The COVID-19 Discussion Thread (OTB)

[Trebuchet]

I'm in my early 70's with a couple of underlying conditions, so have been very careful. My wife is a year older with much more serious underlying conditions, and would likely not pull through if she got it, which doubles our carefulness. But I still have to go into town periodically. Today I had to go look to an auto parts store, a jeweler, and two groceries. It worries me.
My cousin is older than me and has been even more careful, getting everything delivered. But she got it anyway.
And my other cousin, younger than me, lived in a state that was doing the denial thing. She got it and died.

I don't know if there's any point to the above. More just frustration, I guess.

[profloater]

Perhaps "Am I likely to die if I catch Covid?" is significant. But people (my wife's friends, for example) can acknowledge that they do have a significant chance of dying if they catch the disease, while believing that so long as they stay within the official guidelines they will be protected from catching the disease. So there's no problem, as far as they perceive personal risk.
My colleagues in hospital are in despair over how often they hear, "But I always wore my mask!" from people who have developed severe Covid. There's a really widespread belief that world is cleanly divided into "safe behaviours" and "unsafe behaviours", and that masks in particular are some sort of miraculous "get out of Covid free" card.

Grant Hutchison

Yes I see that too. The letter of the law but not the spirit. A kind of self delusion even if the basic idea of infection is quite easy to grasp. It seems to be explained over and over, yet people fall back on a guideline that is clearly, well, not an instruction that if meetings of six are lawful, you must go out and find five people to mix with.

[Noclevername]

Yes I see that too. The letter of the law but not the spirit. A kind of self delusion even if the basic idea of infection is quite easy to grasp. It seems to be explained over and over, yet people fall back on a guideline that is clearly, well, not an instruction that if meetings of six are lawful, you must go out and find five people to mix with.

For something to be easy to grasp, first you have to want to understand it. Too many are deep in denial, automatically tuning out sources that contradict their existing assumptions.

We really, really need classes in Critical Thinking in our schools. Our biases are literally killing us.

[grant hutchison]

For something to be easy to grasp, first you have to want to understand it. Too many are deep in denial, automatically tuning out sources that contradict their existing assumptions.

We really, really need classes in Critical Thinking in our schools. Our biases are literally killing us.

I think that's certainly a problem.
More common, in my part of the world at least, are those people who are in general well-informed and quite capable of critical thinking, but prefer not to ever think about things relating to their health, and instead put their trust in authority figures. "Whatever you think's best, doctor."
I actually did some research on this, decades ago, asking people what sort of information they wanted to know about their anaesthesia and surgery, and what things they would prefer not to know. I handed out the same questionnaire (with minor linguistic differences) in Ontario and Scotland, and the difference was astonishing. Folks in Ontario seemed avid from every little detail of the horrors that might befall them, whereas Scots just wanted to be along for the ride. (And I didn't get much sense of a change happening, up to the time I retired.)
I think that's probably what's going on with my wife's friends--they'll follow the letter of the guidance (while always seeking back towards making life as normal as possible), but are utterly unwilling to think about the problem beyond that, even when it has implications for their health.

Grant Hutchison

[Jens]

I handed out the same questionnaire (with minor linguistic differences) in Ontario and Scotland, and the difference was astonishing. Folks in Ontario seemed avid from every little detail of the horrors that might befall them, whereas Scots just wanted to be along for the ride. (And I didn't get much sense of a change happening, up to the time I retired.)

That’s kind of fascinating. I really wonder what the source of the difference might be. Whether it’s people in the new world versus those in the old world, or perhaps language differences.

[grant hutchison]

That’s kind of fascinating. I really wonder what the source of the difference might be. Whether it’s people in the new world versus those in the old world, or perhaps language differences.

At the time, we wondered if it arose because of differences in the emphasis on "informed consent" in the two countries--respondents in Canada put a lot of emphasis on having a "right to know" certain things, whereas Scots almost never did. The things Scots wanted to know were generally what we called "landmarks to recovery"--when will I be able to eat and drink, when can I go home, and so on. But on the whole they were very keen not to know anything about rare life-threatening complications.
But I suspect there's also a pretty deep cultural difference too. I once had the idea of an international study comparing people's attitudes to doctors with their attitude to restaurants--I wonder if there's a correlation between a culture's desire to second-guess the chef in a restaurant ("Could I have this, but without this, and maybe some of this instead?") and their desire to be talked through every little detail of their medical treatment.
Anyway, when you're at the coal-face it's a real problem if some people want to know every horrible thing that might happen to them, and many don't. The people who want details will usually feel better after hearing them, because it gives them a sense of control over the decision-making; the people who don't want details will definitely feel worse if they're given that information. And we know that outcomes after anaesthesia and surgery are better if people go into the process with a low level of anxiety. So I was always juggling the issues of informed consent versus paternalism.

