Health, Humanitarian Emergencies

Navigating Safely Through The Pandemic

My personal pandemic panic

Sep 2 2020 - Having reported on SARS, Ebola, Bird Flu (H5N1) outbreaks, as well as writing about efforts to combat HIV, I was horrified by what was going on in Wuhan, China last Jan mainly because of how fast this new SARS-CoV-2 virus spread. By early Feb it seemed likely there’d be a global pandemic and by the end of Feb I started to freak out as the pandemic took hold. I’ve never been to Wuhan or China nor seen anyone who had; and I hadn’t travelled any where recently. It was nearly impossible for me to have encountered the virus but that didn’t keep me from getting sick with fear and dread knowing that a goddamn microscopic parasite was going to turn our lives upside down when we already had multiple crisis of on our plate. (You know, climate, ecological collapse, rise of populism and authoritarianism.) I refused to write about the virus or the disease it causes — COVID-19 — until I had to face the little bastard personally.

Hockey arena as COVID-19 testing centre

“Moved up two places!!” I texted my partner one glorious summer morning while standing in a long line outside a COVID Assessment Centre. A few days before I’d been to a couple of outdoor patios with friends and woke up that morning with a sore throat and feeling very fatigued, two potential COVID-19 symptoms. I live part of the time with health-compromised relatives over 80 and a pregnant daughter.

So, as you do in a time of pandemic, I went to get a free COVID-19 test.

It didn’t occur to me that spending a couple of hours inside a converted but still chilly ice-hockey arena with 200 odd people who maybe infected might be a lot riskier than having a beer with a friend on outdoor patio. I wasn’t the only one thinking this given the way our bodies were repelling each other like the equal poles of magnets. It was nerve-wracking, while being super boring. Three hours after lining up outside the arena, I reached the once-feared-but-now-welcome climax: a small screened off area where a no-nonsense nurse jammed a cotton-ball lollypop up my left nostril to tickle my brain.

Three observations:

    • Observation #1 Health care workers
    No one wants to be in a COVID-19 testing center, especially the health care workers. It’s noisy, busy, and stressful. The unvarying work of registering people, interviewing and testing them is monotonous as hell. Spending all day with hundreds of people near catatonic with fear and/or pissed off that their family/boss made them come probably isn’t much fun either. And some of these folks are infectious. Health care workers are indeed our true heroes.
    • Observation #2 Little kids
    There were a lot of little kids, some only a few months old in that tense, noisy arena. What was that doing to their mental well-being? And what about the pandemic itself? Everything in their nascent grasp of the world has been shattered. Maybe it’s similar to the experience of British kids at the outbreak of World War II. One day everything changed with a few innocent words declaring Britain was now at war.
    • Observation #3 On being a pariah
    I did not like being a pariah. While awaiting the results of the test I had to self-isolate in case I was infected. Suddenly I was a potentially mortal threat to the people I love. My presence in the same house made everyone nervous. Everything I’d touched — and, really who can remember? — was now a hazard. I wanted to shout: “I’m fine! It’s just a plain old sore throat!” But of course it might not have been. The consequences of not taking precautions could be calamitous.

Luckily it only took 27 hours to get the negative result and my sore throat had cleared up by then. My 27 hours as a pariah are nothing compared to those hundreds of thousands (millions now?) who have done the 14-day quarantine. Although my experience was relatively trivial, I’m pretty sure not many would say that their 14 days of self-isolation was the best vacation ever or great opportunity to get work done.

And for many the disease itself, COVID-19, is no picnic.

I’m now pretty motivated to find how to avoid having to go to a testing centre again while living some kind of life. I’m not a virus expert, or expert in anything really, except maybe explaining stuff. So this is my take on how to minimize the risks of catching the virus.

The chart below from the Texas Medical Association shows how doctors there ranked the relative risk of various activities. Relative is the key word here. Few things are risk-free and we largely ignore or unaware of the risks we take in our daily lives. Driving a car is probably the most dangerous thing we do on a regular basis. But since it’s familiar, and believe we’re in control of the risk we tend to discount or ignore the danger. However the odds of being in a fatal car accident are 1 in 106 in your lifetime. And the odds of that happening this year are 1 in 8,300. I’d be a lot happier if it was one in a million.

How to eliminate risk of COVID infection besides moving to New Zealand?

