Risk assessing in a pandemic

 

Having had all sorts of discussions online over the recent months, I thought I would write down my thoughts right now about how we assess risks during a pandemic and highlight the risks for families like mine during this pandemic. 

Some background: 

I worked as a risk manager in the construction industry for years.  I co-authored a book on risk management and taught on a Masters course about how to implement risk assessment on projects.  I understand risks and how to assess and manage them.

I am part of the relatively tiny number of working age people who are at high risk of severe illness if we catch Covid 19 (I am clinically extremely vulnerable, a shielder).  I am part of an even smaller subset of this group who has a teenager in our household.

 

Many different opinions

As the UK covid 19 infection numbers start rising again and the government brings in the rule of 6 discussions have increased about the risks of Covid 19.  It seems to me that most people can be put into one of these groups when it comes to their feelings about restrictions to gathering:

• A small proportion of people are convinced life should continue as normal.

• Some people think we should be careful but a limit of 6 people gathering is too strict.

• Some people think the rule of 6 is hard to live with but necessary.

• Some people think the rule of 6 is good but pubs and other public gatherings should be shut as well.

• A small proportion of people think we should be going back into lockdown.

It is easy to judge people who are in a different group to yourself when thinking about covid 19, I have fallen into this trap myself; but in the end we fall into one of these groups by what we feel about the risks.

The trouble is that the actual risks are different for everyone, the perceived risks are even more varied and the ability to understand risks for other people you don't know personally is very hard to assess, let alone accept.  

And of course there are many different risks at play during a pandemic:

• Risks of catching Covid 19

• Risks to mental health from changes to our lives eg loneliness

• Risks to mental health from fear of Covid 19

• Risks to the economy from lockdowns

• Risks to education

• Risks to social development of children and young people

• Risks to wider health due to impacts on the NHS 

• Risks of domestic violence

• Etc etc etc

All these risks interrelate, are different for each person and are constantly changing.  This is why it is so complex to assess risk.

So how do we assess risk?

There are two aspects to risk assessment:

1. Probability of the risk happening

2. Impact of the risk if it happens

Most people think about the chance of catching the virus when they think of risk.  The trouble is that we are all bumbling around in the dark because, at the moment (September 2020) the scientists are not absolutely sure on the ways it is transmitted.  

We "know" that the virus is spread in droplets; but we don't know how long those last on clothing or different surfaces, or how far they can spread in a classroom or office or pub or outside.

We "know" that you can have covid 19 and be asymptomatic (especially if you're young) and therefore anyone could have covid 19 in their droplets at any point in time but there's no way of knowing who.

We "know" that mask wearing and washing hands and not touching faces reduces the risk of the spread of these droplets; but not everyone can wear a mask and then there are people who think they don't help and won't wear them.  

We "know" that masks stop you sharing your droplets with others and so relatively little to stop you receiving someone else's droplets.   So we can't actually do much to protect ourselves, we have to rely on other people to take actions to protect us.

That's a lot of its and buts and variables for assessing the chance of catching Covid 19.

Then on top of that chance of catching Covid 19 there's the impact of that on the person who catches it; and everyone has a different vulnerability.  Some people won't even notice, some will have a mild illness, some will be quite ill for a while and recover, some will have an ongoing illness for months afterwards, some will be severely ill and need hospitalisation, some might die.  None of us know this absolutely sure how we might be personally affected, it's not known yet.

So it's complex, really complex to assess the risk of Covid 19 for any one of us, because we're all different and we all live different lives.

So how do we risk assess for ourselves?

Let's take a secondary school as an example for assessing the probability of catching Covid 19.  

I'm using this because my 15 year old daughter has gone back to school.  We've decided that she needs to go back for social reasons as much as educational ones and that currently the risks of catching Covid 19 are less than the negative consequences of being off school.  However we are constantly reviewing, especially as the arrangements in school aren't as safe as we would like and the numbers of cases are increasing. 

Even if we could work out the chance of someone having the virus in one of my daughter's many different classes or in the corridor; then we'd need to work out the chance that that child could pass it to my daughter.  That's possible theoretically but not practically because it depends on location in a room, air flow, if masks are worn, how the infected person is breathing etc etc etc

Then there's the impact of the risk on the person who catches it.  For most kids in the classroom (including my daughter) they probably wouldn't know they've caught it.  For most of their parents it might be a low level illness and they would recover quickly.  

For most families therefore the current probability is low and the impact is low; most people are in a low risk situation.  Though of course if they then come into contact with people who have a higher risk if they contact Covid 19 they could cause them to have a higher risk.

For me it would probably be hospitalising, possibly be fatal and if not would most likely increase my disability.

For us as a family therefore the risk probability is probably low at the moment, but the impact is extremely high.  We are in a high risk situation all the time.  

What does this mean for families like ours?

I know I am in a pretty rare situation being cev and the mum of a teenager; but it feels like we are being forgotten about.  

We don't know how to balance the risks for our daughter - she's really my prime concern rather than my own health.  

How do I balance the risk of her being off school and away from social contact in order to ensure I'm safe, with the risks of me being critically ill.  

And how does she cope if she thinks it's her actions in the world which bring the virus to me?  And it doesn't matter how many times we tell her it wouldn't be her fault, she's a bright child who understands the issues and the risks and has read the science.  

Since she is back at school I am choosing to be actively less careful so that we can honestly say I could have caught it at X, y or z if I catch covid.  I want to protect her emotionally from any perceived blame.

It's extremely difficult for all of us and anxiety is high for all of us all of the time.  We naturally see everyone as a risk and are risk assessing all the time.  

It would be so much easier if we just went back into lockdown as a family, but there are risks of that as well for mental health and for a teenagers development.

How you can help

I haven't written this to make anyone feel guilty.  I just want people to understand what some of us are living with and what it actually means to try and minimise the risks for everyone.

I don't want anyone to have to limit their lives, I don't want to make young people restrict their social contact; if my daughter was at primary school or at uni I wouldn't have the same worries because primary kids don't mix independently with friends and if she was at uni she would be away from home.  But she's in an important school year, at an important time for emotional and social development and at school with very independent teenagers who are hanging out with lots of others very closely.  

Oh and there's almost no mental health support available either, so that's just increasing the risks.

We are living in difficult times and we are all affected in some way, let's try to understand how different groups of people might be feeling and be considerate of each other.