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Harvard Health Blog
Daily decisions about risk: What to do when there's no right answer
- By Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing
Let's face it: there's still a deadly virus out there and it's not going away anytime soon. And that means we all must make a lot of decisions that involve personal risk. And for many of these daily decisions, there's no single right answer: no Centers for Disease Control (CDC) guidelines, World Health Organization recommendations, or expert advice exist. And as more places lift restrictions keeping people at home, more questions arise:
- Is it safe to go to the grocery store? And, how often is okay?
- How safe is it to fly on a commercial airline? Get a haircut? Go out to dinner?
- Should I avoid a friend whose daughter works someplace where someone tested positive?
A new CDC guideline on venturing out shares ways to lessen risk for certain activities: frequent handwashing, wearing a mask, keeping your distance, and other familiar protective measures feature prominently. While helpful, the guideline won't tell you whether it's okay to visit your cousin, drive cross-country, or get a massage.
Based on duration of exposure, setting, and "dose" (the amount of virus to which you're exposed), we do know that some activities are riskier than others. Spending 15 minutes or more in a small room with someone who is coughing while neither of you wears a mask is considered high-risk. Going for a walk outdoors, well away from others, is low-risk.
But each of us must make our own decisions about all of the things in the middle — including activities now allowed in many places — without much guidance.
We already calculate risks every day
We already have to make daily decisions about what is safe or less safe, and how much risk we're willing to accept. Each time we decide to drive, fly, or go skiing, we make judgements about our safety without precise data, specific guidelines, or expert advice for our particular situation.
Of course, there is an important difference when we're talking about COVID-19. Here, the threat to safety is catching, and possibly spreading, an unpredictable, potentially deadly infection. So, my behavior affects not only my health but may affect the health of others. And the behavior of others can affect me.
Sometimes you have to improvise
Strong opinions aside, no one actually knows what's best for many everyday decisions. There's a lot of making it up on the fly and rationalizing: a friend recently "expanded his social circle" for a birthday party with the plan to quarantine himself afterward. But the recommended quarantine was "just too long," so he decided six days was enough. When I asked him where the six-day figure came from, I got the look that means "don't judge me, it's my personal decision." In fact, he'd chosen six days because that's when he had to return to work.
How can you make decisions around personal risk?
If you're considering relaxing restrictions in your work or social life, consider these three important steps:
- Think about your risk factors for developing a severe case of COVID-19; do the same for others with whom you'll have contact.
- Find out if community spread is common where you live.
- Gauge how risky the activity is.
And then what? Weigh the five Ps to round out your reckoning of risks and benefits:
- Personal risk tolerance. Is your mantra "better safe than sorry"? Or is it closer to "you only live once"?
- Personality. If you're an extrovert, you may be willing to dial down your restrictions (and accept more risk) because the alternative feels like torture. For introverts, limiting social interactions may not seem so bad.
- Priorities. If you put a high priority on dining out, getting your hair done, or getting a tattoo, it's a bigger sacrifice to put these off than it is for someone who doesn't care about these things.
- Pocketbook. Although the pandemic affects everyone, it does not affect everyone equally: some can weather the economic impact better than others. As a result, keeping one's business closed or staying home from work are less appealing for some than others.
- Politics. One's preferred sources of information and political affiliation have a dramatic effect on views about restrictions related to the pandemic.
The bottom line
We all will have to continue to make challenging decisions each day about how to behave in this pandemic, until far more people are immune due to infection or a vaccine, or until we have effective treatments. And that could be many months or even years away.
So, listen to the experts and their recommendations, especially when they change in response to new information about the virus. Spread out your risk if you can: if you go to the grocery store today, put off your haircut to another day — in this way, the "virus dose" may be lower than if you're out doing multiple errands among other people over a few hours.
Think about your decisions and how they may affect you and others. Try to be reasonable, consistent, but flexible in considering new information. Avoid the temptation to "COVID-shame" those who have chosen a different approach; if their decisions put you at risk, do your best to avoid them.
Talk about your plans with those with whom you're sharing space. When there's no right answer and our decisions may affect each other, it's especially important to understand others' perspectives.
Follow me on Twitter @RobShmerling
About the Author
Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing
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No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
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