During the first six weeks of the pandemic, I have answered hundreds of questions about COVID-19: What are the symptoms? How long does the virus live on surfaces? Are masks effective? Behind the myriad of questions, however, was a single concern: How do I stay safe and protect myself, my family, employees and patients? While COVID-19 is a new virus, many of these early questions had answers, since there was existing knowledge about coronaviruses, managing public health outbreaks, and the efficacy of personal protective equipment.
In addition, there seemed to be an overarching sense of safety as elected officials mandated social distancing and stay at home measures.
Now, we are entering the next phase of this pandemic. Governments are loosening restrictions and re-opening the economy, however COVID-19 continues to spread and effective medication, safe vaccination and/or enough herd immunity are still 12-18 months away. And there are more questions: What is the accuracy of antibody testing? If testing shows that I was exposed, can I get it again? How can I be sure I’m stay safe and protecting myself, my family, employees and patients?
We all want answers, but the reality is — we don’t have them because answers to these critical questions must be based on COVID-19 specific research. Unfortunately, science just doesn’t move that fast. In the absence of answers, there is little guidance that policy makers and scientists can offer. Ultimately, it will be up to each of us to navigate through the uncertainty and decide, for ourselves, how to stay safe.
Good decisions come from being well-informed and avoiding the trap of latching onto the most convenient or comfortable interpretations of studies, statistics and sensational headlines. Let me give you an example. As of April 27, there were 987,467 confirmed cases of COVID-19 in the US and 56,164 deaths. The case fatality rate — the number of deaths divided by the number of confirmed cases — was 5.7%. While mathematically correct, this fatality rate is inflated because the number of cases is low due to the lack of widespread testing. What’s the correct number of cases? We don’t know. However, based on studies in New York and California, there is good evidence that COVID-19 has already infected 4% of the population. In the US, this suggests about 13.2 million people may have already been exposed.
There are two equally valid and opposite ways to contextualize and react to this data:
- One on hand, the higher number of cases means the infection fatality rate recalculates to .43%. This is higher than the rate for influenza. Concerning, but not terrifying, considering that many early estimates were far higher.
- On the other hand, COVID, like other viruses, will predictably spread to 40% of the population. Since 10 times more people will be infected, a proportionate number (561,640) will die. Terrifying – especially if you or a family member is higher risk.
Your interpretation will influence how diligently you wash your hands, whether you wear a mask, continue with telehealth, or fully re-open your office. The choices you make will differ from those of a colleague because the right answer is a personal one that depends on how you balance risks and benefits and make trade-offs.
Even in adjusting the way we meet the needs of patients during and after this time, uncertainty will be the new normal and there is nothing easy or comfortable about it. The only definitive advice I can share is to anchor your decisions in science. Surround yourself with different points of view by listening to more than one news outlet, one tweet, one colleague, or one doctor. No one has answers during this turbulent time, and you owe it to yourself, your staff and your patients to make well-informed decisions.
Rather than run and hide from the uncertainty, we must face it head-on and figure out how to best operate amidst it. It makes the uncomfortable a bit more comfortable… and safe.
Archelle Georgiou, MD, is the Chief Health Officer for Starkey. She is responsible for Starkey’s initiative to improve individuals’ overall wellness and quality of life through our products and better hearing. She develops and maintains strategic relationships within the medical community, oversees the Healthable features embedded in the company’s hearing aids, and brings hearing health to the forefront of overall health.