Redefining Our Risk Tolerance During “Re-entry” in the COVID-19 Era

By: Richard G. Fried, MD, PhD

Life is a dangerous and unpredictable endeavor. Sadly, in the end, no one gets out alive. Prior to Covid-19, most of us consciously or subconsciously made peace with the reality that life comes with risks that cannot be completely obviated. Attempts to decrease our risks such as healthy eating, regular exercise, weight control, moderation in indulgences, safe driving, medication adherence, and avoidance of people and places that are known to be dangerous provide for us a sense of control. These “healthy and smart” behaviors have been statistically proven to decrease the probability of premature illness and death. We believed that we were mitigating risk. Sadly, in addition, there was always a concomitant threat to our wellness and viability. Viral, bacterial, fungal, and parasitic infections have been well known threats for many millennia. With the advent of the Internet and the plethora of information sources available, we regularly heard warnings and horror stories about hepatitis, HIV, meningitis, Zika, Ebola, SARS, MEARS, Herpes, gonorrhea, chlamydia, flesh eating Strep, MRSA. Somehow, most of us maintained our equilibrium prior to COVID-19. We managed to assimilate these threats in such a manner that allowed us to engage sufficiently with others in order to work, maintain our family relationships and functioning, sustain and nurture our friendships, and engage in recreational activities without undue or overwhelming fear and anxiety. Now, things are different. As we contemplate and navigate re-entry into our “previous lives”, examination of our risk tolerance consciously or subconsciously is mandatory.

Disengagement-isolation risks. In the early months of the Covid pandemic, the mandated forced quarantine literally overnight ripped people away from their jobs, families, friends, houses of worship, and recreational activities. It was in many ways analogous to being kidnapped and held hostage. For many, the emotional sequelae were very severe including debilitating anxiety and depression accompanied by feelings of anger, helplessness, hopelessness, confusion, and desperation.  For some, as time passed, they responded to COVID-19 and its imposed human losses in emotional stages of grief analogous to those described by Elizabeth Kubler-Ross in her book on death and dying denial, anger, bargaining, depression, and acceptance. I believe that across the globe, it appears that many individuals are still progressing through these stages. Those who have successfully arrived at an emotional place of acceptance may be best suited to deal with their re-engagement into society. However, for others, arriving at emotional acceptance may be analogous to acquiescing to their COVID-19 capture and imprisonment, losing the drive for freedom. Clinically, this may be manifest by an apparent apathy. Many may have forgotten the simple joys of human contact and desires for it have been subjugated to ongoing fears and inability to even imagine taking the “risk” of re-engagement.

 The early work of Spitz during the second world war with orphaned children who were unexplainably wasting away despite being fed led to the concept of “failure to thrive”. Once human contact was reestablished during the attention and physical handling that occurred during their evaluations, these children reversed their physical deterioration and began to thrive. The present geriatric literature is replete with similar deteriorative occurrences with isolation and/or loss of a loved one.

How many have been unable to see their parents, children, grandchildren, friends, coworkers, co-exercisers, waiter or waitress, grocery store cashier? A looming and distressing question is how much isolation, for how long, and in whom, until there is irreparable damage done to the psyche, body, family, friends, and vocational viability?

Contemplating re-entry. The occurrence of the COVID-19 pandemic has forced every one of us to re-examine and potentially redefine our risk tolerance. How safe must the world be before we reengage with the people, places, and activities that previously defined our lives. Both personally and professionally, most of us have observed a wide range of perspectives and behavior. We have seen via remote telemedicine those who have not left their homes since March 2020, unwilling to take any perceived risk of acquiring Covid and its potential ravages on themselves and their family members. At the other end of the spectrum, there are those who deny the existence of Covid and have not curtailed their behaviors one iota since the beginning of the pandemic. As each day passes and the numbers of vaccinated persons increase, returning carefully and abiding by CDC recommendations will likely be a relatively safe endeavor (unless a resistant and more virulent Covid 19 variant occurs).

Risk tolerance during reentry from Covid captivity. Obviously, no matter how we redefine our risk tolerance, a “risk-free” life is not an attainable goal. Even if we stay confined to our own place of shelter and isolated lives, there are risks. Fire, carbon monoxide poisoning, burglary, falls, and meteorites crashing through the roof occur. Aspiration, myocardial infarction, fatal arrhythmias, cerebrovascular accidents, and ruptured aneurysms can and do occur. Thus, we are not necessarily “safer” living isolated from the outside world. Hugs, smiles, breaking bread with others, scintillation of the visual-auditory-gustatory-olfactory-tactile senses, all are hallmarks of meaningful engagement in life. Perhaps it can be stated succinctly: do we wish to “exist in life or live our life”. Human connectedness extends the quality and length of our lives. The pace and extent of re-entry into the outside world is a difficult and nuanced process for each of us. For some, “existing” in a largely isolated place removed from others with perceived personal safety is sufficient. For others, existence without engagement is intolerable. It is my sincere hope that each of us choose our re-engagement strategies carefully and judiciously allowing reasonable protection for ourselves and others. I also wish to assure you that with gradual re-engagement, your comfort level will return allowing you to find a “new normal”, which may or may not include contagion precautions that were not part of your pre-Covid 19 life.

I urge you to not be disheartened by the ubiquitous chants stating that “things will never be the same”.  This is a truism as it always has been. Historically, as time and life move on, things change both for the better and worse. Fear not, change is good and can be exhilarating for the mind and the body! Take a deep breath, look out your literal and metaphorical window. Carefully contemplate what are you willing to “risk” for your sustenance and happiness today and tomorrow.

 You obviously have survived today’s perils associated with venturing out of your bed and carrying out your morning routine and the necessary activities of the day. All other events and endeavors are relegated to your “daily possibility plate” for contemplation. Please remember that all of today’s contemplative decisions are not etched in stone. Each step during the reentry often does not necessarily “feel right” at first. And then before you know it, these steps feel natural and liberating. Please recall and be assured that the mind, body, and psyche have an amazing ability to bring us back to a comfortable place of health and happiness. Allow me to reiterate, life is a risky business. May each of us safely dip our toes, noses, and hearts into the post COVID-19 world of opportunity and reengagement.