Help me calculate my father's covid risk
March 15, 2022 3:30 AM Subscribe
I'm overwhelmed with all the variables in figuring out how to manage my father's covid risk and keeping him safe, while balancing that with his mental and physical health needs. Especially now that everyone around me seems to have decided the pandemic is over. Please help me understand how much he is at risk, and what measures are non-negotiable, vs where we can maybe relax a bit?
We're in South Africa. We're at the end of summer, and all the articles I've read predict another wave of covid infections as winter arrives.
Everyone in this question have been vaccinated and 1 booster shot. We can't really access tests easily, tests are expensive and time consuming (you have to go to a doctor or clinic, no at home tests here)
My father is in his mid eighties. He has asthma. He is not physically active, and rather overweight. I believe these are all risk factors.
I don't live with my father but I visit often. I live with my husband who works in a place where there is no social distancing, poor masking, and he's in contact with many people. He's had covid twice so far. I've had it once.
Now that my husband, myself, and my father is vaccinated and boosted, I've been relaxing my covid protocols with my father a bit - driving in the same car (both of us masks on, windows open) so that I can take him to doctor's appointments etc. Occasionally going inside his house with him (me masked) so that I can help with domestic things.
Other members of my family are not so careful. They pretty much interact with him in pre-covid ways, no masks, etc. (They are all vaccinated and boosted)
They argue that his need for human contact is much more important than the minimal risk of covid now that he's been vaccinated.
Now that it seems clear that this thing is not going away any time soon, are they correct? Is it "well, he might get a bit sick but he's vaccinated" or "he's at risk, we still need to be very careful"? Although if it's the latter, I have no clue how to convince my family.
Appreciate answers that are based on information, studies, and facts, not personal opinion. Everyone's risk tolerance differs, but what do we base our risk calculations on?
We're in South Africa. We're at the end of summer, and all the articles I've read predict another wave of covid infections as winter arrives.
Everyone in this question have been vaccinated and 1 booster shot. We can't really access tests easily, tests are expensive and time consuming (you have to go to a doctor or clinic, no at home tests here)
My father is in his mid eighties. He has asthma. He is not physically active, and rather overweight. I believe these are all risk factors.
I don't live with my father but I visit often. I live with my husband who works in a place where there is no social distancing, poor masking, and he's in contact with many people. He's had covid twice so far. I've had it once.
Now that my husband, myself, and my father is vaccinated and boosted, I've been relaxing my covid protocols with my father a bit - driving in the same car (both of us masks on, windows open) so that I can take him to doctor's appointments etc. Occasionally going inside his house with him (me masked) so that I can help with domestic things.
Other members of my family are not so careful. They pretty much interact with him in pre-covid ways, no masks, etc. (They are all vaccinated and boosted)
They argue that his need for human contact is much more important than the minimal risk of covid now that he's been vaccinated.
Now that it seems clear that this thing is not going away any time soon, are they correct? Is it "well, he might get a bit sick but he's vaccinated" or "he's at risk, we still need to be very careful"? Although if it's the latter, I have no clue how to convince my family.
Appreciate answers that are based on information, studies, and facts, not personal opinion. Everyone's risk tolerance differs, but what do we base our risk calculations on?
Response by poster: Sorry, not thread sitting but had to drop in to say that I do, in fact, still call my father "Pappa" <3 :)
posted by Zumbador at 4:26 AM on March 15, 2022 [3 favorites]
posted by Zumbador at 4:26 AM on March 15, 2022 [3 favorites]
They argue that his need for human contact is much more important than the minimal risk of covid now that he's been vaccinated.
