Tag: covid-19

Whose Risk Assessment?

Bad joke from the old “famous last words” series: “Hey guys! Watch this!” It is said that in normal circumstance, half of emergency room visits happen this way.

I remember when a family member injured her knee skiing. She said to my brother, a physician, that she was okay, she just needed to sit a bit. His follow-up to her, “How good are you at knowing when you need help?”

Some of us are not very good at assessing risks in general and risks associated with the pandemic in particular. Various distortions can happen. We might think things are safer than they are. Some people smell gas when others don’t. Then whose judgment do we go with? Some people think the risk of COVID-19 to themselves is low. They may be right. Then they get sick and suffer from an overwhelmed medical system. Famous last words.

In the other extreme, “The sky is falling!” when it is simply sprinkling. This tends to be the case for people who are anxious in general. They frequently think things are worse than they are and hopefully learn that about themselves.

A great divide is occurring in our society over what the COVID-19 risks now and going forward. Many people who are following best practices consistently either assess the risk to be great or they are willing to comply with what the experts and authorities are asking or requiring of them. Some of these people are in fact at greatest risk of death or severe illness should they contract the disease.

An important question in risk assessment is risk to whom or what? It can’t just be the risk to me when the consequences affect others. With the pandemic, a first consideration has been the risk of overwhelming emergency services and hospitals. That is the point of flattening the curve and getting the number of new severe cases per day down to a manageable level. Then we can resume treatments that have been put on hold, like non-emergency surgeries and standard medical appointments. The people who should be best at assessing risk are those with the greatest amount of information. And they need to be people not just concerned with self-interest.

The second question is what information is needed to adequately assess risk. The average citizen does not have access to all of the data. Nor do they know what they don’t know but need to know. The experts do and they inform the civil authorities whose responsibility to stay informed is far greater than the rest of us.

So, the situation calls for us to evaluate how much weight to give to our own and other people’s assessments. How objective am I, are they? How much access to data do I, they, have? The civic mindedness, love your neighbor question is our willingness to accommodate those who assess risk to be greater than we do. We might be willing to accommodate out of concern for our neighbors. We want them to feel safe, not just be safe, now and when things open up more.

Making Reopening Successful

“You would never know there was a pandemic going on.”

Following best practices got us to the point where reopening activities may soon be possible. Then, our behavior will continue to be a deciding factor in whether it is successful or harmful. But applying coronavirus best practices to old settings is not going to be easy. The Florida beaches have been reopened and a reporter noticed she was the only one with a face mask. She was the only one doing social distancing. For everyone else, it seemed to be a normal day at the beach. One person interviewed even said it was a welcome break from having to think about the pandemic. That will not be sustainable.

This is exactly what public health officials feared would happen and will continue to happen. The beachgoers had not prepared themselves mentally to carry safe practices into their beach experience. There was no group pressure to conform. So, they behaved at the beach the way they always have.

One of the things working against successful re-opening of activities is state specific learning. What we learn in one setting does not automatically generalize into other settings. We have to be deliberate about it or it won’t happen. What is more likely to happen is that we will be like the beach goers and act like we did before.

A helpful process for this is mental rehearsal. Before going to the beach or back to work, you imagine as clearly as you can doing so while following social distancing, wearing a facemask, keeping control of what you touch, and doing good hand cleansing. Repeat this several times before you go. The repetition will give you really good momentum and help you see when you or others start to deviate. We may need to give other people reminders, something many of us are uncomfortable doing. But that is part of being in this together.

Another big thing that shapes our behavior is how those around us are acting. When they don’t follow best practices, we are less likely to. We don’t want to be the only one. But when we keep the behavioral standards in mind before entering the situation, we are less likely to drift to how others are acting.

Already, in the essential service of grocery stores, more and more managers are feeling the need to protect their employees from careless customers. They are considering eliminating in-store shopping and only doing online shopping with home delivery or curbside pickup. This means other customers are witnessing careless behavior that are public health hazards and letting it go.

Careless behavior in a store is not just between the customer and the employee, it is between the careless customer and everyone else present. So, to be successful with having open stores and businesses, we need to exercise more mutual accountability.

Since beginning these blogs on the psychology of dealing with the pandemic, I have stressed mutual vulnerability and mutual responsibility. Those are what motivated following best practices. Now we must add mutual accountability. It is through mutual accountability that new behaviors become the norm. This is really hard. Holding others accountable and being held accountable by peers is very uncomfortable. It works best if we assume good intentions on everyone’s part. What we are doing then is bringing a person’s attention to what they had lost track of. Then our response will be to thank the other person, not get upset or defensive.

Even if the person does not care about best practices, this approach of assuming the best has the greatest chance of bringing out the best in them. If it brings out their worst, then they need to experience that they won’t just get away with putting others’ health at risk.

