by Sanjay Gupta
I couldn’t agree more. Even among my colleagues, low-evidence data sometimes get presented with the same confidence as high-evidence data. Asking someone to bet on their prediction isn’t glib—it is a way of setting the same table for everyone and adding a degree of accountability. It’s such a brilliant way of looking at the world. Think about this too, which Maria posited: If everyone on social media in general had to put money down for every opinion, a lot of our armchair experts would suddenly evaporate.
Maria summed up her lesson by giving me a new mental construct to consider in my next risk-riddled decision-making process: Get into the mental habit of almost fact-checking yourself and thinking, Okay, I’m about to make this decision. How much am I willing to risk? It may also help to pretend the situation involves your mother, your grandmother, your sister, your daughter, whatever it is. What am I willing to risk? Do I think that the data support what I’m about to do, given that the person I’m seeing here might be actually someone I really love and care about?
If we constantly go through that calculus, our risk assessment will change in a profound way.
As more of the country is vaccinated, we have seen plummeting cases, hospitalizations, and deaths. By spring 2021, most experts had finally started to sound notes of cautious optimism. With the increased population immunity and the warmer weather, which makes it harder for the virus to spread, many public health officials started recommending a loosening of the restrictions: fewer masks, more gatherings, restaurants, and travel. In our household, we have had more visitors, coffee dates, hugs, and dance parties.
No question, there is an earnest desire to return to normal. The vaccines have made us more willing to take a risk because the thinking is that the reward now clearly outweighs it. But with hundreds of millions of doses now administered by late spring 2021, some people decided this gave them a built-in reason not to get the shot, with the rationale that others were doing enough of the immunity work for the rest of us. As a result, the likelihood that enough people would have immunity, by either vaccine or previous infection, to reach herd immunity became more elusive. And without that level of immunity, there would always be the risk the virus could resurge and once again cause outbreaks. So how will that affect our return to normal? And how will it shape the level of risk you are willing to tolerate for yourself and your community?
There are plenty of reasons for continued caution: the variants, the heartbreaking outbreaks in India and Brazil, the inequitable vaccination rates across racial and political divides. But our risk assessment is now increasingly based on what the public can see: We are winning the war on COVID in the United States, and we have learned to adapt better than the virus can. That means being willing to again deploy tools such as testing, tracing, isolation, masking, and even brief, highly targeted shutdowns if they are needed.
Special Note for Women
The disinformation campaigns around the safety of the COVID vaccines for women of childbearing years have been epic, with false ideas proliferating online that attract and persuade even the most educated people. Women have been told that the vaccines mess with their menstrual cycle and cause infertility, miscarriages, and death of babies being breast-fed from moms who took the jab. Another popular myth is that the vaccines have caused more deaths than the disease itself. Online groups perpetuating these false stories have thrived in unexpected places like mommy and parenting groups on Facebook, Twitter, and Instagram, even though these social media platforms have pledged to combat vaccine hesitancy and disinformation. By the time these dangerous accounts are removed, it’s often too late. The information has already metastasized among scores of women who believe that the vaccines are much riskier than getting COVID. That could not be further from the truth.
Nearly two-thirds of anti-vaccination content posted on Facebook and Twitter between February 1 and March 16, 2021, was attributed to just twelve influencers, dubbed the Disinformation Dozen.11 And what’s truly shocking is that some of these individuals, many of whom are well financed, hold medical degrees—or they did until they let their licenses expire or were denied relicensure. Their fearmongering messages are as compelling as the conspiracy theorists who keep the Flat Earth Society going.
Let me be clear: The vaccines save lives, including pregnancies and babies. Pregnant women who contract COVID are at an increased risk for severe illness, premature birth, and maternal death compared to nonpregnant people. And vaccines will protect women who are years away from starting a family. My three daughters have all been vaccinated, and I plan on being a grandfather someday.
Use Technology
Several mobile apps and websites have been developed to communicate the risks of COVID to the public. This type of technology is here to stay and will play a much bigger role in future outbreaks. The Web-based COVID-19 Event Risk Assessment Planning Tool, developed by scientists at the Georgia Institute of Technology in Atlanta, estimates the probability that you will encounter someone with the pathogen at a gathering, based on the size of the group and where the event takes place.12 The 19 and Me calculator, developed by Mathematica, a policy research company in Princeton, New Jersey, leverages demographic and health information as well as user behaviors such as hand washing and mask use to determine relative risk of exposure, infection, and serious illness. And Johns Hopkins University’s COVID-19 Mortality Risk Calculator estimates an individual’s relative risk of death from COVID on the basis of his or her location, preexisting conditions, and general health status.
Obviously, these tools require the latest data and models to make accurate predictions. They also must take into consideration new science from the latest peer-reviewed literature to refine their infection models. The CDC’s official app provides up-to-date news on health and COVID. The WHO dashboard, which follows the number of confirmed cases and deaths by world region and hardest-hit countries, is designed for easy viewing on a mobile device. There are also plenty of apps to help you lessen contact with others, participate in COVID research at major universities and institutions, and monitor your own health whether you’re healthy or potentially infected.