What does Pappa want? My mum's in her 80s too. She's decided how much risk she's willing to take. The whole family is vaccinated as much as we can be, as are her few social contacts. She's still mobile enough to go out to do shopping once a week, but only goes at quiet times, and always wears a mask if she's out. She has asthma and other health issues, but she doesn't want to spend her last few years isolated from grandchildren and friends, so has to strike a balance. Maybe a sensitive conversation with Pappa would help you to get a handle on whether he feels comfortable with your other family being around him unmasked, or whether he'd rather they took more care. Maybe suggest a few options (opening some windows and turning a fan on when there are people about, wearing masks in the car, meeting outside when the weather's good, and so on) that would lower the risk without preventing the family contact he needs. If he can advocate for himself, they're more likely to listen than if it comes from you, who they might dismiss as "the worrier".
posted by pipeski at 4:50 AM on March 15, 2022 [6 favorites]
What does Pappa want? My mum's in her 80s too. She's decided how much risk she's willing to take. The whole family is vaccinated as much as we can be, as are her few social contacts. She's still mobile enough to go out to do shopping once a week, but only goes at quiet times, and always wears a mask if she's out. She has asthma and other health issues, but she doesn't want to spend her last few years isolated from grandchildren and friends, so has to strike a balance. Maybe a sensitive conversation with Pappa would help you to get a handle on whether he feels comfortable with your other family being around him unmasked, or whether he'd rather they took more care. Maybe suggest a few options (opening some windows and turning a fan on when there are people about, wearing masks in the car, meeting outside when the weather's good, and so on) that would lower the risk without preventing the family contact he needs. If he can advocate for himself, they're more likely to listen than if it comes from you, who they might dismiss as "the worrier".
posted by pipeski at 4:50 AM on March 15, 2022 [6 favorites]
It's been really maddening trying to manage older family's care, particularly with some distance, particularly if they don't advocate for their own boundaries well, and when no one else cares. I'm answering because I've had to think about this a lot.
There's a few studies that all say the same thing that you already know:
* Good, appropriately worn masks cut down on transmission for both parties.
* Vaccination helps people not die.
* People who die often tend to be elderly and have a few other indicators clustered.
* Testing sadly isn't useful, given incubation times etc.
But beyond that, making it make sense with math doesn't quite work. There's generally "less Covid around right now" and also your father could easily die of Covid; he is in the real target demographic of "people who die from Covid very generally speaking."
This is public health and people management you're dealing with, not science, right? So why don't you try making three categories, and asking him to choose? Having a policy in place at least cuts down on the chaos in your life. You could suggest:
* You put a sign on his door with a mask basket that says "put this N95 mask on before you come in, thanks." You could send everyone the studies that explain good masks. So everyone is asked to mask when in an enclosed space with him. Those who disobey get chewed out by you. (N.B. People who don't want to wear masks wear them badly, and then masks don't help.)
* You give up on asking visitors to mask; a window or two gets opened when they come over. Your father wears an N95 when he leaves the house for appointments. You continue to protect him with a good mask on yourself when you come over, at least in part for your own peace of mind.
* You say fuck it, do whatever you want to do on a case by case basis, dad, and we stop worrying about this — until the next big serious wave happens, and we all reevaluate again.
I think we'd all choose different things and that's sort of the problem, isn't it? But I think we'll all wonder what your dad wants too.
posted by RJ Reynolds at 5:53 AM on March 15, 2022 [3 favorites]
There's a few studies that all say the same thing that you already know:
* Good, appropriately worn masks cut down on transmission for both parties.
* Vaccination helps people not die.
* People who die often tend to be elderly and have a few other indicators clustered.
* Testing sadly isn't useful, given incubation times etc.
But beyond that, making it make sense with math doesn't quite work. There's generally "less Covid around right now" and also your father could easily die of Covid; he is in the real target demographic of "people who die from Covid very generally speaking."
This is public health and people management you're dealing with, not science, right? So why don't you try making three categories, and asking him to choose? Having a policy in place at least cuts down on the chaos in your life. You could suggest:
* You put a sign on his door with a mask basket that says "put this N95 mask on before you come in, thanks." You could send everyone the studies that explain good masks. So everyone is asked to mask when in an enclosed space with him. Those who disobey get chewed out by you. (N.B. People who don't want to wear masks wear them badly, and then masks don't help.)
* You give up on asking visitors to mask; a window or two gets opened when they come over. Your father wears an N95 when he leaves the house for appointments. You continue to protect him with a good mask on yourself when you come over, at least in part for your own peace of mind.
* You say fuck it, do whatever you want to do on a case by case basis, dad, and we stop worrying about this — until the next big serious wave happens, and we all reevaluate again.
