What risks are worth taking?
How to decide what is safe when the stakes are high
Three months after Hamilton and Halton had its first case of COVID-19, the community is having to make decisions about what risks are now worth taking.
When that first case — a radiation oncologist who lived in Burlington and worked in Hamilton at Juravinski Cancer Centre — came as a shock to this area on March 11, there were clear rules to follow not long after. Stay home and only go out for essentials. But now the ground is shifting. The rules are slowly being relaxed and more services are gradually opening with new restrictions. Each individual has to decide what is an acceptable risk.
“All of us are going to have to make good decisions about how we do things going forward,” said Dr. Elizabeth Richardson, Hamilton’s medical officer of health.
Reducing the spread of COVID-19 will now require a careful weighing of risk versus benefit that will be different for each person.
“That is the kind of thinking people need to move into rather than always saying, ‘I have to avoid transmission,’ because then all you can do is lock yourself in at home for the months and years to come and that is not a sustainable option,” said Dr. Dominik Mertz, associate professor of infectious diseases at McMaster University. “It’s re
ally trying to find a pragmatic approach to live with the virus and accept a certain risk of exposure because you cannot avoid it.”
The stakes are high because the decisions you make could affect your family, friends or even the entire community.
“As restrictions are lifted, personal responsibility will be more important than ever to avoid a step backwards,” Ontario’s Finance Minister Rod Phillips said June 8 while announcing much of the province is moving to the next phase of reopening. “We trust you to continue acting responsibly, look out for each other and do your part to stop the spread.”
Hamilton, Halton, Niagara, Haldimand and Norfolk are not moving forward yet to the next stage of reopening. The exclusion will be reviewed every Monday.
However, some key rules are still changing here Friday despite this area being stuck in Stage 1. Up to 10 people will be allowed to gather which is double the current five — although physical distancing is still required.
Child-care centres can start up again and places of worship can open up to 30 per cent of building capacity.
As of June 18, restricted visits can gradually start again at long-term care homes, retirement homes and other residential care settings.
It leaves many wondering how to evaluate the risk each new opening presents and what is worth it.
Start by asking yourself some key questions
“What is my personal risk if I get exposed to the virus,” said Mertz. “Am I 80 or 90 years old and have multiple comorbidities? Then I will be much more careful than if I’m a 20-year-old and entirely healthy. That doesn’t mean that a 20-year-old has zero risk, but has very minimal risk compared to the relatively high risk of an elderly person.”
But you can’t just think of yourself either.
“What’s the risk of people living with me in the same household and do I have regular contact with grandma or a mom or a dad who are in an age category that is a higher risk,” said Mertz. “I may be more hesitant putting myself at risk because I don’t want to put my loved ones at risk.”
It’s also important to be aware of how the virus is spreading in the community.
“Does it look like we are running into a second wave or are things relatively quiet,” said Mertz.
“That does not mean we have zero cases, but a low burn that is more or less constant.”
Stay outdoors as much as possible
There are no rules against going into someone’s house or meeting in a building as long as there is enough room to physically distance and the gathering isn’t more than 10.
But it’s more risky.
“We really need to motivate people to gather outdoors whenever you can,” said Mertz. “That really reduces the risk.”
If you are indoors, consider the size of the room, the ventilation and what you have to do to get there.
“If you have to go up in a long elevator ride with four or five other people when there is asymptomatic transmission going on in your community, you could be putting yourself at risk,” said Dr. Mark Loeb, the Michael G. DeGroote Chair in Infectious Diseases at McMaster.
No matter where you meet, three simple things will keep you and those around you safer.
“Wearing a mask, social distancing and washing your hands, those are the things you can do,” said Loeb.
Stick to a core group
“At the end of the day, the way you can reduce the risk is to minimize the number of bubbles you interact with,” said Mertz. “By bubble, I mean the households. If you always interact with the same people and those same people only interact within the same bubbles as well, you have relatively little risk.”
Nothing is stopping you from getting together with a wide variety of people as long as you physically distance. The increase in gathering size doesn’t come with a stipulation saying it has to be the same people every time. But the more people you add, the more you increase the risk.
“If you can limit the number of contacts you have so it’s not 10 people on Monday, a different 10 people on Tuesday and a different 10 people on Wednesday,” said Richardson.
“Ideally it’s the same 10 people that you start to slowly expand up with (so) you’re not increasing up to 70 over the course of a week.”
It’s also important to keep in mind how many households are among that core group.
“If it’s two families of five meeting together, you only have the two households. The risk that one of those households is currently infected with COVID-19 with no epidemiology is very, very low,” said Mertz. “If you have five households with two people from each household, you’re still at 10 people, but each of those households has its own risk to have the virus which will make that whole interaction higher risk.”
What matters most?
“There are risks that are worth taking,” said Mertz.
What matters most for one family might be returning to a place of worship, for another it may be getting back to work, while for another it’s sending the kids to daycare. It’s about what is at the top of your hierarchy of needs.
“Day camp is really something that you need because both parents have to work and they are unable to supervise their children,” said Mertz. “I’ve seen data from the U.S. that there was an increase in drowning because small children weren’t supervised to the extend that they require.”
He added, “It’s really taking all those risks into consideration and accepting that there is nothing we can do that is zero risk.”
As a result, in our new normal, each person has to decide what “small risk we are willing to take because it’s the best for us,” said Mertz.