It can be difficult to act graciously when you feel unsafe or angry. If we remind others as we would like to be reminded, it won’t be woke scolding. It is really a way of collectively taking ownership of safe behaviors instead of blaming the government for imposing it on us. So, our skill set for reopening needs to include the willingness to hold others accountable and be open to them doing the same when they notice our lapse.

It is time also to remind ourselves to watch for thoughts that justify making exceptions for ourselves and others. We covered this in an earlier blog, Dangerous Thoughts.

Statisticians are Saving Us

This month is Mathematics and Statistics Appreciation Month. What a coincidence! It is statisticians after all who created the curve we are trying to flatten. They are putting in long hours, sleeping in their offices next to their supercomputers. Their data will guide governors in decisions moving forward. The statistical modeling they produce is about all we have to go by in making these decisions with their enormous consequences.

While many people now are trying to follow the data, it takes great knowledge, experience, and self-discipline to accurately interpret that data. Statisticians need to be objective. It is not fair to call this cold, rather, it is honest. It is about integrity, the integrity of the data and the integrity of the interpretation. The rest of us will see in the data what we want to see or see what we fear.

Because of this, statisticians are also subject to coercion from the politicians and people they work for who want a certain outcome. So, their work also takes courage, as they may be the bearers of bad news that conflicts with people’s agendas.

One knock on statistical modeling is that it does not produce certainty. It only produces probability. This knock was recently used to justify not lowering the emission standards for smoot. This response is either a dishonest excuse or it is based on ignorance.

Statisticians and mathematicians got people to the moon and back through probability, not certainty. Major decisions on Wall Street and in corporate America are based on probabilities. Computer simulation speeds up development of new drugs even though it produces probability, not certainty. And on and on. If we aren’t comfortable with probability, we are severely impaired and should not be making major decisions.

So, let us add mathematicians and statisticians to our list of COVID-19 heroes. They are saving lives. Their work is taxing on them and their families. But like front line workers, they love what they do, and they love being of service. They also love being acknowledged and appreciated, just like the rest of us.

With the central role they are playing in the war on COVID-19, maybe now we can allow statisticians to shape other vital decisions that impact the environment, instead of wasting their good work by allowing greed and indifference to prevail as they have.

The Accomplices of COVID-19

Alvanei Xirixana, a 15-year-old Yanomami boy, has died of COVID-19. His indigenous tribe in the Brazilian Amazon is legally protected from outside contact in order to preserve their health and their way of life. A land reserve was established to do so. But it turns out, that land contains riches, which is the scourge of all indigenous tribes.

While incursion into that area is illegal, gold mining and logging operations make daily forays into the reserve, bringing disease and polluting the rivers with toxic elements. This is how Alvanei contracted the virus. While the government of Brazil has known for some time of these illegal activities and the threat they pose, they have not stopped it. Now, the very survival of this tribe may be at stake.

Greed and indifference are the accomplices of COVID-19. They aided and abetted its spread and have stood in the way of successful control of the virus. Greed and indifference will remain long after this pandemic, fueling future disasters unless we address them as central threats to human life.

Since the 16th century, indigenous peoples of the Americas have suffered massive losses from diseases brough by European invasion. Again, greed and indifference. Smallpox was even used as a weapon to wipe out tribes in Western North America to make westward expansion easier. In 1763, British Field Marshall Lord Jeffrey Amherst concocted the idea of lacing blankets with the smallpox virus and giving them to the Indians as a gift. The plan was carried out with some success. Lord Amherst was honored by having a town in Massachusetts and an elite college named for him.

Another item: the link between poor air quality and severity of coronavirus symptoms has been established. Despite that, Trump’s Environmental Protection Agency has decided to not reduce standards for soot pollution, which damages lungs and compromises a person’s ability to fend off the virus. Greed and indifference leading to death.

With COVID-19, self-interest and indifference allowed authorities to deny, minimize and delay acting. Indifference leads to not wearing face masks and practicing social distancing. Due to greed, essential medical supplies go to the highest bidder, certainly immoral when lives are at stake. Now supplies purchased by governors are being intercepted and pirated by agents of the U.S. government. Indifference and self-interest allow that to continue. The major pressure to “re-open the economy” is from people who don’t believe the government has any right to restrict their behavior. When restrictions are lifted on our activities, greed, self-interest, and indifference are what threaten a second wave of infection.

So, this isn’t just a war against a virus. The real war isn’t fully over until we neutralize its allies – greed, self-interest and indifference, or they will do other forms of harm. They are the major players in climate change, poverty, racism and so on.

We are winning the war on the virus with extraordinary compassion, courage and determination, in addition to knowledge and skill. These will all be needed to take on greed, self-interest and indifference to the suffering of others.

