Saturday, June 13, 2020

Interesting article from an ER Doctor. Here’s What I Feel OK Doing as My State Reopens.

 Here’s What I Feel OK Doing as My State Reopens.

Each person’s calculus will be a little bit different depending on their comfort with risk and their priorities.

By Amita Sudhir

June 09, 202011:20 AM 

As states continue to open up, but COVID shows no signs of magically disappearing, many of us are asking ourselves: What is the safe and responsible thing for me to do? Even if my state says it’s legal for me and a hundred of my closest friends to cavort around a swimming pool in close quarters, swilling margaritas, should I? How much do I owe it to my fellow humans to stay at home, and how much can I allow myself to taste just a little bit of freedom?

I’m an emergency physician, and I have been mulling this over in my own head for weeks. I’ve fielded a few questions from friends that start with: Am I a bad person if … ? This seems to be the crux of the problem: Just because something is allowed does not mean it is safe (or necessary). Each state seems to be approaching this with varying degrees of scientific insight and common sense, which is certainly adds to the confusion. But more broadly, there are simply many things that I have chosen not to do for safety reasons, even though they are not against the law. For instance, I don’t own a gun. I wouldn’t hurtle at highway speeds in the back of a pickup truck even if I lived in South Dakota, where such an activity would be legal. I would never skydive. So should I just ignore the fact that restrictions are easing, and stay home?

Well, I haven’t been.

Yes, we would all be safer at home. If you had the ability to ride out the pandemic, however long it takes, by staying home, growing and cooking your own food, ordering nothing off the internet, and avoiding contact with anyone except those who had chosen to isolate themselves with you, you could be 100 percent guaranteed not to be infected with coronavirus. You would also be guaranteed not to die in a car accident, an occurrence whose lifetime risk is 1 in 100 for people who live in this country. And yet most of us drive every day.

I know that people want to be safe and healthy but that they also want art, and laughter, and music, and bourbon—to create them and to consume them.

Responsible people take risks all the time in the course of normal life. And as responsible people, both out of regard for ourselves and for others, we take steps to mitigate those risks. We drive, but wear seat belts; we bike to work, but wear helmets; we drink alcohol, but don’t get behind the wheel of a car right afterward; we have swimming pools in our yards, but have fences around them. So can we return to some semblance of normal, but do it without endangering ourselves or others?

For every activity I think about going back to, I consider the opportunity costs. For example, just as Virginia began to ease restrictions, a local sports club reopened its outdoor tennis courts. I called a friend and we played tennis for an hour. We were well over 6 feet apart, and although we obviously had indirect contact through the balls, we were careful not to touch our faces and we washed our hands afterward. It felt safe, and also exhilarating. Did I absolutely need to play tennis? Of course not. Was it terribly risky? Probably not. Did it make me happy? Undoubtedly, it did. And we are all in need of a little happiness right now.

The value of a life is not just in the simple act of living it, but in how you do so. I know that people want to be safe and healthy but that they also want art, and laughter, and music, and bourbon—to create them and to consume them. Not everyone can do those things in lockdown, but if you can, how do you decide?

There are three things that enter my calculus for what I should and shouldn’t do right now. The first: Am I putting anyone else at risk? For me, “anyone else” includes all my patients, so I feel acutely responsible for making sure I am safe. For many people, “anyone else” will be family members or close associates who are elderly or have other risk factors for getting very sick from COVID. I consider the downstream effects of increasing my risk on those whose well-being I am responsible for. Without this, being young-ish (42) and with no chronic illnesses, I might be tempted to be more cavalier. The risk to others is perhaps the most complicated to determine. When I think about visiting my parents, who are in their 70s, I worry about infecting them. And, of course, it would be safest to stay away. But I also worry about them feeling isolated, and the fact they miss their grandchildren. So one weekend, just as Virginia began to lift restrictions and I had not worked a shift in the ER for five days, I drove my family up to see them, and we sat in their living room with masks and on their back porch without them. If case numbers climb where I work, I probably will feel less safe visiting them and will stay away. But if this drags on for years without a vaccine, I imagine I will then feel differently. They and I will weigh the risk of them getting COVID and dying, against the sorrow of missing their grandchildren growing up, and perhaps we will all decide the risk is worth it.

Because I consider myself a possible risk to others because of my job, I might not invite friends over for dinner inside my house right now. But I might consider grilling in the backyard, with people I trust to wear masks in public, wash their hands, and realize that the coronavirus really is a threat. (This brings up a side note: This is a time to reflect upon the company we keep. If we gave freely of ourselves in the pre-COVID era, perhaps it is time to consider just how important any given person is in our lives. Some people we were friendly with before just might not make the cut. There is legitimate value right now in keeping one’s social circle a little bit smaller.)

