COVID-19: This Time It’s Personal

As regions and municipalities start to relax their lockdowns, advice is starting to pop up about risk and decision making. It is almost entirely addressed to readers in the second-person singular. For instance, Madison physician James Stein outlined different levels of personal risk and says “I can’t make decisions for you”; The New York Times op-ed “Putting the Risk of Covid-19 in Perspective” uses the “micromort,” or one in a million chance of dying, as the way to measure Covid-19 risk.

But all of these perspectives are highly personalizing, as if risk is an individual decision. The reporting sounds like it’s from the lifestyle section, where you can decide whether you want to follow the no-knead or sourdough approach to baking bread, or whether it’s ok to still like a Michael Jackson song. Covid-19 is like none of those things in terms of risk or responsibility.

Since nobody can know if they have been infected with the virus, risk is not a personal decision. In going out, or not wearing a mask, you are making decisions to put other people at risk, both by potentially transmitting the virus, and by thereby potentially filling up emergency rooms and intensive care units (NB: Montreal’s ERs are already over capacity).

I am not arguing against going out or even some measure of harm reduction. Rather, I am arguing that if you are concerned about the virus and think that the lockdown was a good idea, the right approach in assessing risk is civic, rather than personal. How much risk should the others around you tolerate so that you can exercise the freedom of going out? How can you move about the world in such a way as to minimize risk to others? I realize that there are people who don’t care, as amply demonstrated by the anti-mask and anti-lockdown protests in the U.S. I am not writing for them. I am writing for the people who care, or want to believe that they care.

All of this has a fine point for me because Quebec just announced its triage guidelines in the event that intensive care units are overrun. While there are a lot of great things about our healthcare system here compared with the U.S. system in which I grew up, it is subject to the same managerialist cost-cutting one finds elsewhere, which means that there are real limits to what the system can accommodate in a crisis.

The guidelines are shockingly ableist, and the Société québécoise de la déficience intellectuelle has launched a project to persuade the National Assembly to change them not to exclude people with disabilities. But even if that gets fixed, I am caught up in another net that is unlikely to change.

Among the people who will be triaged out of intensive care are people with “metastatic malignancies,” in other words, people with cancer that has metastasized to other organs. That’s me. Although my drugs are working well and my cancer is “well-controlled,” if ICU’s were overrun and I showed up at the hospital, even though I am technically not sick from the cancer and only from my treatments, I would be triaged out.

I am not saying I’m special here: plenty of people are told by the state that their lives don’t matter, as the police murder of George Floyd yesterday in my hometown of Minneapolis sadly demonstrates, and as the Quebec guidelines also show.

But I’m seeing a lot of people who consider themselves progressive and good-hearted starting to talk in terms of personal risk. Don’t. If we’re friends, instead of thinking about how much risk you’re willing to tolerate for yourself, consider if you’re willing to put me in mortal danger, knowing that my safety net just got a lot thinner. Then, remember that everyone you might bump up against has someone who loves them. That should be our measure for how to act in public.

And if I turn down your social invitation in the next couple weeks, or counterpropose a Zoom dinner, you’ll know why.