Testing and the Shame Game

Emily Oster

8 min Read Emily Oster

Emily Oster

Testing and the Shame Game

Emily Oster

8 min Read

I hope the holidays so far have been…well, what you settled for. I mostly cooked: turkey (great), stuffing (failed again), celeriac mashed potatoes (vegetable sneak), brisket (this was the 5 year old’s decision, improbably pulled from the Asana company cookbook), Swedish meatballs (a lot of work), fluted almond cookies (hard to get out of pans), mac and cheese in instant pot (cleanup almost marriage-ending), chocolate pudding. My older kid made some excellent mini cupcakes with marshmallow chocolate frosting, a peanut-and-chocolate sauce for the almond cookies, and some type of chocolate-coated cookies for Santa. Oh, and chocolate covered marshmallows. Basically, I ate my way through the week. It’s all salad for January.

We are now staring down New Years and the hopes that 2021 brings better things. There are reasons to hope on the COVID-19 front. A new administration will get a crack at better managing the virus (and everything else) and as of this writing the New York Times reports 1.9 million people have been vaccinated. But as many, many people have noted, vaccination is not a solution that will work next week. We have at least another few months in which better non-vaccine management will save lives. Maybe tens of thousands of them. And beyond that, the fact is that the virus isn’t going to completely go away, probably ever. (Mutations — as in the UK variant — may arise, but more than that there simply isn’t any reason to think we can control this like smallpox and completely eliminate it).

To be frank, a worry I have is that the promise of the vaccine will lower public and policy interest in other approaches. This would be a mistake.

What other approaches? There are the obvious ones: mask wearing, distancing when possible and hand washing. And then there are the harder things, the restrictions like not seeing others, avoiding large gatherings, and so on. And, finally and to me perhaps the most central and ignored: testing.

I remember a call I had, early in the pandemic, with Ashish Jha, who is the Dean of the Public Health school at Brown, and has been a guiding force for many in the pandemic. When we talked, back in May or even before, he focused on the promise that easy, frequent testing would allow us to return to normal far before the vaccine. I wrote, way back in April, about the value of random testing for tracking the virus. In these early days, when the vaccine possibilities were less obvious, there was a sense that more testing would help us find a way out.

In some situations, testing as held up to some of this promise. At many Universities in the Boston area (including my own), the virus has been largely controlled by testing the entire population twice a week. In Colorado, a pilot program has provided weekly testing for teachers. Some (private) schools have been doing comprehensive testing of their populations. But by and large, the kind of testing Ashish and I talked about in May has not come to pass.

This reflects probably a few failures. Testing infrastructure took a very long time to develop (it’s still hard to get a test in many places). Test results take a lot of time to come back. The approval of rapid tests has been very, very slow, in part because it’s hard for people and policy-makers to understand their value. They are not quite as sensitive as diagnostic tests, but are hugely valuable for population surveillance.

The arrival of 2021 provides a new opportunity to refocus this discussion. The FDA has just issued an Emergency Use Authorization for an at-home COVID antigen test, and hopefully more will follow. The Biden administration is focused on the role of testing for their goal of reopening schools. Rhode Island put a rapid COVID testing site in the mall, so people can pop in for a test while they shop.

I’m going to talk more about this in the upcoming weeks. I hope to have an interview with Michael Mina, who has spearheaded some of these tests and strategies. And I’ll talk, of course, about using these in schools. I think there is a lot of promise. But I think there are also two very large barriers.

The first is the lack of a plan. In order to appropriately use testing — in homes or in schools or nursing homes or restaurants — we need to outline very specific plans for timing, frequency, implementation. There is a huge, huge gap between saying “Let’s test all kids for COVID twice a week at school” and actually doing it. Logistics of this type have been one of the failures of the pandemic, and if we want to avoid failing at this again, we need very concrete action plans.

These plans would ideally be centralized or at least suggested by some central policy actor. Pandemic response suffered from a bizarre degree of local control. Quarantine policies for COVID vary across states but also, in some cases, across neighboring suburbs. Local control has its moments, but my guess is our testing plans will be better developed if they are a little more coordinated. Central to this will be deciding how we use rapid tests versus PCR tests, and considering testing frequency. There are plenty of local plans we can learn from, we just need to do it.

The second significant barrier is a little different. It’s shame. Whether we recognize it or not, there is a lot of shaming people for getting COVID, and a lot of shaming of any location known to be a place where COVID was spread. The goal of this type of shaming seems to be to encourage better behavior — do well, and you wont get COVID and be shamed.