I think we'd all choose different things and that's sort of the problem, isn't it? But I think we'll all wonder what your dad wants too.
posted by RJ Reynolds at 5:53 AM on March 15, 2022 [3 favorites]
Assuming he doesn’t have dementia, his risk is his to manage. The elderly folks I know definitely are not choosing isolation or masking with relatives anymore. All you can do is manage your own perceived risk of giving him covid.
posted by haptic_avenger at 6:32 AM on March 15, 2022 [4 favorites]
posted by haptic_avenger at 6:32 AM on March 15, 2022 [4 favorites]
What I've learned in two years of pandemic-ing is that it's essentially impossible and therefore a waste of time to convince someone to be comfortable with your standards for COVID. I mean that both ways: I have friends who are more cautious than I am (I'd say I'm somewhere in the middle) and I can't make them do something that they don't feel comfortable with; and I went to a museum with my sister and her young kids over the weekend and I was the only person in our group who was wearing a mask because my sister thinks they're no longer necessary.
On that note, you can ask others who will be around Pappa to practice COVID-safe behaviors like wearing a mask when they visit, but you also have to be prepared for the possibility (likelihood?) that they won't do that. My dad is in his late 60s and has heart and vascular problems, and my stepmom and stepbrother have people in and out of their house constantly, mostly maskless. I'm extremely frustrated about it (I was even more pre-vaccines), but there's literally nothing I can do outside of attempting to block people from entering their home.
As others have noted, there's also the consideration of what Pappa wants and is/isn't doing. My dad dines indoors weekly with a group of friends. He's done this as long as restaurants have been open since March 2020. Drives me bonkers, but again, what can I do?
To summarize, human behavior is unfortunately not nearly as rational as math. Calculating his risk assumes a perfect world scenario that doesn't exist. You can continue to assume that his risk is relatively high and adjust your behavior accordingly, but you also need to acknowledge that you and he are going to encounter people who won't adjust theirs.
posted by anotheraccount at 6:35 AM on March 15, 2022 [3 favorites]
On that note, you can ask others who will be around Pappa to practice COVID-safe behaviors like wearing a mask when they visit, but you also have to be prepared for the possibility (likelihood?) that they won't do that. My dad is in his late 60s and has heart and vascular problems, and my stepmom and stepbrother have people in and out of their house constantly, mostly maskless. I'm extremely frustrated about it (I was even more pre-vaccines), but there's literally nothing I can do outside of attempting to block people from entering their home.
As others have noted, there's also the consideration of what Pappa wants and is/isn't doing. My dad dines indoors weekly with a group of friends. He's done this as long as restaurants have been open since March 2020. Drives me bonkers, but again, what can I do?
To summarize, human behavior is unfortunately not nearly as rational as math. Calculating his risk assumes a perfect world scenario that doesn't exist. You can continue to assume that his risk is relatively high and adjust your behavior accordingly, but you also need to acknowledge that you and he are going to encounter people who won't adjust theirs.
posted by anotheraccount at 6:35 AM on March 15, 2022 [3 favorites]
The elderly folks I know definitely are not choosing isolation or masking with relatives anymore.
That is the same thing I am seeing, both in my family and out in public. The risk part is mostly knowable -- in broad terms, we know masks help, vaccines help, and that there are conditions (like age, etc.) that increase risk; we also have a sense of whether the spread of the disease is higher or lower at a given moment. But the costs of social isolation, and people's risk tolerance, is really individual, and doesn't lend itself to the same numbers-based approach.
I agree with everyone saying that what he wants should be given importance. If he would prefer visitors wear masks, then people are being rude by not participating. But if he doesn't care, or would prefer to see family maskless, then that is a reasonable choice for him to make. It's riskier than not, but also has benefits in terms of social connections and closeness -- that is a tradeoff that people can choose to make.
posted by Dip Flash at 6:40 AM on March 15, 2022 [2 favorites]
That is the same thing I am seeing, both in my family and out in public. The risk part is mostly knowable -- in broad terms, we know masks help, vaccines help, and that there are conditions (like age, etc.) that increase risk; we also have a sense of whether the spread of the disease is higher or lower at a given moment. But the costs of social isolation, and people's risk tolerance, is really individual, and doesn't lend itself to the same numbers-based approach.
