fitness

We’re all (fake) epidemiologists now: risk assessment as a disorienting dilemma

Nicole’s post on Monday about balancing her desire to run with other people’s worry that runners are spreading risk really resonated with me. I’ve been thinking a lot about the different ways we assess and react to risk right now — and I’m particularly wondering how we are going to navigate those as the world opens up gradually. I’m thinking a lot about how we are being asked, as a society and as individuals, to navigate new uncertainty and unknowable risk with mental models and emotional responses that really yearn for certainty and safety.

As I wrote about last week, the only certainty at this point is that while there is a lot of science underway, we don’t have a vaccine yet; testing is still underutilized in most jurisdictions; we don’t really understand transmission; we don’t understand what kind of immunity can be developed against Covid19 but it seems like having it once doesn’t necessarily make everyone immune; and we don’t even really understand what approach to containment is most effective. At the same time, curves are flattening in most places and there are many arguments in favour of gradually resuming a more interconnected life.

Yesterday, the Ontario government shared a framework for reopening in waves, with time to assess any spike in cases before another wave is permitted. This morning, I woke up to an epidemiologist on our local CBC radio morning show arguing that we shouldn’t consider opening up anything before we shut down services even further first — he argued for a curfew and a redefinition of “essential” to “not include things like the cheesecake factory.” This perspective is a strong contrast to the French prime minister announcing a gradual end to the lockdown because of fear of economic collapse, saying “we’re going to have to learn to live with the virus.” (Similar to Quebec’s announcement that schools will reopen and that “natural immunity” will emerge). This was followed by a strong backlash about opening schools because we have no idea what the ultimate impact covid19 might have on children, or how much children might be silent carriers.

In the west, most of us (especially white westerners) have the privilege of not living with unmanageable health risks in our day to day lives. Unlike the large parts of the world who live with daily risk of diseases like dengue or malaria, which have no vaccines and no cures, we are used to navigating our days with a lot of agency — and an underlying (privileged) belief that we can protect ourselves and our loved ones from most dangers.

To do this, we actually draw on our own personal harm reduction and mitigation strategies all the time. We might choose to ride (risky) bikes, but we wear helmets and avoid busy streets. We drive (dangerous) cars, but follow speed limits, don’t drink and drive and wear seatbelts. We make choices about whether or not to get vaccinated for influenza based on whether we have asthma, are exposed to large groups of people or have vulnerable people in our lives. We make choices about how much risk to take about the possibility of sexually transmitted infections. We each have our own system of choosing “healthy” vs. “unhealthy” foods, how much we exercise, how much health screening we do. We practice harm reduction and risk assessment all day, every day.

With covid19, we don’t know how to assess risk or make informed choices — and it’s disorienting. And when we’re disoriented, we react, we freeze, we worry, and in some cases, we lash out at other, the way Nicole has experienced.

I think the fox on the left is yelling at the other one about social distancing

I know I’ve found myself feeling… impatient… toward people who don’t assess risk the same way I do. I veer between thinking some people are too cautious to thinking others are reckless, and it’s an easy step from that to dismissing the fear, anxiety and yearning underneath each other’s reactions. I haven’t yelled at anyone for their choices, but I’ve definitely snoozed some people on social media. And there may have been some furtive mutterings with like-minded people.

When I find myself in this kind of place, I haul out my social scientist training and try to analyse the different perspectives that people are coming from. I find recognizing that people are just doing their best to make meaning of an unprecedented, complex and distressing situation helps me relate to them with a lot more compassion.

So, social scientist hat on, I see a few different sets of perspectives — these could be called mental models, discourses, narratives, framings or “interpretive repertoires“, but basically they represent the different sets of ideas that people are using to make sense of and respond to what’s happening. None of these are “truths” — they are descriptions of the different lenses that people seem to be using for deciding what level of risk taking is “correct.”

Narrative #1 describes the dominant discourse up until the last few days: Covid Kills; we need to minimize or eliminate risk of this virus as much as possible, regardless of discomfort or other concerns. This is the simplest public health message, and the one that guides the strong reaction against sending kids back to school before there’s a vaccine or immunity is understood. If I apply this lens to the dilemma Nicole described about whether running is “okay” or not, you might hear something like “yes, I know that transmission from runners to bystanders is purely theoretical, but why take the risk?” (You might also hear, in a more fundamentalist interpretation, “runners are being selfish and dangerous”).