It’s simple enough to eliminate the risk of a fatal car accident: don’t ever get in a car. But what can we do to virtually eliminate/dramatically reduce our risk of contracting COVID-19? A move to New Zealand would do it since there’d been no community transmission for more than 100 days until recently. At end of August there were just over 100 active cases in a country of nearly 5 million people. Meanwhile the US reported between 50,000 to 60,000 new cases every day in July and August according to The COVID Tracking Project. New Zealand’s borders are effectively closed to non-residents so that’s probably not a viable COVID-risk reduction strategy for the rest of us.

The plain truth is that living in a place where a lot of people are already infected with this highly transmissible virus increases your risk of infection. Just as someone who drives 10 hours a day faces a higher risk of a traffic accident than a person driving five hours a week. And so the current number of active cases in your area is a major indicator of the level of risk.

In Ontario, Canada where I live, there were just over 1000 active infections at the end of August. These are people who have tested positive and able to infect others. However there are also untested, infected people with no symptoms or very minor symptoms who are also able to infect others. But how many?

Biostatistician Ryan Imgrund, who does the COVID-19 tracking for Ontario, has a sophisticated way to estimate how many people may be capable of passing on the infection currently in addition to the known active cases. It roughly works out to between 4 and 5 times the active case load in Ontario, so around 5,000 people with transmissible infections. Given population of Ontario, this works out to one transmissible infection floating around for every 2963 people at the end of August.

Given that the odds of a fatal car accident is 1 in 106 in your lifetime, one potentially infectious person in 2963 looks almost as good as New Zealand. But to be a 1 in 2963 chance, everyone would need to stay at home until a vaccine is delivered to their door.

What’s your dinner party risk?

Since that’s not going to happen Imgrund used this data to calculate the chances of encountering an infected person in various social situations. As the chart below shows if you attend a diner party in Ontario with ten people the chances of one person at the party with a transmissible COVID-19 infection is just 0.3 percent.

At a wedding with 250 in attendance the chances shoot up to 8.1 percent. That’s almost a one in ten chance someone there could transmit the virus. Attending a concert or sporting event with thousands of people and you’re pretty well guaranteed at least one person could transmit the virus.

Now even if there is an infected person at a party, or a couple of them in a busy bar, that doesn’t mean you’ll get infected. There’s a number of factors that can increase or decrease your risk — air circulation, humidity levels, distance, the viral load of the infected person and more.

Unfortunately Imgrund’s Risk Assessment Chart and method of estimating total transmissible infections only applies in Ontario. States count active cases differently than Ontario does. And these can be different from state to state. This summer Centre for Disease Control (CDC) Director Robert Redfield estimated the actual number of U.S. residents who have been infected with the coronavirus is likely to be 10 times as high as the number of confirmed cases.

Navigating safely through the pandemic

Despite the risks, we’re generally very comfortable behind the wheel of a vehicle. After all driving is much safer after 100 years of mass automobile use. A wide range of efforts have gone into making driving less risky: seatbelts, air bags, well-designed roads, signage, signal lights. There are dozens of laws and rules we have to follow. And we’ve invested a lot of time learning the rules in the Driver’s Manual, developing the skills needed to safely navigate a vehicle and passing drivers’ tests.

All of this — knowing and following the rules, developing the skills, having years of driving experience — greatly lowers our risk. Insurance companies have the data to prove this which is why the insurance cost for new drivers is so high.

By contrast we’re just six months into the pandemic. There are now some rules in some places, like wearing masks inside public spaces. Unfortunately it’s far too soon to have anything like a Safe Pandemic Manual to study or a set of safety rules to follow. We’re all trying to figure out the best ways to stay safe. One thing we need to know is that like driving, pandemic risk is situational. In other words the risk of catching the disease, as well as the consequences, depends on the circumstances you happen to be in.

A COVID-19 mantra: Time and Place, People and Space

Ryan Imgrund has an easy to remember catch phrase or “need-to-know mantra” that can help us evaluate the risks of various situations to help reduce the risk of catching the virus: Time And Place, People And Space.

Let me break it down:

    • Time:
    The longer you’re in a place with other people the higher the risk. A 10-minute conversation on a sidewalk is low risk, a two-hour chat on the porch is higher.
    • Place:
    Indoors is risker than outdoors. A stuffy, crowded bar is way risker than a group picnic in a park.
    • People:
    The more people in a place the bigger the risk which Imgrund’s chart clearly shows. Being with a few COVID-savvy people is lower risk. These are folks with a tight social bubble of 10 people or fewer; who avoid all high risk activities, and regularly wear masks and their wash hands.
    • Space:
    Keep your distance: two meters or one caribou.


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