Garth Rattray | How to get back to ‘normal’

Thankfully, we are able to enjoy a limited and much-needed reduction in the suffering, deaths and austerities caused by the COVID-19 pandemic. Already, the relaxation of precautionary measures has become evident. People are congregating in numbers at parties, events, restaurants and some places of entertainment without masking or distancing. In some instances, it appears as if the pandemic is a thing of the past.

However, we need to keep in mind that pandemics come in waves, with peaks and troughs. Therefore, a reduction in infections does not mean that COVID-19 is over; it means that it is going through a cycle that is driven by human activity. We are hoping and earnestly praying that the peaks will be less fierce and the troughs will be much longer. Eventually, it is expected that COVID-19 will transition from a pandemic into an endemic – just like dengue and the ‘common flu’. We have been living with those for a very long time.

The SARS-CoV-2 virus is always trying to get inside our bodies, replicate itself (sometimes at our expense), perhaps mutate, and move on to the next available body/host/factory. It doesn’t care if you become sick or die. That sounds horribly callous but, there are innumerable people who, as long as they don’t feel sick and are comfortable, don’t care if someone else becomes sick because of them or dies because of them.

People protest, gripe and moan about COVID-19 measures. However, if the government did nothing to protect us, and citizens began dropping like flies, people would also protest, gripe and moan. It’s catch 22 for the authorities. Here’s the interesting part, if people were to wear masks properly when out and about, distance themselves from others, sanitise, vaccinate, and obey the [health] regulations when they enter the country, there would be no need for the government to institute anti-COVID-19 measures and laws to protect the vulnerable and preserve our greatest asset… our citizens.

IN A FIGHT

Living in COVID-19 times is like being in a fight. You should protect yourself at all times. You should always keep your guard up and pay attention. Although the numbers have fallen precipitously, we are not out of the woods by any means. COVID-19 is still here, and the numbers can rise again. Additionally, because the naysayers have allowed the virus to have its way, new strains may pop up anywhere and wreak havoc.

However, it is not too late. We can still keep COVID-19 at bay if we manage our risks properly. We hear the words ‘chance’, ‘risk’ and ‘probability’ being bantered about, especially nowadays, because of the pandemic. These words convey the same meaning, but the nuance of each is different from the others. They are statistical terms transferred to everyday situations. The word ‘risk’ refers to a situation of being exposed to danger; it has a negative connotation.

On the other hand, ‘chance’ and ‘probability’ denote the possibility of something, or anything, happening. These neutral words have dual functions and are sometimes used in positive situations, like “What is the chance/probability of winning the Lotto?” But they can also convey a negative meaning; as in, “What is the chance/probability getting COVID-19?” In general, therefore, they are used to speak to the possibility of positive or negative outcomes.

Obviously, scientists and physicians consider a COVID-19 infection as a negative experience because of its association with terrible outcomes. We, therefore, tend to use the word ‘risk’. This is a very important concept, and we use the appreciation of risk in every aspect of medical care for our patients. We are constantly balancing and comparing risks in the practice of medicine. The overarching principle is that there is always risk; there is no such thing as zero risk.

For example, in dispensing an antibiotic, we must consider that there may be a risk of allergic reactions, side effects, damage to our (essential) gut biomes, drug tolerance, drug resistance, tachyphylaxis (needing more and more of a drug to get the desired effect), and drug-drug interactions. But, if a patient ‘must’ get antibiotic treatment, we weigh the risk of the possible negative outcome against the expected positive outcome. If the expected positive outcome exceeds the possible negative outcome, we prescribe the antibiotic.

MANAGING RISK

These principles have direct relevance when managing the COVID-19 pandemic. It is all about managing risk – personal and public risk. Since the SARS-CoV-2 virus is mostly airborne and transmitted by whatever we exhale through our mouths and nostrils, we need to first focus our risk management on this aspect of the disease. Masks are the first line of defence. Masks and physical distancing go hand in hand.

Masking and hand sanitising only carry an infinitesimal risk of skin problems. But your risk of catching COVID-19 increases markedly when you are unmasked (or improperly masked) in public. Being unsanitised is also very risky. Distancing carries the risk of alienation, but clustering is a major risk factor for spreading the virus. Vaccinations carry a minimal risk of an unfavourable outcome, but being unvaccinated significantly increases your risk of a bad outcome during the COVID-19 pandemic, and increases the pressure on our healthcare system.

If you want to continue enjoying the relaxation of the rules, if you want to get back to ‘normal’, you need to do your part in reducing the health risk for everybody. We can beat this thing together.

Garth A. Rattray is a medical doctor with a family practice. Email feedback to columns@gleanerjm.com and garthrattray@gmail.com.