Dr. Rochelle Walensky became the director of the Centers for Disease Control and Prevention at what was both the darkest period of the pandemic and a moment of remarkable optimism. In early 2021, several thousand Americans were dying each day in Covid’s first, brutal winter surge. But vaccines were already being delivered, faster than in nearly any other country, and the inauguration of Joe Biden, who had campaigned in part on Donald Trump’s mishandling of the pandemic, promised a science-forward public-health reset.
Two and a half years later, with the public-health emergency officially over, Walensky is leaving her post, a few months after the retirement of Dr. Anthony Fauci and a few weeks after the departure of the White House Covid-19 coordinator Ashish Jha — together the three faces of pandemic management in the Biden era, which is also functionally the vaccine era. And while the pandemic has now retreated for most Americans, it has proved to be a long and bumpy road of vaccination and infection, mitigation and normalization.
About two-thirds of American deaths from Covid were recorded after Inauguration Day 2021, with the country experiencing what was effectively a nine-month surge beginning in the summer of 2021 that ultimately cost more than 350,000 Americans their lives and had no parallel in our peer countries. “I viewed my primary charge as bringing this country from the dark and tragic pandemic days into a more restored place,” Dr. Walensky recently wrote. But critics of the new administration’s handling of Covid have described the public-health mission of the past few years in more cynical terms, as “the sociological production of the ‘end of the pandemic.’”
In June, shortly before she left the agency, I spoke with Dr. Walensky about those brutal years, the Biden administration’s handling of the pandemic and what lessons the C.D.C. can learn from her experience. This interview has been edited and condensed.
Let’s start with some relatively good news. I’ve just been looking over recent mortality data, and it’s remarkable to me how much of a better situation we seem to be in now than six months or a year ago. We’re down to perhaps 100 or 200 deaths a day.
Well, I don’t consider that good.
Perhaps not, but it’s much better than where we were. Our excess mortality is running only a fraction as high as it was in the fall or last spring. What’s changed?
First of all, everybody — or most people, I think, at this point — understands what they need to do to protect themselves, whether it be to test if they have symptoms, to get Paxlovid if they are at high risk, to get vaccinated, to get boosted, all of those things. We have been saying it now for months or even years, and people really do understand now what they need to do to keep themselves safe. Last year we were also coming out of a pretty dark Omicron period, and we’d bolstered a huge amount of immunity after that.
That infection-derived immunity looks to be the story to me. It’s what’s changed most significantly.
We now have 96 or 97 percent of the population that has either been vaccinated or infected and often both. That does put up an incredible wall of protection.
But the pandemic lull has also allowed for some revisionist history to flourish, too. In your recent congressional testimony you said it’s clear that with Covid-19, we failed to heed the lessons of previous pandemics. I see something similar happening already with this one, with a growing consensus — not just on the right — that the country did too much and went too far.
I think you’re raising a whole bunch of interesting issues. One is the really important defense mechanism that we have as humans to minimize real difficulties of the past. It is really hard to go back and remember the fear. I remember working clinically, before I was at C.D.C. There was a morgue truck outside the hospital. Every day we were building a new I.C.U. because we lacked capacity. I was thinking, “I wonder if my parents are going to survive this pandemic.”
They did. But that wasn’t obvious to everyone. People knew that those who were older were going to be those who were most impacted. And those were really scary times. We didn’t have a vaccine. We didn’t know when we would have a vaccine.
Most people didn’t believe it was possible to develop one in just a year.
And to now say, “Oh see, everything’s fine,” when 1.1 million people have died — we have a lot of fragile pieces to pick up. It’s very easy to say that it wasn’t so bad or we should have done differently. But I think some of that is a defense mechanism. It’s just too painful to remember.
You observed that first phase of the pandemic as a civilian. As you were taking the reins, what did you think could be done differently? What were you hoping could be changed about the broad public health response of the federal government and, in particular, at the C.D.C.? What seemed possible then?
In January of 2021, it was just six weeks after the vaccine trial results had been announced. There was tremendous hope. And so what I really hoped to do — what I felt like my biggest charge was — was to get vaccines into arms, to get us out of the darkest days of the pandemic and to restore the trust that the agency had always had but had been undermined by politicized activities from the prior administration.
Is that how you understand what happened through 2021 — the effects of politicization? Because it’s really in 2021 that U.S. mortality took a comparative turn for the worse.
