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  • Dr. Kemia

Stay In The Discomfort of Uncertainty


The grey mists of uncertainty always breed intense discomfort. Unfortunately, in our haste to move out of uncomfortable places we can all-too-easily position ourselves at the binary poles of abject fear or sneering disdain.


Neither of these extremes are healthy; not for mind, soul or body.


We are all trying to learn to live with varying degrees of emotional and psychological discomfort. One day, I seem to have a handle on it: I’m rational, I’m calm, I’m unhurried, I’m patient, I’m organized and I’m able to provide comfort to those around me. The next day (ok, hour. The next HOUR) I’m down the rabbit hole, convinced this is psychosocially unsurvivable and willing to lick a Covid covered doorknob to put an end to the latest round of homeschool-teacher failures (mine) and marathon-zooming (marazoom? Zoomathon? Somebody help me out, here!)


*Pro-tip: don’t lick doorknobs, even coronacovered ones. Firstly, this is a respiratory virus and it will do nothing in terms of moving you into that “herd-immunity” category and, depending on the doorknob, you are likely to end up with e-coli. Secondly, gross. Thirdly, I can’t believe I need to put this disclaimer in here, but these are strange times in which we live…


(also, don’t drink or inject cleaning supplies or UV light)


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My goal was to chase fewer squirrels today as I write but, as I’ve mentioned previously, linear thinking has become an increasingly rare commodity.


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We live in truly uncertain times. And not for lack of seeking clarity: Everywhere I turn I see people – politicians, scientists, physicians, educators, everyone -- grasping for something Certain. Certainty feels safe, and the simple fact that safety is absolutely illusory seems utterly lost on us all.


Let me begin with an acknowledgment that this is all incredibly, unbelievably overwhelming, frustrating and confusing. Recommendations keep changing. The data keep changing. The modelling keeps changing. The “worst case” keeps changing. The peak keeps changing. Potential dates for “reopening” or a “return to normal” keep moving. And every day brings new and seemingly contradictory information from across the country and around the world.


(That said, if the only thing that doesn’t seem to change are your pajamas, now would be the right time for that.


I’ll wait...


And while you’re at it, grab a tall glass of water ‘cause hydration, y’all. We keep talking about hydrating, and still…)


Ok. You back? Hydrated? Breathing? here we go.


I want to gently push back on the notion that “by now we should know what to do.”


Covid19 has been around for 5 months, America. FIVE. Granted, the last two months have been the longest decade of our lives, but scientifically speaking, five months is NOTHING – a blip.


The rate at which the scientific community is accumulating data on this pandemic is absolutely astounding and utterly overwhelming. And it is the overwhelm that has us all running away from that grey area of uncertainty in which we actually learn and grow, and into dangerous, binary ways of thinking, believing and behaving. Fear or Disdain become our natural choices. Neither end of the spectrum is appropriate.


FEAR is not useful in a pandemic. Fear is a thief that steals our ability to reason, to weigh multivariate options and to make rational choices. It tells us that nothing is ok, that everything is dangerous, and that our only option is to hide. I want to remind us all: the point of statewide#suppressionstrategies was NOT to wait it out until the virus disappeared and the “danger passed.” The point was to slow the spread, thus flattening the curve and buying time for our healthcare systems to come online with enough staff, stuff and space to deal with the (approximately) 5% of Covid19 cases who would need critical care.


I’ve written many, many times before: for most of us an infection with Coronavirus will NOT be life-threatening. And hidden in the avalanche of data we’ve been collecting is this piece of good news: the denominator of this disease is much bigger than the original data showed it to be, meaning that the case fatality rate is lower.


(No. this is STILL not “just like the flu.” It is much, much worse than the flu for all the reasons I’ve previously detailed).


DISDAIN is not useful in a pandemic, either. In particular, it is not useful – is in fact HARMFUL – in THIS pandemic. Disdain tells us that because the science is continually evolving (that’s how science works, folks) that all of this is useless, overblown hooey. That we have crashed the world’s economy for no reason and that it is “Time To Get Back To Normal.” Disdain would have us reopen it all and let the chips fall as they will as we rush to bring the economy back online.


Disdain is particularly dangerous in this pandemic because, while it may be time for us to begin making moves to reopen and restart certain industries and businesses, we also must do so in a way that mitigates and dampens the risk to one another. Our best protection going forward is US. I protect YOU by masking and keeping some physical distance between us; you protect me in the same way. When we understand and respect one another in this way, we mitigate the risk to all of us as we reopen.