But who will lead the campaign against greed and indifference with the same determination and skill as we are doing with COVID-19? They may be what it takes to stop such mass destruction. Religious leaders might call for it, but organizing an effective campaign is something else.

What Day is It?

People are joking that they don’t know what day it is anymore. For many of us, the name for the day of the week no longer carries meaning anyway. With having to clear our calendars, one day became the same as the next. This may have been refreshing at first, but no longer. For many essential workers, it is the same, but for different reasons. They don’t know when their next day off will be. There is no hump day for them. Every day is like Tuesday. You worked yesterday and a free day feels a long way off.

For some of people, undefined time is emotionally distressing, even the breeding ground for depression. With little or no definition in time, they just feel lost.

Suppose you were out at sea, not knowing where you were, but you had a machine that gave your location. It gave you numbers for your longitude and latitude. Now you would know where you are, right? Not really. Not if you didn’t know where your destination is relative to those numbers. Without a reference point, all you have are meaningless numbers. This is how some people are feeling about days of the week and calendar dates.

Some people who are used to being busy actually feel ill when they are idle, dubbed Leisure Sickness and Sunday Neurosis. Pastor Rob Bell has written that when he started taking a meaningful Sabbath day free from work and responsibilities, he felt depressed in the early afternoon of what was supposed to be a gift day.

While some people get through this distress to become comfortable, others do not. They are better advised to create structure in time, even if they only have little things to work with. While many people are doing this, others need a nudge. The first thing has been creating online ways of doing what you did before, like Zoom support groups, book clubs, breakfast clubs, music lessons, tutoring sessions, worship and business meetings. Some find it helpful to check off days on the calendar while other find it distressing. It is worth finding out.

There is more, though, to having the name of the day be meaningful, and that is keeping personal structure. So instead of noticing you had a hair cut appointment you now can’t keep, you cut your own hair and schedule the next appointment with yourself. Schedule when you take walks, get groceries, and so on. Decide when to work on puzzles, when to eat what. Couples are keeping date night in new ways rather than letting it go.

While this all seems simple enough for many of us, for some, it takes deliberate effort and reinforcement. They are more likely to just do things when they feel like it rather than keep a structure. While that sounds like freedom, it can unwittingly fade into darkness.

Let us also not forget those of us for whom the calendar now only consists of stressful dates. The day bills are due are anticipated with dread. When unemployment checks come with their additional value, the end date will be burned into the back of the mind. The day of the week you get your weekly food allowance from the food bank has meaning. You don’t miss it. In such circumstances, the above methods for structuring time with positive things matter even more.

While some physicists say time may not even be real, for us humans, it does matter in how we relate to it.

They Care for Our Dead

Have you seen the footage of people caring for the COVID dead? We have been good about naming the heroes in this pandemic and recognizing the enormous sacrifice and horrible trauma they are experiencing. What I don’t see mentioned, though, on the list of those to thank are those who care for the dead bodies. These people don’t save lives, so they are not heroes, I suppose. But their service is essential and it is numbingly traumatic.

In many locations in the world, they deal with hundreds of dead bodies a day. It is very akin to war where the casualties are heavy.  Like the military personnel who have loaded and unloaded cargo planes full of body bags and coffins. In many cases, the dead are being buried in mass graves for safety reasons or are being incinerated.

They might wonder who the people are whose bodies they have responsibility for. Some of these dead are heroes who gave their lives fighting the pandemic. Some are victims of chance exposure or exposure they could not avoid. Some are victims of their own reckless behavior or the reckless behavior of others that exposed them to the deadly virus. The virus got them all.

Unlike medical personnel and first responders, those who care for the bodies of our neighbors, friends and family had no opportunity to get to know the people whose bodies they tend to. No bonding. No sense of the context of their lives. They don’t know who is in the body bag, who is in the coffin. All of the body bags, boxes and coffins are the same. And yet, these dead are not mere statistics. Bodies are heavy, Statistics are not.

It seems that being a grave digger has always been a lowly job. Upstanding people did not associate with them. Yet, these were and are the people who bury those with no money, no known relatives or associates. Without knowing their names or where they came from, grave diggers give them a home, just as they do for those with large monuments.

Let’s name those who deal with the dead bodies among the people we lift up for our thanks and for our blessing. They are servants of our communities.

Survivor Guilt: Destructive or Instructive?

While many Park Avenue tenants are comfortably sequestered in their peaceful summer homes with spacious grounds, their fellow New Yorkers are having trouble sleeping due to the unceasing wail of sirens. Many have died. Many suffered a long time, near death, but somehow recovered. The joy of their recovery is dampened by their guilt – the guilt survivors commonly feel. They survived, while others did not.

Unlike the wealthy New Yorkers, I didn’t have to leave town to be in a safe place. I live in one. Unlike those with inadequate resources, I could have left town if I needed to. It is wise to feel unsettled about that.

