Hi, I’m back as Robin-Schoenthaler-the-Boston-cancer-doctor-who-writes-about-Covid.
(And it’s okay with me if you want to share.)
Today I’m going to talk about thinking about Covid science when we think about Covid risk.
As we enter into fall/winter there is increasing anxiety about
a) how on earth we are going to survive months of being stuck much more often much more inside and
b) whether this epidemic will ever end
The first issue I totally get, totally, in my heart and soul: the specter of a long cold mostly indoor winter ….. very very tough.
The second I am much more confident about because in all of history, All Epidemics Always End. (More poetic version: “Every storm runs out of rain.” )
Some epidemics end because a virus vanishes or mutates or fades away, and some epidemics end because of science.
This one, I’m betting, will end because of science.
Covid science isn’t straightforward, and there’s been some confusing moments along the way.
But I heard a great quote on a TWIV the other day. [For the uninitiated, TWIV is “This Week in Virology,” a fantastic YouTube podcast about “Viruses: The Kind That Make You Sick.” This show has labored in obscurity for years and years but suddenly folksy virology peeps are rockstars.]
A terrifyingly smart doc named Mike Yaffe in Episode 669 said, “In science…our understanding of truth continually evolves. Things that were true today can be false tomorrow. And that’s totally acceptable.”
This is a hard concept for people (especially Americans). We want everything to be Black.And.White. No gray. We want things to be PERFECTLY CLEAR. And unchanging. And 100%.
But that just isn’t the way science is. It evolves. It’s never One-And-Done.
Still, right now we are at a place where we really have a lot of solid science that can help keep us safer because it’s shown us:
1) Masks/masks/masks/masks; masks really work. Maybe they’re not 100 billion percent perfect but overall they are a fantastically effective way to protect ourselves from the germs in Other People’s Mouths and Noses and to protect other people from our own germs.
2) Outside is way safer than inside. Close together is worse than distanced.
3) Much Covid is transmitted by People With Mouths and Noses who do not have a clue they are infected (asymptomatic)
4) Surface transmission of Covid is a minor cause of infection
5) Handwashing makes Covid vanish from hands that touch surfaces.
6) Shorter interaction with people is lower risk than prolonged contact.
7) Being with people who are Good With The Covid Hygiene (wearing masks, staying further from each other, lots of hand washing especially before and after food) is safer than being with people who don’t take precautions.
8) Anybody can get Covid. ANYBODY. But the people who tend to get it worse (really sick, need oxygen, need hospitals, need ventilators, die) tend to be older, of color, and/or have serious chronic conditions. So people in these categories should have a different attitude towards risk.
So now, right now, we can use all this science to make what I call our “Fork-In-The-Road” Decisions— the decisions we face every day about whether to do something maybe slightly more risky than sitting in our basements with our Netflix.
Fork-In-The-Road Decision One: You are sitting in your office without a mask and someone maskless comes in to chat. What do you do?
You look at your own risks (age, medical issues) and:
At the very least you put your mask on.
You can ask the person to put their mask on.
You can ask the person to step back a few feet.
You can invite the person to walk with you outside.
You can keep the conversation short.
Or:
You can clutch your palms to your chest and say, “DUDE, don’t you know I have ankle-oozing migratory spondylizardiasis and I DON’T WANT TO CATCH COVID, go get a damn mask” and/or
You can start fake coughing or sneezing til they go get a mask
I don’t actually recommend either of the last two and would probably never do either of them myself, probably.
Fork-In-The-Road-Decision Two: You are invited to a birthday party for a twenty-year-old.
You look at your relationship with this person and think about exactly how important your attendance is in the grand scheme of things and
You look at your own risks (age, medical issues) and:
You definitely don’t go if it’s inside
You cancel if it rains and they move the party inside
If outside, you consider whether there’s good space outside and a good ratio of space-to-people.
Tiny porch and lots of people? No go.
Big backyard with lots of room for separate tables? Better!
If outside, is it mostly a big bunch of Friends of Uncle Maskless? No go.
Or is it a small group of people who are Good With The Covid Hygiene? Much more reassuring.
You’re 20 or 40 and are yourself Good With The Covid Hygiene? Maybe yes.
You’re 80 or debilitated or chronically ill? Absolutely no. You need ALL your friends and family to be masked. All the time. Period.
Fork-In-The-Road-Decision Three: Your kids are at a school where they are Good With The Covid Hygiene. There’s no cases. A classmate invites one of your kids to a Halloween party at their house. What do you do?
Is it inside? No go.
Is there no masking of adults or kids? No go.
Is there bobbing for apples or other hygienically grody group activities? No go.
They are having wholesome Covid-safe scavenger hunts/mask parades/pumpkin carving contests outside? Awwww!
Fork-In-The-Road-Decision Four: Do you travel for a major family event?
Is this a major major family event? Would you go if it was happening during the London Blitz?
Is community transmission low on both ends?
Can you reasonably protect yourself while traveling?
Can you quarantine easily while there or when you come home as needed?
Can you get tested before and during your trip?
Are the people you are visiting ready and willing to be Good With The Covid Hygiene?
Will your family promise to tell you if they feel unwell so you can check into a nearby hotel instead of spending the night with them?
Can you hide your visit from Uncle Maskless?
Fork-In-The-Road-Decision Five: Your spin studio opens up. You’re ecstatic!
But first, you remember this story about the Canadian spin studio that opened up and did “everything right” — EXCEPT MASKS. And promptly saw sixty-one cases.
When they said they did “everything right,” they meant they cleaned, they pulled half the bikes out, they had people wear masks walking in and out — but they didn’t have people wear masks on the bikes. And they got a disaster.
This is science in action here. Huffing, puffing, shouting without masks inside? Hideous potential for transmission.
No masks inside a gym? No go. Period.
We’ve hit some terrible milestones this month: over a million global deaths, more than 8 million US cases, 210,000 US deaths. All of these have slowly agonizingly helped advance Covid science. The least we can do now to honor all this suffering is to recognize our Fork-In-The-Road Decision moments for what they are: an opportunity to apply these science lessons and help ourselves stay safe.