It is estimated that the average adult makes about 35,000 decisions every day–that’s about 32 decisions per waking minute or one every two seconds. Whether you hem and haw or make an unconscious choice, one element of the decision making process is the calculation of risk.

Humans as a species are actually quite poor at risk evaluation as demonstrated by numerous psychological studies. Perhaps it’s because we don’t (usually) have the same life-or-death decisions as our ancestors. We are comfortable atop the hierarchy of animals on this planet, and it shows. During the COVID-19 pandemic, I’ve seen posts across social media about how the risk of coronavirus has been overblown. I’m not really sure how to react to that given that 5 million people have gotten sick and 350,000 have lost their lives. For those of you who think that a relatively low number of cases in your geographic area means that lockdown wasn’t necessary should instead consider thanking the lockdown for sparing your community.

I’m not going to call anyone out here, but a few of you have even gone so far as to state you are more scared of dying from Ebola virus than SARS-CoV-2. This is one of the most ridiculous risk judgements I’ve ever heard. Everyone on the planet today has a greater risk of dying from COVID-19 than Ebola. The reason is that the risk of contracting Ebola virus is so infinitesimally small (even during the biggest outbreak in 2014) as to negate the high mortality rate of patients who are infected. Our current president even tweeted about how it was dangerous to bring a patient with Ebola to the U.S. in 2014 (highlighted in this Cloudy Media blog article). Extending to decision making for our country earlier this year, this is just a perfect example of how erroneous risk calculations can have deadly consequences.

So let’s talk a little about risk and how it applies to our quarantined lives today. At its simplest, risk is any situation that could cause danger, which could be physical, emotional, financial, or otherwise. Inherent within the situation is a level of uncertainty because risk is not a binary feature. That is, most situations do not carry 100% risk or no risk at all. It is instead, a spectrum and we have to take some risks in life (big and small). The risks of taking a new job, trusting in a new friend or companion, or starting a family are part of what makes life exciting.

Risk is also not static. The risk of contracting COVID-19 in February (in the U.S.) was relatively low–I even blogged at the time that a flu-like illness was still more likely to be influenza (we know that COVID-19 was circulating in the US earlier than previously thought, but the general risk for the public was low). Likewise, the risk of COVID-19 today in Massachusetts (where I live) is greater than if you live in nearby New Hampshire. There are many reasons for this, but it’s important to consider your local epidemiology (how many cases are in the town or county where you live, work, and shop) when taking the risk to venture out as our society starts to open back up.

It’s important to keep in mind that number of cases only represents those we know. It is an underrepresentation because some people escape illness altogether, though it remains unclear this point how many people fall into this category. Case numbers are also at least partially a reflection of the past because someone diagnosed with COVID-19 today could have been unknowingly spreading it in their community for the last few days. And the thing is, there is no magic number that makes it safe. Reduction in cases reduces the risk of coming into contact with someone spreading virus, but doesn’t ameliorate it altogether.

Evaluating one’s own risk for something is also an emotional exercise. If for example you lost a loved one in a car accident, you might inadvertently calculate driving as a higher risk activity than you would otherwise. If you had a traumatizing experience as a child, you may shelter your own children from that experience in an attempt to minimize that risk for them. Whether conscious of it or not, all of our experiences feed into evaluating risk, and this pandemic situation is no different. From the get-go I feel as if I’ve had a heightened sense of dread because of all the respiratory infections I’ve had over my life. Add to that the fact that I have a Ph.D. in Immunology and Virology (with the ability to understand how truly terrifying this virus is turning out to be) and it’s no wonder that I can count on one hand how many times I’ve left my house in the past 10 weeks.

These days, I feel more acutely aware of risk than ever before. Though it was always happening in the background, I rarely consciously thought about the risks of leaving my house. Unless you’re agoraphobic, it’s likely that you feel the same. Today, a few new risk calculations have to be made before leaving the house, and just doing so can cause a lot of stress and anxiety. First you have to consider where you’re going, how many people will be there, what their protocols for safety are, and determine if it’s worth it at all. A trip to the grocery store because you need food is not without risk, but following the rules minimizes this risk. Venturing out to the newly reopened bar to grab a drink with a friend, while great for emotional wellbeing, is probably not worth it.

