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COVID at six months: UCSF update from Dr. Bob Wachter

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Bob Wachter, Chair of the Department of Medicine at UCSF and the man who coined the term “hospitalist” in 1996, is often considered to be the father of the hospitalist medicine field, and also simply a very reasonable and caring guy.  I often find my way to his Twitter feed for a breath of fresh air – grounded in good science and common sense – during these crazy times.  Of particular interest recently was his September 14th post, marking a half-year of COVID, in which he walks us through his decision-making in regard to visiting his ailing father in Florida, attempting to answer the question, “how to make sound decisions about risk in the face of uncertainty, longing, frustration & fear.”  It’s worth a full read, but a few highlights to intrigue you:

3/ I’m sure I’m not alone – all of us are having to make nuanced risk-benefit decisions re: Covid, nearly constantly. Do I see friends? Inside or outside? Visit family? Send my kids to school? Wear masks? It’s exhausting. And, for 99% of us, this isn’t what we do for a living.

 4/ The muzzling of the @CDCgov means there is precious little trusted guidance coming from what would otherwise be the usual source. Which leaves all of us even more on our own as we make dozens of daily decisions that are at once small and monumental.

 5/ Not only do we lack trustworthy data from national sources, but one’s assessment of risk (e.g., of your kids going to school) & of the benefits of various interventions (e.g., masks) are colored by which political team you root for – another cost of today’s political insanity.

Getting more philosophical, he continues, “While the March-April full lockdown was emotionally hard, it was cognitively easy – there were few decisions to make.  In the face of fear and uncertainty, most of us sought zero risk.”  But, he explains, as we learn more about COVID (outside is better than inside, masks work quite well, fomites aren’t so bad) and are given more leeway as things open back up, the cognitive risk analysis underlying each daily action weighs heavily on our minds and can be overwhelming. In fact, he reviews evidence suggesting that humans “stink at weighing risk.” “How do we quiet the primitive part of our brains that overweighs shark attacks & underweighs the risk of driving?” he asks. “And how do we give proper weight to pleasurable activities?”  He explains his view that, “We simply have too many months of COVID ahead of us to stick with a notion that zero risk is the only acceptable – and moral – target,” likening our situation to dieting and exercise: “…to succeed long-term, you need to find a regimen you can live with, not a quick but unsustainable win.”

He provides a helpful resource he used when analyzing whether to fly to Florida to visit his parents – “The microCOVID Project, which has an awesome online calculator that takes in key inputs (including constantly updated local prevalence stats) & produces a risk estimate for various activities (including flying, eating out, etc).” He also highly recommends this hour-long conversation between @ezraklein @voxdotcom and Harvard epidemiologist @JuliaLMarcus as a superb overview of a framework for making key life decisions while also managing pandemic risk.

He ends by coming back to how he made his decision –

I plugged in my Florida visit & microCOVID came up with the calculations below – my estimated risk of getting Covid was 40 in a million (or 1 in 25,000). Though not zero, it seemed worth it to see my folks. Check out the site – it’ll help you make more rational choices.

Jennifer Abrams, MD, September 23, 2020