Survivor guilt is quite normal. Depending upon what you do with it, it can be either meaningless or transformative, destructive or instructive. It is meaningless when we flee from it like fleeing from the memory of the illness itself. It is instructive when we sit at its feet and learn from it. It is destructive when we torment ourselves with the question “Why?” Why did I survive when so many others did not? Does my life have more value than theirs? Am I blessed but they are not?

Survivors may well have some physiological quality that helped save them. Or maybe they were just lucky. For some, they survived because their wealth allowed them to have decades of better nutrition, less financial stress. They lived in safer neighborhoods. They were not weakened by other medical conditions or mental health conditions.

Even though the wealthy might think that God has been good to them, Jesus pushed the point that it isn’t so. The poor and sick are not out of favor with God. That isn’t what is happening. God’s goodness is scattered equally to all, he said.

These are the kinds of things that are instructive about survival when others perish. They only come with reflection, which is positive use of the guilt.

The wealthy in their safe quarters may not feel guilt for surviving. They haven’t been taken to school about injustice and chance the way survivors have. They might have come out of this more awakened had they stayed and served in their communities.

Awakened, survivors understand their responsibility to work for justice and fairness. It is sobering, as it should be.

Is This a Marathon?

I dreamt that I was in a marathon. But I’m a sprinter. I hadn’t signed up for this race, and I couldn’t get out of it either. And no one knew how much farther it was to the finish line. I felt distress and confusion and saw the same in the faces around me. Terrified, I woke up.

I woke up to find it was real. We can’t get out of this and don’t know how much longer it will be. But is it a race we are in to get this over? I decided to go back to sleep and finish the dream.

This time I found myself among a flock of geese high in the air on a long migration. This was very different from the marathon. Despite the dangerous situation, it felt strangely peaceful. Geese can only migrate by sticking together and working together. The flock felt strong and committed. By flying together, migrating birds actually create the conditions that make such a long journey possible. No geese are strong enough to do it on their own. Flying together in formation, they create draft that eases their way so they can go farther and farther. They must stick together, simultaneously helping and being helped. Helping and being helped. Pulled along by their combined effort, they can go many times farther than they ever could alone.

This is how front-line pandemic workers are doing it. It is demanding, dangerous and of unknown duration. And it is only possible by sticking together as a team. Together, they create the conditions that make it possible. Even though they may not know the person working next to them at any given moment, they are in the same flock, honking reassurance to each other.

“I’m here.”

“I’m here.”

This is how the rest of us are doing it as well.

Dangerous Thoughts

“I think it will be all right. It seems safe enough.”

The Surgeon General of the United States is concerned about the next couple of weeks determining our ability to flatten the curve and relieve the pressure on our emergency services. He is asking for greater compliance with the best practices they have established for our mutual safety. This means following them consistently, even when we don’t think we need to. Masks are the latest requests, with compliance not so good. So, it is timely to refresh our understanding of what leads us to make exceptions and not follow best practices, especially when they are being imposed on us. Many of us rebel against that.

While there are several lines of reasoning that tempt us to not comply, they all lead to the thought, “I think it will be alright. It seems safe enough.” We can listen for that thought, and ones like it. When we think like that, we are trusting our own judgment instead of people whose judgment is based on far more data than we have.

“I thought it would be alright.” Painfully, as a psychologist I have heard this expressed by many professionals who knowingly did not follow professional boundaries and best practices. They thought things would be alright because that is what they wanted to believe. But things went bad and out of their control. People got hurt.

“I think it will be alright” has led to many disasters that would not have occurred if people had followed guidelines instead of their own judgment. Lest we think we are immune to this kind of thinking, among the disasters due to not following guidelines was the Space Shuttle explosion. These were intelligent people. So also, were the people who died on Mt. Everest from not heeding the 2pm rule of the mountain, to turn back toward camp at that time regardless of how close you are to the summit. Some of the climbers convincing themselves and each other that it would be alright. There hadn’t been bad weather in a long time. An unexpected snowstorm came up and many people died. Others were put at risk to try to rescue them.

Tragically, a community choir recently encountered unnecessary illness and death. They thought it would be safe to get together and sing to lift their spirits because there had been no reported cases of COVID-19 infection in their county. “It hasn’t happened around here. I think it will be alright.” This is called distance bias. Even though it has happened elsewhere, if it hasn’t happened around here, we don’t take the threat as applying to our location. That was there; this is here, the reasoning goes. Well, it did happen to this choir. With this virus, it can happen anywhere.

Of course our minds will want to find exceptions to make things easier, get us what we want or not make us look foolish wearing a mask, for instance. Let us be vigilant, recognize when these thoughts when they occur and not follow them. Thank others for doing the same and encourage those that don’t.