What’s Your Risk Budget?

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In March of 2020 when we started to wash our groceries and searched desperately for masks, I joined a book discussion class offered by the Alliance Française of Seattle. The book was “La Peste” by Albert Camus.

At the time, it awed me that Camus so aptly chronicled how his fictional town of Oran responded to the plague – the tendency at first to deny it, not to want to quarantine or wear masks, the anger, the looking for scapegoats, the dread, and finally the start of the return to normal life as the plague subsided. I wrote for Post Alley about how Camus seemed to foreshadow our COVID experiences

Camus ends his book by observing that the plague isn’t gone for good. As the people of the town rejoice, the book’s narrator observes that: “le bacille de la peste ne meurt ni ne disparît,” and one day “la peste réveillerait.” It isn’t dead, hasn’t disappeared and will wake up again.

Welcome to our COVID-19 world. Many of us thought with the first arrival of vaccines that life would soon return to normal. Then there was the Delta variant followed by Omicron, and we began to understand that this virus has the potential for endless variants. It may doze a bit, but keeps waking up.

How are we now supposed to react? The Atlantic calls the latest uptick in COVID cases the So What? Wave, saying that “The United States could be in for a double whammy: a surge it cares to neither measure nor respond to.”

The Associated Press tells us: “It’s not over: COVID-19 cases are on the rise again in US.”

Axios says: “We’re reminding you — yet again — we’re not out of the woods with this pandemic.”

The New York Times announces that “the choose-your-own-adventure period of the pandemic is upon us.”

Taking as a starting point that here in the Seattle area we live in the one of the bubbles where people mostly followed mask mandates and got vaccinated, how do we move forward when headlines tell us cases are increasing at the same time that we are doing away with the measures that helped protect us?

A federal judge in Florida, a Trump appointee, this Monday struck down federal mask requirement on airplanes, trains, buses and other public transportation. The judge ruled that the Centers for Disease Control and Protection had exceeded its authority. The CDC said it would continue to recommend masking for enclosed public transportation, while major airlines promptly began announcing that they would no longer require masking.

All of these unfolding day-to-day COVID developments are making it even more challenging for each of us figure out how and when to protect ourselves.

I never thought specifically about having a risk budget until a friend, who is a psychiatrist, used the term to describe the daily decisions we each make about potential exposure to the virus. I also found an NPR story that advised thinking of a risk budget as “like a regular budget: you only have a certain amount of risk to spend, so choose the things you want to prioritize.”

We weigh the risk versus the reward. Going to Benaroya Hall to hear pianist Yuja Wang, my risk budget appreciated that patrons still had to show proof of vaccination and photo ID and stay masked the whole time inside.

While at this point I continue to mask going to get groceries and to other stores, the next challenge is the return of in-person board meetings and social gatherings. Will my risk budget stretch to allow me to be comfortable without a mask, my security blanket of the past two years?

If I still lived in Washington, D.C., I may have attended the Gridiron Dinner as I had in the past – a formal dinner of journalists and powerbrokers where the Fourth Estate sings ditties poking fun at politicians and politics. After a pandemic hiatus, it was held in person again this year. Seeing a photo of a group of my elegantly attired friends at the dinner made me wish I had been with them — until I read that at least 10 percent of those who attended confirmed getting COVID afterwards, including a friend in that photo.

Every day we continue to make dozens of decisions influenced by the ongoing pandemic. To mask or not to mask: whether the reward of normalcy — of going to a family Easter dinner for 40, or to your pilates class or attending a board meeting or going to a gala for your favorite non profit — outweighs any potential virus risk?

Would any of us want to live in Shanghai where the government, committed to zero COVID, imposed a severe lockdown when cases starting climbing again?

Are we at the “so what” stage and ready to shrug off increases in COVID cases, reassured perhaps by the decline in hospitalizations?

We are weary. We all know people who caught the virus but had mild cases that didn’t disrupt their lives. But then we read about those long haulers who after months still have problems. Will we take the risk that we are fully vaccinated and boosted and would likely get a mild case — or not?

We may not be ready to say “so what” to the continued risk of catching the virus, but maybe it’s time to adjust our personal risk budgets. As Leana Wen, an emergency physician and public health professor at George Washington University, told NPR:

“I believe that the end of the pandemic is in sight. And by the end of the pandemic, I don’t mean that COVID-19 is going to go away. But, rather, that we’ll able to turn COVID from an existential emergency into something that we’re able to cope with and … that the majority of us will be able to live with it, so that it is a minor annoyance in our lives rather than something that we have to base all of our decisions around.”

Still, I can’t imagine leaving the house without keeping a mask handy in my pocket.

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Linda Kramer Jenning is an independent journalist who moved to Bainbridge Island after several decades reporting from Washington, D.C. She taught journalism at Georgetown University and is former Washington editor of Glamour.

4 COMMENTS

  1. I think this is a great way of thinking about it, Linda. My risk budget is such that I drove on I-5 just now, knowing full well that tens of thousands of people die on the highways every year, but also knowing that the reward of faster travel outweighed it.

    To me, the role of public health agencies is not just to help chart the path of least harm, but also to provide clear, reliable education on risk and harm so that people may make informed decisions.

    For COVID, the risk-reward tradeoff is incredibly age-dependent, as well as influenced by comorbidities. Polls show most Americans still dramatically mis-estimate hospitalization risk by age cohort by several orders of magnitude. It’s led us to make net harm-imposing decisions rather than harm-reducing ones.

    Informed consent has always been the better path, in my view. We have a long way to go to restore trust in the institutions which inform us.

  2. Good, I don’t have to be the one who brings up motor vehicles. What about wearing a helmet while driving? I’ve read that it would cut down significantly on disabling injuries. Will you consider it?

    Leave aside the question of whether that’s true or not – and likewise the eternal same discussion relative to bicycling. We don’t drive without helmets, but insist on bicycling with helmets, because we have the facts and they support that position; we do it because that’s how we do.

    Number one, because the facts are elusive. Same with COVID-19. Check for consensus on anything – how long you might be infectious before or after testing positive, how likely you’re infected if you test negative, … anything. The advice will tend “err on the side of caution” because we really don’t know for sure.

    Number two, because humans can’t operate on that basis. We can’t balance statistical risks vs. rewards. How important is it to see people’s faces? Very important? Kind of important? Give up – you can’t quantify this and see if it’s greater or less than a unknown statistical risk of infectious outbreak. There’s no rational basis for making this decision, you have to just go with what feels right. (Just try not to be influenced by people who manifestly find it in their interest to bring us down.)

  3. I like your phrase Steve about “net harm-imposing decisions rather than harm-reducing ones,” and as you note these decisions would be clearer if public health agencies could give us guidance that is unequivocal — and if politics stayed out of the decision making and discussion.
    I spoke earlier today with someone who said a non profit gala in NYC had required proof of a negative CIVID rapid test within 24 hours of the event. How would people react if more events went that route?

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