A common refrain of mine throughout the pandemic has been “well, it depends on your personal relationship with risk.” Friends and family know I’m paying attention to covid19 details to design my personal safety routines, so they ask me “is it safe to ...” as if there’s a clear yes/no answer. March 2020: Is it safe to visit with friends outside sitting six feet apart? March 2021: I’m vaccinated, do I still need to wear a mask? March 2022: Is it safe to work out at the gym? What it comes down to, in terms of personal decisions, is how comfortable you are with uncertainty.
Over two years into the pandemic, few risk questions have definitive yes/no answers, a reality inherent in dealing with a brand new pathogen and the massive numbers involved. Here’s a definitive yes: Wearing a well-fitted mask protects you even if others aren’t wearing masks (N95s reduce risk by 83%, surgical masks by 66%).
My answers to friends’ queries always involve three components: These are the facts (few); these are the suppositions (many); your personal risk tolerance is what decides yes/no. That’s what I have for you today, very few facts, many suppositions, and an overarching question to answer in the poll below: Who else feels like one of the only people still trying to avoid covid19?
Yesterday, I read that the number of new covid19 cases in the U.S. right now is five times higher than a year ago. Last Memorial Day weekend, cases were plummeting thanks to vaccines, immunity built up during the 2021 winter surge, and public health mitigation measures, although I wasn’t joyously rushing into “hot vaxx summer.”
Last year, we didn’t have in-home covid19 tests readily available so the case rates, based on PCR testing, were more meaningful than now, and the test positivity rates offered another good clue. This year, most people test at home. We don’t know how many of those positive tests are also reported to public health or confirmed by PCR and picked up in the official reporting data, more people are vaccinated and may not have noticeable symptoms, so now both the case rates and test positivity rates (still based on official lab tests) are much less relevant to risk assessments.
The actual covid19 case rate is much higher than what is reported, but we really don’t know what it is. An infectious disease specialist at Columbia University “whose lab has worked to model the true number of infections … thinks the true number of cases may be in the ballpark of eight times higher than case counts. In other words, instead of 100,000 new cases a day, the true number may be 800,000 cases per day.”
Although more than half the U.S. is currently classified by the CDC as having medium or high covid19 levels, images of concerts, protests, basketball games, and other events show bare-faced crowds shouting, singing, conversing ... just like the olden days. The only reason I know those images are current and not prior to 2020 is the sight of one or two people wearing N95 masks in clean air (no wildfire smoke).
I consider longshots to be more possible than do all those maskless people in crowds, apparently. My actual personal risk from covid19 is also higher than that of younger, healthier people and even if it weren’t, I don’t want my brain to age 20 years in a few weeks. I have permanent disabilities from a 1999 tick bite that encompass many of the long-covid symptoms. Then, in 2018 my home (along with my town and much of the adjacent region) was burned up by the state’s deadliest wildfire. So, tell me that only 1.4% of people die from covid19, or that only X% of people who get infected need hospitalization, or that 10 to 30% of people get long covid (yikes!) and I can easily imagine myself in those groups.
I know there’s more to consider than will I live or die. I’ve had 3 full vaccine doses (Moderna) and one booster (Pfitzer), and am not encouraged to learn that a fourth dose of Pfitzer wanes faster than the third (in one Israeli study, thus not yet a definitive fact). I already have a version of longcovid due to Lyme disease, so I’m wearing my KN95 (most N95s are too broad for my face and don’t fit tightly enough) whenever I’m indoors with other people and I’m limiting my exposure risks (no in-restaurant dining, for example).
Below are some resources about covid risk assessment, long covid, and psychological and social aspects of risk assessments. That last topic points out the intriguing truth that what we see around us, our social context, influences (inaccurately) our decision about riskiness. Even though the majority of people in crowd photos or at the grocery store are unmasked, I’ve not decided the risk is significantly lessened for me. It may be even greater now because so many people are unmasked. I don’t mind being the weird one still wearing a mask in Trader Joe’s or standing apart, upwind, when a neighbor stops to chat at the mailbox.
Have you stopped wearing a mask and avoiding crowds or are you still being cautious? How has your risk assessment changed during the pandemic?
Covid risk assessment facts and suppositions
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Almost as contagious as measles: Coronavirus spins out worrisome new mutations — “The variants now dominating around the world may be five to 10 times more infectious than the original virus that sparked the pandemic in China in late 2019 … The basic reproduction value—a number meant to represent how many people could be infected from a single case—for these subvariants may be approaching 15, an astonishingly high score that would put the coronavirus on par with measles.”
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COVID in California: UCSF’s Dr. Bob Wachter says he’s masking up again — FDA officials anticipate ‘new normal’ with yearly COVID shots. Pfizer says it’s OK to take more Paxlovid if symptoms return. Travelers still urged to wear masks, CDC says. Impact of severe COVID on brain equivalent to 20 years of aging, study finds. “’If you’ve decided you’re OK getting COVID ... then fine to keep mask off in crowded indoor spaces,’ he tweeted. ‘If you’d prefer to avoid COVID & have become less cautious, it’s time to re-think.’ Wachter cited his concerns about long COVID and other virus-related risks (”heart/neuro/diabetes”). For masking: “I’ll now do 100% N95 in crowded indoor spaces.” People should keep their ‘eyes open’ because “there’s a lot of COVID out there,’ he warned.”
Long covid
- What We Know About Long Covid So Far (NY Times) — “studies estimate that 10 to 30 percent of people report persistent or new medical issues months after their initial coronavirus infections — a constellation of symptoms known as long Covid. People who experience mild or moderate illness, as well as those without any underlying medical conditions, can nonetheless experience some debilitating long-term symptoms, including fatigue, shortness of breath, an erratic heart rate, headaches, dizziness, depression and problems with memory and concentration.”
- Stop dismissing the risk of long covid (WaPo) — We don’t know the precise risk of long covid, but it is not rare. “Estimates range from 0.5 percent of infections to 30 percent, with 10 percent being a commonly cited risk. Furthermore, there does not seem to be a correlation between the severity of the initial infection and the odds of getting long covid. ”
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Their virus symptoms were minor. Then they had long Covid. (CNN) — “Emerging research suggests that a small portion of people who now live with long Covid may have showed no Covid-19 symptoms at all when they were initially infected – or their symptoms were mild or unusual,”
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Brain fog, other long Covid symptoms can last more than a year, study finds (NBC News) — “The devastating neurological effects of long Covid [which include brain fog, numbness, tingling, headache, dizziness, blurred vision, tinnitus and fatigue] can persist for more than a year, research published Tuesday finds — even as other symptoms abate.
The study, published in the journal Annals of Clinical and Translational Neurology, is the longest follow-up study of the neurological symptoms among long Covid patients who were never hospitalized for Covid.”
Decision fatigue
- COVID-19 decision fatigue: Expert tips on how to cope (Medical News Today) — “Decision fatigue happens when, after making many decisions at once, a person’s ability to make decisions declines. Complex decisions, such as those posed by the COVID-19 pandemic, deplete one’s capacity for decision making especially quickly.
According to a survey by the American Psychological Association published in October 2021, 32% of adults in the United States struggled to make basic decisions, such as what to wear, due to COVID-19-induced stress … Signs of decision fatigue include brain fog, feeling tired, and other signs of physical or mental fatigue. These may intensify the more decisions a person makes throughout the day.”
Social norms