Fact-Based Covid Missive 7/5/20: Minimizing Risk, Calculating Your Covid Age, and Are You An Anecdote Person?
Hi, I’m back as Robin-Schoenthaler-the-Boston-cancer-doctor-who-writes-missives- about-Covid.
(And it’s okay with me if you want to share.)
Today I’m talking about Minimizing Your Risk Through Common Sense, Anecdotes vs Statistics, and Calculating Your Covid Age.
Massachusetts continues to do well. We actually had one day without a single death! Now that was no doubt just a function of reporting but still, all the metrics we now measure (seven-day average of positive tests, three-day average of people hospitalized, three-day average of deaths) are good.
In fact, Massachusetts has been written up in the national news as the state that is doing it right. We have smart leaders who like science, who listen to scientists, and a smart population that knows who to listen to. We are so far tolerating our slow steady summertime reopening well and are moving into a hopefully long Phase 3.
As you’ve been hearing, though, there’s a whole lot of ghastly stuff in a good portion of the rest of the country with horrible hotspots and increasing burdens on health care workers and hospitals. Every day my feed is full of posts from anguished doctors and nurses who are working under the most stressful conditions imaginable, just like us in mid-April. One big difference for them is that they come out of their shifts and see zillions of photos of parties and bars and church services and nobody wearing masks. We in Massachusetts fought hard alongside most everybody staying home. Thank you, MA!
Some of our states are on the border of catastrophe. Everybody has a different definition of what “catastrophe” is but I think it’s important to be very clear about we mean. My definition of catastrophe in a pandemic is not rising cases or high positive test results — my definition of catastrophe is when the hospitals don’t have enough beds. Everything we did in March and April in the Northeast was designed to minimize the number of people who got sick and to maximize our ability to take care of the afflicted.
Now our job is to try to minimize our chances of getting or giving Covid to each other and our loved ones.
I do want to emphasize that I said MINIMIZE THE CHANCES, not eliminate all disease. Everything now involves thinking about how this disease spreads and how we can — with common sense and evolving data — minimize that spread.
So if you have germs in your lungs is it common sense to put a bag around their exit tract, ie your nose and mouth? Of course! Is it better with a thick mask or a cloth mask or a filtered mask or inside or outside or upside down? Oh, let’s not dance with the angels on the head of a pin on the details, let’s just wear a mask around our mouth and nose whenever we’re close to other people.
If you are around someone who speaks loudly or coughs/sneezes or just exhales, is it better to be six feet or three feet or 27 feet away from them? It’s common sense that it’s proportional — 27 feet is actually probably better than six feet which is better than three, but any distance at all is better than, say, sitting on somebody’s lap. (Three feet (one meter) is the WHO recommendation; six feet comes from the CDC).
If your sister-in-law tells you her cough is from allergies and she felt a little hot last night, should you spend three hours shopping at the cute little stores on Cape Cod with her? No, and don’t go in the same car with her either. Spending less time with people (under 15 minutes) has been shown to protect health care workers and it just makes common sense.
I love common sense.
I also love statistics.
One of the things I’ve learned in all this is that there are two kinds of ways people are integrating our tsunami of information. One is what I call the Statistics Person and the other is the Anecdote Person.
Anecdote People hear a story in the news or on Facebook and it sticks with them; they can’t shake it. They modify their behavior because of it. Sometimes that’s great (your co-worker gets breast cancer and you run to schedule your overdue mammogram). Sometimes it’s not so great (you hear a kid got Covid in your town and you make plans to never let your own kid out of the house again).
I am a Statistics Person. I am greatly comforted by statistics. They stick with me and help me make sense of the world — and I like to think that helps me make hopefully reasonable risk-minimizing decisions.
Some Anecdote People can hear statistics until they’re blue in the face but they can’t get past their anecdotes. They read about a one-in-a-thousand bad outcome and they are convinced it happens to everyone and that it will in turn happen to them. It’s hard.
And it’s particularly hard right now because our media — particularly Facebook and clickbait newsfeeds — is absolutely teeming with anecdotes. Everywhere you turn, another terrifying anecdote.
I hate terrifying anecdotes. I prefer to stick with statistics.
Here are some statistics that I have found interesting this week.
The average age of people getting Covid in Massachusetts is 51. The average age of people getting hospitalized is 68. The average age of people dying is 82. And these numbers have been rock solid since the start of the epidemic.
Likewise, 63% of all deaths here (and many places) were in people staying in long-term care facilities. In Pennsylvania, more people over the age of 100 died than all the people under 45 combined.
So. This remains a serious disease in older people and we are continuing to see that the majority of younger people are staying relatively safe. (The exceptions are the anecdotes.)
Age matters so much. So how old are you? This is actually a complicated question. When we look at cancer treatment, we look at a patient’s “biological ” age as well as their “chronologic” age — eg is she a young-young yoga/zumba/bridge game 78-year-old woman, or is she a frail/26 pills a day/uses-a-walker 78? We might make different treatment recommendations for people at different ends of the spectrum.
As a way of sorting out the risks for “biological age” in Covid, some Statistics People have put together this medical calculator that you might want to check out.
It takes your own age and a bunch of known risk factors for severe disease and puts them together to give you your “Covid Age”. I offer it up as maybe a way to help both Statistics and Anecdote people get some ideas about how much risk they are willing to take.
And maybe it can help minimize your chances of being a statistic or an anecdote, or anybody’s definition of a catastrophe.