Dr. Nancy & Dr. Howie

Let’s talk about risk, baby Let’s talk about you, and me Let’s talk about all the good things and the bad things that may be... Can I fly to see my grandparent...s for the Important Holiday My Family Observes? Can we play rec soccer again? My babysitter went to a party last weekend... is she ok to be around my kids? I’m asked a lot about what in COVID-19 is ok. First off, I really enjoy the fantasy of myself as an omnipotent being able to officially sanction anything. Secondly, analyzing any decision- be it sending children to school or participating in courteous and well-reasoned discussions about the upcoming election- is best done in the context of facts, and then a grid of risk, benefit, and personal psychology. Firstly, the facts. 1. Pack your crampons- we’re gonna climb all winter: COVID-19 cases are on the expected global seasonal upslope. The US is now >50k/day, and that is not expected to abate. 2. Although it’s a frustratingly unsettled exact number, it seems between 40-50% of all SARS-CoV-2 infections remain asymptomatic. This is a major driver of spread. 3. Universal masking is by far the most effective population level transmission reduction strategy, and replaces complete lockdown in terms of its effect on R-0. 4. No matter the risk of transmission in an individual event or encounter, it’s always lower with a mask (note: this is not true for masks with those valves that open upon exhalation and spray out droplets because SERIOUSLY PEOPLE COME ON THIS IS LIKE A LEGIT SCREEN DOOR ON A SUBMARINE) 5. Inanimate object transmission and aersolization CAN occur in perfect blue-sky conditions, but are trivial in the context of the overall pandemic. So stop bleaching the eggplants, Doris. (Bleach and disinfectant poisoning is up many-fold since March). 6. Pre-adolescent children behave differently, both in their fondness for watching other people open Easter eggs on YouTube, and epidemiologically. They do not sicken, become seriously ill, or pass on the virus at the same rate as adolescents and adults. However, their risk is certainly not zero. 7. The incubation period of the virus, before symptoms, is about 4-7 days. Peak infectiousness- when the Covid patient spews out the most virus- is the day prior to symptom onset. 8. Testing is a huge muddle right now which I will write about separately. In short: the rapid tests aren’t as reliable about picking up cases. If you get a positive, you should believe it, but a negative is more suspect. The PCR tests are still perfect IF there is any virus in the specimen. The tests cannot distinguish between viral RNA and alive, intact infectious virus. 9. Being outside is awesome and is to be encouraged. Now let’s leave the world of facts. (But Dr. Kasten, I hear you say. I’m reading this on Facebook- I left that world a long time ago.) What gives your life meaning and purpose? What is worth incurring risk, to you? Do you have an absolute duty to minimize risk at all costs? To what degree do your decisions impact other people- either the vulnerable, or people you’re directly responsible for (children, that dude who’s stealing your Netflix)? Here’s where I’m going to talk about myself. This is all opinion. I believe 1) when minimizing risk is easy and effective it should always be done. The most obvious example is masking, which has no downside other than mask-ne, and immense upside. 2) Incurring large amounts of risk for something trivial, like an arena concert, is ethically more suspect than taking on small amounts of risk for something which one feels is deeply important, like visiting grandparents for Important Holiday. Back to facts. One fun thing which anyone who’s ever been in a romantic relationship knows is that you can’t control other people’s behavior (you just saved a lot of money on therapy- thank me later). People around you will be infected, or potentially infected, and you won’t know, which adds spice and variety to life, amirite! Pencils at the ready- real world exercise time. Remember the babysitter who went to the party last weekend? Is she safe? -indoor parties without masking are high risk transmission environments -40-50% infections remain asymptomatic, higher in younger people and women -incubation period is 4-5 days at a minimum -rapid tests are reliable if they say you’re positive, but not so much if negative -you can’t order her not to go to parties. -children, if infected, generally do well. Adults less so. -you work for a living and need a babysitter -interacting in some fashion with other humans is both unavoidable and also generally desirable, unless you’re one of those Cheeto-covered basement dweller types. -you can minimize but not eliminate risk. There is no optimal scenario wherein risk becomes zero. What’s best? Requiring a negative PCR test about 5 days after the party, perhaps? Lastly- remember at all times that these decisions about risk are SUBJECTIVE. If the Patels derive meaning and purpose from mud wrestling then by God let them mud wrestle (outdoors in small groups). If Doris can’t sleep without bleaching her eggplants, well, that’s why we have Poison Control centers. Some people will want to have family Thanksgiving even if it means inviting a blasé college student niece who’s been enjoying sorority row; others say nope, maybe next year. So you do you, boo, albeit in a mask.

Pediatric Family Support September 14, 2020 at 7 pm (PST) Join Zoom Meeting... https://us02web.zoom.us/j/2854246029 Meeting ID: 285 424 6029 Passcode: 905241