There is an element of truth here. Clearly, there are more and less safe ways to behave and more and less safe ways to run your business/school/long term care facility/etc. But there is also a huge element of chance.

COVID is a contagious disease. You can get it even if you do everything “right”. And you might not get it even if you do things which are really unsafe. It’s possible for a restaurant to take all the right precautions to lower the COVID risk and still have a transmission occur; similarly, they can do nothing and avoid it.

There is a fine line between discouraging risky behavior and shaming people who get COVID-19. And when we cross the line to shaming, it’s not likely to be productive.

For one thing, shaming people is not usually an effective way to get them to do things. For another, in this case shaming discourages testing. Imagine you come upon a pop-up testing site in the mall while shopping for pants. No line! Public health is served by your testing. In the unlikely event you do have COVID, we want to know. You can isolate at home and take the virus out of circulation, possibly avoiding passing it to the cashier at Old Navy.

We want people to test. But if they know they’ll be shamed if they do have it, they’re going to be a lot less likely to do so.

This isn’t just about asymptomatic testing. We have probably all heard reports of people with symptoms avoiding testing, waiting it out, perhaps in part due to the fear of judgement. We need to reframe testing as a part of being responsible. And, by extension, we need to send the message that, yes, people can get COVID-19 even if they are “good”, whatever that means.

The shame extends to institutional entities, even to governments. Our accounting of the pandemic across locations has focused on case rates — count of case per 100,000 people. Such case rates are increased with testing. The more you test, the more cases you uncover. This is good in the sense that people can be pulled out of circulation, but it makes the case rate look worse. Governors who do not want to be the “worst” state have odd incentives in terms of encouraging testing.

Institutions like schools have the same problem. I hear from school staff who tell me that their school has discouraged them from testing because they do not want a case to be associated with their school. Some schools are resistant to widespread random testing of students and staff for fear they will be called out for positive cases.

This all limits our ability to learn. In the case of something like schools, even if they are low risk, they aren’t no risk environments. If we identify transmission in schools, we want to know how it happened. Not to blame schools or the people who are sick! But to avoid infections in the future if possible.

If we can make testing easy — rapid, frequent, routine — that will help dial down some of the shame. Basically, we’ll realize that a lot of people are getting COVID for random reasons, and it will hard to sustain the COVID-shaming. Plus, we’ll start to see the benefits of the added detection. But the shaming may be in the way of getting to more testing in the first place.

Again, this isn’t to say we shouldn’t encourage safe behaviors among both individuals and institutions. We should! But one of those safe behaviors is testing. And testing will find cases. So for 2021, a resolution, a hope: More tests. Less shame. Less COVID.

Happy New Year.

Covid-19 rapid antigen tests arranged in a pattern on a yellow background.

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Updated CDC Guidelines for School and Child Care

NO QUARANTINES!!!

Emily Oster

Instagram

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Just eat your Cheerios and move on.

Just eat your Cheerios and move on. ...

The AAP’s guidelines recommend sleeping in the same room as your baby “ideally for the first six months.” However, the risk of SIDS is dramatically lower after four months, and the evidence in favor of the protective effect of room sharing is quite weak (both overall and even more so after four months). There is also growing evidence that infants who sleep in their own room by four months sleep better at four months, better at nine months, and even better at 30 months.

With this in mind, it’s worth asking why this recommendation continues at all — or at least why the AAP doesn’t push it back to four months. They say decreased arousals from sleep are linked to SIDS, which could mean that babies sleeping in their own room is risky. But this link is extremely indirect, and they do not show direct evidence to support it.

According to the data we have, parents should sleep in the same room as a baby for as long as it works for them! Sharing a room with a child may have negative impacts on both child and adult sleep. We should give families more help in navigating these trade-offs and making the decisions that work best for them.

#emilyoster #parentdata #roomsharing #sids #parentingguide

The AAP’s guidelines recommend sleeping in the same room as your baby “ideally for the first six months.” However, the risk of SIDS is dramatically lower after four months, and the evidence in favor of the protective effect of room sharing is quite weak (both overall and even more so after four months). There is also growing evidence that infants who sleep in their own room by four months sleep better at four months, better at nine months, and even better at 30 months.

With this in mind, it’s worth asking why this recommendation continues at all — or at least why the AAP doesn’t push it back to four months. They say decreased arousals from sleep are linked to SIDS, which could mean that babies sleeping in their own room is risky. But this link is extremely indirect, and they do not show direct evidence to support it.