One note of caution: Be careful about which apps you download and use. Through this pandemic, and future ones as well, there will be another constant: scammers. They have consistently taken advantage of the chaos caused by the virus. Some claim to offer apps to track COVID cases, but instead infect and lock your device and demand ransom. This type of crime is on the rise. Scammers will even pose as government or health officials to steal your money or personal details. Just when you’re trying to lower your risk for infection and keep you and yours safe, you’ve opened yourself up to other risks. As digital contact tracing apps and exposure notification systems become more established, essential to these tools’ success will not only be improving the technology but also protecting privacy and building trust before the next pandemic.
Kids Complicate Risk
If you’re single, vaccinated, and healthy, the post-COVID world has opened up to you, and making personal decisions about where to go and whom to socialize with may not be that difficult. But for people with children, the risk-benefit analysis is more complex. Families make decisions based on their tolerance for risk, and there is more than one reasonable approach. As a father of three teen and tween girls, I know that too many kids suffered during the lockdown, isolated from their friends, activities, schools, and extended family. And for parents who’ve lost jobs and income, their children suffered further as a result.
Let’s assess the death risk. COVID’s effect on children has been fundamentally different from its effect on adults: Pediatric deaths from COVID in the United States have been in the hundreds, not the hundreds of thousands as with adults. We didn’t know this in the beginning, and keep in mind some viruses, such as H1N1, were more problematic for children compared to adults. While some kids infected with COVID have developed an inflammatory condition, it’s very rare. When reports of children—mostly between the ages of three a
nd twelve—developing a rare condition called multisystem inflammatory syndrome (MIS-C) hit the media, I took many frantic questions from parents worried about their own children’s risk for this complication. The syndrome is characterized by inflammation of different body parts, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs and appears to be associated with a COVID infection in the past or present. Many children affected with MIS either didn’t know they’d been infected with COVID, or only experienced mild symptoms from COVID before the problems began. And most are diagnosed with MIS long after the infection has cleared. Scientists are still trying to understand this newly emerging inflammatory syndrome but it once again underscores the importance of avoiding infection and protecting oneself through vaccination when possible. We just don’t know what an individual’s lifetime risk for other health conditions will be after recovering from MIS (and most do, though on rare occasions it can lead to serious complications and rarer still is MIS in adults).
Future variants could have a more severe impact on children, and the long-term effects of COVID are unclear, but overall, COVID is a negligible risk for the vast majority of kids with no underlying health issues. Families will have to weigh one set of dangers against another when choosing where to go and what to do with their children as the pandemic works itself out.
When I spoke with public health experts about COVID and kids, most were quick to point out that the risk for COVID is on par with the risk for flu, and the flu does not upend most children’s lives. They go to school when the flu is circulating, though many do get flu shots. My hunch is that most kids will be vaccinated before the end of 2021. These experts highlight the risk of COVID within the context of other risks in a kid’s life. About twice as many children drown in a typical year as have died from COVID over the past year, and about five times as many die in vehicle accidents. So if fully protecting children from low risks but serious harm was our top goal, we would keep kids away from pools and out of cars.
Now that we have a much clearer idea of absolute risk of COVID to children, we have to look at the relative risk. Dr. Amesh Adalja, a pandemic expert at Johns Hopkins University, reiterates, “Everything has risk.”13 In other words, acting in the best interest of children is not the same as minimizing COVID risk. COVID may dominate the minds of adults, but it should not necessarily tower over the lives of our children.
As we moved into spring and summer 2021 in the United States, it was clear that the light was increasingly on our faces, but there was still a stutter-stepping into normalcy as the trauma of the past year weighed heavily on people’s minds. I understood it, but also reminded people, including my own parents, that these amazing medications and vaccines are created to not only save your life but to return your life to a more normal one. And while it is absolutely true that we have been humbled by the virus and its subsequent variants, we also know that zero risk is neither an attainable goal nor a worthy one. Humans have always had to tolerate some degree of risk to move forward, and that has not changed. Your obligation is to make sure you best understand that risk for yourselves and those around you.
Although many families may hesitate to vaccinate their young children, including those who have been infected naturally, it’s imperative that we inoculate them now to protect their future health. As I’ve been stressing, we just don’t know what this virus will do later on, and withholding vaccinations may fuel more variants that will come back to haunt all of us.
Respecting future risks is real. We advocate for the HPV vaccine in adolescents so they reduce their risk of cancer later in life, as the human papilloma virus can infect the cells of the cervix, mouth and throat, anus, penis, vulva, and vagina. HPV infections turn normal cells into abnormal cells that can lead to certain cancers over time. Like many COVID infections, HPV infections often have no symptoms and go unnoticed. But once you catch it, your lifetime risk for cancer goes up if your body does not effectively clear the virus, especially if you’ve contracted one of the thirteen types deemed “high-risk HPV.”