Narrative #2 is more surreptitious but shows up in a lot of different forms: This is all a bit overblown; we are having a massive overreaction to something that isn’t that different from the flu. This tends to show up among people who aren’t seeing any first hand evidence of illness or loss. This narrative might be accompanied by stats about the number of covid19 deaths compared to car crashes, skepticism about institutions and government, or full blown conspiracy theories — a friend asked me pointedly the other day “do you actually KNOW anyone who has died? it just seems weird no one I know KNOWS anyone…” Using this frame, the dilemma about whether or not to run might sound like “I know my running feels dangerous to you, but that’s your anxiety to manage.”

Narrative #3 describes the framework that’s starting to infuse more public discussion: Covid19 is a dangerous and unknown thing, but we need to have a balanced perspective; staying locked down poses more grave risks to mental health/development/vulnerable and marginalized people/long term health for people with existing conditions/ the economy. Today’s acknowledgement that some people have died of cancer because of delayed surgeries during the lockdown is a poignant illustration of this perspective. Nicole’s description of her decision to run on the weekend fits this as well — “I pick a quieter time, I’m careful to always leave a lot of space when I’m passing anyone, and it still makes me anxious but I know I need to do it.”

Narrative #4 is a bit more blunt-edged, with a hint of darwinism: We need to find a “new normal” that includes higher risk to some for greater good. This is the perspective behind any policy based on herd or natural immunity in a world without a vaccine, and tends to prioritize collective outcomes over individual experience, fear or vulnerability. It also incorporates ideas like “we have to get back to normal life or people will just stop complying with these draconian needs/will stop consenting to be governed.” The run/don’t run discussion from this interpretation might sound like “if there are no rules forbidding it, it’s fine, just maybe think twice about visiting your grandparents.”

Narrative #5 is a bit broader, and could co-exist with any of the others, but tends to have a longer-lens perspective: Covid19 is the universe telling us to pause and stop destroying the earth; this is an opportunity for us to completely rethink our norms and never return to the same way of living. The primary impulse here is a mindfulness about collective, long-term impact of any decisions we might be making right now. The run/don’t run dilemma here would probably point us toward a need for environments that are more conducive to healthy, human-powered movement all the time, not just during a pandemic.

Laying these discourses out, I am clear that I affiliate the most with the third and fifth — which is why I can be impatient with the others. But — if I pause and reflect, I also can see that each of them resonates for me at different times and in different ways — which gives me some compassion for people in each of those perspectives. And it also makes me realize that what we are seeing right now is a tussle over what kind of harm reduction makes the most sense — but where all of the tradeoffs seem inadequate. How do we resolve it, then?

Keeping my social scientist hat on for one more minute, I haul out Mezirow’s definition of a disorienting dilemma — an experience you can’t make sense of using your existing understanding, and where the only way to move forward is to make some change in your views of the world. (Usually considered to be a key factor in transformative learning). That rings true, here — we don’t know how to factor this much uncertainty and risk into our lives and still keep our lives moving.

My hunch is that we are going to have to accept more risk, more uncertainty — with, I hope, some compassion for the disorientation, fear, worry and love that each of us is experiencing.

Fieldpoppy is Cate Creede, who is demonstrating disorientation in Toronto.

5 thoughts on “We’re all (fake) epidemiologists now: risk assessment as a disorienting dilemma

  1. I love this post Cate, thank you! Conceptualising the different narratives is really helpful and as you say, I’ve also found myself falling into one or the other at different points in time or even depending on who I’m interacting with. And I also think the boundaries are blurry between them, there’s not always a clear-cut delineation.

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  2. I’m mostly narrative 1 except I don’t think it means not paying attention to the harms of locking down society. Even if, on balance, it’s the thing we need to, we do it and address the costs and dangers where we can. We need to pay extra attention to violence in the home, pay extra attention to other health issues affected by the lock down–such as mental health, cancer treatment, etc. That doesn’t mean ending the restrictive approach. It does mean addressing the harms. For me, I’m still influenced by how quickly things flare back up again, by now much I want to avoid Toronto becoming New York. I don’t want to overrun our health care system and I want to buy us some time to learn more about how to treat people with the virus. A series of on and off lockdowns seems what we will have to do to avoid this. I am in favour of opening more spaces, as long as we can do that in a way that requires physical distancing.

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