Well, I do think politics getting involved is one big challenge. Ultimately it became that you valued your health only according to how you voted. And that shouldn’t be. I think misinformation and disinformation, people working to undermine the messaging — that was a problem. Throughout the pandemic, I think there has been an undermining of trust in science and trust in medicine, trust in health care providers, trust in public health and in government. And I think all of that has worked to our detriment.
In a recent guest essay for the Times, though, you weren’t emphasizing the importance of science but the need to balance its insights with political considerations.
“We in public health must recognize that recommendations do not occur within a vacuum; rather, they affect other sectors of American life,” you wrote, adding, “The job of public health is to strike an appropriate balance between protecting the health of all those who live in the United States while minimizing the disruption to the normal functioning of society.”
As C.D.C. director, you presided over almost two-thirds of American Covid mortality. In retrospect, how do you think the country did in balancing those two impulses — the need to protect the vulnerable and the desire to return to normal?
Ultimately the job of the C.D.C. is to provide guidance and recommendations at a population level for public health. When you’re working at a population level, it means you are offering a sort of on-average guidance. I always tell the joke “Your feet are in the freezer, your head’s in the oven, and on average you’re fine.” We can’t be fine on average in this country. Public health doesn’t work that way. Infectious threats don’t work that way. And so when we are offering on-average guidance, we could be very off for somebody at either of those two extremes. Somebody who has a lot of comorbidities, disabilities or immunosuppression may want us to be incredibly protective. And those who have none of those and are very risk tolerant tend to be very liberal, if you will, with their activities. And that makes it very difficult to do, providing guidance for a country. At the extremes, you may displease both sides.
On the vaccine question, approximately 80 percent of adults have completed their primary vaccination series, according to the C.D.C., including nearly 95 percent of seniors. And in some ways, that seems really impressive to me. These vaccines were invented in days, trialed over a handful of months and rolled out within a year, and we got 95 percent of the really vulnerable people to take them.
Yes. But I also think that you’re making the mistake of looking under the lamppost because that’s where the light is.
Where should I be looking?
At the 1.1 million people who died. They would disproportionately be unvaccinated. We have the benefit now of looking at the people who’ve survived. There’s a selection bias there. The people who have passed are those who either were diagnosed early on, when they didn’t have access to the vaccine, or opted out together.
I think you’re right that there’s some statistical effect, but I also don’t know that it’s right to say that the large majority of the dead were unvaccinated. There are a few different ways to tabulate these numbers, but 550,000 had died by April 1, 2021, which you could mark roughly as both the end of the initial winter surge and the beginning of the vaccination era. And from September 2021 and on, looking at the month to month data, I would guess somewhere between roughly a third and half of Covid deaths have been among the vaccinated. We don’t have nearly as many deaths now, but more than half are among the vaccinated. It’s not a trivial share.
Yes. But partly that’s just a statistical phenomenon. Over time it becomes the case that if 95 percent of your most vulnerable are vaccinated, by definition, the share of deaths is going to reflect the fact that you have a much larger pool of vaccinated people.
Right, but nevertheless it does raise the issue, for me, of whether we did enough in 2021 to emphasize the ongoing risk of breakthrough infection and even breakthrough death, particularly for the vaccinated elderly.
We’re not going to be able to do the quantitative stuff on the napkins here, but what I will say is that it was the case that our messaging did change over time. Early on, it was so important to get the most vulnerable vaccinated.
But what I’m asking about is the messaging in the summer and fall of 2021, after mass vaccination rollout began, which, again, was the period when American mortality was, by global standards, most exceptional. You have Anthony Fauci and Vivek Murthy saying that 99.2 or 99.5 percent of deaths were unvaccinated, when in those months the share of vaccinated deaths was about 10 times that high. In early August of 2021, you told CNN that breakthrough infections caused mild illness: “They are staying out of the hospital. They are not dying, and I think that that’s the most important thing to understand.” At the time, about 5 percent of American deaths were among the vaccinated, and the share would quickly grow, to 22 percent by September and 41 percent by January 2022.
