A Clever Tool to Help You Stay Safer this Winter

So many of our conversations about COVID-19 involve absolutes. Vaccines either work or they don’t work. COVID is either a plague of biblical proportions or a media hoax. Masks are necessary everywhere or they are costumes for virtue signaling.

But the thing about COVID - and about all medical topics - is that the real, correct answers are almost never absolute. The most important sentence in medical school is “there’s a bell curve for everything”. That means that while nuance may be long gone from our political debates, it is crucial if you want to effectively manage anything from an ear infection to metastatic cancer to COVID-19. The range of symptoms, treatment options and outcomes for most diseases is very wide, and it's rare there is a simple, single answer to everything. Uncertainty is a big part of medicine, but we still have to make decisions based on the best information that we have at any given time, always looking for more and better data.

Our personal choices make us more or less likely to get COVID. More or less likely to be hospitalized. More or less likely to die or to have long term complications or to pass the virus on to people who can’t fight it very well. It’s an endless game of statistics and probability. Some things, like our choices, we can change. Some things, like our genes, we can't. Why does one person have a brief exposure to someone with COVID and end up in the ICU, while another person stays healthy even though they are unvaccinated and out in bars every night? That's the bell curve!

And that’s why I really like this interactive graphic from BMJ, the British Medial Journal (h/t to the brilliant Gareth Lock for sharing it). It lets you see how a wide range of factors affect the likelihood of transmission of COVID from an infected person to an uninfected one. Click on it to enter your own variables and see how this changes your risk of transmission.

People who talk about vaccines or mask effectiveness in absolute terms rarely correct or operating in good faith. When you read something like - “..the CDC said the vaccine would stop COVID but this vaccinated person died of it so that means that vaccines don't work and they must by lying about everything else”. - that person is either uninformed or deliberately trying to spread misinformation.

A good doctor knows that nothing is absolute. I tell my patients and their parents that if a doctor guarantees them any outcome, run away. Every human body responds to threats in different ways. That doesn’t mean that we can’t help. But it does mean that as clinicians we are just trying to shift the odds in our patients' favor, not waiving a magic wand to guarantee success.

Even though winter is coming, we are in SUCH a better position now to face the Omicron variant than we were last year. We have vaccines, better testing, better ICU care, and some effective antiviral therapy. And most important, we have KNOWLEDGE. We understand the modes of transmission so much better than we did before, when we were bleaching our groceries. We understand more about the timing of vaccines, and about the contribution of past infection to immunity. We need to put that precious knowledge into practical use.

We really CAN attack this pandemic with logic and science. We can resist the urge to make it just one more awful political football, one more collection of talking points in our endless culture wars. Every little thing that you do makes a difference. We don’t have to go into lockdown at this point, and even if we did, we probably wouldn’t - that’s fairly clear. But we can make smart decisions about which activities we and our kids do, and which we avoid. We can get vaccinated (and boosted!), we can watch the daily COVID weather, we can think about how the virus is actually spread.

And we can avoid falling for social media content that is designed to optimize revenue and to encourage division and alienation.

We can do this.