According to the data we have, parents should sleep in the same room as a baby for as long as it works for them! Sharing a room with a child may have negative impacts on both child and adult sleep. We should give families more help in navigating these trade-offs and making the decisions that work best for them.

#emilyoster #parentdata #roomsharing #sids #parentingguide
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It was an absolute pleasure to be featured on the @tamronhallshow! We talked about all things data-driven parenting and, in this clip, what I call the plague of secret parenting. To balance having a career and having a family, we can’t hide the fact that we’re parents. If mothers and fathers at the top can speak more openly about child-care obligations, it will help us all set a new precedent.

Watch the full segment at the link in my bio 🔗

#tamronhall #tamronhallshow #emilyoster #parentingsupport #workingparents

It was an absolute pleasure to be featured on the @tamronhallshow! We talked about all things data-driven parenting and, in this clip, what I call the plague of secret parenting. To balance having a career and having a family, we can’t hide the fact that we’re parents. If mothers and fathers at the top can speak more openly about child-care obligations, it will help us all set a new precedent.

Watch the full segment at the link in my bio 🔗

#tamronhall #tamronhallshow #emilyoster #parentingsupport #workingparents
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Invisible labor. It’s the work — in our households especially — that has to happen but that no one sees. It’s making the doctor’s appointment, ensuring birthday cards are purchased, remembering the milk.

My guest on this episode, @everodsky, has come up with a solution here, or at least a way for us to recognize the problem and make our own solutions. I’ve wanted to speak with Eve for ages, since I read her book Fair Play. We had a great conversation about the division of household labor, one I think you’ll get a lot out of!

Listen and subscribe to ParentData with Emily Oster in your favorite podcast app 🎧

#emilyoster #parentdata #parentdatapodcast #parentingpodcast #householdtips #fairplay #invisiblelabor

Invisible labor. It’s the work — in our households especially — that has to happen but that no one sees. It’s making the doctor’s appointment, ensuring birthday cards are purchased, remembering the milk.

My guest on this episode, @everodsky, has come up with a solution here, or at least a way for us to recognize the problem and make our own solutions. I’ve wanted to speak with Eve for ages, since I read her book Fair Play. We had a great conversation about the division of household labor, one I think you’ll get a lot out of!

Listen and subscribe to ParentData with Emily Oster in your favorite podcast app 🎧

#emilyoster #parentdata #parentdatapodcast #parentingpodcast #householdtips #fairplay #invisiblelabor
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Prenatal vitamins 💊 If there is any product that seems designed to prey on our fears, it’s this one. You’re newly pregnant and you want to do it right. Everyone agrees you need prenatal vitamins, so you get them. But do you want to be that person who just… buys the generic prenatal vitamins?

Good news: fancier vitamins are not better.  Folic acid is the most important prenatal ingredient. Iron (with vitamin C) and DHA are also nice to have. Other included ingredients have only weak or no evidence to support their use. (If you do not consume animal products, add B12, plus a few others depending on your diet.)

Vitamins are just vitamins. Any prenatal vitamin that contains these is enough. 

Comment “Link” for a DM to an article with everything you need to know about prenatal vitamins.

#emilyoster #parentdata #prenatalvitamins #pregnancydiet #pregnancytips

Prenatal vitamins 💊 If there is any product that seems designed to prey on our fears, it’s this one. You’re newly pregnant and you want to do it right. Everyone agrees you need prenatal vitamins, so you get them. But do you want to be that person who just… buys the generic prenatal vitamins?

Good news: fancier vitamins are not better. Folic acid is the most important prenatal ingredient. Iron (with vitamin C) and DHA are also nice to have. Other included ingredients have only weak or no evidence to support their use. (If you do not consume animal products, add B12, plus a few others depending on your diet.)

Vitamins are just vitamins. Any prenatal vitamin that contains these is enough.

Comment “Link” for a DM to an article with everything you need to know about prenatal vitamins.

#emilyoster #parentdata #prenatalvitamins #pregnancydiet #pregnancytips
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When it comes to introducing your newborn to the world, timing matters. It’s a good idea to minimize germ exposure in the first 6-8 weeks; after that, it’s inevitable and, very likely, a good idea! This doesn’t mean you need to be trapped inside. The most significant exposure risks are from seeing other people at home — family, etc. These interactions are not infinitely risky, but they do pose more risk than a walk or a trip to the grocery store, since they involve closer interaction. Think simple and make sure everyone is washing their hands before holding the baby. 💛

#parentdata #emilyoster #newborncare #parentingadvice #parentingtips

When it comes to introducing your newborn to the world, timing matters. It’s a good idea to minimize germ exposure in the first 6-8 weeks; after that, it’s inevitable and, very likely, a good idea! This doesn’t mean you need to be trapped inside. The most significant exposure risks are from seeing other people at home — family, etc. These interactions are not infinitely risky, but they do pose more risk than a walk or a trip to the grocery store, since they involve closer interaction. Think simple and make sure everyone is washing their hands before holding the baby. 💛

#parentdata #emilyoster #newborncare #parentingadvice #parentingtips
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The first edition of Hot Flash is out now! Comment “Link” for a DM to learn more about the late-reproductive stage.