It’s an interesting question and an interesting conversation that we can have. We did an assessment of who was dying. And we published it in November, I believe, and part of that was showing that those people who are dying from Covid are those who have very high rates of comorbidity. Some of them are dying at home. Some of them are dying in hospice. That is not to dismiss their death. They’re important deaths. But the character of the kind of person who was dying is different. And the backdrop of immunity was different, and the case fatality rate of different variants changed over time, as well. And maybe the messaging that you heard was not as loud as it should have been, but we have throughout said these vaccines are imperfect — certainly after we recognized that they were working better to protect against severe disease and death than to protect against infection. And I think about all of the messaging that we did over the last three years. We have all known that throughout all of this, the elderly and immunocompromised were the ones that were being hit the hardest. And that has been the area of focus.
But I don’t think the public really appreciated just how large that skew was, with people in their 80s facing a mortality risk from infection perhaps thousands of times as large as the one faced by teenagers and maybe several times as large as people in their 70s.
Vaccination reduces those risks dramatically, but it doesn’t eliminate them. And through Delta and Omicron, it seemed there was very little messaging along the lines of, “If you’re 85 and vaccinated, act like you might if you were 70 and unvaccinated.” There was much more focus on the power of the vaccines and much less about their limitations. Again and again, we heard that binary language, the “pandemic of the unvaccinated” — a point Biden made in September 2021 and then returned to in December, when nearly 30 percent of Covid deaths were among the fully vaccinated or boosted.
On top of which, there are also two different components of mortality risk: the infection fatality rate, which measures your chances of dying from an infection, and the prevalence of the disease, which is a good proxy for your risk of being infected in the first place. And if you have vaccines, which cut the I.F.R. by, say, a factor of three or four for the elderly, but also a variant that is spreading much faster both because of its inherent transmissibility and because people are taking fewer precautions, the overall effect on the risk by an individual is effectively null. And yet during this time, almost no one was saying that especially for the most vulnerable, the risk landscape hadn’t changed that much.
And maybe there’s more you can do to decrease the prevalence than you can in potentially decreasing the I.F.R. And so where do you try and put your efforts? There was a lot of effort in decreasing prevalence in Omicron.
There was plenty of messaging about the coming Omicron wave. But I also think about the C.D.C.’s switch to a five-day quarantine guidance from a 10-day quarantine guidance, which happened right in the midst of that wave. You were loosening C.D.C. guidance just as the country was heading into the biggest spike of infections in the whole pandemic. And the two months after that guidance was changed featured the second-largest spike of deaths in the whole pandemic.
I would love to unpack that moment.
So it was Christmas — literally Christmas. I mean it was the few days before and the few days after. People in the country weren’t testing. They were not actually adhering to 10 days of quarantine and couldn’t. The calls that I was getting are pharmacies in Minnesota that don’t have pharmacists because they were out sick. Patients can’t get their diabetes meds. FedEx could not deliver dialysate, and dialysis units were being closed. I.C.U.s had beds, but they didn’t have health care workers. And so the question was, from a harm reduction standpoint, how do you decrease the harm associated with what was happening at the moment? And the answer was, if people are not going to stay home for 10 days, let’s have them stay home for the five most important days, the days that they are most infectious. If you’re not going to stay home for 10, let’s see if you can stay home for the five most infectious days. And that was the issue around the guidance. People were not doing what needed to be done.
I think the science wasn’t quite so clear. Many people reached peak infectivity at or after five days. But even so, if the issue is the health care crunch, why not propose one set of guidelines for health care workers and another for the rest of us?
We did. We most definitely had a different set of guidelines for health care workers. But many of the things that we needed as society were technically outside of health care. We needed transport, we needed mail to work, we needed pharmacies to be stocked, and we needed pharmacies to be open. Those kinds of things were not just limited to people who consider themselves health care workers.
The issues you’re raising are obviously important. There are some whole-of-society costs to certain broad mitigation measures. But that also sounds a lot like the logic offered by mitigation skeptics in 2020 — that the costs of these measures outweighed the benefits.
I think you’re painting a very different picture than the one we painted at the time. In 2021 we knew when you were maximally infectious. We had a vaccine. We knew people should get vaccinated, and we were not suggesting bars should be open. We wanted to make sure that hospitals were open, and we needed people to work in them. So we were saying that you should mask, and we were saying you had the most infectious variant that we’ve ever seen before. We were putting out those warnings. We were doing press conferences. We were conveying the science and the importance of getting vaccinated. So I take issue with your parallel.
Of course there were differences. But the deaths tell the story: The Omicron wave was the second-highest mortality peak of the whole pandemic. I don’t think you can look at that data and say that this was a safer time to loosen up guidance than at previous points in the pandemic.