Grant HUtchison

[profloater]

Having been through that with an emergency appendectomy followed in a few months by a heart valve repair I knew in both cases there was no alternative so I just let the anaesthetist get on with it. I was interested to know , and sign for, the a,b,c,d options for the heart valve but had no interest in the dead on the table odds, since I was not going to pull out and reckoned on not being aware of the last possibility. But then I still have to weigh up blood thinners. Reduced stroke risk vs bleeding. Here it feels more like a real decision with genuine options. But if there is no option, why worry about the risks?

[21st Century Schizoid Man]

At the time, we wondered if it arose because of differences in the emphasis on "informed consent" in the two countries--respondents in Canada put a lot of emphasis on having a "right to know" certain things, whereas Scots almost never did. The things Scots wanted to know were generally what we called "landmarks to recovery"--when will I be able to eat and drink, when can I go home, and so on. But on the whole they were very keen not to know anything about rare life-threatening complications.
But I suspect there's also a pretty deep cultural difference too. I once had the idea of an international study comparing people's attitudes to doctors with their attitude to restaurants--I wonder if there's a correlation between a culture's desire to second-guess the chef in a restaurant ("Could I have this, but without this, and maybe some of this instead?") and their desire to be talked through every little detail of their medical treatment.
Anyway, when you're at the coal-face it's a real problem if some people want to know every horrible thing that might happen to them, and many don't. The people who want details will usually feel better after hearing them, because it gives them a sense of control over the decision-making; the people who don't want details will definitely feel worse if they're given that information. And we know that outcomes after anaesthesia and surgery are better if people go into the process with a low level of anxiety. So I was always juggling the issues of informed consent versus paternalism.

Grant HUtchison

I have heard people complain about the way they are treated in hospital, often citing a loss of control - people do things to them without necessarily explaining or asking, etc. On the relatively small number of occasions I've gone to A&E (and I regret to say two of the three occasions were in 2020 ), I've had rather the opposite experience - something of a feeling of relief once they plunk me down in the wheelchair. Once that happens, whatever it is, is now someone else's problem.

Perhaps it would be different if the condition were intensely painful or life-threatening - mine weren't life-threatening, and only moderately painful. On the last occasion, it took me a couple of days to get in, because I didn't realise how bad it was at first.

[Gillianren]

I know that, four years ago, I was asking Irene's doctor what the best-case scenario was and not the worst-case, but as I told him, I could easily imagine all the worst-case scenarios myself.

[Noclevername]

It comes down to being aware what affects you personally versus just having things happen to you out of the blue. I have enough of stuff just happening to me in my life. It makes me feel helpless, powerless to be a passive recipient of actions that can directly affect my present and future. Ignorance is only bliss if you don't know you're ignorant, otherwise it just drives fear.

[schlaugh]

All of which reminds me of a story Rodney Dangerfield would tell about the time he went into hospital for a procedure. A reporter asked how long Rodney was going to be staying in the hospital.

“If it all goes OK, a couple of weeks. If not, a couple of hours!”

[grant hutchison]

Yes, a lot of this is about locus of control. Having a disease is a loss of control, and some people feel better if they feel empowered to any small extent--even listening to a list of potential problems and formally accepting them is a way of feeling, "I'm still in charge of what's happening." Other people, though, feel their sense of control ebbs even further if they're given a list of additional things to worry about which they'd never even considered before. So doctors need to be sensitive to those particular coping styles--giving people what they need, but not overwhelming them. When things are really down to the wire, people often just want to ask, "If it were you, doctor, what would you do?"
The other side of that, though, is something profloater alludes to--that when it comes to choosing between roughly equal risks of very different kinds of bad outcome, people can have very different attitudes, either because of their circumstances, or because of the emotional weight they assign to certain outcomes.

Grant Hutchison

[Swift]

I think that's certainly a problem.
More common, in my part of the world at least, are those people who are in general well-informed and quite capable of critical thinking, but prefer not to ever think about things relating to their health, and instead put their trust in authority figures. "Whatever you think's best, doctor."
I actually did some research on this, decades ago, asking people what sort of information they wanted to know about their anaesthesia and surgery, and what things they would prefer not to know. I handed out the same questionnaire (with minor linguistic differences) in Ontario and Scotland, and the difference was astonishing. Folks in Ontario seemed avid from every little detail of the horrors that might befall them, whereas Scots just wanted to be along for the ride. (And I didn't get much sense of a change happening, up to the time I retired.)
I think that's probably what's going on with my wife's friends--they'll follow the letter of the guidance (while always seeking back towards making life as normal as possible), but are utterly unwilling to think about the problem beyond that, even when it has implications for their health.

