Decision-making in the time of omicron
MARY LOUISE KELLY, HOST:
Two years into this pandemic, we've gotten the hang of a few things. Wearing a mask in crowds - check. Washing our hands frequently - check. Some things are way better than where we once were. Vaccines are here. Schools are mostly back to in-person learning. Testing is more available, though rapid tests can be maddeningly hard to find over the holidays. But some things feel way worse. Hello, omicron. And with the arrival of omicron, the situation seems to be changing so fast that it's hard to figure out which activities are safe on any given day. So we wanted to check back in with Dr. Leana Wen and Gaurav Suri. Dr. Wen's an emergency physician, and Suri studies how humans make decisions at San Francisco State University.
Welcome back, you two.
GAURAV SURI: Thank you.
LEANA WEN: Great to join you.
KELLY: Dr. Wen, let's start by reintroducing a strategy you advocated when you were on the show a year ago. This was a strategy for making decisions that you called a risk budget, the idea being what?
WEN: What the idea is that we should think about risk as being cumulative. And so if - a lot of people may have this misunderstanding that if they're doing one thing that's risky when it comes to COVID that they might as well let down their guard and do everything else. But actually, it's quite the opposite that when you choose one thing that's of high value to you, perhaps you should actually be reducing the other aspects of risk in your life.
KELLY: Gaurav Suri, let's turn to how our brains are trying to make sense of it all. I am talking to you today, vaccinated, boosted, in such a better place than a year ago. And yet we're all being asked to mask up again and to test again. How are our brains processing what risks to take?
SURI: Right. One of the biggest misconceptions about decision-making is that we pursue value exclusively. Value and rationality and utility maximizing is one component of our decisions, but emotions, habits certainly enter into the picture. I think it's good to acknowledge the exhaustion that people - many people are feeling and to try to incorporate that and not force this about, oh, this makes sense and, of course, I'm going to do this because that usually leads to decisions that don't hold over time.
KELLY: Which sounds like a really reasonable approach. But let's just acknowledge the exhaustion that we all feel at this point. I mean, without wanting to depress you two, I went back and listened to our conversation on this program a year ago. Gaurav Suri, you were talking about how important it was that we protect ourselves over, and I quote, "these next three or four high-risk months." And Dr. Leana Wen, you said, quote, "We just have to get through this winter because a vaccine is not far on the horizon." That was November 2020, and here we.
SURI: But I want to say one thing - that we are not at the same exact place. We are in a better place. The risks are less than they were before. The new challenge is to acknowledge the risk that exist, acknowledge the exhaustion that we have and then adjust to it so that we make it through this coming risky period.
WEN: I certainly agree with everything that professor Suri just said. We are at a vastly different place than we were last year at this time. And, in fact, I believe that the end of the pandemic is in sight. And by the end of the pandemic, I don't mean that COVID-19 is going to go away - all of us, I think, in science and public health have accepted that it's going to be with us for the foreseeable future - but rather, that we're able to turn COVID from an existential emergency into something that we're able to cope with and to live with for the most part. I do think that the majority of people who are vaccinated, boosted and generally healthy can make the decision to move on with their lives. And those people can choose to engage in all the things that they did before with one exception, which is before they see their vulnerable relatives or friends. They might want to reduce their risk, essentially quarantine and then get tested right before seeing that vulnerable person. But I think that a lot of people can go back to life as before.
KELLY: OK. A number of friends have put this next question to me, so I want to put it to the two of you. And these are - by the way, these are vaccinated, boosting, mask-wearing, trying-to-do-the-right-thing friends who say, I just want to get it. I want to get it over with. If omicron is so contagious that this is practically inevitable anyway, why not just get sick, get the immunity - would be a bonus - and be done with it? To which each of you say what? Professor Suri.
SURI: Well, I think that exposing oneself to the true consequences of the disease might be dissuading from this notion of I want to get it. I know that this strain is less harmful, less likely to result in very serious illness, particularly for the vaccinated, but it is not consequence-free.
KELLY: Dr. Wen, how do you think about this? - this idea of, if I'm going to get sick, I want to just be done with it.
WEN: I understand where this is coming from because people are so exhausted. That said, of course, I agree with professor Suri that just getting COVID and exposing yourself to it - basically having a chickenpox party, if you will - that's not the best thing that we should be doing. There are real consequences. There's the possibility of long COVID. Also, you have the potential of spreading it to others. In addition, we do have health care systems that are really strained right now, and I'm sure none of us want to contribute to that.
KELLY: How are you two both staying sane (laughter) in this moment that a) feels endless and b) feels ever-shifting and precarious?
WEN: I think it's really hard for me and for my family, with our two little kids. The timeline keeps on getting pushed back. Now it looks like for children under the age of 5 that it may be the second quarter of 2022 that we're able to get a vaccine available for them. And so it's hard. My husband's family is all in South Africa. My husband's mother hasn't met the baby, my baby, who is now 20 months old. And so I'm looking to the future and really believing that 2022 is going to be a much better year because we now have all the science. The science, at least, is in place. Now we just have to ramp up testing and ramp up oral treatments, get vaccines. I mean, we have to do certain things. But at the same time, I believe the science is there. And I do think that 2022 is going to be much better.
KELLY: Do you want to react to that, Gaurav Suri?
SURI: I, of course, agree with what Dr. Wen said. And my own family faces many of the same restrictions she alluded to. One added component for me is the emotional aspect of it. So our emotions of exhaustion, disbelief, dismay are real, just as the virus is real. And the virus does not care about our emotions, but we care about our emotions. Acknowledging these, accepting these and saying - this is the reality of where we are. What do I do? How do I make it forward in this reality? - while acknowledging how difficult it's been and what needs to be done. Having these internal conversations, practicing acceptance, practicing looking at how I can make my way forward, being internally aware of everything we're feeling, I think, is a useful thing to do.
KELLY: Gaurav Suri, computational neuroscientist at San Francisco State. And ER doctor and public health professor at George Washington University Leana Wen. Here's to a better 2022, and thanks to you both.
SURI: Thank you.
WEN: Thank you.
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