I agree with everyone saying that what he wants should be given importance. If he would prefer visitors wear masks, then people are being rude by not participating. But if he doesn't care, or would prefer to see family maskless, then that is a reasonable choice for him to make. It's riskier than not, but also has benefits in terms of social connections and closeness -- that is a tradeoff that people can choose to make.
posted by Dip Flash at 6:40 AM on March 15, 2022 [2 favorites]
I agree that at his age, to some extent you have to let his preferences drive. That doesn't mean throwing all caution to the wind but it might mean choosing a few specific things that for him personally improve his quality of life so much that a bit of additional risk is worth it. Only he can decide what those things are - maybe he really wants to see relatives unmasked, or maybe what he really wants is to resume (restaurant eating, church, a social thing with friends, whatever) and to make that risk reasonable for him it would help a lot if the family all stayed masked. Maybe he wants to see family but doesn't want to have mask arguments, so the conversation can turn more to "how can we facilitate outdoor family visits so no one has to get into a mask fight?"
I think all you can do is have a real discussion with him about his priorities and his quality of life. And try to listen with an open mind to what you hear. (I know this is easier said than done. My elderly father recently decided he absolutely needs to start eating at indoor restaurants again because it's the thing that gives him joy in life and his days on this earth are limited and he wants to spend some of them on expensive meals. I can't understand that particular priority. But you know, if he knew that my one wild covid risk was my monthly haircut-and-outdoor-coffeeshop trip, he'd think that was really stupid. It's okay; we don't have to find our joy in the same things.)
None of this means you have to act any differently. You get to keep wearing a mask when you visit him, and to enforce windows-down rules in your own car - and I would definitely do those things, in your shoes! But I don't think you can lay down any rules about what other people do until you've found out what he wants those rules to be.
On to your question about how to ascertain risk: I don't know if there's some similar tool more fine-grained for South Africa, but microcovid.org does have a setting for South Africa, and while imperfect, will provide you with at least one possible way to assess risk and talk about risk with your loved ones, and assess relative risks of different options.
posted by Stacey at 7:07 AM on March 15, 2022 [2 favorites]
I think all you can do is have a real discussion with him about his priorities and his quality of life. And try to listen with an open mind to what you hear. (I know this is easier said than done. My elderly father recently decided he absolutely needs to start eating at indoor restaurants again because it's the thing that gives him joy in life and his days on this earth are limited and he wants to spend some of them on expensive meals. I can't understand that particular priority. But you know, if he knew that my one wild covid risk was my monthly haircut-and-outdoor-coffeeshop trip, he'd think that was really stupid. It's okay; we don't have to find our joy in the same things.)
None of this means you have to act any differently. You get to keep wearing a mask when you visit him, and to enforce windows-down rules in your own car - and I would definitely do those things, in your shoes! But I don't think you can lay down any rules about what other people do until you've found out what he wants those rules to be.
On to your question about how to ascertain risk: I don't know if there's some similar tool more fine-grained for South Africa, but microcovid.org does have a setting for South Africa, and while imperfect, will provide you with at least one possible way to assess risk and talk about risk with your loved ones, and assess relative risks of different options.
posted by Stacey at 7:07 AM on March 15, 2022 [2 favorites]
You might like to read this post by epidemiologist Katelin Jetelina about risk assessment. It’s recent and US-centric but still might help you and your family think about it. (tl:dr she says numerically the chances of an average over-65 dying of Omicron is about 6000/1,000,000, similar to a person’s chances of dying during a year fighting in Afghanistan — very US analogue but hopefully still helpful in contextualizing the risk levels)
You might also like to check out the website Microcovid which calculates the riskiness of individual behaviors based on the number of infections in your community. I find it helpful because it cuts through the binary “well we have to do EVERYTHING because otherwise it’s too isolating” mindset — some activities are a lot more dangerous than others, and sometimes mild changes can strongly shift the riskiness of an activity.