Grant Hutchison

I've never noted such a difference from country-to-country (but I wasn't looking either), but I have noticed this difference from person-to-person. There are people who want to be as informed as possible about their medical problems and those who, as you say, just go along for the ride. I'm certainly in the former category, having discussed journal literature with my gastroenterologist, for example. My wife is not completely, but tends toward the later category.

[Jens]

It comes down to being aware what affects you personally versus just having things happen to you out of the blue. I have enough of stuff just happening to me in my life. It makes me feel helpless, powerless to be a passive recipient of actions that can directly affect my present and future. Ignorance is only bliss if you don't know you're ignorant, otherwise it just drives fear.

It's definitely tough, because as humans, we are always recipients of actions that can directly affect our present and future. We can never operate in a sphere that we can actually control. And yes, it definitely makes us feel helpless.

I was thinking of this, because I was listening to one of my favorite songs by Peter Gabriel, that sort of deals with that theme.

https://www.youtube.com/watch?v=r1JPO91IpV4

[grant hutchison]

I've never noted such a difference from country-to-country (but I wasn't looking either), but I have noticed this difference from person-to-person. There are people who want to be as informed as possible about their medical problems and those who, as you say, just go along for the ride. I'm certainly in the former category, having discussed journal literature with my gastroenterologist, for example. My wife is not completely, but tends toward the later category.

Yes there's wide interindividual spread--both Ontario and Scotland had people with attitudes spanning the whole range of responses. The statistically significant differences in what we grandly (and unjustifiably, given the scope of our research) called "national attitudes" show up strongly in the median scores on our little assessment tool. Our publication spurred a few other studies, using the same questionnaire, in other countries--I have absolutely no recollection of what people found, though. And in any case it was a good thirty years ago.

Grant Hutchison

[grant hutchison]

Ignorance is only bliss if you don't know you're ignorant, otherwise it just drives fear.

Well, it's undoubtedly possible to know you're ignorant and be more happy and less fearful because of that--as witness the many patients I've had over the years who have specifically asked not to be told stuff. (That was the germ of the idea that led to our research project.)
People who find lack of knowledge a fearful thing always seem to struggle to understand the viewpoint of those who would prefer to avoid certain information, and who prefer not to be involved in potentially life-changing decisions about their own health. And vice versa. But these are both cognitive strategies that let people get though life with the minimum of stress and anxiety, and I think we need to accept both.

Grant Hutchison

[Noclevername]

People who find lack of knowledge a fearful thing always seem to struggle to understand the viewpoint of those who would prefer to avoid certain information, and who prefer not to be involved in potentially life-changing decisions about their own health. And vice versa. But these are both cognitive strategies that let people get though life with the minimum of stress and anxiety, and I think we need to accept both.

I can try to accept it, inasmuch as anyone has ever asked my opinion on it . I don't necessarily understand the view of people who decide not to be informed about their own health, but maybe it has to do with information overload, something I know a great deal more about. Being given too many options or too much heavy news can become paralyzing.

My mother is a nurse, so I grew up comfortable with hearing medical terminology. I tend to forget sometimes that others are stressed by the same words that I find comforting and familiar.

[profloater]

In the case of death, I think I have accepted it will happen, but I am certain that I do not want to know the date in advance. So ignorance is bliss there. The problem comes in weighing up outcomes of an intervention. We know people live with pain and restrictions but it is hard to know in advance one’s own attitude to choices like that as we grow older. Is the clinging to life instinct resistant in all cases? How much does the attitudes of loved ones influence that? Many variables.

[grant hutchison]

I don't necessarily understand the view of people who decide not to be informed about their own health, but maybe it has to do with information overload, something I know a great deal more about. Being given too many options or too much heavy news can become paralyzing.

That's not generally the issue, though. Usually, it's people just accepting that they don't have the knowledge or training to make a properly informed decision about a complex issue under time pressure, and judging that filling up their heads with half-understood alarming stuff is not what they want to do. When it comes down to it, I'm advising you to have a thoracic epidural because I've been doing the job for thirty years. I can defend that advice in depth, but do you really need a tutorial on cardio-respiratory physiology and a list of possible adverse outcomes for epidural/no epidural right now? When you're about to embark on one of the most pivotal experiences of your whole life in a few hours time? A lot of people think, Nope, got enough to deal with at present, and he seems like a trustworthy sort of chap, so I'll just let him do whatever he thinks is best.
The other side of that coin is of course the patient who arrives with a sheaf of print-outs from the internet (sometimes in a ring binder with coloured tabs and a summary sheet). That's when I need to go and find myself a comfortable chair, and possibly ring my wife to say I'll be late home. You need to give people what they need to help them get through it.