These decisions will ramp up over the next few weeks as shops and restaurants open back up. I’m pretty certain that I won’t be sitting down to eat at a restaurant any time soon, but I might make the decision to get a haircut if my hairdresser is open and following the necessary protocols. These are my own risk judgements based on my desire to eat out (not dire) and to get my hair cut (it’s getting wicked annoying). You’ll have different judgements based on what you value.

Once you’ve decided to go, then it is important to have a plan to minimize risk for yourself and others. How many stops will you make? How many masks do you need (provided you don’t want to wear one in the car between stops–be sure to bring a bag to put the contaminated ones in)? Will you have to touch anything and should you bring disinfectant wipes and/or hand sanitizer in the business with you? Is someone else going with you and what do they need? How long will you be gone and what other things might you require? Do you have plan of re-entry to your house that doesn’t put anyone in your household at risk?

I can’t tell you specifically what the risk is for any single activity at a particular time and place. This is a judgement we each have to make for each situation at the time. What we do know, however, is that crowded, indoor spaces pose the biggest risk for viral transmission. Erin Bromage wrote a fantastic article outlining the risk of viral transmission in a few common locations including offices, restaurants, and family gatherings/parties. The take-home message is that successful infection = exposure to virus + time. That is, the longer you are in close proximity to someone shedding virus*, the greater your chances of contracting it.

*It needs to be repeated because I feel like sometimes this point gets lost — a person does not need to be sick to transmit the virus. You can be shedding virus before you get sick or you can shed virus and never knew you had it at all. So that friend that wants to come over your place because they feel fine is still NOT ok.

What this all means is that physical distancing remains our biggest weapon in this war. Always wearing a mask in indoor public spaces and when physical distancing isn’t possible outdoors is a second layer of defense. This does not mean you can’t see your friends and family. I have had a few “driveway dates” and I can attest that having a conversation with someone in real life is 1000% better for my mental health than doing it over Zoom. So get out and meet up with your friends. Just do so with caution. Here are some general tips:

• Find a large enough area that physical distancing is possible. This could be a driveway, yard, or perhaps a public setting like a park or beach.
• Limit the number of people or family clusters so that physical distancing is possible and not confusing when another group shows up.
• Have everyone bring their own chairs, in addition to food or drinks. Do not share anything — not food, drinks, or even a ball or frisbee.
• Explain the rules to children. Make it a game to not cross a “line in the sand” if you need to.
• Don’t shout or sing. This sounds ridiculous, but we expel more droplets into the air this way.
• In the ideal scenario, no one would have to enter someones house. However, depending on the situation, a trip to the bathroom may be necessary. Have a protocol in place and ask that your visitors adhere. Make access to the bathroom easy so that guests touch the least amount of door knobs. Request washing or sanitizing hands upon entry–hopefully everyone will wash their hands afterwards. Disinfect the bathroom thoroughly after the visit.

We are currently living in the world’s biggest experiment. It is scary to consider your own mortality. It is frustrating that we don’t have all the answers. It is anxiety-provoking when the rules keep changing. And yet, research on COVID-19 and the SARS-CoV-2 virus that causes it is happening at breakneck speed. International and interindustry collaboration resulted in potential drug therapies being tested in clinical trials within weeks (WEEKS!) of the pandemic. Multiple vaccine candidates are being simultaneously evaluated in clinical trials and some have shown promising preliminary data.

The lockdown in the U.S. started as ’15 days to slow the spread’, which turned into 30, and then an undefined time frame currently out to 10+ weeks for most of the country. I know you all want to get out to see your friends and family and regain some sense of normalcy–I do too. Please do so with caution as businesses open back up. Know the protocols and follow the rules. Stay vigilant. Stay safe.

Interested in tracking the COVID-19 cases in your area? Here are some good resources:
Worldometer (good global resource with ability to drill down to state-level data)
The Weather Channel (it’s true and a good resource for county-level data)
Mass.gov (new daily cases posted about 4pm, drill down to hospital- and assisted living facility-level data)
Or find your state/country health department website