I think you’re imposing causality here where there isn’t any, suggesting that the change in guidance from 10 days to five days led to a certain amount of deaths.
Oh, I’m sure that in the big picture, the policy didn’t have a huge effect. But that’s probably true of many policies and guidance, which we undertake anyway to try to make some difference where we can.
If you really look at the infectious period, I’m going to say that 90 to 95 percent of your infectious period is before those five days. So I think we should look at prevalence. I think we should look at the death toll among those who are vaccinated or unvaccinated during that period of time.
In January 2022, 41 percent of deaths were among those fully vaccinated or boosted. In February, it was 40 percent. In March it was 43 percent.
Among the boosted?
No, the boosted are a much smaller share.
That was among the things that we were doing and saying. We had had a booster available since September and were trying to promote it.
But by April, 36 percent of deaths were among the boosted, and 59 percent were vaccinated. This was the period when we began hearing so much that we have the tools we need to protect one another. But whenever I hear anyone from the administration saying that, I wonder: Whose responsibility is it to protect those who don’t have access to those tools? Whose responsibility is the provision of services and treatments to those people? And what about those, particularly the elderly, for whom the tools aren’t perfectly sufficient? Whose responsibility is it to protect them? And how can we do a better job of that in the future?
We have to recognize that every time we look to see whether there are disparities in access, the answer is yes. Anything that we roll out at any time, we should assume that those who are marginalized and generally don’t get access are also not going to have access in this case. Because the foundation of public health in this country, it’s frail. There have been decades of underfunding public health. Some have estimated we are 80,000 public health jobs in deficit. Go to any state lab, and they don’t necessarily have the standard machine that people want to use. I think that we need to recognize that as a place that we need investment. Our data systems — we are still receiving data by fax. We are still receiving data by fax! You are ordering a coffee by QR code, and we are receiving data by fax. That can’t be how we operate.
Why hasn’t that been fixed?
I would say we’ve made a huge amount of progress. At the beginning of the pandemic, we had 187 health facilities that were reporting electronically. We’re up to 25,000. That’s a massive increase. But it’s only about 25 percent of our health care facilities. We have — 73 percent of our emergency departments now doing some syndromic surveillance for respiratory viruses and other syndromes. We have 80 percent of our death registries that are now able to report within 10 days, which is pretty fast. actually. It’s why you’re seeing the opioid deaths coming so much faster than they used to. So we’ve made great strides.
But just to give you a sense of the investment, there has been a $1 billion investment in the last several years in data modernization. I came from a single hospital system where it cost a billion dollars to upgrade their electronic health record system. And we have a billion dollars to do it for the entire country. So we’ve made great strides. But we still have a lot of work to do. And I think it gets back to the defense mechanism that we started with. It’s hard to go back there and remember how frail we were and how difficult it was and why we still need to invest in this today.
We have a real problem in this country of what I call sort of roller coaster funding for public health. And it’s easier to say, now that we’re out of it, “Thank God. That’s over,” rather than say, “What do we actually need to do to invest so that we’re in a better place?”
Speaking of data, I wanted to ask about the change in the way the C.D.C. mapped community spread, sometime in February 2022. It was a pretty significant departure from the standards that had been used to describe infection risk by the C.D.C. up to that point — raising thresholds of concern much higher so that levels of community infection that previously triggered alarms would be defined instead as not worrisome.
I think that you’re not necessarily articulating some of the fundamental things that were key to that decision. One being that we had not changed how we were measuring transmission since it was first being measured, since that time when we didn’t have enough tests, since that time when we had only the wild type variant, since that time when we had no vaccine. By the time this change came in, we had enough vaccine for everyone and boosters, too. We had the Omicron variant that was, though far more transmissible, far less virulent. And so fundamentally, the backdrop of the infection had changed, and we had a responsibility to change with it.
All of that is true, and yet that month deaths still reached the second-highest peak of the whole pandemic. But let’s talk about vaccination rates for a second. At the beginning, they were very impressive. In fact, other than Israel, the United States had, for a time, the fastest vaccine rollout in the world.
