Angelo Falcone, MDCovid and Personal Risk Assessment – What’s Thanksgiving Look Like in Your House?
As we come out of the dark times of having to shelter in place and not seeing close relatives and friends for what seems like years and transition to actually going out and eating again at restaurants and reconnecting with friends and loved ones, there is a question that keeps crossing my mind: What is our new normal?
Recently I began traveling more as I give talks on integrative health to CEO groups across the country. The differences in communities on mask wearing to me is striking. People in locales like those around Washington DC continue to wear them routinely when indoors while others, like Charleston and Houston, have all but abandoned their use except for those who work in industries like hotels where policies still dictate it for staff.
The question of who was right in this assessment of the balance between community health and economics will be hotly debated for years by epidemiologists, social scientists and economists. The answers (and there will certainly be a wide range of correct ones) will consume researchers for years to come.
The question I continue to ponder though is personal. How does one assess one's own risk tolerance when it comes to the health of ourselves and our families? In order to do that a few assumptions and data points need to be acknowledged:
There is risk both short-term and long-term and everything we do in life. From our daily food choices (especially), to getting into the car and driving across town, to playing sports or walking across the street.
Vaccines dramatically lower the risk of serious disease and death by 97 — 98%. That debate has been settled.
Masks, especially when worn indoors, markedly lessen the the chance to catch and transmit Covid as well as other upper respiratory diseases like the flu.
Covid will not be eradicated as once was hoped. It is now and will be an endemic disease constantly circulating in our communities, just as the flu does.
I found this risk assessment tool published by the Texas Medical Association which summarizes the relative risk of different everyday situations quite well:
If the above are fair assumptions than how do we approach personal interactions and societal functioning as we move forward? Do we feel comfortable sitting around Thanksgiving dinner table with our relatives who have travelled from far away?
Personal risk assessment, to state the obvious, is different for every person. One definition states it is a process to identify hazards, define the risk associated with the hazard and determine the best way to control or eliminate them.
On one extreme we have those still not coming out of their homes or interacting socially. For some individuals with severe immune system issues that may be a reasonable decision. For most, the consequence/fallout of that risk equation involves social isolation leading to a loss of personal connections, increased anxiety and rising chance of depression. Many of us have witnessed this over these last two years in ourselves and our children.
There is always a balance of outcomes based on our decisions to do something. Or as the saying goes the decision not to make a decision carries its own consequences. That often goes under appreciated. For example, if we choose not to get vaccinated, we increase not only our personal risk of getting Covid but the chance it continues to spread and develop variants which may be more deadly than the current version.
So, what exactly are you supposed to do for yourself and those you love? Here are my suggestions:
Get vaccinated. It clearly has been shown to decrease risk of serious disease and death. I would now extend that to encouraging boosters. While the overall risk is low for children I advocate that all who can be vaccinated do so. My 11-year-old son and five-year-old granddaughter were both vaccinated last week.
When indoors in a crowded environment, especially in the winter months, continue to wear a mask. As winter comes to the northern latitudes and we spend more time inside this will be more critical. While we used to look curiously at Asian societies wearing masks in public the wisdom of that simple act is now apparent.
Know your local community rates of vaccination. The higher the rates the better. If low, below 70%, show more caution and wear a mask in public.
Get out to see friends and family. Social isolation is harmful and all living beings need interactions with others for health and well-being. Reach out to those friends and neighbors. It is good for both of you.
Continue to get outside as much as possible as the benefits of being outdoors in nature are profound as well as having a negligible risk of transmitting Covid.
Personal risk assessment is in the end something each one of us will have to do for ourselves and our families. As the world opens up again, we will begin to travel and visit those relatives we have not seen for quite a while. Some common sense and a few reasonable data points will allow each of us to make informed decisions on assessing the risk. And as Sgt. Phil Esterhaus concludes the roll call in Hill Street Blues with his signature line: "Let's be careful out there."