Your exit, not mine

by Brian on May 10, 2020

in Cancer,Health,In the News

It felt better when we were in total lockdown. The sense that we were all in this together – the young and the seniors, the healthy and the immunocompromised – was comforting in a time of chronic uncertainty. 

But now, as we plunge headfirst into the easing of restrictions, with plans to open schools, beauty parlors, beaches and IKEA outlets, the message is clear: the country is done with sheltering in place. Let’s get back to the way things used to be – as much as we can with masks and social distancing. 

But not everyone is down with the emerging climate. For nearly two months, we’ve been told: kids don’t visit your grandparents. If you have a pre-existing condition, stay indoors. The new rules are all happening so fast – what if we’re wrong and there’s a surge of new infections? 

It’s not that this transition to whatever will become the new normal is ill conceived. On the contrary, an economy cannot remain shuttered forever. I’m just saying how it makes me feel, as an at-risk cancer patient, gravely worried as the country opens up again.

I should be thankful I don’t live in Las Vegas, where Mayor Carolyn Goodman offered up her 650,000 constituents as a “control group” against statewide shutdown orders while the virus was still raging. Or that, here in Israel, those in charge didn’t listen to Hebrew University economist Prof. David Gershon, who callously commented that deaths due to illnesses are inevitable, and that the only criterion for assessing how a country should react is whether the health service is in danger of melting down. 

I will not be reduced to a statistic.

But what happens now when some of us can go out again, to shop and to shul, while others are still at risk, even if the danger is dropping?

If my son Aviv’s music school reopens, for example, with mask-less orchestra rehearsals (he plays saxophone, after all), what do we do when he gets home? Must I hide myself in my office, so that he can reenter life out in the world?

He could move out, I suppose. But what about my wife, Jody, with whom I share a bed and much more? Must she give up seeing her clients for the foreseeable future? Or do I separate from her, too? 

No, I refuse! That’s a prophylactic too far. 

And yet, if I compromise for one person, why not them all? Why not go out and see friends or have the kids come visit from Sderot (seeing as how visits to immediate family members have been permitted again, albeit with no hugs or kisses for grandparents)? 

At a certain point, I feel like just throwing my hands up and screaming, “Screw it, I’ll take my chances with whatever’s out there. If I get sick, then that’s my fate. At least it will take one thing off my anxiety list.”

The key for people like me lies in uncoupling uncertainty from risk. 

Writing in The Atlantic, Harvard Business School senior fellow Arthur C. Brooks describes uncertainty as involving “unknown possible outcomes and thus unknowable probabilities.” 

Risk, on the other hand, “can be managed.” Indeed, risk management is a core part of the insurance and finance industries.

The COVID-19 crisis embodies extreme uncertainty. Will you get the virus or not? If you do, will it be mild or severe? Is our government making choices based on sound counsel? How and when will it all end?

Could some sort of risk triage resolve our family’s post-lockdown paralysis? 

We know, for example, that wearing masks, washing hands and maintaining social distance has made a big difference already. 

Could we extend that understanding to create our own at-risk family rules? Such regulations might seem odd to outsiders – for example, Jody could insist that when she meets clients, they both scrupulously wear masks and maintain two meters of distance long after everyone else has gotten lax – but it might give us a better sense of security. 

All guests coming into our house would have to wear a mask, as well; that means no food served, not even water. It would be awkward, but then these are awkward times.

The Dubai-based airline Emirates is now conducting rapid coronavirus screening for all boarding passengers. The finger-prick blood draw returns results in just 10 minutes. Israeli startup Nanoscent is working on a technology that can “smell” COVID-19 in less than 30 seconds. If this kind of testing were readily available in Israel, would it be too much to ask my family to get pricked or sniffed before returning home? 

This is not the first time I’ve had to tease out risk from uncertainty. When I was diagnosed with cancer two years ago, I had to make choices about treatment options based on incomplete information. While the risk factors were clearer than they are for COVID-19 – extensive clinical trials showed the percentages of who would go into remission, for how long, with this kind of chemo or that – you could still never know in advance which side of the average you’d be on. 

We made a decision with what we had, and we acted on it. Can we do the same with COVID-19? There are now plenty of ICU beds and ventilators available in Israel. New treatments look promising. Infections and hospitalizations are way down.

Is all this enough? I honestly don’t know. I feel alternately lonely and jealous, although sometimes at peace, too. But I’m clearly at a turning point. The only question is whether it will be because I’m despondently crying “screw it” or it’s a matter of quiet acceptance based on calculated – though far from assured – risk assessment.

I first weighed risk against uncertainty at The Jerusalem Post.

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