Why I fled - Germ Nurse

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Erin Archer

Erin Archer, RN, BSN, CIC at GermNurse

Writer, Nurse, Consultant, Journalistic, B2B & B2C Content Creation.

What is your tolerance for risk of COVID infection?

If your risk-tolerance and risk-taking are above zero, are you protecting those around you who are vulnerable?

My gym re-opened 2 weeks ago. Although I advised my 75 year-old mother against returning, I’d been secretly hoping to sneak back in to a class or two a week. After all, I don’t yet have her diabetes or high blood pressure, and we mostly wear masks around each other, anyway.

Hoping that it was safe to go back after 6 months away, I began to reason with myself this week about what level of risk I’m willing to accept. The gym had announced that they were requiring masks and practicing social distancing for the duration of people’s visit, so… that’s good, right?

Unfortunately, the answer is “maybe”.

Infection Prevention During the COVID-19 Outbreak

I work as an Infection Preventionist, a professional who specializes in preventing the spread of infectious diseases. I’m also a Registered Nurse who has investigated infectious disease outbreaks.

In mid-January 2020, I began hearing stories about “2019-nCoV (2019 Novel Cornonavirus)” a SARS-like pneumonia that was emerging in the District of Wuhan, China. By late January 2020, I was working on screening protocols for my employer’s Emergency Department, screening protocols that we had hoped were overkill locally, like Ebola.

It’s only been 8 months, but it feels like a lifetime ago.

This virus’ closest relatives, SARS-CoV and MERS-CoV had caused alarming illness, but they each have had only about 800 reported deaths globally. Today, nine months into the pandemic, the world is poised to cross the threshold of 1 million deaths from SARS-CoV-2, the current name for the virus that causes COVID-19.

At first, my colleagues and I truly didn’t expect it to come to this. Arizona isn’t a massive international hub like Los Angeles or New York City, so I was flabbergasted 2 months ago, when my state had the highest positive test rate in the United States.

The accepted thinking is that our Governor, Doug Ducey opened up some of our businesses too early, in late May. A lot of people took that as a sign that things were safe and began to party in large groups. After Memorial Day, our cases exploded.

Last weekend was Labor Day. Gyms and movie theaters were allowed to open again right beforehand. Additionally, the University of Arizona students are back in town, going to classes and parties. Meanwhile, our rates are comparable to when we re-opened in May.

Epidemic curve for COVID-19 cases. Accessed from the AZ Dept of Health Services. Sept. 13, 2020.

How to Lessen Your Risk

The only way to have zero risk of COVID is to avoid people entirely. A close second is to have only a few people in your life who also avoid everyone else nearly entirely.

For those of us unable or unwilling to live that way, how should we view risk? How much risk is tolerable? For me personally, I’m willing to accept only minimal risk. I also realize that if I accept any risk whatsoever, I will need to take increased measures to protect those around me… namely, distancing and masking for potentially over 24 days per incident. Why 24 days? Let’s look at the math.

The incubation period for COVID-19 (whether symptomatic or asymptomatic) is thought to be 2–14 days. Let’s say optimistically that I develop an asymptomatic infection — I would be contagious for potentially 10 days (20 days if I had severe immunocompromise or a case of severe illness) after developing my asymptomatic infection that could begin anywhere in that 14 days incubation period. If I choose to go to a restaurant (where we remove masks) or anywhere infection control is lax, the responsible thing I must also do choose to wear a mask if I’m within several feet of my mom or anyone else for the next 3 1/2 weeks or so, or I expose THEM to my risk-taking.

Stuff We Know for Sure, Already

I have seen what this illness does to people, have seen the patients in my hospital face-down on ventilators in the ICU for months, only to ultimately die alone. I hope to never get COVID, period. Never getting COVID is the best-case scenario. The second-best-case scenario is that I would have an asymptomatic infection AND that I wouldn’t infect anyone else with it.

There is some discussion in infectious disease circles that asymptomatic infection is more likely if the level of viral exposure is low. And so that is part of my calculus also… If I breathe in virus at all, trying to make sure that I don’t breathe in a lot of it, what would be referred to as a low “inoculum” of virus.

Below are all things that help to lower the exposure risk, by diminishing the inoculum to which you are potentially exposed:

Everyone is wearing a face covering/mask and is wearing it correctly. That means wearing it over your nose and your mouth, not just your mouth. It also means not removing it to talk (which defeats the point of wearing it) and not keeping touching and fussing with it.
People are spaced at least 6 feet apart and preferably more. This does not mean that masks are not needed.
Avoiding touching your face, especially the “T-zone” of your eyes, nose and mouth, especially after touching your mask or touching “high-touch” objects in public.
Minimizing touching of objects in public, and cleaning your hands immediately afterward.
Participating in activities with other people outside. Even though this virus seems to spread by near contact with people, controversy still exists over whether the virus’ spread can be exacerbated by HVAC systems.
Minimizing yelling and singing.

What is Your Tolerance for Risking Yourself and Risking Others?

This week, Dr. Fauci warned us that we should not expect a return to anything resembling our pre-COVID normal until possibly the end of 2021, over 1 year from now. Anything that we do with others will involve risk, so it’s important that you think about your tolerable level of risk before putting yourself in those situations.

Make a risk calculation for yourself. Are you elderly or have pre-existing conditions that make you more vulnerable to getting ill?
Make a risk calculation for those close to you. Do you have unmasked contact with other people? Then realize you are bringing your risks to them. Do not be unmasked around them if they do not consent to that risk or if you cannot live with the idea that you might infect them.
Realize that certain venues like restaurants (where we remove our masks to eat) inherently contain risk of exposure. You can minimize the risk by going to restaurants that have outdoor seating or which are not busy during your visit, but some risk will remain.
Realize that certain venues like gyms (where we breathe heavily and sometimes yell) pose more risk if infection control policies are not followed.

Look around you. Are the people around you several feet away AND wearing a mask properly? Ask yourself if that is a level of risk that you can tolerate. Picture that they are an asymptomatic spreader of COVID-19. If you are both wearing effective masks without breathing valves, you will probably be ok. If the other person is wearing a mask with a breathing valve, my risk tolerance dictates that I move away from them. They are protected from me, but I may not be protected from them.

So… Why I Fled the Gym

So, why did I flee the gym? I fled the gym because their practices exceeded my tolerable level of risk. As far as I was concerned, they’d lied. They had signs up everywhere that said “Anyone not wearing a mask will be asked to leave immediately!” and “Stay at least 6 feet from others at all times.”

What was happening instead? The app used to limit flow into the gym was rendered optional, so the gym was full of people. Multiple people who came in the room for my exercise class showed up with their noses hanging out of their masks, intentionally. Some people took their masks off altogether. People out on weight floor were crammed together, and many were removing their masks when they talked to each other. College kids were taking off their masks to take selfies at the gym. Cleaning supplies were everywhere, but being used minimally. I fled before class even started, went up to the desk to cancel my membership.

Beware of businesses where their supposed “safety protocols” are for show, left in the hands of low-paid workers unable or unwilling to enforce them. Do not trust businesses to protect you.

I exposed myself to risk yesterday, even though I didn’t get a workout. I’ll wear masks at home with my loved ones for the next 24 days, while I watch with daily horror as the epidemic curve trends back upward.