In addition to keeping everyone up to date with vaccinations, one of the best things a family can do to stay as safe as possible in the future is to optimize everyone’s health in the household for the postpandemic era. It’s the next step in pandemic proofing you and your family.
CHAPTER 7 O: Optimize Health
Prime the Body for Pandemic Proofing
Ahmad Ayyad didn’t know where he was when he woke up in the delirium of his COVID illness.1 The forty-year-old also didn’t know why there was a tube down his throat, or how long it had been since he last fed his dog. And when he looked down, he barely recognized himself. Just weeks previously he’d been a 215-pound strong and chiseled athlete but was now sixty pounds lighter. “I woke up and looked at my arms, my legs, and my muscles were gone,” he said. “I was kind of freaking out, like, Where are my legs? Where did my legs go?”
It had started with an overwhelming feeling of weakness. As someone who was managing his own restaurant and club in Washington, DC, while also working at his family’s retail furniture business, Ahmad was the consummate multitasker. He also ran marathons, competed in obstacle course races, took basketball classes, and boxed. But then his entire life turned upside down. Everything was challenging and exhausting, from walking up the stairs to cooking, driving, and even talking. Soon the coughing and sneezing commenced. Eventually a high fever set in with a total loss of energy and appetite, and trouble breathing. At the urging of one of his friends, a physician assistant, he took an Uber to Sibley Memorial Hospital. The date was March 15, 2020. At the time, there had only been 529 cases of COVID-19 officially diagnosed in the United States, and Ahmad became another one of them. Like most other people who test positive, he didn’t know when, where, or how he was exposed to the virus. Perhaps it was a three-day trip he had taken to visit his brother in Florida, but he wasn’t at all certain. What was certain was that the virus had quickly debilitated an extremely healthy fitness buff. In addition to COVID, he tested positive for influenza. Ahmad was intubated and immediately transferred to Johns Hopkins Hospital in Baltimore, where he was put in a medically induced coma for twenty-five days. The last text he sent to his sister read, “Am I going to die?” On many nights, the doctors informed his parents that he wouldn’t make it through the night. “My son is a fighter, he’s not going to die,” his father would reply.
Ahmad became the hospital’s third COVID patient and the first to be placed on a ventilator. Defying the doctor’s predictions, he survived and went home on April 22 with a blood clot in his left arm and damage to his heart and lungs. He spent the next month struggling to do anything without losing his breath. But his warrior spirit, as he described it, kept him going, and he made incremental improvements over the many months of recovery. Ahmad’s experience was unusual given his fitness going into the illness, but it served as a wake-up call for anyone who didn’t think the virus could be harmful to the healthy.
Nearly a year after Ahmad contracted the virus, Alber Elbaz succumbed to the disease in Paris at age fifty-nine. A self-proclaimed “priest of fashion,” the Moroccan-born Israeli was one of the industry’s most beloved designers.2 My interview with him in 2014, when he was creative director of the designer house Lanvin, remains one of my favorites of all time. He said something then that’s quite telling now: “Fashion is all about changes. You know, there is a saying in America, ‘If it’s not broken, don’t fix it,’ and I think that if it’s not broken, fix it before it breaks.”
It bears repeating: Fix it before it breaks. Anticipate. Optimize. Learn from the past. Do not forget. We have a lot of fixing to do… to keep from breaking again.
Chunk, Monk, Drunk, Hunk
Almost everyone I’ve talked to has some story of change through the pandemic whether for better or worse. I joked that you come out of this either with more weight on (the chunk), stronger spirituality (the monk), a greater dependence on alcohol (the drunk), or a leaner, fitter
body (the hunk). And plenty of people have been a version of each of these individuals on the pandemic’s long timeline. Early on during the crisis, as we grappled with unprecedented stress levels and competing impulses to manage fears and uncertainty, it was a given that sales of comfort foods and alcohol would soar. Stress has a powerful effect on what people choose to eat and drink. But this also led to people gaining unwelcome weight, inspiring many to pivot and focus on their health and immunity.
According to the International Food Information Council, one in three consumers said they ate healthier foods in 2020.3 Those under the age of forty-five were most likely to make healthier choices. At the same time, the eating habits of 19 percent of those surveyed became less healthy, and women were more likely than men to tip toward indulgence. More than one in five people admitted to stress eating during the pandemic, and one in four turned to comfort foods. Many individuals sought out energy boosters, with 28 percent drinking more caffeinated beverages—no doubt fueled by the increased demands of working from home and remote schooling of children. And while 22 percent drank more alcohol (total off-premise alcohol sales were up about 24 percent during the pandemic, and spirit sales surged more than 27 percent from 2019, with men and younger consumers more likely to imbibe), roughly the same amount tried to cut back on booze.