The New Normal

by Jennifer Ashton, M. D.

  Assessing Headlines About New Drugs, Devices, and Vaccines

  Few stories have the ability to impact your health like those that detail a new drug, device, or vaccine. Now that we’re more than a year into the coronavirus pandemic, we can expect to see more medical news about vaccines and treatments for COVID-19—you can think of it like the next frontier for fake news. It’s also the Wild West for bad science, since some researchers—or the countries or corporations that back them—may have something to gain politically or financially by publishing premature or uncorroborated results on new drugs or vaccines. That’s why these stories on treatments, devices, and vaccines are often the ones most likely to be sensationalized or include inaccuracies. Here’s how to get to the bottom of headlines touting new treatments and try to determine whether a new drug, device, or vaccine might be right for you:

  1. Determine the timeline. When you hear about a new treatment, the first question to ask is how far away it is from prime time. If someone is extolling a drug that hasn’t been tested in humans, you have some time before the treatment will become available to the public. Make sure the article you’re reading or segment you’re watching includes information on expected release—if it doesn’t, it’s probably not a reliable place to get your medical news, as the goal of all responsible medical journalists should be to educate, not instill false hope.

  2. Find out about the follow-up. The duration of a study can tell you a lot about the hype around a headline. In general, the longer researchers have been studying a drug or device, the better they know and understand its possible outcomes, both favorable and adverse. If researchers or journalists are drawing definitive conclusions about a drug or treatment based on a six-month study, you should have a degree of healthy skepticism.

  3. Make a risks and benefits list. If you’re curious about whether a new drug, device, or vaccine might be right for you, the first step is to speak with a doctor or other qualified healthcare provider. He or she is your best and most reliable source for accurate information.

  While consulting with a doctor, there are also four questions you can ask to help you reach a decision about whether a new drug, treatment, or vaccine might be right for you:

  What are the risks of doing it?

  What are the risks of not doing it?

  What are the benefits of doing it?

  What are the benefits of not doing it?

  In the instance of a COVID-19 vaccine, the risks of vaccination might include experiencing mild side effects. The risks of not getting vaccinated might include possible infection, serious illness, and/or death from the disease, as well as possible transmission to others. The benefits of vaccination might include reduced possibility of infection, serious illness, death, and transmission, along with potential peace of mind and the ability to participate in public or social activities that require vaccination. The benefits of not getting vaccinated might include experiencing no vaccine-related side effects. A risk-benefits analysis can usually help to clarify confusion or distill the noise around potentially controversial medical decisions.

  A pandemic by nature is an incredibly challenging time. If you don’t understand the information or can’t find reliable sources for your medical news, the consequences can be grave. On the other hand, learning to find trusted sources and interpret medical headlines can help you navigate more smartly and safely through our new normal. These skills will also make it easier for you to interface with doctors and understand medical concerns you may face in the future. Think of it like learning a few words in another language before you travel through a foreign country: Our new normal is foreign to us all, and the sooner we can adjust to the landscape, the easier it will be for us to adapt and thrive.

  Chapter 9

  Family and Friends

  In pre-pandemic times, we interacted with friends and family how, when, and where we wanted. Today, in our new normal, our friends are all possible pathogen threats and family falls into two groups: Those we worry we might make sick, like our parents, grandparents, and newborn babies, and everyone else, whom we fear we might get sick from.

  Never before have we had to scrutinize our closest relationships so carefully, evaluating the health behaviors and risk tolerance of others in order to make tough decisions about whom we will and won’t see. In the B.C. (before coronavirus) years, we had friend groups and extended family. Now we have pandemic pods—small, self-contained circles of people with whom we socialize exclusively. We judge others based on whether they wear a mask, and we worry about sharing a bed with a spouse or romantic partner who goes into an office or out to a crowded bar. We agonize over whether to see our elderly parents and fret about allowing our children to go to a playground or birthday party. We even worry whether our dogs and cats might get sick—or make us sick.

  This is an entirely new way of thinking. Most of us have never had to assess our health and daily behaviors relative to the health and daily behaviors of every person we meet. This happened to some degree at the height of the HIV epidemic, when every sexual partner posed a possible danger and it was imperative to take precautions, ultimately trusting the person you were with.

  Today, we’re taking similar safeguards, but the threat is no longer just sharing the same bed, it’s sharing the same breathing space as well. Everyone has become patient zero, as we look sideways at family and friends, wondering where they’ve been, whom they’ve been with, and whether they’ve been safe. It sounds a lot like STDs, except the fallout and emotional anxiety, judgment, and stigma is all-inclusive this time.

  Of course, there is concern, too. Many have had to put the health of others in front of their own convenience or needs. That’s a beautiful thing to behold in our new normal, even if it’s required some painful sacrifices at times.

