Assess your Risk
BIG PICTURE MEDICAL UPDATE
Today is about MAKING DECISIONS in the era of COVID-19.
Remember your class in middle school that was vaguely called something like “Discovering Me” or “Body Choices” that was basically SEX ED—? The class you took when your parents suddenly and awkwardly over dinner seemed interested in your line of study?
Well, here we are, back to basics: MAKING DECISIONS for our bodies and minds. While I’ll spare you my musings on sex, today I’ll try to address your “Corona Conundrums”: the day-to-day mental gymnastics of deciding WHAT TO DO and HOW TO BEHAVE in a pandemic.
FYIs:
I’m not here to preach, judge, or pretend I know it all. I am as flawed as the next person—I promise. (And to act like I’m perfect would be not only misleading but also really annoying, right?)
I can’t make decisions for you—nor should you WANT me to. (See above declaration.) Instead, I’m glad to dispense facts and provide a framework—basically a way for YOU to decide.
In no way can I manage every decision my fine readers are facing. And please know I’m not able to reply to all of your wonderful emails, but I do read every one!
There are both INDIVIDUAL and SOCIETAL risks to every single thing we do, and, in my humble opinion, BOTH ought to be considered—in general, but particularly in a pandemic.
So now with expectations (hopefully) managed, ONWARD!
Recall that pre-pandemic, we made decisions every day. Picture a typical cloudy Monday morning, for example. You’d ask yourself “Should I drive myself into work and enjoy my time alone—and risk getting road rage in traffic? Or should I ride the Metro, save time and money, and reduce my carbon footprint—but risk getting doused in the rain on the walk to the station?” Whether you were cognizant of it or not, your brain was honing your RISK/BENEFIT ANALYSIS skills, and NOW it’s time to unleash them.
Indeed, a similar decision-making rubric applies to the COVID era:
Understand the facts.
Assess the risks inherent in your question—and the available tools to mitigate them.
Assess the benefits inherent in your question—and the relative importance to you.
Make a decision.
Live with it. (Enjoy the benefits, own the consequences, and don’t blame the weatherman when it rains.)
Let’s start with coronavirus facts (and for a full refresher, review my three-week course of COVID school that begins here).
Handwashing works extremely well to kill coronavirus. By washing your hands thoroughly and frequently—and by not touching your face—you are dramatically reducing your risk of infection.
Disinfecting surfaces also works well. Environmental transmission of coronavirus seems to account for only 6% of coronavirus infections, but cleaning high-touch surfaces like countertops and doorknobs is an excellent way to bring that percentage closer to zero.
Social distancing matters. Community spread occurs mostly from people who DO NOT HAVE SYMPTOMS. Repeat: you can be carrying coronavirus in your body, NOT KNOW IT, and infect someone else. The virus is spread mostly by respiratory droplets. And while it can indeed travel more than six feet with a hearty sneeze or open-mouthed cackle, the viral “load” decreases the further you stand from an infected individual—whether they have symptoms or not. Upshot: staying six feet apart from other humans—and in well-ventilated spaces like nature—is an ESSENTIAL way of reducing transmission.
Infectivity (“contagiousness”) starts before symptoms do. In other words, people carrying the virus who don’t know it yet are MOST contagious when they are ABOUT to get sick but still don’t have symptoms—and also in the early stages of illness. Meaning: people who are at higher-risk for infection (essential workers or individuals not being careful about precautions) are important carriers or “vectors” of disease. And because we can’t readily identify carriers who aren’t sick, distancing and masks are essential.
Masks work. As we learned yesterday, another robust study suggests that near-universal adoption of non-medical masks (when combined with public health measures) could successfully STOP community spread.
Screening, self-reporting, and testing people with symptoms dramatically reduces infection. (This is the part where I tell you again to get a doctor.)
Doing all of the above IN COMBINATION will allow us to re-enter life safely. None of the above measures is foolproof. And there is no way to bring the infection risk to ZERO. But vigilance with ALL of the above measures is as good as it gets until we have a vaccine and/or treatments. In other words, your chances of getting sick are almost zero if you use the above list as a daily checklist and when we all STICK TO THE RULES.
Anyone who has been following the rules—handwashing, distancing, wearing a mask, reporting symptoms, and getting tested as needed—is VERY UNLIKELY to infect other people.
Risks stack up. Example: any time you engage with another person, you add risk. If both of you have been extremely careful, the risk of infection is quite low, particularly when you interact at six feet, outdoors, and masked. But if one of you has been traipsing around town maskless then insists on close-talking in a small, poorly ventilated room, that person’s risk of transmitting the virus to you is much higher.
If everyone together would follow the same rules, we would ABSOLUTELY CRUSH this virus. We would! This is where culture matters. If we all could agree that we value other people as much we value ourselves, we’d be out of this pickle much faster.
