COVID-19 Risk Tolerance

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COVID-19 Risk Tolerance
Lt. Gen. Mahmud Ahmad Akhtar

As the number of reported cases of Corona have dropped, the people have questions: Will it be safe to travel by bus train or plane. Visit the hair Saloon, to have indoor meetings, to attend Muharram gatherings or to open schools etc. These are vital decisions about lives and livelihoods.

There are many known parameters in the equation; the health condition, the prevalence of cases where a person lives; the safety precautions being observed at the places to be visited but the final answer may depend on individuals own risk tolerance to exposure to infectious diseases. Most Pakistanis alive today have never before had their self-assessment. Elizabeth Rosenthal a physician and medical journalist from USA says “Most Americans have never before had their self-assessment”.


Lt. Gen. (R) Mahmud Ahmad Akhtar

In the past the deadly out breaks of cholera, plague, flu and polio were regular occurrences up until the end of 20th century there were measles, mumps and chickenpox to contend with- in Pakistan and Afghanistan polio also. In a world of effective antibiotics and anti-Virals and other advances in treatment, deaths or even serious illness from infectious disease seems nearly incomprehensible. So our fear is enormous and our risk tolerance for exposure is just zero.

There are people depending upon vaccine saying “we are not going back to life until there is a vaccine”. They expect that vaccine will immediately eliminate risk. Epidemiologists and clinicians opine that it will not. Even if one of the vaccine works, it would take a long time for it to be widely distributed- more so in the developing world countries not practicing Universal Health Care System.

There are many other issues involved before the vaccine is available to the public- particularly to the people of low middle income countries. Dr. Rosenthal says “For the foreseeable future the people will be living in a world with some level of coronavirus out there”. So if we want to get out of our bunkers, we will all need to take stock of our risk tolerance.

These decisions should not mean ignoring the data and the specialists recommendations as it is seen what many people are doing these days as they throng the markets, offer prayers in the mosques, hold Muharram Majlis indoors, are planning to open schools, indoor restaurants, sports events etc.- not using mandates masks, not observing physical distances etc. Some still saying “It is hoax”. Our National response is so scattered, flat foot and incompetent.

Actually it is kind of the opposite. Accepting risk does not mean throwing caution to the wind. It means taking all precautions and deciding that one can live with the very reduced risk that remains. With the coronavirus the only way to eliminate all the risk is to move to the country side and live in a family bubble. It is a privilege of only a few wealthy people.

Masks should be mandatory and enforced till it becomes a part of the National culture as being done in the countries like Japan, Cambodia, Singapore, etc. Mask is not about individuals risk tolerance but about keeping everybody safe. Sanitizing as is done in the hospitals/clinics should be done everywhere. In addition to mask and physical distancing when not at home, one should avoid prolonged periods in indoor spaces with crowds or strangers, wash or sanitize hands and try not to touch “high- touch” surfaces that a lot of people have grabbed before. There should be automatic doors rather than doors that have handles. We have to demand that everywhere we go- buses, trains, hair saloons- require that the patron follows the guidelines strictly.

About the reopening of schools, once school’s administrations have put in place appropriate science based steps most teachers (not high risk group) and children (again not the high-risk group) should return to schools. In Pakistan, many public schools don’t have potable and running water, electricity, furniture, soaps, sanitizers etc.

Covid-19 is a very serious disease but it is not the Black-Death which killed up to half of Europe in the 14th century. About the Covid-19 messaging to the public should be in the correct lines to avoid like the wrong one done earlier. Appropriate fear of epidemic is a factor employed in prevention. A vaccine when and if it comes will be a big help. But in the meantime we have science, we know what ensues Covid-19, how to detect or prevent and treat it every day. It is time to take stock of our risk tolerance. In those places where governments, businesses, administrators have to set the stage properly we can with sensible precautions begin to live again.

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