May 26, 2020


Patients, friends, family want to know “what’s the risk if….” This is not always an easy answer. The results can be different and unexpected.

This is a tale from Morgan Housel, an investment advisor at Collaborative Fund, about risk and what it means to him. He tells a tragic tale of risks he and friends took (or didn’t take) as young hot shot high school skiers. He learned the difference between the odds of having something happen, the average consequences of having something happen, and especially the tail-end consequences. Those are the low probability but high impact results, the ones you have to live with, the ones we have to live with afterwards. It is worth a read to put things in perspective.

This virus is still young and we are still learning about it, we don’t yet accurately know the actual death rate since not everyone with it has been tested and the deaths are not accurately counted. But we do know that even if the survival is 99%, many people have damage to their lungs or kidneys or other organs, many suffer symptoms for weeks like Peter Piot, the AIDS researcher in this follow up story in the New York Times. This is not just the flu.

I appreciate this cautionary story in the New England Journal of Medicine about advising people about their risks of returning to work. I worry about giving advice. What if I am wrong and they get exposed? How will I feel if they get really sick or die? Those are some of the tail-end consequences I might have to live with. Risks exist, especially in older people or people with high risk conditions.

This chart below can help put your risks in a sensible order. We can use this for activities and chores, decide what risks to take depending on our ages and health. Some of us have to return to work because of the nature of our work and the need for income. We can protect ourselves by wearing masks, and having co-workers mask, washing hands, limiting contact time, and physical distancing. If you are very high risk, ask for a doctor’s note to excuse you. I write them for my patients that need one. But the bottom line on safety is distancing, masking up, handwashing, and time of exposure. We have been doing it well, so keep it up. It’s the tail-end results that matter. I want us all to be here at the end.

Many of you have probably heard about the hair salon in Springfield, Missouri that had two stylists diagnosed with COVID after exposing more than a 100 people. Fortunately masks were required, but both stylists had symptoms. The Health Department is doing contact tracing, counseling, isolating, and testing those exposed since good records were kept. We will soon know the results of this unplanned experiment on how effective the masks were. But of course it depends on people wearing the masks correctly. Cover your nose!

Wash your hands.

And finally, my caveat is that this is my experience and my opinions, which are subject to change as more information is available, and not related to the organization I work for. Thanks for reading.