Decisions, Decisions!

The Coronavirus Disease 2019 (COVID-19) pandemic has posed difficult decision making challenges for us as individuals as well as professionals and policy makers. Should the schools reopen? Should I send my children back to school if they do open? Should I go to my doctor or dentist office appointment? Should I have that mammogram or colonoscopy? Should I go to the barber shop or hair salon? Should meat-packing plants, movie theaters, amusement parks and other entities open? Should I dine indoors at a restaurant?

When is it safe to shop for clothing or groceries, ride the bus or subway, visit an aging relative, or go to the gym? Should my college-age children return to campus? Should they be playing organized sports? Should my family be attending church services?

Should we be going on our annual vacation: to the beach, the mountains, or to grandma’s farm?

What does it mean that some places are open but not others in one state, but different rules in a bordering state? How do individuals make sense of apparent conflicting advice about the transmission of COVID-19, surface spread, toxicity of hand sanitizers, face masks, quarantine after travel, to name a few. Are you really considering that airplane travel to Mexico?

Risk analysis attempts to translate technical research and knowledge into terms you and I can use on a daily basis to answer questions like the above. Safety is at the heart of all these decisions.

Economists teach us that everything has a cost. In our personal lives, decision-making involves weighing costs against benefits. Related to the process of decision-making is the balance of being unconditionally safe versus not safe enough. Sometimes, the goal of absolute safety can be paralyzing.

How many of us before driving our car do a 360 degree walk-around and inspect the hydraulic brake system for damage? From a safety standpoint, we should. We would be safer. Most accept the risk, presume all is well and drive away. Estimates suggest that 40,000 Americans die every year as a result of highway fatalities. Essentially all those lives could be saved by lowering the speed limit to 5mph. Yet, society has considered the costs and concluded that those 40,000 lives apparently aren’t worth the costs and inconvenience of a 5 mph mandate. Safety belts, airbags, early warning systems attempt to mitigate lives lost.

Decisions involving COVID-19 risks pose three questions that the professional community must answer and communicate its answers to individuals so risk-benefit assessments can proceed.

How much disease is in the community? Local and state health departments report these statistics almost daily. The prevalence estimates need not be perfect, just good enough to allow individuals to make better decisions.

What is the risk of exposure to COVID-19? Knowing the prevalence of disease from question number 1, exposure can be managed by an individual’s activity at the mall, grocery store, gym, doctor’s office, etc. Three familiar factors: concentration or viral load when one coughs, time in close contact and distance are the risks. We all know to manage this: social distancing, limited time of close contact, masking.

How much can individuals do if exposed? This is most challenging as one may not always know if an exposure has occurred. This involves self-protection: hand washing, disinfecting surfaces, wearing masks as well as avoiding vulnerable family members and of course LUCK.

Risk decisions are never about one risk alone. With COVID-19, these decisions involve trade-offs between risk and benefits — returning to work, school or family or the trade-offs of flying versus driving. Do your homework, study the risks and benefits and make good decisions.


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