Conversations about risk during the pandemic don't often make sense.  We talk about everything like its all or nothing; when we should be talking about trade offs instead.  That's the topic of this week's healthcare triage.  
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As I recently wrote in the New York Times; my daughter isn't happy about not being able to spend time over at friend's houses, or them at ours.  According to her she sees them at school, so what difference does it make if she sees them outside of school?  As I pointed out, she and most Americans are thinking about risk the wrong way.
We can't neatly sort every activity into a "safe" or "unsafe" category.  there are degrees of risk, and we can take actions to reduce the risk for many activities.  This was so true for Halloween; a holiday that I argued can be enjoyed, mostly, to the fullest this year with a little effort on our part.  Sure, full blown haunted houses and bobbing for apples were out, but trick'o'treating was fully on the table!  It's outside, it was on a Saturday this year so we had plenty of time to space things out.  It's pretty easy to provide candy in a socially distant manner.  Masks are an easy sell on this of all days, and candy is pre-packaged so it can easily be disinfected before opening.  
However, the CDC issued a list of "low," "moderate," and "high" risk activities for Halloween cellebrations.  Listing traditional tric'o'treating as "High Risk" and modified trick'o'treating as "moderate risk." Clearly, I disagree and I hope kids, after all they've given up this year, were still able to have some Halloween fun.  
For those activities that carry a fair amount of risk no matter how you slice it, we can manage risk exposure by engaging in some activities in lue of others.  For example, school is an important activity for my daughter for many reasons.  Yes, it comes with risks, but we can balance that risk by forgoing others, like hanging out together with friends in a basement after school.  
We should view our choices in an additive rather than all-or-nothing manner.  Imagine you've got a pile of safety and a pile of risk; when you do things like wear a mask, stay six feet away from people in public spaces and forego large group activities, you're throwing a little more on the safety pile.  When you choose to attend a gym class, play on a sports team, or engage in some other group activity, you throw a little on the risk pile.
The trick is keeping your safety pile bigger and your risk pile smaller.  To do this, you have to be willing to trade for the higher-risk activities you really want to engage in.  If that Saturday morning gym class feels critical to your mental health examine what you might be able to give up in order to balance that with less risk exposure elsewhere.  Maybe your trade off is choosing delivery over dine in when you're craving something from your favorite restaraunt.  Maybe you love massages but you're willing to give them up for now.  
From a policy perspective we've been just as bad.  Almost everyone thinks that opening schools is extremely important, including me; but no one discusses what we might be willing to close to make that happen.  If we want to make it safer for kids to attend school, we might need to consider lowering the number of people who can drink in bars, or eat in restaurants for example.  
If Americans were willing to invest in bigger picture solutions we could all have nicer things.  A massive testing program would cost money and require a lot of people to run it, but it could make many activities much safer.  Giving people the resources they need to stay home instead of work in person would significantly reduce close contacts.  Ubiquitis and affordable high speed internet would make online education easier and lots of other things easier too.  We can't all live in bubbles at Disney world like the NBA, but we could make use of their testing methods.  We could emulate their plans to hunker down and limit exposures.  We could acknowledge that they were willing to make personal sacrifices to have a season.  I'm sure millions of dollars made it easier, but lots of us would be happy with more modest, less tangible rewards.  
Even if there's lots of disagreement in society-at-large about what to prioritize, the choices we make as individuals make a big difference too.  And if enough of us make those kinds of choices, we'll all move closer to getting things more under control.  
And instead of asking why we can't do certain activities, we might consider what we're willing to give up to do them even more safely.   Even better, we might consider what we're wiling to give up so that others can do them too.  
Hey did you enjoy this episode?   You might enjoy this other episode on Brady kinin storms.  We'd appreciated if you would like the video and subscribe to the show down there and head over to patreon.com/healthcaretriage where you can help support the show even during a pandemic.  We'd especially like to thank our research associates James Glasgow, Joe Sevits, Josh Gister and Michael Chinn and of course our Surgeon Admiral Sam.