The Post-Covid-19 Casino: Gambling Your Life
After months of pandemic restrictions, you may want to ask: how risky is it to do the things we are now allowed to do? Life is a risky business, but all agree that the risk of serious injury, or worse, falls away precipitously once you are dead.
Mordant humour aside, an entire business sector — insurance — has its foundation in risk assessment. There are computational charts that enable risk assessors to “price” the scale of risk and its probability. Typically, one axis measures the gravity of the risk from minor to catastrophic, while the other measures its likelihood of occurrence. I am not suggesting these should become part of your daily life. But since life is a succession of risk calculations, it is surprising that generally, schools offer us little direct training.
So, focusing solely on Covid-19 and the relaxation of rules (taking the UK as a benchmark), let’s review some basic principles to assess the risks. We know that the risk of serious illness is highest among the elderly (let’s just say aged 65+), and higher among people with preexisting conditions including things like obesity. In many countries, vaccination programmes have given priority to people who are likely to need hospital treatment if they contract the virus. So, risk assessment has to take account of the person and their vaccination status. My risks are not necessarily yours.
You also need to be precise about which risk you are assessing. The risk that you will contract Covid-19 and die is by no means the same as the risk that you will contract it; and a mild, asymptomatic case may make you more likely to transmit it to others. The data on vaccination suggests that the fully vaccinated face far less risk of death and serious illness but remain able to transmit the disease. While everyone wants to celebrate the benefits of vaccination, the reality that you can still get the virus is in danger of being overlooked. I don’t want to rain on your parade, but I do want to recommend an umbrella.
Assuming that you are indeed fully vaccinated,(which includes a further two weeks typically for immunity to build), what you can do safely is based on what we know about how the virus spreads.
First, it is primarily an airborne disease, borne by the minuscule water droplets in exhaled breath. At present, there is no conclusive scientific finding about the virus’s longevity on surfaces and so there’s a small risk that if you touch a contaminated surface and then touch your mouth or eyes, you may become infected, but most agree that this is much lower than the direct risk from airborne particles.
So, masks remain sensible. If you are an a-symptomatic carrier, the exhalation of viral droplets is limited by your mask. If people around you wear masks, the risk to you is similarly reduced. Because the transmission risk increases if you remain in the same stagnant air for a protracted period, there is now an emphasis on good ventilation. This is why governments allow facilities to re-open initially for transactions conducted outside where air circulation is better than in many interior spaces. On that basis, and remembering always that you need to consider the current infection rate locally, here are some activities classed as low risk.
- Opening letters and parcels
- Getting food, medicine or takeaway food delivered
- Filling up at a pay-at-pump petrol station
- Playing tennis or golf
- Going camping with your household or support bubble
- Seeing friends or family in their garden or for a walk, run, or bike ride
- Sending children to school or nursery
- Seeing a family physician or going to a hospital appointment
The highly cautious may have been wiping mail and other deliveries with some form of antiseptic, but as far as we know, there has been no incidence of viral transmission by post, not even special delivery! The outside location and non-contact with a cashier explain the low-risk assessment for using pay-at the-pump. The consensus that the virus does not thrive in the great outdoors also feeds the promotion of tennis and golf since they are non-contact sports that usually occur outside; risk will, of course, increase when you crossover to change ends, and increase still further at the nineteenth hole.
The household or support bubble itself has always been a risk compromise. Most of us prefer not to live alone and enjoy its benefits, but inevitably we then share enclosed space with significant others. As the tragic saga of care-home deaths indicates, the security of support bubbles depends on all participants remaining virus-free. That goal may be realistic for a couple or small family, but as the data on transmission in crowded multi-generational households suggests, risk rises exponentially as numbers increase. Big bubbles are more likely to pop! Like the notorious “spike” within the virus itself that enables it to bind to living tissue, each member of a bubble may have points of outside contact. Thus, the safety of outside activities such as biking, running or even camping is predicated on the security of the bubble itself. If the transmission risk is low at home, it will not rise sharply in an outdoor location involving the same people.
Items on the list confirm that low risk is a spectrum rather than a simple category. Seeing friends and family in the garden contains a number of variables. How many friends? how big is your garden? for instance. It assumes not only that most adults are fully vaccinated, but that safeguards like social distancing and hand-washing remain in place. Sending children to school and going to medical appointments represents a typical juggling of different kinds of risk. Children are less likely to become seriously ill from Covid-19, although it is unclear whether they are less able to communicate it to others. There is some evidence that nursery school children are far less likely to transmit the disease than adolescents. Overall, the risk of transmission posed by schools matches the broader community rate of infection. If the latter is high, it is probable that someone will bring the virus to class. This explains efforts to test and trace infections in school populations. The transmission risk, however, is increasingly judged alongside the multiple risks associated with disrupted education, not just poorer formal curriculum delivery and student attainment, but slower skills acquisition in terms of social development. In short, not sending the child to school may pose a graver, longer-term threat than the risk that s/he may bring Covid back to a household where fully vaccinated adults are unlikely to become seriously ill.
