Perceptions of risk and coronavirus: thoughts of an epidemiologist

As a physician epidemiologist and former public health official, I find myself confused by people’s perceptions of risk related to coronavirus, particularly as we struggle to reopen our economy amidst a surge of cases. I’ll meet an older adult with diabetes who could care less about distancing or masks, but then a healthy person in their 30’s too afraid to walk outside. I’ll encounter a mother who is too terrified to eat outside in a restaurant but who has no fear going indoors to a nail salon or to send her kids to an overnight camp (where they live in close quarters with children from everywhere). Or I’ll chat with a college student who vapes and occasionally smokes who thinks he’s invincible as he heads mask-less to a party (even as we learn more about increased coronavirus risk for people who vape or smoke).

Perceptions of risk (or lack thereof) are all over the place in the U.S. This may be a result of the lack of a consistent public health voice and the mixed messages that we’ve witnessed throughout this pandemic. Or it may be a result of heightened emotions, whether extreme anger or fear, which can skew perceptions of risk. Or maybe it’s just that people have a hard time understanding and managing risk. It’s why some people are too afraid to get on an airplane, but feel just fine driving 10 miles over the speed limit on a highway in the rain. And now, as COVID-19 cases surge, this ability to judge and mitigate risk takes on increasing importance. People’s perceptions of risk influence their behavior – and those behaviors directly impact both viral spread and our ability to successfully reopen our economy.

COVID-19 risk levels for people depend on a lot of factors: who they are, where they are, and what they are doing.  And it can be hard for the average patient to differentiate what’s scientifically accurate versus a sensational headline.  I work with employees of numerous large companies, many of whom are considered essential workers, who are constantly weighing risk for themselves and their families.  The analogy I’ve found most useful for them is the following:

When thinking about coronavirus risk, imagine that you are considering driving a car.  Clearly, this is not a zero-risk activity. People die of car crashes all the time (it’s a leading cause of death in the U.S.). So what goes into your decision to drive the car? Certainly, you might consider the type of car (is it in top shape or is it falling apart?), the weather conditions (a sunny day versus a snowstorm), the distance you might need to travel,  your own experience as a driver (are you a teenager who just got a license or a 90-year old with eyesight and hearing loss?) and behaviors that might affect your driving (did you just have a few alcoholic beverages?). Your decision to drive will likely vary depending on the answer to those questions, as will your level of risk. And factors that might mitigate your risk (is the car equipped with airbags and seatbelts?) might affect your decision-making as well.

So when it comes to the coronavirus,  walk patients through a similar thought process:

First, ask them to establish personal risk: Are they older?  Do they have underlying conditions that can put you at risk for more severe illness (diabetes, obesity, etc.? )  Do they smoke or vape?  Are they part of a racial or ethnic group that has had more severe outcomes?

Then ask them to consider factors related to other people or the community: Do they live with or often interact with someone who might be at high risk?  Is there a lot of virus circulating in their community? Are there a lot of COVID-related hospitalizations or an increase in influenza-like illness (ILI) in their area?

Finally, consider the activity they will be engaging in, along with risk-mitigating factors:  Will it be outdoors or indoors? Will they and others be wearing masks? Will they maintain six or more feet of distance? Will they be sharing drinks or other personal items? How important is this activity to them, their family, and their mental health? Is it worth the level of risk?

I try to remind my own patients:  The only way to bring your risk to zero is to never leave your house or interact with anyone. Most of us will be taking calculated risks, whether it is going to the grocery store, getting a haircut, stopping at a gas station, or going for a run outside. And reopening successfully will depend on all of us judging risk more successfully. Bottom line: Outdoors is safer than indoors; masks are better than no masks. Avoid being close to people (especially face-to-face) for very long, particularly in an indoor setting. And take into account both your personal level of risk and the risk of those around you.

Tista S. Ghosh is an internal medicine physician and epidemiologist.

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