Grant Hutchison

[Gillianren]

I don't remember if I mentioned it or not, but the other day, I came across my favourite Alan Alda story again. He was in Chile, filming something for Scientific American as I recall. And he had a severe intestinal blockage that needed immediate surgery. I think he even had to be airlifted to the hospital where they performed the operation. And the doctor was explaining slowly and carefully exactly what they were going to do--not helped by the language barrier. After a little bit, Alda cheerfully said, "Oh, an end-to-end anastamosis!" When the doctor showed surprise that he knew what that was, he reminded the guy that he'd "performed" them for twelve years and still remembered a fair amount of the terminology he'd picked up from M*A*S*H.

[geonuc]

You need to give people what they need to help them get through it.

Grant Hutchison

A wonderful sentiment.

I'm in the group of those who like to know what's going on with my health to the extent that I can understand it, particularly in these times of COVID where I'm less likely to seek medical attention. But "to the extent that I can understand it" leaves a lot out, so I tend to trust in my doctor's training and experience. I'm reminded of a recent telehealth conversation with her discussing a recent affliction. She remarked "you're an engineer so you'll understand this ...", speaking of a particular aspect of what was happening in my body that I did indeed understand because of my training. I appreciated that and it caused my trust in her to rise higher than it was already.

[Noclevername]

A lot of people think, Nope, got enough to deal with at present, and he seems like a trustworthy sort of chap, so I'll just let him do whatever he thinks is best.

I think that's part of it ... trust. Not only personal trust of the skills and competence of medical personnel, but your fate being in someone else's hands to begin with, giving up that sense of direction.

[Swift]

She remarked "you're an engineer so you'll understand this ...", speaking of a particular aspect of what was happening in my body that I did indeed understand because of my training. I appreciated that and it caused my trust in her to rise higher than it was already.

My GI has made similar comments to me.

[grant hutchison]

She remarked "you're an engineer so you'll understand this ...", speaking of a particular aspect of what was happening in my body that I did indeed understand because of my training.

Yes, engineers are good. Physicists are terrible. And I once looked after a guy who'd done some plumbing work on our central heating, and was able to say, "You remember how turning on the heater in the kitchen removed all the flow from the upstairs radiators? That's exactly what's going on here."

Grant Hutchison

[grant hutchison]

I think that's part of it ... trust. Not only personal trust of the skills and competence of medical personnel, but your fate being in someone else's hands to begin with, giving up that sense of direction.

Yes, the therapeutic effects of trust are huge--in essence it's an application of the placebo effect to real drugs.
I used to give a lecture on the placebo effect in real clinical practice (as opposed to drug research), and I had a slide that read, "Trustworthiness: Fake that and you're almost there". It was a jokey introduction to a really important concept, which is that people make judgements about trust very very quickly, and if you blow it in the first second of meeting your patient it will take a lot of effort to recover, and you're not doing them any favours.

Grant Hutchison

[Trebuchet]

My late mother was kept alive for two and a half years by blood transfusions. Since she died I've been paying it back by donating every time I'm eligible. Covid has wrecked that, I haven't been able to donate in more than a year because the mobile drive hasn't been to our county. It's frustrating.
I got multiple notices yesterday for a drive at a collection of car dealerships in Kitsap County. But Kitsap had 30 new Covid cases just yesterday. Not going there.
We are lumped in with Kitsap for reopening plans, so despite my county, Jefferson, doing much better we still can't move to "Phase 2".

[Gillianren]

I will say, at least our case level seems to be leveling off if not dropping. We're actually showing some sense in our county. Finally.

[Extravoice]

I usually donate regularly, but the last time was nearly a year ago. I checked with our local blood center several times, but they were only scheduling appointments for platelets and double red cell extraction.

[schlaugh]

NPR has been publishing a vaccination chart to track progress in the US. As a nation about 10.8 percent of the population have received at least one shot. The page also shows the percentage awaiting a second dose.

https://www.npr.org/sections/health-...-in-your-state

[ozduck]

Our lockdown - 1 week severe and then 1 week mild - has now been removed as we have had no new cases. We are almost back to what they were on before the case 'escaped' quarantine. The main difference is that whenever you enter any premises, other than a private house, you must either scan your phone over a QR code or sign a register. This includes picking up takeaway. The records are maintained to enable tracing any possible contacts and are erased after 14 days.