But then a number of gaps began to open up. The one with Republicans was most dramatic and most famous. By September, 90 percent of Democrats had received at least one dose, according to the Kaiser Family Foundation, compared with 58 percent of Republicans. But with a lot of other groups, the vaccination rates weren’t much better or even a little worse. Among uninsured people under the age of 65, only 54 percent were vaccinated by September. Rural Americans, 62 percent. Non-college-educated adults, 67 percent. Political independents were 68 percent. Those with incomes under $40,000 were 68 percent vaccinated. Men overall were only 69 percent, and Black adults overall were only 70 percent.
How do you think about why that happened, and what might’ve been done differently or better?
I have so many answers to this. One of the things that’s critically important to understand is that we have an infrastructure in this country to vaccinate children. We do not have an infrastructure to vaccinate adults. We have Medicare to help vaccinate adults. But if you’re looking at the demographic of 18 to 65, we do not have a vaccine for adults program. This is now a real goal. It’s in the president’s budget.
There are also differential rates of vaccination by insurance status, for instance, for flu, for hepatitis B —
For everything, basically.
For everything. So we were working on an infrastructure and a scaffold that didn’t exist. We were very intentional early on to look at those demographics to plan vaccines. Our retail pharmacy program planted vaccines intentionally in places where people who couldn’t have access wouldn’t be able to get access. We looked at that very, very carefully. And so we had to be very intentional in working with communities and going door to door.
And so ultimately we would get those people who wanted to be vaccinated, the people who were going to come to us. And then we have this large group, what we call the movable middle — the people who were going to be harder, the people who we needed to listen to, the people who mis- and disinformation had reached. And we actually needed to reach them with more time, more effort, more energy. We were very worried about the race and ethnicity divides. But ultimately some of the real challenges were in the rural-urban divide, and we can talk about whether politics had something to do with that as well.
One thing I’ve always wondered about is just how significant it was that the virus spread through the country the way that it did, beginning on the coasts and only slowly moving inland. When the country was in its most intense period of fear, with the highest levels of mitigation policy and with nonpharmaceutical interventions most uniformly embraced, there were large rural areas that hadn’t seen many cases and hadn’t seen many deaths.
And if you lived there, you could look around and think, “What are we doing any of this for?”
Right. And I actually think that raises a really important point. You said the whole country kind of locked down at once. Well, maybe we needed to really lock down in places that had the most virus instead. Which is why it’s so critically important that we see the data that happens locally.
Let’s talk about schools.
When I came into office I believe 46 percent of schools were open. By that fall, it was 95 percent that were open.
One thing that occurs to me about this subject is that, contrary to much of the debate about it, a majority of that closure period was, at the federal level, under Republican leadership. Schools closed in March or April 2020 and were basically open again by September 2021.
Thank you for saying that.
But tell me how you think about that story, how you assess our performance as a country and why it took us longer than so many other peer countries to get kids back in school.
Early on, we knew flu and other respiratory viruses affected children, and a lot of what we did was take data from meningococcus, flu and other respiratory viruses. So schools closed in March. I will tell you I had three kids at home with me and one of my first academic papers during the pandemic was a modeling study that looked at how we could get our colleges back open. So I was deeply invested in getting kids back to school in my own personal life and in my academic life.
On Jan. 20, I become C.D.C. director, and three weeks later, we had our school guidance. That was really intended to say, “This is a road map for how you get our kids back to school.” We needed to do a lot of work, in terms of we needed buy-in from all of the stakeholders. We needed teachers and superintendents and school nurses and parents and parents of immunocompromised kids. So we did a massive amount of outreach.
In retrospect, teachers and teachers’ unions have gotten a lot of criticism about this. And probably they did slow some things down. But it isn’t the case that we had parents and administrators and public health officials all uniformly pushing for rapid reopening and the teachers’ unions resisting. Many parents didn’t want schools to reopen for a long time, either.
So why was it so hard to get everybody on board? Could we have simply started from a messaging baseline of “These environments are relatively safe for kids,” rather than from a baseline of “We need to go through a whole checklist of precautions to make them so”?
Having done webinars in schools in Massachusetts for teachers, I think that cat was long out of that bag before this administration. It was so very charged. People would say, “Who’s going to pay for my funeral?” The goal was to get kids safely back and teachers safely back. But I think this all got really charged very early. And people do like to check boxes. They do.
So why wasn’t this such an issue in other countries? Why were the majority of schools in England reopened in September? Other parts of Europe opened even earlier, in the spring, after just a month or so of closures. What was different over there? In your mind, what explains why the United States had an unfortunately slow reopening?