A second consideration is the risk of the activity I want to partake in against its importance to me. And although some of the things I would like to do could be categorized as frivolous, I intend to do them anyway. Friends have asked me: Are pedicures safe? Perhaps they are, and so may be spa visits and haircuts; weeks after two Missouri hairstylists exposed more than a hundred customers to COVID because they worked while sick, no customer has yet tested positive at the time of writing. If this remains true, it suggests that close quarters with masks, which the two stylists were both wearing, might be OK. While none of these activities are essential, they are things many of us are longing to do. And what we have learned is that there are real ways to make them safer: physical distancing, masks, and good working conditions for employees. (This matters because it’s a good indicator of how able the employees can protect themselves as they want to—if you were already worried that your nail salon was exploiting its workers, now is definitely not the time to go back, for their sake or yours.) If you don’t long to do something, then maybe holding off on doing it for now is the best option. For example, there is no dearth of movies on Netflix I haven’t seen, so going to see a new release in a theater holds no fascination for me. But if everyone is 6 feet apart at the movies and wearing masks, an armchair movie critic might choose to make this their first pandemic outing. Similarly, if I couldn’t drive to see close family, I might consider getting on a plane but would wear a mask and bleach-wipe my surroundings. Each of us will decide, with a certain degree of arbitrariness, what we consider safe and important. But I wouldn’t go to a crowded bar, or a pool party where no one was wearing a mask, no matter how much I wanted to. That would clearly just not be safe right now.

It’s not just the frivolous that concerns me. As the days with COVID march on, some of the things we have been avoiding will become necessary. Adults will need to go back to work, and we’ll need to send our children to school and day care. How will we learn how, and teach our children how, to be safe in those settings? The CDC has published mitigation strategies for schools and business, and we will want to know that our employers and school districts are taking them seriously. While there is data that suggests children aren’t a huge source of transmission, we really won’t know how safe school is until we have tried it. I intend to send my children back as soon as schools are open, but I imagine there will be some parents who won’t want to. Until that long-awaited back-to-school day arrives, I’ll try to ingrain COVID safety in my kids. They now always wash their hands for 20 seconds or leave their shoes by the door, and they are learning to be comfortable in masks. And for us adults, the skills we acquire in our occasional forays into the world will serve us well when work in an office is a regular occurrence again; not touching our faces, and sanitizing obsessively, will have to become second nature. We’ve already contended with decisions about something that is morally necessary: protesting. People have done integrated strategies to mitigate their risk of COVID even as they march and kneel in the streets.

My last consideration as I weigh how I will go back to normal life is not about my risk of getting COVID—it’s about the risk I pose to the broader world. Carbon emissions across the world are down 17 percent. Skies are clearer. Previously obscured mountains are visible. Snow leopards are being spotted where they have never been seen before. The pandemic has given us a glimpse of a dire future but also one of a better Earth that may actually be attainable. Now that we know we can go a few months without doing certain things, why not go without them forever? So I will also ask myself, will this activity allow me to tread lightly upon the earth, and if it doesn’t, do I really need to do it? Is it worth the fossil fuel I will burn to accomplish it? That’s one thing I’ve taken away from this time apart—you might have had your own realization of what you’d like to pay more attention to in your life.

Once I decide to do something, I set myself assiduously to the task of making it as safe as possible. As evidence accumulates in favor of masks, there really is no excuse for not wearing them. Using hand sanitizer before and after activities seems prudent. Keeping a 6-foot distance from others when possible should be easy. An event with 10 people is safer than one with 20. Having your best friend over for cocktails in the backyard is probably fine; having the guy you just met on Tinder over to snuggle on the couch probably isn’t. We might ask what businesses are doing to keep us and their employees safe, and choose the ones that are following the rules. Our local gelato place recently reopened; they sanitized my credit card before handing it back to me, and both employees in the store washed their hands after serving us. I can’t wait to go back.

It will be a little while before we know exactly how dangerous certain things are, so it makes sense to start with baby steps and for those baby steps to be the things we really care about, things that don’t make us feel like we are teetering on the COVID precipice. As we navigate how to live with COVID in our lives, we will misstep, in either direction, as we walk the fine line between safety and freedom. I felt a little frisson of anxiety as I bit into the manchego a friend served me on her porch. Was it OK to do that? I still don’t really know, and that uncertainty is something we will have to learn to live with too.

There’s a lot of shaming on the internet of people who want to go out and do things, and this makes us question our desires to do so. Yes, we all want to survive this pandemic. But we also need to learn to live with COVID around us and take steps to protect ourselves and our communities. Ultimately, most of the risks we will all take won’t be about pedicures, or haircuts, or eating at a steakhouse. They will be about seeing the people we love, being with the people who sustain us, interacting in a way that makes us feel human. While love can be expressed in an email, on a computer screen, in a phone call, those digital forms of communication are no substitute for sharing the same physical space with another person, even if the words are the same. And wanting that closeness does not make you a bad person. 
Just wear a mask when you do it.

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