Perspective, Part 1: Reducing infection risk

Coronavirus anxiety

I wrote the original version of this post on Monday (five days ago), but it wasn’t reading quite right, so I thought I’d come back to it on Tuesday with fresh eyes. I didn’t manage to open the file again until today (Saturday), with a new perspective given how this past week unfolded.  On Sunday, my younger kid was sneezing and sniffing, and I was fighting small panic attacks that he had somehow managed to catch SARS-CoV-2.  On Monday, my older kid started sneezing and sniffling, which was actually a relief, because a one-day incubation period, while very typical for a ‘cold’, it is not typical for our current nasty coronavirus (SARS-CoV-2).  Added to that, very few kids show symptoms when infected with SARS-CoV-2. On Tuesday it was my turn: sneezes, sniffles, watery eyes…

This pandemic certainly increases anxiety, and when we face complicated and threatening situations that seem out of our control, we tend to categorize the situation as either ‘an immediate threat’ or ‘something to ignore’.  With coronavirus, some people live with very high anxiety and try to control the situation with extreme self-isolating, cleaning, and rule enforcement, while others buy into the idea that the pandemic is being blown out of proportion by sensationalist media, possibly for political purposes.  Those in the first group live with extreme anxiety, often making decisions based on an exaggerated sense of risk that may cause emotional damage.  Humans are social creatures; while extreme self-isolation reduces risk of catching SARS-CoV-2, it is very stressful for adults, even more so for children and adolescents. Those in the second group grossly underestimate risk, increasing the likelihood that they, their family members, and people in their communities will become infected with SARS-CoV-2.  A better, but more difficult, way to approach a complicated, stressful situation is to actively assess risk, to ourselves, our families and our communities.  We can then make decisions based on that risk assessment, balancing risks (and possible outcomes) and benefits of different choices.  With this post (Parts 1, 2 and 3), I hope to give us all a better feeling for how we can think about and manage risk in response to the coronavirus pandemic.

My family’s recent experience with this cold virus is a stark reminder of how tricky viruses can be.  As a family we are social distancing, limiting shopping to just the grocery store, wearing masks when in public/populated places.  Other than an occasional trip to the local beach and bike rides for my older son with his friends (masked except when eating snacks together), my kids mostly play with their friends through a screen. FaceTime, FortNite, Roblox, and MineCraft have all been real lifesavers for kids in this time of social distancing!  If social distancing were graded, our family would probably score in the B+/A- range, and we still brought home a virus.  So how did we end with this virus in our house?  Given how serious the SARS-CoV-2 virus is for our community health, the fact that we picked up an infection while practicing social distancing kind of freaks me out, to be honest. But then I remember that this is the very first illness we’ve had in our house since March.  Five straight months with no stuffy noses, sore throats, or coughs.  In a house with five people, all going different directions, and two of them kids, a five month stretch with not even a cold among is pretty remarkable. 

Reducing risk of infection:

The key to this story is that completely preventing infection is nearly impossible even with extreme self isolation. We all need contact with the outside work, for supplies and for our own mental health.  On the other hand, unlike the common cold, SARS-CoV-2 can cause serious and sometimes fatal illness in many who become infected.  We can’t just give up and let this virus move unimpeded through our populations. Ultimately, to give ourselves the best chance of staying both physically and mentally healthy, we have to focus on things that we can control that are the most effective ways to reduce risk. 

Mask-wearing is a key piece in reducing viral spread. Masks that are more efficient, blocking more of the droplets that form when we speak (or cough, or yell or sing) reduce transmission rates more than masks that block fewer droplets.  A recent study tested 14 different kinds of commonly used masks to see how well they reduced transmission of respiratory droplets.  N95 masks performed the best, blocking nearly 100% of respiratory droplets, but quite a few ‘non-professional’ masks also blocked 80% or more of respiratory droplets, including  3-layer surgical masks, cotton pleated (1-2 layer) and unpleated masks (2–3 layer).  Knitted masks work less well, but still blocked around 60% of respiratory droplets. Bandanas and fleece masks (like neck gaiters) were bad, working no better than wearing no mask at all.  The take-away from this study is that as long as you avoid bandanas and fleece masks, any mask you choose is way better than no mask at all.

Social-distancing is another key piece to preventing coronavirus spread, but not all of us can manage ‘perfect’ social distancing.  We may work in situations where we are in contact with many people.  We may want to spend time outside of our homes, where we may be near others.  We may need to stay social in order to maintain our mental and emotional health.  All social contact should be considered carefully because we know asymptomatic and presymptomatic people can spread virus, and people who feel healthy may engage in ‘higher risk’ activities that put others at risk of infection.  We know, however that certain high-risk social settings account for as much as 80% of new infections.  These ‘super-spreader events’ involve situations where people have gathered in high densities in areas with poor ventilation, especially with chilled air (meatpacking facilities, strong air-conditioning) where people are coughing, yelling (meatpacking facilities, bars, sports events), or singing (church/choir). See this Scientific American article for more detail. Careful avoidance of these super-spreader conditions reduces our risk of infection substantially.

Trying to keep track of all the different moving pieces (masks, social distancing, ‘super-spreader’ conditions…) can be difficult, but scientist have built models of how all these different factors interact to increase or decrease risk of infection.  National Geographic just published an article using one of these models to make a very nice interactive about infection risks.  This interactive allows you to see your infection risk in a number of settings (bus ride, classroom, office space) given the infection rate in your area, whether you or other people are masked, and how long you spend in the space.  It also shows the difference in infection rates under a number of activities (indoor gathering, strenuous activity, bus ride) in different conditions (masked vs unmasked, low vs high incidence rate). Another useful resource is this graphic from The Texas Medical Association that ranks the risk associated with different activities. For more detailed information about specific activities and considerations, visit the CDC Coronavirus webpage, specifically this page about coping with daily life during the pandemic. And keep in mind that masks are always a good idea when you are near other people.

A global pandemic is frightening, and in our fear and anxiety, we may over- or under-react to the challenges we face.  But if we focus on simple actions that we can each take, we can make ourselves and our communities safer.  We have to commit to long-term adherence to mask-wearing and social distancing, even if infection rates are low. We have to pay attention to ‘threat levels’ in our communities and respond with increased social distancing and decreased travel when necessary.  These actions make it harder for this virus to spread from person to person and will cause infection rates in our communities will drop.  As infection rates drop, it becomes easier to block further spread of the virus, making our communities safer overall.  

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