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Uncertainty and Risk

August 29, 2021
by Mark David Siegel

Hi everyone,

Certainty creates obvious decisions. When it’s pouring, we wear raincoats; when it’s sunny we don’t. But when the forecast is uncertain, cautious people pack raingear while others cross their fingers.

That’s how the pandemic has gone. When we didn’t know how the virus was spread, precautions were ad hoc. Some wore masks; some didn’t. Some wiped down groceries; some didn’t. Some stripped off their clothes before entering their homes; some waited to get inside (I waited). Before data emerged, personal risk tolerance drove behaviors more than anything else.

Eventually, we learned what mattered and what didn’t. I don’t regret the time I spent sanitizing milk cartons, though it seems silly looking back. I also don’t regret buying scrubs, and I still wear them, however unnecessary, because they’re cool and comfortable. But what I’m most thankful for is the way we embraced masking and social distancing, even before we knew for certain how the virus was spread. This approach saved—and continues to save—lives.

There’s still much we don’t know. As the virus becomes endemic, will it become less dangerous or more? As population immunity grows, how will personal risk assessment change? Under what circumstances, if any, will we stop wearing masks indoors or feel safe returning to indoor restaurants? Will we continue to avoid contracting COVID at all costs, or will we start to treat it like the acceptable risks we’ve long been accustomed to, like going to the movies during flu season, or eating raw oysters and steak tartare? Even if we start to accept the risk to ourselves, how will we protect vulnerable members of our community, like the elderly and immunocompromised? Within the residency, how will we decide whether to bring back in-person teaching or resume the holiday ball?

Even now, uncertainties breed inconsistent behaviors, even among responsible people who know the data. Some won’t be caught in public without an N95, while others are fine with face masks. In the US, children are masking up to go to school, while their counterparts in England are not. Yale University has resumed in-person teaching, while residency teaching remains virtual.

Hopefully, in the not-too-distant future, as risk starts to fade, we won’t have to take so many precautions. But we’re not there yet. As I write today, we remain immersed in yet another wave of the pandemic. Though things are worse in other parts of the country, particularly in the South, New Haven is once again a high transmission zone.

As physicians, we have an added responsibility, even though we’re vaccinated,* to avoid spreading infection to each other and to our patients. For this reason, we have to do the right thing at all times. This is especially important in the hospital, where we must wear masks without exception and we must forego eating in the workrooms. We do this not just to protect ourselves, and not just to protect our patients, but because others are watching and will model their behaviors after our own. I’ll be the first to admit my own mask-wearing lapses, but today I’m challenging myself, and all of you, to help bring this latest wave under control.

In the face of all the uncertainty posed by the pandemic, there are certain things we do know: masking and social distancing work. The day will come when we can relax these restrictions, but that day isn’t here yet. For now, I’m certain we can join together to do the right thing, because that’s the kind of community we are.

Before I end, a final request: please send me pictures of yourselves in masks. Let’s create a COVID mask-collage!

Have a good Sunday, everyone,


*100% of our residency is vaccinated- well done, everyone.

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Submitted by Mark David Siegel on August 29, 2021