There are times when we expect hormonal shifts. Our reproductive lives are bookended by puberty and menopause. We discuss those changes often because they are definitive and dramatic — a first period is something many of us remember clearly. But between ages 13 and 53, our hormones are changing in more subtle ways. During the late-reproductive stage (in your 40s), you can expect a lot of changes in your menstrual cycle, including the length and symptoms you experience throughout. It’s an important time in our lives that is often overlooked!

🔥 Hot Flash from ParentData is a weekly newsletter on navigating your health and hormones in the post-reproductive years. Written by Dr. Gillian Goddard, Hot Flash provides all of the information you need to have a productive, evidence-based conversation about hormonal health with your doctor.

#emilyoster #parentdata #hotflash #perimenopause #womenshealth

The first edition of Hot Flash is out now! Comment “Link” for a DM to learn more about the late-reproductive stage.

There are times when we expect hormonal shifts. Our reproductive lives are bookended by puberty and menopause. We discuss those changes often because they are definitive and dramatic — a first period is something many of us remember clearly. But between ages 13 and 53, our hormones are changing in more subtle ways. During the late-reproductive stage (in your 40s), you can expect a lot of changes in your menstrual cycle, including the length and symptoms you experience throughout. It’s an important time in our lives that is often overlooked!

🔥 Hot Flash from ParentData is a weekly newsletter on navigating your health and hormones in the post-reproductive years. Written by Dr. Gillian Goddard, Hot Flash provides all of the information you need to have a productive, evidence-based conversation about hormonal health with your doctor.

#emilyoster #parentdata #hotflash #perimenopause #womenshealth
...

There are plenty of reels telling you how to parent. Plenty of panic headlines saying that “studies show” what’s best for your kid. Even good data, from a trusted source, can send us into a spiral of comparison. But I want you to remember that no one knows your kid better than you. It’s important to absorb the research, but only you will know the approach that works best for you and your child. 💙

Now tell me in the comments: what’s a parenting move you’ve made recently that feels right to you?

#parentingcommunity #parentingsupport #parentingquotes #emilyoster #parentdata

There are plenty of reels telling you how to parent. Plenty of panic headlines saying that “studies show” what’s best for your kid. Even good data, from a trusted source, can send us into a spiral of comparison. But I want you to remember that no one knows your kid better than you. It’s important to absorb the research, but only you will know the approach that works best for you and your child. 💙

Now tell me in the comments: what’s a parenting move you’ve made recently that feels right to you?

#parentingcommunity #parentingsupport #parentingquotes #emilyoster #parentdata
...

Let’s talk about sex (after) baby! Today on the podcast, I was lucky enough to speak with @enagoski about her new book on sexual connection in long-term relationships. Especially after having kids, this is something many people struggle with. Emily tells us to stop worrying about what’s “normal” and focus on pleasure in its many forms.

Listen and subscribe to ParentData with Emily Oster in your favorite podcast app 🎧

#parentdata #parentdatapodcast #emilyoster #emilynagoski #comeasyouare #cometogether #longtermrelationship #intimacy #relationships

Let’s talk about sex (after) baby! Today on the podcast, I was lucky enough to speak with @enagoski about her new book on sexual connection in long-term relationships. Especially after having kids, this is something many people struggle with. Emily tells us to stop worrying about what’s “normal” and focus on pleasure in its many forms.

Listen and subscribe to ParentData with Emily Oster in your favorite podcast app 🎧

#parentdata #parentdatapodcast #emilyoster #emilynagoski #comeasyouare #cometogether #longtermrelationship #intimacy #relationships
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Ever wondered if you can safely use leftover baby formula? 🍼 The CDC says to throw out unused formula immediately because of the risk of bacterial growth. However, research suggests that bacterial concentrations do not appreciably increase after 3, 12, or even 24 hours at refrigerator temperatures. Good news! This means there’s not a strong data-based reason to throw out formula right away if you store it in the fridge.

