Decisions/ Decisions |
Being isolated is HARD! We have been in quarantine for three months, give or take 100 years. With talk about things starting to open up, I have gotten many questions from friends and patients asking for my counsel about how to make a good decision about their personal “opening up”. People need to figure out work, childcare and/or seeing their family and friends. Some schools are reopening. I have some friends who are busting to hold their grandchildren and haven’t been able to. Others have made creative quarantine schedules to allow visits. How and when to normalize is on everyone’s mind. As much as we wish we could wave a magic wand, this virus is not going away anytime soon. Staying inside is not realistic for another year. We need to find the crucial balance. At the same time, watching other states reopen and have numbers surging is an uncomfortable situation. During the past couple of months, many people made individual choices about how much they would actively isolate. Here is an important fact - you can be as careful as can be, but if you are living with someone who is not taking adequate precautions, then you may be wasting your efforts. Some people have created an absolute bubble. They have had no in-person contact with anyone. All of their food is delivered and decontaminated before they touch it. If we are assigning grades, they get an A+. Other people I know have been making more relaxed choices. Folks with a wide social circle, who congregate but keep their masks on are probably a C+. If they go out without a mask, they get an F. (How masks became a political football is beyond me; it is a simple action. It broadcasts that you have an awareness and are taking an action that is in your control.) I will assign myself the grade of an A-. I have been very careful about who I see. I have done some safely distanced walks outside with other friends who are also at least an A-. I have gone into some supermarkets, but not when they were crowded and I did a full scrub when finished. I always have a mask with me and put it on when I am within 6 feet of anyone outside my home. I make a conscious choice to not judge anyone else's decisions. I give full respect to people that will avoid me because I am not an A+. I give my understanding to the people who have a lower grade. Some of those have no options. They have to work or deal with childcare. While I don’t question their choices, I maintain my own boundaries. Being over 60, I have tried hard to keep people out of my orbit unless I am comfortable that they “make the grade.” Understand that these grades are arbitrary and are made up on a scale that is only found in my brain. You all get to create your own scale. Remember, your grade is only as high as the people you are with. Or in other words, you are only as safe as your weakest link. If I spend time with a B-, then my grade goes down to a B-. I am not privy to any special inside scoop, but I am good at problem solving. This is all about risk vs. benefit. What do I mean by that? Here is an example that my husband Sandy uses. He had to do a personal risk assessment regarding resuming activities after major orthopedic surgery, and his surgeon taught him how to think about it. In 1990 he tore his anterior cruciate ligament playing basketball; he also participated in a variety of other sports, but this was his passion. This was the dark ages of orthopedic surgery and there was no such thing as arthroscopic surgery for this injury back then. So, he had almost 7 hours of surgery, with 4-6 inch scars on both sides of his knee. He was in the hospital for 6 days and non-weight bearing for 8 weeks; This was going on while I was quite pregnant with our second daughter. His rehab was excruciating and took a full year. When his doctor told him he was free to resume an active sports life, he expressed serious reservations, because he never wanted to go through this again, and he was fearful of tearing it again. So the doctor asked him a series of questions – how would he feel if he ended up back in his office after tearing it playing softball? Sandy said he would regret it and believe it to have been a waste. How about if he ended back there after skiing? Sandy said he liked skiing but also would not feel it was worth another surgery and rehab. What about basketball? And here Sandy said yes, it would be ok if he injured it again playing basketball because he loved it that much. So the doctor said – ok, there’s your answer. Go out and play basketball! And he did! But what he first had to do was weigh the consequences of a number of potential activities against the benefit he would derive from each, and only one met that hurdle. Unfortunately, Sandy got a real-world test of his analysis 8 years later when he tore his other ACL. But he had no regrets, even before seeing the same surgeon. As luck would have it, arthroscopic repair had become the standard for this surgery; he was in the hospital one night, weight bearing the day after surgery, and back on the basketball courts in 4 months, where he continued to play for many years. So all of you need to play the risk/ benefit game for your family. No one has the exact same situation. So, how do we approach these very complicated choices that have potential ramifications that go beyond the risk of knee injury. Simplify it as much as you can by marking down all of the important considerations. What are the benefits of the action you're considering? And what price are you willing to pay to do it? Make a list. Writing it all down might help you get clarity. Start with contemplating your risk tolerance. Kids are generally not getting very ill from this, and the young adults are not as safe as once thought, but if someone in your quarantine bubble is over 60 or has any preexisting conditions, that needs to be taken into consideration. Where are you located? That is an incredibly important factor. Keep an eye on the numbers in your city. They are likely changing weekly. Keep your finger on the pulse. In San Francisco, the numbers are relatively low and flat compared to other large cities. Find a database that you trust and keep checking it. I do a daily look at the US and world counts here: https://ncov2019.live/ I check the bay area here: https://projects.sfchronicle. Another excellent source are the tweets of Bob Wachter, Chief of Medicine at UCSF: twitter.com/Bob_Wachter Keep in mind that all life activities involve risk. Just getting in a car or crossing the street involves some risk. So, what is it that you want to do? For instance, going to a movie theatre right now would seem like a silly choice right now; you can watch a movie from home. That is an easy one. Pedicure? Paint your own toenails. Questions like childcare are a bit more complicated. Who might be coming into your orbit? What is their grade? Are you contemplating a visit with family or friends who have not been as careful as you are? Have a serious and civil conversation. Perhaps they are willing to do a week of clean living to raise their grade in order to accommodate you. Of course we don’t know if a week is adequate. Two weeks would be safer. Come up with a solution that feels right for all of you. One of my cousins has planned an Air BnB get away with her kids. She has been an A+. Her daughter has been a B, but is going to spend a very careful week or so raising her grade before joining her parents for what will surely be a wonderful getaway. Their son has been going to a lot of protests in NYC. He wears a mask, but is not going to change his lifestyle to get his grade up high enough. He won’t be joining the rest of the family. They all love each other and completely respect each other's choices. While you do your figuring, here are some things we know about contracting the virus. Some of these factors carry more weight than others.
Regardless of whether or not you are inside or outside, the risk goes up if you are around people who are coughing or sneezing, but it also goes up if people are shouting or singing. There was a church choir that was severely impacted early on in this pandemic. If you have wandered outside the safety of your home, washing your hands for at least 20 seconds and avoiding touching your face are the most protective actions that you can take. Hand sanitizer is useful but you need to use at least a dime sized dollop and then after generously spreading it, allow it to dry. Once you get back to a sink, do an extra wash with soap and water. In the unlikely event that the virus has landed somewhere and is actually still alive, shiny surfaces are riskier than rough ones. There was a story in the news this week about toilet seats.. Oy, I am not even going to go there. Just please wash your hands. Looking at the above information, it stands to reason that taking a walk outside while wearing a mask is probably pretty safe. Being inside the corner fruit store for 5 minutes and washing your hands before you touch your face, probably okay too. Singing duets inside a building for an extended period with someone who is not usually in your bubble, is quite a bit riskier. Whatever happens...accept that you made the best choice you could in the circumstances. Parents it is essential that you work as a team here. There can be no finger pointing if things don’t go as planned. Whatever plan you cobble together, shake on it (and then go wash your hands!) You are in this together. This is all a guessing game. Put thought into the process and do the best you can. No beating yourself up. This will pass at some point. We will find some kind of new normal that doesn’t feel as restrictive. Scientists are actively working on improving testing, tracking and working on vaccines, but I am not optimistic that we will have true answers this year. We need to carefully balance safety with the need to resume some normalcy. |
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