Moving out
Hi everyone
I start again with a practical tip – if you are more bothered about when you get deliveries than who supplies it you can use the www.shoppingslot.co.uk website which pools times from a number of organisations. Thank you dear reader for this tip.
We are now moving into more uncertain territory – the lock down rules are changing and each of us will need to be making decisions about what activities are personally acceptable - with whom, when and where. With (even limited) freedom comes responsibility. I remember many years ago a patient was transferred from Broadmoor where he had been for some years following a murder. Their policy is to give their patients no freedom nor choice at all initially – in a padded cell. With time some choice is introduced - until they have their own room which they could decorate. Coming to our district psychiatric hospital was another step towards freedom – the ward was locked for the first month and then it was opened. The question was whether the increasing freedoms – and choices – would be too much for him. (It was – he ran off, was picked up 300 miles away in Scotland and returned to Broadmoor.)
So what can give us confidence that it is safe and desirable to start moving out from our secure ‘stay at home’ last six weeks. At least three factors are at play – being dutiful or independent, the desire to have contact and the fear of being infected or of infecting others. The first two factors are probably fairly set so let us look at the fear factor.
We usually act because of underlying emotions (known or unknown) rather than logically. Positive emotions are great drivers – as in the gratitude seen for health care workers. However negative emotions, such as fear, especially if intense so that take us over, may not be helpful – indeed they can paralyse us. The government’s (successful) message for the last six weeks has been based on creating some fear of the virus encouraging people to stay at home. It worked for me as I now realise how fearful I am of being infected – even though I have a better than 95% chance of survival. Compare this with my decision to not take statins which statistically is riskier. One decision is thought through, one is driven by emotion. So as the country opens up, and I need to engage more with the wider world, how can I address this fear? One way is to begin to consider that some situations are extremely low risk while others are to be avoided.
Let’s get back to basics. Getting infected. There are two ways – direct or indirect. In earlier blogs I have covered the indirect transmission – from people to an object, from the object to your hand then face then into your system. See https://www.bremzero.com/staying-safe-summary
Now direct transmission is becoming more relevant. This is the spread of disease by the direct inhalation of virus particles that are in the air. The key understanding is that to become infected you need a certain viral load – and that load arrives through a combination of the rate you breathe in the virus and the length of time you are breathing it in. An infected sneeze in your face gives you a huge viral load over a very short time while sitting at an adjacent table in a restaurant to an infected person gives you a low load over a longer period. Both may be sufficient to infect you. Some factors reduce the likely viral load notably good ventilation (air con machines may be turned up in offices) especially outside with its additional benefit of ultraviolet.
So to assess the risk of any situation think of three things:
numbers of people (as we know that infected people shed virus before they get symptoms so each person is a risk),
level of ventilation
length of contact.
On that basis some scenarios are higher risk than others:
High risk – taking a meal indoors at a restaurant, cinemas, pubs, public transport including flights, some workplaces, some jobs eg bus conductors, working on the checkout, any crowded meeting in small rooms
Low risk – all contacts outside, golf, outdoor meals, supermarkets, jobs in well ventilated offices with few people
Social distancing is particularly helpful for the brief outdoor contacts, and masks particularly helpful for the higher risk situations.
(For more detail on this see https://www.erinbromage.com/post/the-risks-know-them-avoid-them )
By using this sort of risk grading we have a basis for gaining the confidence that we need to move out from lock down and begin to have more contact with friends and family. The process allows us to note our fears, but not be controlled by them as we take simple graded steps towards a more normal life.
It also explains the government’s approach. This cannot cover every situation so we will need to use our own authority and common sense. Although there will continue to be deaths albeit in a reducing rate and although there will be localised outbreaks – give us local contact tracing – we are seeing the end of the beginning.
With love
Derek
I welcome feedback and do send details of any resources you have found particularly useful.
There is a summary of how to stay safe at https://www.bremzero.com/staying-safe-summary
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