Comment “Link” for a DM to an article on another common formula question: should you throw away old formula powder?

#emilyoster #parentdata #babyformula #babyfeeding #parentingstruggles

Ever wondered if you can safely use leftover baby formula? 🍼 The CDC says to throw out unused formula immediately because of the risk of bacterial growth. However, research suggests that bacterial concentrations do not appreciably increase after 3, 12, or even 24 hours at refrigerator temperatures. Good news! This means there’s not a strong data-based reason to throw out formula right away if you store it in the fridge.

Comment “Link” for a DM to an article on another common formula question: should you throw away old formula powder?

#emilyoster #parentdata #babyformula #babyfeeding #parentingstruggles
...

What’s the most important piece of advice for new parents? Here’s one answer, but I want to hear from you! Share your suggestions in the comments ⬇️

#emilyoster #parentdata #parentingtips #parentingadvice #newparents #parentingcommunity

What’s the most important piece of advice for new parents? Here’s one answer, but I want to hear from you! Share your suggestions in the comments ⬇️

#emilyoster #parentdata #parentingtips #parentingadvice #newparents #parentingcommunity
...

What's in the bag of a Vagina Economist? 👀 Someone please tell me this looks familiar to you.

What`s in the bag of a Vagina Economist? 👀 Someone please tell me this looks familiar to you. ...

Comment ”link” for a DM to learn more about tongue ties 🔗

Breastfeeding is often difficult, especially at the start. For babies with tongue ties, many infants (and their moms) struggle to get the hang of a good latch. This can lead to painful nipples and to inefficient feeding, and then low weight gain.

So what does the data say about the increasingly common practice of cutting tongue-ties in infants to improve breastfeeding success? Several weeks ago, @nytimes published a long and quite scary article on this topic.

After diving into the data, here is what I found. There is limited evidence that frenotomy procedures improve breastfeeding efficacy and the harms of the procedure are minimal. Many women do report that it alleviates pain and helps them with breastfeeding. However, it should not be a first-line treatment for breastfeeding problems.

#parentdata #emilyoster #tonguetie #tonguetiebabies #breastfeedingsupport

Comment ”link” for a DM to learn more about tongue ties 🔗

Breastfeeding is often difficult, especially at the start. For babies with tongue ties, many infants (and their moms) struggle to get the hang of a good latch. This can lead to painful nipples and to inefficient feeding, and then low weight gain.

So what does the data say about the increasingly common practice of cutting tongue-ties in infants to improve breastfeeding success? Several weeks ago, @nytimes published a long and quite scary article on this topic.

After diving into the data, here is what I found. There is limited evidence that frenotomy procedures improve breastfeeding efficacy and the harms of the procedure are minimal. Many women do report that it alleviates pain and helps them with breastfeeding. However, it should not be a first-line treatment for breastfeeding problems.

#parentdata #emilyoster #tonguetie #tonguetiebabies #breastfeedingsupport
...

Tag a friend who needs to hear this 💛 For many choices in parenting, there is no one right answer. We can use research and data to make informed decisions, but ultimately, it won’t tell you what to do. Only you can decide what will be best for your kids and your family.

I’m here to remind you to take a deep breath and trust yourself. I’ll be here to support you along the way. 

Thank you to everyone who submitted videos, including:
@sarah.consoli
@jess_lynn627
@nicolevandenwills
@thedrblair
@ncbenedict29
@haleycimini
@iamkellysnodgrass
@calesse_smith
@garnet__gordon
@jencoopgaiser87
@danigirl18c
@jamielundergreen
@carly_comber
@thecelebratingmama
@emilyannbynum
@eeliz413

#emilyoster #parentdata #parentingadvice #parentingsupport #parentingquotes

Tag a friend who needs to hear this 💛 For many choices in parenting, there is no one right answer. We can use research and data to make informed decisions, but ultimately, it won’t tell you what to do. Only you can decide what will be best for your kids and your family.

I’m here to remind you to take a deep breath and trust yourself. I’ll be here to support you along the way.

Thank you to everyone who submitted videos, including:
@sarah.consoli
@jess_lynn627
@nicolevandenwills
@thedrblair
@ncbenedict29
@haleycimini
@iamkellysnodgrass
@calesse_smith
@garnet__gordon
@jencoopgaiser87
@danigirl18c
@jamielundergreen
@carly_comber
@thecelebratingmama
@emilyannbynum
@eeliz413

#emilyoster #parentdata #parentingadvice #parentingsupport #parentingquotes
...