Dear Advice Team: I recently hung out with a family member who didn’t tell me at the time that they were feeling some COVID symptoms, but then told me the next day when they tested positive. We were indoors and also in a car with closed windows for almost an hour without masks (both vaccinated though), and so I got lucky by not coming down with it, but what can I do to encourage people around me to be more up-front, and how do I keep myself safe? P.S. I am planning to fly cross-country to spend the holidays with family in an area where masking is not common — there are indoor gatherings, restaurant meals etc. planned with people from little kids to grandparents. I’m getting worried about that.
Welcome to Pandemic Problems, an advice column that aims to help Bay Area residents solve their pandemic and post-pandemic conundrums — personal, practical or professional. As COVID evolves into an endemic disease, we know readers are trying to navigate the “new normal.” Send your questions and issues to pandemicproblems@sfchronicle.com.
Today’s question is fielded by The Chronicle’s Annie Vainshtein.
Dear Reader: What a difficult — but not uncommon — dilemma. At this stage in the pandemic, with health mandates and contact tracing no longer the rule, it can be really difficult to reconcile our own risk tolerance with what the rest of the world is doing around us.
This is especially challenging when people’s direct actions, over which we have little control, put us at direct risk.
First things first, I have great empathy for the situation you had to go through with your family member. I imagine it was quite stressful to find out afterward that they not only had been feeling COVID symptoms but turned out to have an infection, and to worry in the days after that you, too, could be positive. I’m glad you didn’t get sick.
Nearly three years into the pandemic, I think it’s safe to say that many of us have gone through similar experiences. Stanford infectious disease expert Robert Siegel certainly has, and specifically has dealt with incidents where students who were in class with him tell him just hours later that they had tested positive.
Whether your family member was intentionally concealing a possible COVID infection is unclear, but regardless, I’m sure it felt like a breach of trust.
“I think people have a certain amount of denial because they want to be a part of things,” said Siegel. “A lot of times people won’t really test.”
This tracks with what we’re seeing on a national level. More than 40% of Americans lied or misled others about their COVID status or precautions, according to a study published in JAMA Network Open.
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Your question seems to be two-pronged: how can you encourage the people around you to be honest about their health status, and what can you do to keep yourself safe from infection.
Infectious disease experts and psychological experts were mixed in how to tackle your first question. In many cases, the values and beliefs people hold about COVID safety can feel cemented at this prolonged phase of the pandemic. And most of the time, appealing to people’s sense of logic isn’t always the best route — because the beliefs that fuel our risk behaviors are often not the most rational, and rooted instead in habit, emotionality or denial, experts said.
“Two and a half years later you’re not going to convince someone to wear a face mask just based on facts,” said Stanford professor of medicine Eric Widera. “People have heard all the arguments already.”
What is still an option, experts say, is being as up-front and genuine as you can to let the people around you know what you need, what you’re feeling and what’s worrying you. Though it sounds like this family member may have known about your comfort level with COVID risk and chosen to skirt it, in other scenarios people have vastly different expectations when it comes to disclosing health symptoms they might be feeling.
So the first step, Widera says, is to have a discussion that clarifies your risk tolerance with COVID, and in many ways, what your boundaries are. Are you comfortable seeing someone if they have the sniffles? Would you prefer everyone get tested before a family function? Are you going to wear a mask if you’re unclear about the situation?
These are ideally conversations to be had before an incident like this, but you could also clarify these points in a conversation with your family member, where you should feel free to fully express how the breach of trust made you feel.
“It is so hard to set boundaries, yet it’s so important,” said San Francisco psychologist Nicole Lako. “When we set a limit to protect ourselves, we also have to accept that the other people might be uncomfortable or have a hard time with that.”
This means it’s possible that even if you’re being as clear and transparent about your comfort levels with COVID, the people around you can still choose to do things that you don’t agree with, or could put you at risk.
And that gets us to your second question: ways to keep yourself safe.
We rarely have control over what the people around us choose to do, but we can control the extent to which we tell them what we need and feel, and the measures we take to keep our risk low.
When it comes to gatherings or travel, many families are opting to make sure everyone is vaccinated, or at least has tested negative before gathering, said Siegel, who says he does this with his own family.
If you’re going to a place where that’s not likely to happen, you can take some precautionary measures on your own.
For example, you can choose to wear a mask while gathering with family and friends, or try to schedule as many outdoor events as possible.
There’s also the larger question of cost and benefit for any social interaction, especially if you are immunocompromised or particularly worried about getting sick for another reason. Does the benefit outweigh the risk for you? If not, you might choose to forgo the trip.
We all have had such varying experiences, including with COVID, that dictate our decisions about avoiding or inviting risk. It’s important, Widera says, to try your best to suspend the moralization of these different health choices.
“We have stigmatized this disease, with some making it a sign of virtue to have never contracted this virus through strict COVID precautions that often only the most privileged can afford, like working from home, having all your needs delivered to you, and avoiding contact with all but the smallest social bubble,” said Widera.
According to seroprevalence data from the National Institutes of Health, more than 85% of us have had COVID, even if we didn’t think we caught it. But the way many people describe it conveys a sense of shame or blame: “I did everything right, and yet I still got COVID,” Widera added. “Somehow ‘right’ becomes an unattainable state of being where you live in a strict COVID bubble, and failure means that you didn’t mask hard enough.”
Overall, experts say it’s important to keep in mind that the pandemic has compromised so much around social contact, and though it’s never OK to withhold necessary health information, the decision not to disclose an infection can often come from a very fearful and vulnerable place. That understanding may help as you encourage others to be up-front and while also taking measures to protect yourself from harm.
Pandemic Problems is written by Chronicle Advice Team members Annie Vainshtein, Kellie Hwang and Anna Buchmann, combining thorough reporting and guidance from Bay Area experts to help get answers and find a way forward.
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