There are a couple things to note about this. But I also think we are still learning. There was just a JAMA paper, I think a couple of weeks ago — they demonstrated that kids have been responsible for 70 percent of family infections.
I think there were some questions about the methodology, but it did seem to suggest some significant spread from children.
Right, exactly. So maybe the kids aren’t spreading it to each other at school, but they might be spreading it to Grandma at home.
There’s also — everybody has compared us to Sweden.
Even though a lot of their secondary schools were closed.
A lot of the kids were home there. And there was not a lot of data on kids in schools, but the data on teachers showed that if the schools were open, the teachers had a twofold increased infection rate.
I’d like to ask a few questions about how you see the future, both for Covid and for public health and the C.D.C. On Covid, how worried are you about a new variant upending things? As recently as a few months ago, there was a White House meeting where Trevor Bedford estimated a 40 percent chance of an Omicron-like event happening over the next two years. How do you see it?
They pay me to worry, and I will say that while everybody is really trying to move on from Covid-19 and the public health emergency is over, we at C.D.C. still have our pedal to the metal or noses to the grindstone on all of these questions. There is always the threat of a variant that can evade immunity — likely not in ways that are so immune evasive that people will end up with no protection, but ….
Even now, when things seem pretty good, it’s still the leading infectious-disease killer in the country and probably will be for the foreseeable future.
Which is why people still should still get boosted.
And then thinking slightly longer term: long Covid and post-acute sequelae. How do you think about those risks and challenges as they affect the broader health of our country?
I call these post-Covid conditions. And in fact, there are a lot of postinfectious conditions. We’ve seen them in flu. And with Covid, it turns out we had millions of people get it, and so they’re not presenting as rarities. They’re presenting en masse.
We do have a lot to understand there and at a huge volume. But I am heartened by the fact that some of this seems to resolve over time. But we still have a lot to learn. And then there’s almost everything else — the mental health challenges, the excess mortality or the loss of cancer screening, the lower rates of vaccination in children. I think that a lot will be written about the health of this country coming out of this pandemic.
What do you think the role of the C.D.C. is, in that context? Not just the long shadow of Covid but the life expectancy data we’ve been seeing lately, with the United States taking a few big steps backward in recent years. Covid explains some of that recent decline, but there’s also gun violence, opioid deaths, maternal mortality and infant mortality.
Suicide. And when you talk about that massive loss of life expectancy, it is infant mortality. It is youth suicide, because that’s where you’re losing 60 years per person, 70 years, 80 years per person. Firearm violence is the same. I did a calculation at one point on the average life expectancy loss from Uvalde — that one school shooting resulted in hundreds of years of life expectancy lost.
We still have plenty of work to do in preventing elderly deaths — don’t get me wrong — but where I think the loss of life expectancy really comes from is deaths in the young.
And what can the C.D.C. do about that? It’s now often said that at the outset of the pandemic the institution was too academic in its orientation. Where should it be moving, and how should it be evolving now?
First, I will say I think that this is squarely in C.D.C.’s lane — not solely in C.D.C.’s lane but squarely in C.D.C.’s lane. We’ve talked a lot about data, and it’s not simply because we want to have the data. We want to have the data and then be able to share it. So we have a platform now that is not universal, but it’s in several jurisdictions that count E.R. visits for overdose. And if you can see that there are E.R. visits happening for overdose, then we can go into that jurisdiction and intervene and sort of do the hard work in schools and with parents and with the community to try and intervene in real time. That’s the kind of stuff that we’re going to have to be doing.
Mental health — we do not have the mental health resources that we need. Firearm violence. I think a lot of that is bringing communities to the table. Everybody wants the same thing. Nobody wants an accidental or intentional death at the hands of a firearm. So how do we come together so that we can actually join our goals in the same direction?
A lot of what C.D.C. Moving Forward has been focused on is recognizing the differences across this country, both in terms of prevalence or incidences of an infectious disease but also resources and capacity to implement, whether that be on a rural-urban divide or resources or no resources or shortages or no shortages. And so among the things that we’ve been doing is to have an approach to our guidance that is scientifically founded, scientifically based, but that gives people options. If you can’t do X, then do Y. If you can’t do Y, then do Z. But if you can’t do X, don’t sort of throw your hands up in the air and decide you’re not going to do anything.