A similar logic sees medical facilities as low risk. If any facility is likely to maintain hygiene protocols against infection, surely medical facilities are the ones? However, it also reflects that not seeking medical attention has aggravating the pandemic’s health impact. Some people will die who may have been saved if the pandemic had not delayed diagnosis and treatment. Thus, diagnosis and treatment reduce the risk of harm more than the chance of contracting Covid-19 raises it; however, high community transmission rates may affect the availability of care.
In most countries where vaccine roll-out is proceeding, there is a staged process that allow activities to resume where the level of community transmission has diminished in severity and scale. Accordingly in the UK, the following are some of the resumed activities, now judged to be only moderately risky.
- Staying at a hotel or other holiday accommodation (with your household or support bubble)
- Picking up a takeaway from a restaurant
- Eating in a restaurant and sitting outside
- Visiting a pub beer garden
- Shopping in a busy supermarket, high street or shopping centre
- Taking your child to a playground
- Seeing friends or family inside their house
- Visiting a beach or busy beauty spot
- Getting in someone else’s car
- Attending a wedding ceremony or funeral service
If you compare the medium and low-risk activities, you can see risk rises with the scale of public interaction. It’s assumed that owners and operators will follow guidelines on how to be virus-secure, but the transmission risk still increases because there’s more people involved. By going to collect your takeaway rather than paying for it to be delivered, you are placing yourself in a space where you could have random contact with others and thus expose yourself to greater risk. The same is true of all shopping activities, although the term “busy” signals that a key issue is: can you maintain social distancing or in other ways limit social interaction. The rating also implies that interior spaces are more risky because of the ventilation issue. Hence, it is safer if friends and family stay outside, and if you insist on accepting that lift home, keep the windows down.
Amidst a rumbling debate about confused messaging by the UK government about what people should or should not do, one senior figure observed that there will always be things that you can do, but that you choose not to do. With this wisdom in mind, let’s look at some high risk activities
- Eating in a restaurant and sitting inside
- Attending a wedding reception (up to 30 people)
- Getting a bus or train
- Getting on a plane
- Playing football or rugby
- Giving friends and family a hug (if they are not in your household or support bubble)
- Exercising at a gym
- Going to a theme park
- Going to the pub or a bar
There has been a growing clamour for restaurants and bars to serve customers indoors. However, unless a business has extraordinary standards of air-conditioning, the move from outside to inside increases the risk of transmission. Risk assessments will vary from business to business: but a cosy pub or “intimate” restaurant is less likely to be well-ventilated. What is slightly anomalous here is the assessment of air travel as being as risky as travel by bus or train. The airline industry has predictably insisted that planes do have air circulation systems that are designed to remove and refresh cabin air in a way that coaches and rail carriages generally don’t. However, what does place the three transportation modes together is the risk posed by boarding and alighting procedures. Although you can argue that pre-flight testing and vaccination certification should mean that everybody in line for check-in, passport control or baggage collection is low-risk, there remains the reality that checking documents is producing a situation where people are congregating at known congestion points. Inflaming the situation further is the risk from viral mutation; now given Greek letters (Alpha to Delta) but previously associated with nations: the English, South African, Brazilian, or Indian variants. Taking a plane is high-risk in other ways: less in terms of contracting the disease than of falling foul of costly time-consuming, and changing rules. Come this way to the quarantine hotel, forget all your planned activities, and hand over some extra cash.
The alert reader will have spotted that attending a wedding service is a medium risk activity but attending a wedding reception is high-risk. The reason in a word is: Etiquette. Most of the time — and the exceptions will stay long in the memory — wedding and funeral services proceed with due decorum. A small group at the front does the business, and the larger group reacts. At the reception, by the time Aunt Betsy hits the dance-floor, or Uncle Ted grabs the mike to sing, the chances of a super-spreader event have increased markedly. (So, remember, Covid restrictions provide an excuse for smaller, intimate weddings, and I’m sure Betsy and Ted will understand).
Similarly, whereas “seeing friends and family outside” was low risk, giving those outside your household bubble a hug is still judged to be high-risk. It’s all down to physical proximity, unless you can set up the kind of flexible polythene barriers that were eventually put up at some care homes to allow contact without contact. (Just remember to sterilise both sides between hugs!) The same principle ensures that rugby and soccer as contact sports are ranked high-risk, and that going to the gym remains a risky business. Anyone who went to a gym at peak times in the past will know the following: 1) that the need for social distance was evident in every sweaty droplet; 2) that there are certain people whose exercise routine requires loud plosive exclamations, and 3) that some people don’t wipe down the equipment well, if at all. Whether the gym risk assessment also took account of the health risks of returning over-enthusiastically to your aerobic routine after an extensive lay-off is not clear, but whether on the rowing machine or in the changing room, you may find it difficult to avoid unsought interaction.
In graduate school, I was introduced to the antithetical terms “philobat” and ochnophil,” coined by the Hungarian psychoanalyst Michael Balint. “Philobats” are first in line for the scariest rides at the theme park; they are inveterate thrill-seekers, the kind of people who chase storms and wrestle alligators. Ochnophils are risk averse and take sensual pleasure from moments of stability and security. A great amusement ride satisfies the philobat, but is designed by an ochnophil to ensure complete safety despite the sensation of risk. As you reenter the world, you may want to indulge both sides of your nature, but collectively, it would help if the ochnophil had the last word.