Stuart R. Gallant, MD, PhD
I am sure many of you are so done with Covid 19 that you could not imagine wearing a mask without a government mandate. Hold that thought and listen.
I have a friend—let’s call him Joe. Joe is in sales, and he recently attended an industry conference. He flew to a large US city at the end of the week before the conference. Over the weekend, he set up the company booth and had meetings with other sales team members.
On Monday, he had a cough and red eyes. Because there was free testing at the conference, he got tested, and bam—positive for Covid 19. Here’s the thing—as the week went on, something like 30% of the conference participants tested positive. There were certainly plenty of chances for the virus to spread—there was a mask mandate for the conference, but as soon as participants entered the meeting rooms, the masks came down. And, no one with any kind of excuse wore a mask (at meals, eating a candy bar, or just carrying a cup of coffee around, even if the cup was already empty). Joe used the term “inevitable” to describe the risk of getting Covid 19 during the conference.
When the conference ended, everyone got on their plane flights home (whether they were positive or not). Joe described the scene on his return flight to me. He wore a mask, and all his acquaintances who were positive wore masks. But, he could feel the coughs from people around him wearing their masks. Joe doesn’t know of anyone from the conference who ended up in the hospital, but at least one colleague was prescribed Paxlovid.
Joe’s best guess as to where he picked up the virus was on his flight to the conference or at dinner when he had just arrived Thursday prior to the conference.
Risk
Covid 19 numbers are down. Looking at how the current New York Times heat map looks, I think, “Ce n’est pas une catastrophe [1] .” (It’s not a disaster—the way my French friends would say it.)
But, risk is a combination of the likelihood of an event and the severity of the event:
Risk = Likelihood x Severity
A lot of Americans are starting to see Covid 19 as less severe. They may have gotten vaccinated and boosted—so they feel that Covid 19 won’t be a bad illness for them. Or, perhaps, they never believed Covid 19 was that severe and skipped vaccination completely. However, Covid 19 still falls into the severe category for some Americans. The New York Times tells us that right now just short of 50,000 people are in hospitals with Covid 19, and 5000 people are in intensive care units (ICUs).
What we learn from Joe’s story is that likelihood (and therefore risk) may be a lot higher than we might think based on the New York Times heat map. For a person who is positive with Covid 19, but still capable of walking, an airplane may look like a pretty good option. At the other end of the flight may be home, a warm bed, family, and a job. Balancing those things versus quarantining may be hard (when quarantining means renting a room in a distant city, rebooking airline reservations, and waiting for a Covid 19 test to go negative). What is going on right now is a kind of risk outsourcing, with Covid-19-positive but ambulatory Americans boarding that flight, hopping into that Uber, or going out to get dinner.
What This Means for You
Medical personnel are using the mnemonic “ABC” to allow people to manage their Covid 19 risk [2]:
A = Air: Increase the degree of ventilation in your surroundings (open car windows if you aren’t driving alone, eat outside rather than inside, etc.); use a mask when appropriate.
B = Boosters: In consultation with your primary care physician, ensure that you are properly vaccinated.
C = Covid Testing: If you have symptoms or if you have difficulty controlling your risk (e.g., if your job exposes you to a lot of people), consider getting tested, and take appropriate action in consultation with your primary care physician if you test positive.
I hope this post has helped you think about your personal Covid 19 risk. From my point of view, an N95 mask during a plane flight seems like cheap insurance, compared to the risk of coming down with an illness in an unfamiliar city.
[1] New York Times, downloaded July 29, 2022; www.nytimes.com/interactive/2021/us/covid-cases.html.
[2] San Francisco Chronicle, “With mask mandate gone, how can Uber and Lyft drivers reduce their COVID risk?”; www.sfchronicle.com/bayarea/pandemicproblems/article/Uber-Lyft-covid-17333724.php.
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