The Perils of Risk Judgment in the Age of COVID-19 Vaccines

This content was adapted from a LinkedIn article first published on June 4, 2021

On May 3, 2021 Florida Governor Ron DeSantis declared the 'end of the COVID-19 crisis', while issuing an executive order effectively ending all local pandemic-related restrictions, and banning vaccine passports. He did so claiming: "that's the evidence-based thing to do."

By failing to offer very distinct messages for the vaccinated versus the unvaccinated audience, the Governor squandered a unique opportunity to effectively articulate the benefits of the vaccine, and failed to properly warn the public about the residual risks. The self congratulatory and generalized cheerleading message arguably contributed to the severe misjudgment (and underestimation) of the COVID-19 risks for millions either unable or unwilling to get vaccinated.

Let's review the evidence of why and how, and what can we learn from it.

It's fair to say Floridians (as virtually everyone in states and countries affected by the pandemic) are legitimately exhausted by the crises, ready to move on and resume full, unafraid living again. One doesn't need a formal public poll to assume that this official act was interpreted by most as a welcome, trustworthy signal of the transition to a new, safer environment for Sunshine State residents - and that this was true among unvaccinated people as well.

We know this as travel to Florida has since skyrocketed, with Miami and the Florida beaches setting Memorial Day weekend bookings and visitors numbers on par with pre-pandemic years. With well below half the population being fully vaccinated, again, it's safe to say the exuberance, optimism, and 'risky' behavior - from visiting indoor restaurants and attending large crowd events, to donning face masks - was not strictly limited to the fully vaccinated.

During the four weeks preceding the announcement, Florida recorded 1,655 COVID-19 deaths, which compared to the 1,836 of last November. Added to the smaller number of confirmed cases and lower positivity rate from preceding months, these were indeed presented as uniform 'evidence' of a declining hazard.

Unintuitively, the mortality risk for unvaccinated Floridians in May was approximately 60% higher than in November

Yet, taking into consideration the numbers and demographics of the State's vaccinated population during the April 4 - May 3 period, Florida's at-risk (susceptible) population shrunk from 21.3 (November) to 13.1 million, which respectively translate into 103.6 and 165.8 annual mortality rates - a 60% increase.

There is of course the added 'nuance' that Florida's population registering these deaths by early March was not simply a smaller one, but rather one with a substantively different demographic breakdown, with only a fraction of the more vulnerable groups. This means that some age & gender-specific death rates suffered even more significant risk increases.

Safe-esteem's Personal Risk Explorer is a free Web tool based on a proprietary algorithm used to dynamically estimate the mortality risk for specific demographic groups on a weekly basis for each US county, and compare that mortality risk to those of all other communicable diseases (in honor of the infamous: "it's like the flu") or all causes of death, taking into account the vaccinated population

For most of May 2021, the risk of death for an unvaccinated 55YO male in Miami was about 100% higher than that in a pre-COVID year. To put it differently, the vaccine would have reduced his mortality risk in half (at least during this particular month, and not accounting for race, ethnicity, or other pre-existing medical conditions.) These are substantively higher than those seen in November 2020.

Last, but not least, the above estimates can be assumed to be highly optimistic, overestimating the susceptible population by ignoring those with natural immunity. The CDC currently estimates nearly one third of the US population may have been infected, and have achieved some level of resistance to the virus. If only half that was true, Florida's at-risk population would have to be further reduced to 11M and change, further aggravating the significance of the deaths registered during that month.

The susceptible or at-risk population is made up of the unvaccinated and those who are not yet - or no longer - naturally immune.

The COVID-19 pandemic has shone a new, powerful light on the complexity, bias, and general inadequacy of how we measure, communicate, and ultimately make decisions about personal risks. There is something deeply alarming - and at the same time, extremely intriguing - in the realization of how little most people know about what is likely to harm, injure, or kill them in their everyday life.

We often justify the mental fog, perplexity, or discomfort we experience when facing the probability of disease, injury, or death, as a mental health strategy designed to reduce stress and cope with our mortality. Fact is, this deep uncertainty about our ability to survive and thrive is one of the leading causes of stress and anxiety, it makes us vulnerable to disinformation and manipulation, and ultimately leads to poor judgment and decision-making.

One of the most powerful first steps toward developing a higher personal risk intelligence is to adopt an ounce of modesty and self-awareness about the fallibility of our judgement and gut feelings about complex, acute, and novel risks - regardless of how confident we feel about them. It can mitigate the effects of bias and misinformation, and motivate us to seek credible and vetted data sources, subject matter experts, and institutions that are, by and large, less wrong.