  I’m in a unique position as a doctor, but I still make challenging decisions every day about how to interact with family and friends. My parents, for example, are eighty, healthy, and part of a small pod. They aren’t seeing a lot of people, which is a major adjustment for them, but they still see me—and I go into my office, see patients, and am always in the ABC News studio. When I get together with my parents, I mandate that we eat outside as much as possible, weather permitting. We wear masks and remain at least six feet apart, which takes a lot of effort on my end.

  Despite the fact that both my parents are retired medical professionals, I have to remind them to keep their distance and not pull down their masks while talking. My mother also rolls up the windows when I drive her, even though I insist on keeping them down to improve ventilation and protect her. She tells me she doesn’t want to live like this and that if she gets sick, she gets sick. But I certainly don’t want her to get sick, and neither do my children, Alex and Chloe.

  Managing risks with Alex and Chloe has been easier than for some parents of college-age kids. I’m fortunate that my kids understand what’s at stake in a pandemic and are responsible about their behaviors. What helped is that we all agreed at the beginning of the outbreak that their significant others would be part of our family pod. Today, I don’t worry about them because I know they’re not going out to bars or parties or taking other unnecessary risks. They wear masks, stay at least six feet apart, and don’t go to crowded, public places.

  None of this is to say their lives have been easy in the new normal. Chloe opted out of her sophomore year at Harvard University after the school canceled in-person classes and the Ivy League canceled fall sports—an important aspect of her college career, since she plays for the Crimson ice hockey team. And both Chloe and Alex have had to make tough decisions about their social lives that I wouldn’t have thought would be the new norm for young people. One of my children, for example, agonized for days over whether to see a group of friends who clearly weren’t taking the pandemic seriously. In the end, my kid chose not to get together with these close friends. I was floored: These were college kids saying no to things like meeting for pizza or taking a hike outside, not because of d
rugs, sex, or alcohol, but because of potential viral exposure. That’s what our new reality looks like, and it’s been very hard.

  Being the parent of young kids poses a whole other set of problems in pandemic times. In the instance of COVID-19, while many parents (and even some public health officials) mistakenly assumed they didn’t have to worry extensively about young children, we now know better: Kids can and do get infected and transmit the virus to adults, other children, and other families, creating a potentially far-reaching ripple effect of viral spread. This has caused many to fret over what children, who have a hard time practicing safety precautions, should be allowed to do, creating fissures between families, school administrators, and communities at large.

  These fissures have led to social stigma, judgment, and even ostracization, all of which are acute issues in our new normal. I see it every day in my friend circle. Recently, for example, a friend posted a photo on social media of two cousins sharing a chair without masks, which they’d taken off only for the photo. But after one of the girls’ mother saw the picture, she demanded her daughter be tested immediately (this defies the viral principle of a latency period, or the time between exposure and infection) and now won’t allow her to see her cousin. Another friend who is an ER doc with ten-year-old twins can find only one other family in her friend group willing to let their children play together—other parents say they’re too worried about her exposure, even though most doctors know how to manage their health risks much better than the general public.

  The pandemic is also changing marital and romantic relationships, driving a wedge between some couples while bringing others closer together. I’m lucky to have a boyfriend who is an infectious disease doc: We share the same risk tolerance, and he certainly knows how to stay safe in a contagious outbreak. At the same time, since we don’t live together, we’ve had to overcome the challenge of navigating a new exposure every time we meet. During the initial outbreak, we agreed to get tested for COVID-19 whenever we saw each other, but this quickly became unsustainable (we did it once), and we’ve since learned how to stay safe together, learning how to use surveillance testing more strategically as our exposures increased. Married couples and those who do live together naturally have different concerns, including what to do when one gets sick and you have no other choice but to share the same bed.

  To me, managing all these relationships feels a little like having to draw a Venn diagram over and over again, widening or reducing the area of overlap where the circles of ourselves, family members, and friends all intersect. Some people want a very small area of overlap; others are clearly comfortable with a much wider circle of intersection. But only you know how big you want your overlapping area to be in your pandemic diagram. Neither Dr. Anthony Fauci nor your family physician nor I can tell you who to let into your life and by how much. Instead, these decisions should be based partly on your health and the health of those around you, but also on your risk tolerance and what or whom you believe to be worth taking a chance for in our new normal.

  Still, as an expert in medical science risk management, I can help guide you to make smarter decisions about who, how, and when to spend time with others. In this chapter, you’ll learn how to manage and mitigate risks with older relatives, marital or romantic partners, friends, pets, and children of all age groups, including newborns, young kids, preteens, and teenagers and college-age students. While no one can give you a numerical percentage of what your actual risk is of seeing X person or Y individual, I can help you understand how to stratify your risk and weigh the factors involved in various social encounters. The goal of this chapter isn’t to help you select your pandemic pod, but to show you how to stay happy, healthy, and connected in a new world where we’ll have to think twice about how we socialize for years to come.