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So here’s our Friday roundup (for those of you who have lost track, it is Friday, May 1.


Yes, it is still 2020…)


What we know:


The White House has published a plan for reopening America. It is a tiered, risk-stratified approach that leaves much of the decision making to state governors. It does lay out a series of provisions that must be met when moving from one tier to the next, including testing, contact tracing and trends in new cases. Unfortunately, we are still probably many weeks away from meeting the testing provisions laid out in this plan (we need, at a minimum, to be conducting 500k-1m tests/day), and even further away from having an adequate number of trained contact tracers (nationally we have about 1,500 – we need more than 100,000).


*Reliable Links in the Comments*


The question, then, is do we move forward without the ability to identify and quickly tamp down new flares?


Yes/And.


Yes we need to reopen, AND we may need to reopen more slowly that many of us want. We need to remember that every day we delay we increase our ability to test and trace (and treat!).


Yes we need to reopen, AND we need to accept that there will continue to be necessary limits on the size of group gatherings in order to continue to slow the spread and mitigate unnecessary risks.


Yes we need to reopen, AND we need to commit to taking care of one another through pathologically rigorous handwashing.


Yes we need to reopen, AND we must dedicate ourselves to protecting each other through universal masking when indoors.


Yes, we need to reopen AND we must accept that it won’t be an immediate “return to normal” – physical distancing will allow us to continue to keep that curve flatter by slowing the spread of the illness.


Yes. We need to reopen. AND we need to work together to chart a new normal until we have a vaccine. This is mile 9 of the marathon, folks – we aren’t even to the halfway point, yet.


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A few additional reminders:


1. There is no vaccine, and we are at least 9 (very unlikely) to 24 months away from having one

2. As we reopen there *will* be flares. WE can reduce the number and severity of these flares by doing our best to take care of each other. When you see me walking around the grocery store in a mask, that is me taking care of YOU. That is me telling YOU that your health and your life – and the health and life of the people you love – is important to me.

3. This is a tricky virus. The average time to onset of symptoms is 5.1 days. That means that for 5 days each one of us can be walking around, unknowingly infected and unknowingly infecting others. Universal masking when indoors coupled with rigorous, frequent handwashing and physical distancing of 6 ft can reduce that risk significantly.

4. Living in rural America is no protection from this virus. I’m including a link to the John’s Hopkins tracking site in the comments – they’ve done a nice job breaking it down by county and you’ll see that we have significant flares in many very rural parts of the U.S..

5. There is currently no “cure” nor any reliable medication for Covid19.

6. Despite the extraordinary measures taken thus far, more than 60,000 Americans died in one month. Our vigilance going forward will help keep additional numbers as low as possible.

7. Fear doesn’t help in a pandemic. Caution and respect of others, do.

8. Disdain doesn’t help in a pandemic. Care and respect of others, do.


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We are all going to have to begin deciding what our risk tolerance is in all of this, because unfortunately, there’s no perfect answer for how each one of us should move through it. We know that above the age of 50, Covid mortality doubles with each decade of life. And yet my otherwise healthy, *older* mom would very much like to begin interacting with her grandsons again. We are having conversations around what that might look like: what interactions constitute reasonable risk for her? I suspect that in the weeks and months to come, many of us will be evaluating our lives, our interactions and making determinations about our risk tolerance.


I would ask, however, that when deciding for *others* that we always err on the side of protecting one another. That we show respect and kindness for our fellow Americans by doing all we can to continue to mitigate risk to each other. That we don’t assume that because our risk tolerance is relatively high, that the person we are encountering in the store feels similarly.


Let us choose to be gently and consistently protective of each other in the weeks and months to come.


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Everywhere I look I see trauma.


I know. Occupational hazard with more than a little confirmation bias thrown in. But truly: all I see is trauma. I see it in those living in fear. I see it in those living with disdain. And I see it in all of us occupying the grey middle ground.


I see it in my physician colleagues, in healthcare workers, in teachers, in administrators, in business owners, in parents, in students, in essential workers... all of us.


I hear it in your phone calls and your email.


I see it in the eyes of masked shoppers, and I heard it in the angry words of the unmasked woman who stepped right into my masked face in the grocery store.


I see it when we’re zoomathoning (yep. I settled on that)


I know that real-time trauma mitigation can help, and that we are all capable of doing this for each other. It happens when we take a breath, take a moment, and genuinely listen to, connect with and protect one another.


We can do hard things.


Keep being brave, generous and kind, always.


More soon,


K






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Contact us at 217.691.4441 or kemia@lodestarpc.com