually measured
an increase in news-related stress,
according to the American Psychological Association.
“Some people are quite literally turning away from information about COVID. It’s almost like an ‘ignorance is bliss’ instinct,” Rosenberg said.
The waning attention is lessening cooperation with public health efforts. A September poll found, for instance, 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’re not putting nearly as much effort into this as we put into getting people to vote for somebody,” 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 information mostly from radio and television news, and sometimes the local newspaper. “I can tell you that older adults are not going to public health websites to look things up,” she said.
Lack of federal funding, mobilization
The White House
has acknowledged the confusion
to some extent. But it has also blamed Congress for failing to authorize 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 who, in turn, say they’re looking to the CDC for guidance, said Stanford medicine Professor Seema Yasmin, an expert in science communication.
“In the middle of that, you have hundreds of millions of Americans who are like, ‘Who’s in charge of 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 large campaigns, said San Francisco Health Officer Susan Philip.
Programs such as those that sent teams of people into nursing homes to vaccinate seniors in 2021 have been curtailed or eliminated.
“It’s the people with health insurance, with computers, with transportation options that still can really choose to be vaccinated or not,” said UC Berkeley’s Herd.
Some older and disabled people concerned
The urge to get back to “normal” life
may be stronger
among younger people, but they’re also at lower risk. More than half of confirmed COVID cases in California are among those aged 18 to 49, according to the most recent data from the
state COVID-19 dashboard.
Yet, Californians older than 65 — who are one-sixth of the population — make up nearly three-quarters of confirmed deaths in the state.
Another group at heightened risk of severe illness and hospitalization are people whose immune systems are compromised. As masks come off and precautions melt away, disabled writer, speaker and model Charis Hill, who has the inflammatory disease ankylosing spondylitis, has gone into isolation for self-protection.
“The fatigue of a lot of non-disabled people is that they want to travel again,” Hill said. “My fatigue is I just want autonomy over my own life and daily living activities.”
A return to normal ignores that “normal has never been good for disabled people,” Hill said.
Some jurisdictions are now moving to reinstate limited regulations. Last week, the Oakland City Council
reimposed a mask mandate
inside publicly operated buildings after lobbying from groups such as Senior & Disability Action.
Senior & Disability Action director Jessica Lehman despaired of the mind-set that COVID isn’t serious if mostly older and disabled people are going to the hospital and dying. It reinforces the idea that “seniors and disabled people are less important, less valued in society,” she said.
But most public health officials remain reluctant to enact mask mandates. “We will not be mandating behaviors unless there’s a major change in the virus,” such as a more virulent strain that’s highly infectious, Willis said.
Possible solutions
Short of across-the-board mandates or expensive marketing and incentive campaigns, health experts see ways the general public could be engaged again in helping to slow the virus and protecting themselves.
“You change the environment to make the healthy choice the easy choice,” said Dr. Sara Cody, the public health officer for Santa Clara County.
Simple measures can go a long way: offering free masks at the entrance of buildings, or suggesting patients get the bivalent vaccine when they visit their doctor or go to the pharmacy to pick up a prescription. The key is to grab their attention “at the fleeting moment” they become motivated, said Dominican’s Rosenberg.
It may also involve a rebranding of the vaccine: If part of pandemic fatigue derives from the sense of uncertainty, then “the vaccine itself is actually the remedy because it makes you safer in every way,” said Marin County’s Willis.
Added San Francisco’s Philip, “we need to reinforce the message that … it’s very effective at keeping people out of the hospital.”
Claire Hao is a San Francisco Chronicle staff writer. Email: claire.hao@sfchronicle.com Twitter: @clairehao_