  Eight Rules for Socializing in Our New Normal

  No matter your risk tolerance or whom you want to spend time with, there are a few ground rules to consider when socializing with others in our new normal. Getting together with family and friends is emotionally loaded and will be for months to come, even after certain guidelines are relaxed. Some people will always remain fearful, others may become more dismissive, and many will float somewhere in between, but there’s no way to predict someone else’s risk tolerance and when or if it might change. This makes basic etiquette key to both healthy and happy social interactions. Some of the following eight rules can help you stay safe, while others may help you retain certain relationships without angering or offending others.

  Recognize there’s always a risk. Unless you spend the rest of your life inside a sterile bubble, you can never bring your risk level down to zero, even if everyone gets tested (false negatives) and vaccinated (no vaccine is 100 percent). There will always be the chance of someone getting infected with COVID-19 or any other contagious illness, including coughs and colds, the flu, strep throat, stomach viruses, measles, whooping cough, and dozens of other diseases. What you can do, however, is control the controllables, which means doing everything you can realistically and sustainably to lower your risk level to as low as possible.

  Don’t do it if you’re sick. This should be obvious by now, but we all know that person who comes to Thanksgiving with a cough or shows up in the office or at a birthday party only hours after recovering from a stomach flu. This behavior wasn’t cool before COVID-19, and it’s just downright dangerous now. Bottom line: Stay home if you feel sick. If you suspect you may have COVID-19 or another contagious illness, call your doctor and wait at least one to two weeks before seeing other people.

  Ask before you assume. Don’t think that just because a friend or relative is ostensibly healthy that he or she will be okay if you go in for a hug or come closer than six feet. Ask those around you before having any unmasked, close, or direct contact. If they don’t want to interact, don’t be offended. Recognize that someone’s individual health, risk factors for COVID-19, and unique risk tolerance are deeply personal and have nothing to do with you and/or how much they may want to see you.

  Mask up when not with your pod. Always wear a mask and keep your distance when you’re with anyone who’s not in your pandemic pod, in addition to people over age sixty-five, newborns, and those with compromised immune systems. Remember that it’s not one or the other: The CDC recommends wearing masks and staying at least six feet apart to help prevent the spread of this infectious respiratory disease.

  Get out. Anything you can do outside or in a well-ventilated area will be safer than activities done inside, especially in poorly ventilated rooms. Remember that you’re trying to stop the spread not only of COVID-19, but of many other infectious illnesses, too.

  Stop with the chips and dip. It’s human nature to want to share food and drinks at get-togethers with family and friends. But in our new normal, communal snacks that people eat with their hands like chips and dip, popcorn, and nuts should be off-limits. In addition, don’t share plates, silverware, or glasses, and remain aware when splitting appetizers or meals with others at restaurants.

  Talk boundaries beforehand. Getting together in our new normal can be tense, awkward, and uncomfortable. People are sensitive and will be for a while. The best way to avoid offending friends and family or potentially alienating relationships important to you is to talk before you visit in order to discuss their boundaries and yours when it comes to COVID-19. If you don’t know the person well enough to have a conversation before you see them, be respectful when you visit by keeping your mask on and staying at least six feet apart.

  Make it about you, not them. If you don’t feel comfortable seeing someone in person, politely explain your feelings, emphasizing that you’re making the decision to protect your health. Even if you believe the other person is taking unnecessary risks, you don’t need to share that with them to decline an invite. If you make it about you and your health, the other person is less likely to feel judged or offended. If you refuse an in-person invite, suggest an alternative. If you don’t feel
comfortable attending a dinner party, for example, offer to call in via video to say hello to the guests before everyone sits down to eat. Or if you don’t want to attend a wedding, communicate with the couple that you’d love to see photos or the wedding video once available.

  Spending Time with People Over Age Sixty-Five

  The relationships that seem to be causing the most anxiety in our new normal are the ones we have with our older relatives and friends. The concern is valid: Age is the single biggest risk factor for serious complications from COVID-19, and eight out of every ten COVID-19 deaths in the United States to date have occurred in people age sixty-five years or older.1 Older people are also much more susceptible to the flu and other infectious illnesses.

  If you’re going to spend time with older family members or friends, you should be cautious about if, when, how, and where you’ll do so. Here are my guidelines to help you make the decision and safely see older people if you decide it’s sensible to do so.

  Make the Decision

  Visiting an older relative or friend in our new normal is a decision to make, not a privilege to take. The first step is to speak with the older relative or friend and determine if he or she feels comfortable with an in-person visit. If the person doesn’t feel safe, don’t feel hurt or angry or try to pressure them. Remember that everyone has a different risk tolerance and the right to be protective of their health and well-being.