Trust No One -

Don’t Let “Caution Fatigue” Result in Getting Infected with Covid19

Joshua Hoehne via Unsplash

Trust no one. Harsh sounding words but following them is essential during this pandemic. Everyone knows the basics: wear a mask, social distance, avoid crowded spaces, avoid areas where air circulation is limited and, of course, use good hand hygiene. Most of us do it now.

But there is another very critical issue — never assume another person is virus free, no matter what they may think or tell you.

It’s worth repeating — never assume another person is virus free. They may feel fine with no symptoms, no fever, no cough, no sneezing, no difficulty breathing yet still be infected and still be spreading the coronavirus with just breathing or speaking. We now know that more than half of infected individuals never have symptoms, never feel ill yet they readily transmit the virus to others via the air. We also know that most transmission occurs among family or friends.

You can’t always trust your physical senses. Just because you can’t “see” the small droplets when someone is coughing … or “hear” someone sneeze five minutes before they turn a corner and shake your hand … or “feel” someone’s elevated temperature, they might still be shedding the virus — and that’s only with symptomatic people! The asymptomatic infected person feels good but is still shedding the virus through aerosolized particles into the air. Hold up a mirror to your nose and breath out. That fine mist is what carries the virus into the air around.

My wife and I live in Charlestown just outside of Baltimore, a retirement community of 2000 residents of which 1800 live independently in apartments. As the pandemic began, the management did a superior job of keeping the virus away from us. It did mean sheltering in place, closing the six restaurants and the gyms and the pool. It meant bringing meals to our doors along with packages and mail and curtailing activities like meetings, lectures, movies — all limiting social engagement.

It worked for more than three months but now there are five individuals in independent living who have developed Covid19. Four of the five had left the campus to visit friends or family. In each case the assumption was that the person or persons visited were not infected. They did not appear sick, said they felt quite well, didn’t have a temperature, and were not coughing or sneezing. Yet they did have infection and they were able to pass it on through simply breathing or speaking. In the fifth instance, the infection was brought into the resident’s apartment by a visitor who likewise did not appear sick.

We all need to learn from this,no matter our age. In a retirement community, everybody by definition is an elder. We are not invincible. Our immunity is lower than even a few years ago and sheltering in place has likely suppressed our immune system further. We can get infected and it can be deadly. But everybody, of any age, is at risk for infection and at any age it can be serious.

So what should you do? These recommendations are for everyone not for just seniors and no matter where you live.

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If you visit in someone’s home you need to wear your mask and keep 6 feet apart from your host. You must insist that your host wears his or her mask and keeps a social distance. If the host is not willing, don’t visit! Don’t enter! Or if you’re already inside, exit! Now.

If you are invited to a friend’s home, and that individual is wearing their mask but not properly such as not over their nose, consider saying something like “I love you but I can’t stay unless you pull up your mask.“ Then add in, “give me six feet,“ while at the same time stepping back. This is role modeling.

If someone you know visits you, it doesn’t matter who they are. It could be your best friend, relative, a grandchild. Whomever, it does not matter. You may be certain that they are very careful, never frequent crowded places, wear a mask when out, etc. — it does not matter. Assume that they may be infected. There can be no hugs, no handshakes, no kissing. Everyone must wear a mask and everyone must stay six feet apart.

It may be your best friend, a close relative, a trusted helper or advisor. But you have to assume that every person you come in contact with is infected and could pass it onto you. And they need to feel the same about you!

This does not mean be suspicious. That is a negative implication toward others. But it does mean be wary, be concerned, be alert. You need to maintain a high level of caution.

This raises the question of why are some people are less cautious than others about people interactions. Part of it may be lack of understanding about how the virus is transmitted and the belief that only people with overt symptoms like a cough can spread the virus. But another very real part is “caution fatigue.” This is a real phenomenon after disasters. First the community comes together as we all did initially but over time that wanes and people get tired, exhausted, even angry. This is especially so in a circumstance where there is no obvious end in sight — which is just where we are today in this pandemic. The result of caution fatigue is to let down our guard, to take some risks, to assume it will all be OK. But of course, this is a fallacy. We all need to be on guard, all the time.

Jessica Tan via Unsplash

It helps if we talk about our covid19 induced fatigue with others. If helps if we recognize it and realize that it comes not from the situation but from our thoughts about the situation. Give yourself s some love, some gratitude for what is going well with your life. Spend some time each day with meditation, with the recognition that right now, today at this moment, you are all right. And as I wrote recently, be sure to eat nutritiously, exercise daily, just a 30-minute walk around will do, and get a good night’s sleep.

Yes, we all need social engagement. It is very important for our physical and mental health. So much of the activities of normal life have necessarily been curtailed that social engagement must come from other approaches. We just need to obtain social engagement in a manner that does not lead to infection. So do not let caution fatigue interfere. Instead, call someone on the phone; setup a ZOOM meeting or write an email. Make strong efforts to maintain contact with others.

My wife and I were walking on the nature trail here recently with its many markers to indicate various types of trees. We saw one labelled “box elder.” It reminded us that we are all elders here. We will all end up in a box one day. But none of us is in any hurry to do so. The best way to avoid that box is to follow these guidelines about visiting with others.

Masks and social distancing with friends and relatives seem very strange indeed. Show others patience if they are not following these simple steps and be a role model to them. But be firm. Be prepared to leave if they will not comply. This may seem harsh and you may be afraid of losing a friend but your health and your well-being — and theirs — must take precedence!

Thanks to Jeff Watson and Carol Schimpff for review and suggestions.

Stephen C Schimpff, MD, MACP, is a quasi-retired internist, professor of medicine, and former CEO of the University of Maryland Medical Center. He is a graduate of Yale Medical School and is board certified in internal medicine, medical oncology and infectious diseases. He has written 6 books for the general public on medicine, health and wellness including “Longevity Decoded — The 7 Keys to Healthy Aging. He is the coauthor with Dr Harry Oken of the new book BOOM — Boost Our Own Metabolism which offers advice on combating the health issues associated with sheltering in place.

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