Good luck with it, these decisions are hard for everyone
posted by hungrytiger at 11:37 AM on March 15, 2022 [1 favorite]
You might also like to check out the website Microcovid which calculates the riskiness of individual behaviors based on the number of infections in your community. I find it helpful because it cuts through the binary “well we have to do EVERYTHING because otherwise it’s too isolating” mindset — some activities are a lot more dangerous than others, and sometimes mild changes can strongly shift the riskiness of an activity.
Good luck with it, these decisions are hard for everyone
posted by hungrytiger at 11:37 AM on March 15, 2022 [1 favorite]
Also consider getting a HEPA filter for the room where he is mostly likely to have company. The MicroCovid model estimates that will cut the risk to just 25% of the original, assuming that the filter is right size for the room and you have good air flow.
Similarly, if your father is willing a N95 or equivalent mask, that will cut his risk to 1/3. Not as good as if the other person is wearing an N95 (reduces to 1/6) or they both wear masks (1/3 * 1/6 =1/18 the original risk) but this is something he can do that is under his own control and makes a measurable difference.
Here's background on where Microcovid gets their estimates.
posted by metahawk at 3:38 PM on March 15, 2022 [1 favorite]
Similarly, if your father is willing a N95 or equivalent mask, that will cut his risk to 1/3. Not as good as if the other person is wearing an N95 (reduces to 1/6) or they both wear masks (1/3 * 1/6 =1/18 the original risk) but this is something he can do that is under his own control and makes a measurable difference.
Here's background on where Microcovid gets their estimates.
posted by metahawk at 3:38 PM on March 15, 2022 [1 favorite]
Response by poster: Thank you for all the answers here. Really helps me think through this. In case this helps anyone else with a similar situation, the reason I ask here instead of just going with what my father wants, is because he's quite passive in this situation.
He's lonely, but other than saying he wants a dog (we got him one! She a love!) he doesn't do anything about it. He'll wear a mask if we remind him to, but usually forgets.
He accepts whatever we tell him is safe or risky but it doesn't really seem to worry him.
Or it might be that he's very private about it and won't put his needs before ours?
All he genuinely cares about is the book he's writing.
Maybe a version of the habit some men have of delegating certain decisions (about relationships, domestic arrangements etc) to others.
I've asked him how he feels about seeing friends and social interactions and he's far more concerned about the risk of falling than with the risk of Covid.
So maybe all of this combined is why I feel like it's my responsibility to work out this stuff for him.
posted by Zumbador at 8:28 PM on March 15, 2022
He's lonely, but other than saying he wants a dog (we got him one! She a love!) he doesn't do anything about it. He'll wear a mask if we remind him to, but usually forgets.
He accepts whatever we tell him is safe or risky but it doesn't really seem to worry him.
Or it might be that he's very private about it and won't put his needs before ours?
All he genuinely cares about is the book he's writing.
Maybe a version of the habit some men have of delegating certain decisions (about relationships, domestic arrangements etc) to others.
I've asked him how he feels about seeing friends and social interactions and he's far more concerned about the risk of falling than with the risk of Covid.
So maybe all of this combined is why I feel like it's my responsibility to work out this stuff for him.
posted by Zumbador at 8:28 PM on March 15, 2022
By the way, the risk of death from a fall in older adults (over 65) is 650/1,000,000 so about one-tenth the risk of death from COVID using hungry tiger's estimate. Maybe that might help engage in a little more in protecting himself?
posted by metahawk at 9:59 PM on March 15, 2022 [1 favorite]
posted by metahawk at 9:59 PM on March 15, 2022 [1 favorite]
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While having booster do make even the Omicron variant far less like to require hospitalization, your "papa", being in his 80's, even a chance of hospitalization can be a life or death situation. On the other hand, isolation can be problematic. I don't think there's like specific studies on 80+ year olds and their chances of surviving Omicron yet.
As everybody is vaxed and boosted, I think the best you can do is mask up around "papa" and ask everybody else to also do the same. Call it "courtesy". Keep the windows open, and have "papa" wear an N95 mask.
posted by kschang at 4:08 AM on March 15, 2022 [1 favorite]