Because of my professional history, I often get questions about just how seriously we as individuals should be taking the COVID-19 pandemic.

NOTE: pick the correct link

A friend suggested that “all this sheltering in place and extensive disinfecting feels over the top.”

I want to offer perspectives from my professions. I’ve had more than one.

They all bear on the information overload and confusion with which we are inundated. I am 70 years old, and this unalterable condition also influences my perspective.

Three Professions

My first profession was as a chemist. I was a hard-core biophysical chemist steeped in the theories and models of physics. Mathematical modeling was my friend, as it is with engineers. Physics is so accurate and precise in prediction that engineers can build airplanes with such reliability that failure almost never happens. This allows us to feel safe flying in airplanes.

Imagine sitting in a window seat, looking out. Three inches away is instant death, if the window fails. It never does. So few failures occur that we can sensibly claim no near-death experiences when we fly. We expect this kind of risk-free existence in our automobiles, high-rise elevators, electrical and gas outlets, and traffic-light managed intersections, even though instant death is potentially inches away. We unconsciously expect such unfailing safety, constantly.

COVID-19 drive-thru testing in Kakaako Waterfront Park, March 29. There are few certainties when it comes to this pandemic. Cory Lum/Civil Beat/2020

My second profession was a physician. I encountered death. I resuscitated patients, succeeding and failing to save a life. I saw dead bodies, many of them children. I consoled, cried, carried on with my duties. If you are a doctor, a nurse, an emergency medical technician, then you know this. If you fought in a war, you experienced death and dying that is seldom shared.

Doctors know how to diagnose and treat disease. They are experts in applied biology. The individual is their world. Since we have all been patients, we can relate to this one-on-one relationship. We expect our doctors to definitively know from what we suffer and how to deal with it. Even if there are diseases for which treatment is not so definitive, doctors are good at supporting our bodies and lives until we heal ourselves or learn to live with our situations.

We have come to expect of our physicians the same level of surety that we unconsciously expect from engineers. But the focus is the individual, with names like George or Susan. We are hardwired to think and feel this way, and this is socially reinforced.

Error And Misinterpretation

My third profession was in public health, specifically epidemiology. While the focus in medicine is the individual and the biology of humans, public health and especially epidemiology focuses on groups described by numbers; but it is complex, and the numbers are highly prone to error and misinterpretation.

How many cases of COVID-19 are there in African-Americans working as caregivers in Brooklyn? Is there an association between this group and how sick they get, compared to African-American caregivers in Mississippi? What causes an association?

Epidemiologists constantly live with a high degree of ambiguity.

How to count, who to count, how to measure, what kind of association, is it causal or confounded? It gets complicated quickly.

Epidemiologists constantly live with a high degree of ambiguity. They lack the specificity of science theory and measurement systems found in engineering and medicine.

They learn to deal with this in ways that other public health experts appreciate, but which can be difficult to comprehend without specific education and experience.

Compared to the more assured focus of physicians, and especially the deterministic focus of engineers, public health relies much more on instinct to sort out confounding and confusion.

In summary, engineers have been so successful in creating certainty that our culture expects certainty in all aspects of life. Focused on the patient, physicians seek a similar level of certainty with measurable success, but under very complex science.

Public health is the poor stepchild. Its science does not lend itself to causal understanding in the same way as biology, and its methods are inexact. But it is the only way to understand what is going on in communities.

How Does This Relate To COVID-19?

The problem in sorting things out in our personal lives — what to do — is compounded by ambiguity, misapplication of the wrong science, unrealistic expectations, and poor communication at multiple levels. The press and politics are responsible for much of this, especially at the national level, but less so at state and local levels. Of course, our own personal and conditioned expectations and behaviors are also responsible.

My focus is only on the question of how to sort this out in our personal life. From the preceding section several points can be made:

  • We as a nation and we as individuals have come to expect certainty in every aspect of life, even when it was never there. We have become conditioned to expect a risk-free existence and expect our environment to be such, constantly.
  • With notable exceptions, we as a nation and as individuals have little experience with death, dying, and serious disease compared to our grandparents and great-grandparents.
  • Our leaders and our stewards of daily information — the press — suffer from the same expectations and behave accordingly. Yet, we as individuals look to them with expectations of infallibility, which neither group rarely nor sincerely admits.
  • We are ignorant of 1) the biology of this virus; 2) the dynamic between medicine and public health; and 3) the cultural and personal balance between the roles of individual freedom and social welfare. Our ignorance requires us to seriously examine what we need to change, now:
    • We can do nothing, individually, about ignorance of the biology of this virus.
    • We can resort to established yet forgotten public health practices that allow us to live 
with ambiguity and ignorance, but which will protect us as individuals.
    • We can re-examine just where the balance is in valuing personal freedom and social welfare. This is not limited to what is spoken or written. It is how we shall act.

Like A War

As much as we want engineering certainty, it is not possible to predict who will die just because we are older or because we may have a susceptibility caused by unknown predispositions. We will not know. We will not know if we are asymptomatic carriers, and our loved ones and the strangers with whom we come into contact will not know we are carriers.

We will not know if a doorknob, a faucet, or an ATM key was last touched five minutes before by someone shedding virus. We will not know if the pizza box or the delivered bag of groceries was inadvertently contaminated. We will not know.

The only way we can protect ourselves is constant avoidance.

As a physician, there were situations where “fanatical” behavior was expected. One was surgery: don’t contaminate the wound. Another dealt with a patient who was highly susceptible to infection: don’t drag germs into their environment. A third was a patient who had a highly infectious disease: fail to protect yourself and you will get bubonic plague.

I learned to be constantly conscious of whether I was properly suited up and where my hands were at all times. I constantly kept this in mind and behaved accordingly — and did my job. This is the world of clinical medicine.

In the public health world of quarantine and sheltering in place, of prevention, our homes are safety zones. We can relax, to an extent. But leave the boundaries and it’s a different world; come back from the outside and we must wonder if we’re bringing contagion back home.

This pandemic has been likened to war. The analogy works well. In combat, base camp is relatively safe. Everyone looks out for everyone else. The enemy is very reluctant to attack a well-fortified camp. Leave its boundaries and it’s a different story. One’s mind goes into hyper-alert. One’s senses become so finely tuned that nothing escapes notice.

Nighttime is worse. The enemy cannot be seen but they are there. You can smell them, literally. You and your buddy will die if you don’t pay attention, and it’s your buddy who will help you just as you help him.

This analogy to combat is relevant in placing the importance of behaving in a certain way to protect yourself and your loved ones. It is to avoid being “exposed” to missiles hitting you, to coming your way, to being covertly insinuated into the safety zone.

What makes it tougher than combat is that we never see the enemy and we never know for sure where they are. Because we never know, the only way we can protect ourselves is constant avoidance. This is doable.

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About the Author

  • Dan S. Sharp
    Dan S. Sharp, M.D., is a former associate director of science at the Health Effects Laboratory Division, 
National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention. He served as director of the Honolulu Heart Program from 1992 to 1997, located at Kuakini Medical Center.