Dr. Robin’s Covid-19 Update

Shielding Yourself From Covid

Getting Your Risk As Low As Reasonably Achievable

Photo by United Nations COVID-19 Response on Unsplash

Every day there’s another study about how we can/can’t protect ourselves from Covid: mask studies with laser light shows, virus RNA found on every other surface, surges and clusters and curves and contradictions. Some days it’s really confusing to watch the news lurch and lumber its way to data-based guidelines. Science is so non-linear!

But the reality is we do know a lot more about how to decrease our risk of getting Covid than we did six months ago that gives us a lot more control than we used to have.

Here are some science-based guidelines to help you plan your day-to-day decision about connecting with the world.

First off, every situation is different and each one requires a somewhat different mental calculation. But one thing is for sure: when you’re evaluating whether it’s okay to meet up/dine out/ ride bikes/go to the beach, etc etc., your local rates of community transmission are absolutely critical.

So decision-making in Boston (with our 1.4% infectivity rate) can be different than decision-making elsewhere in the country (hello Florida) where you can see infectivity rates that are ten times higher.

What else do we know helps to lower your risk?

  • Being outside is better than being inside.
  • Being masked (mouth and nose) is way way way better than being unmasked.
  • Being some distance away is better than being close.
  • Being close for a shorter period of time is better than being close for a long time.
  • Shouting/singing is worse than speaking (and silence is best of all, you can tell your Chatty Cathy cousin you read it here).

This is what else we know from the science:

  • The time you show symptoms is 2–14 days after exposure (incubation period).
  • Getting tested too early can lead to false negatives where the test says you don’t have Covid but you actually do
  • Getting tested too late can lead to false negatives as well
  • Best chance of accurate test: 5–7 days after exposure (with quarantining in between and while you wait!)

This is what we know intuitively:

  • It helps to be with people you trust to be truthful
  • There are all kinds of ways to see risk — you might see it one way while your family/friends see it another
  • Figuring out your limits ahead of time can help.
  • Talking to people about their situation and feelings about risk can give you important information to help with your own decision-making.

In the world of medical radiation exposure, there’s a fundamental concept about radiation dose called “As Low As Reasonably Achievable” (ALARA). While it’s a big fat complex codified concept {as defined in pages and pages of Title 10, Section 20.1003, of the Code of Federal Regulations (good heavens)}, it’s really a pretty simple goal: every time we expose somebody to radiation, we want to keep the exposure “As Low As Reasonably Achievable;” and so everything we do in medicine is designed to do that.

So here are a few guidelines about get-togethers with friends and family and how to think about keeping risks ALARA with regards to Covid.

For one thing, have an absolute clearcut rule in your head about symptoms. If you or anybody in either household has any symptoms at all, and I mean anything (sore throat, muscle aches, etc), plans are abandoned.

You simply cancel and reschedule. No questions asked, no argument, no hard feelings, the meet-up is scotched (and don’t go to work either).

Secondly, it’s perfectly reasonable to have an honest chat with your friends or family before the meet-up about any potential exposures. “That’s great that nobody in your house has been sick and nobody has any symptoms. And nobody’s been exposed lately?” (because of the incubation period) “And nobody’s waiting for test results yet, right?” (because of the delays in testing).

And finally, maybe you want to set up ground rules ahead of time. What makes you all the most comfortable? Do you want to dine outside? Go in two cars? Go slow and spaced out on the bike ride?

Don’t hesitate to bring this stuff up — due diligence should be considered “de rigueur” in a global pandemic! It’s really the only sure way to get to an “ALARA” risk state that keeps you safe.

With all the upheavals and restrictions and changes of the last five months (not to mention the awkward conversations with Uncle Maskless), it’s hard to remember why sometimes.

I am a huge believer in the power of stories to instill in us a sense of our interconnectedness.

For those who need a little reminder about what our health care workers have done for us may I suggest you listen to some of the “audio diaries” kept by our doctors and nurses and respiratory therapists and ward clerks during this nightmare. There’s a map of several dozen 2–3 minute stories maintained by a story-telling group called “The Nocturnists.” It’s one spectacular story after another and I highly recommend listening to at least a few.

And for those who want a visual reminder of the suffering this disease can cause — there is a spectacular ten-minute Frontline video called “The Last Call” which shows a New York family’s love story ending with a moving good-bye via Iphone.

We should all watch this “Last Call” video, even if it’s wrenching. May the anguish of this wonderful family not be wasted (nor that of the other 170,000 lost to Covid this year); and may it serve to remind us to think about the long-term consquences of our actions and to concentrate on keeping the risk to ourselves and our people ALARA every single time we meet.

(Robin Schoenthaler, MD is a Boston-based cancer doctor who has been writing fact-based no-blame no-rumors all-science-all-the-time essays about Covid-19 since March 2020.)



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Robin Schoenthaler, MD

Robin Schoenthaler, MD


Covid-Translator. Cancer doc: ~Three decades at MGH. Writer and storyteller: Moth Grand Slam Champion. Mom. www.DrRobin.org, @robinshome, robinshome2@gmail.com