“Doc, my daughter, son, and two coworkers have all had COVID-19. I’ve been exposed to all of them and I haven’t gotten sick. I see plenty of people out and about. Why should I bother with masks and other precautions at this point?”
When my 60-year-old heart patient asked this during his office visit, his tone was serious, and I could see that he had been stricken with doubt about the ongoing need for COVID-19 safeguards. After all, his experience flew in the face of all of the warnings. He then admitted that he had recently ventured out a few times to restaurants, and accepted some invitations to non-distanced indoor gatherings with friends. He had dipped his foot, tested the water, and was now feeling ready to dive in. I was worried.
Since the onset of the COVID-19 pandemic, nearly all of my patient interactions have involved some discussion of the virus, regardless of the primary reason for the visit or call. I check to see if my patients are able to get required food and supplies, and ask if they are finding ways to have social interactions, perhaps on video, or small, in-person outdoor gatherings with social distancing. Then I ask if they feel well-informed about the pandemic, or have questions about what they have read or heard. Until recently, the questions have all been very similar:
“When do you think the vaccine will be available?”
“Should I get an antibody test?”
“What should I do if I am exposed?”
But the question from my recent patient, along with others who are wondering if they need to comply with protective measures, has given me pause.
What has changed? In March our instructions were to simply stay home, wear masks when making essential supply runs, use liberal amounts of hand sanitizer, and don’t touch our faces. We are now more than four months into this pandemic, and mixed messages abound. We see maskless crowds at rallies and beaches. Many business restrictions have been lifted as states try to balance health safeguards with economic pressures. This leaves many of my patients in a situation for which they may not be well-equipped — the need to assess and manage their own risk and their responsibility to protect others, in an environment of great uncertainty around COVID-19.
There is no question that the virus is still prevalent and great health risks persist, with cases increasing in many parts of the country. People are still getting sick and asymptomatic spreaders are an ongoing threat. COVID-19 has not retreated. The difference now, with some restrictions lifted and businesses reopened, is that there are more sanctioned opportunities to take chances. And when you take a risk during this pandemic, you can easily become ill, or be an asymptomatic spreader and expose others in your circle of close contacts to that same risk. Worse yet, some of those whom you expose may be in high-risk groups for severe COVID-19 illness or death. This is what I emphasized when I responded to my patient, who questioned why he should care about precautions anymore.
It is time to update COVID-19 doctor-patient conversations, to provide guidance through this morass of contradiction.
“What is my risk for COVID-19 right now?”
“Some things are reopening. What is the best way for me to stay safe?”
Perhaps these and similar prompts will help you have honest, collaborative discussions with your doctor in this new and evolving phase of the pandemic. Like so many other challenges in medicine, there is no one-size-fits-all here. Don’t try to navigate these turbulent waters alone.