And now onto decisions. With the facts in hand, you simply need to APPLY them to your situation, WEIGH the risks of infection against the benefits of the proposed action, know how to MITIGATE risk—then DECIDE what to do.
Let’s go with a few examples of FAQ from my patients and readers:
Q: Do I need to wear a mask outside while jogging, walking my dog, and generally not around other people?
Consider the risks of not wearing a mask: Recall that the risks of not covering up are more about infecting OTHER PEOPLE. And while the risk of infecting someone outdoors who is further than six feet away is very low, it’s not zero.
Consider the benefits of wearing a mask. You are protecting—and respecting— fellow passers-by. You are doing your civic duty by preventing asymptomatic spread (aka by YOU!)
A: You will never be faulted for wearing a mask when outside, and I highly recommend that you do. But what’s MOST important here is understanding the risks of 1) unwittingly infecting others and 2) not reliably predicting your surroundings. Will you be hiking alone or walking on a city sidewalk? Think about it. And here I could tell you what I do myself, but it wouldn’t matter because your situation does not mimic mine. But fine, want to know what I do? For eight weeks I’ve worn a fanny pack all day, every day. I wear a mask wherever I go. And when I’m outside and no one’s in sight, I pull my mask down to breathe. When someone walks toward me, I pull it back on. And because that involves face-touching, I also carry hand sanitizer—and dental floss if you must know—in my pack.
Q: Can I see my grandkids over Memorial Day weekend?
Consider the risks: older people TEND to get sicker if infected. Yet I see 70-year-old patients who run marathons and 30-year-olds with severe immune deficiencies. Age is not everything. Kids can be vectors, but they typically don’t get very sick (or sick at all) with COVID-19. But MINGLING WITH OTHERS ALWAYS ADDS RISK. How can you mitigate it? By not mingling at all. And if you must, stay outside, six feet apart, masked, and be careful with hygiene. And remember that once Memorial Day weekend is over, you bring home the SUM TOTAL of accumulated risks and fold it into your community.
Consider the benefits: LOVE IS LOVE. And difficult to quantify. Particularly during these lonely times, being with grandkids is perhaps the best medicine—if everyone stays healthy.
A: There is no right or wrong answer. You are definitely safer staying home and not combining family pods. But if you are going to engage, please follow the rules to mitigate risk.
Q: What about summer camp for my kids?
Consider the risks. Kids tend to get less sick, but depending on the age, kids also have a hard time with social distancing, masks, and following the rules. And many camps will have natural challenges to keeping kids safe. Is the camp outdoors or in? If indoors, how good is the ventilation and is there enough space and few enough campers to space kiddos out? How much hand sanitizer does the camp provide, how well are they screening campers and staff for infection? What will the COVID case rate likely be in the state where the camp is being held—and from whence campers arrive, thus bringing cross-state germs into the mix?
Consider the benefits of camp (AS IF THEY ARE NOT ALREADY THE STUFF OF YOUR DREAMS): Kids need their friends, parents need to work, we all need a BREAK.
A: First off, let’s agree we cannot predict the future, particularly now. It’s hard enough planning what’s for dinner, not to mention a schedule for July. Camps are working hard to think through these issues. And again, what I myself am doing should make no difference because it’s impossible that my kids’ health, risks, behaviors, and camp scenario exactly match yours. But if you REALLY want to know, my teenage boys were scheduled to work at their beloved sleepaway camp (Netop) in Maine where they’ve been campers/counselors for a combined 18 years. I suspect camp will be cancelled. But if it ISN’T, I will ONLY consider sending my boys if: 1) Maine’s COVID-19 case rate is declining at the time (July or August), 2) local hospitals have capacity, 3) screenings happen daily, and testing is readily available for symptomatic staff and campers, 4) my kids continue to follow the rules at home and strictly self-quarantine two weeks before arrival to prevent infecting others, 5) we are able to drive them to camp, 6) the camp seems able to mitigate the myriad health risks as above, and 7) the strong leadership provides a culture of mutual respect and rule-following by all campers and staff (which happens to be the very reason we love this place). UPSHOT: I think it’s unlikely that all of those criteria will be met, but I never say never.
And now I must move on to my next decision: what I’ll be drinking this evening. Tomorrow, we’ll hear from another kind of doctor as my next guest writer, and I think you’ll love it—and her. Until then, be well.
P.S. Here are some upcoming events for the week:
Join me tomorrow at 2 pm EST on Facebook Live with my incredible colleague, internal medicine doctor and geriatrician, Dr. Clay Ackerly! We’ll be discussing some of the challenges our older patients are facing, from fear about the virus to the strong desire to HUG grandkids. We’ll tackle it all on Wednesday!
Date change: join me FRIDAY at 11:15 am EST on Instagram Live with BBC’s Katty Kay for another COVID NEWS ROUNDUP for the week!