Doctors Share Their Own Risk Strategies --- As Covid cases rise, daily routines are changing

 
"In little more than a week, Robert Wachter, chair of the department of medicine at the University of California, San Francisco, says his assessment of the risk posed by the Delta variant has changed -- and he has changed his behavior accordingly.
Dr. Wachter, who is 63, says he still watches "Ted Lasso" unmasked when his adult son comes over. He has stopped his monthly poker games with eight friends, even though all are vaccinated. The group is big, he reasons, and one member is immunocompromised. Dr. Wachter's age puts him at higher risk, and he says he worries his vaccine protection may have waned somewhat because he was inoculated about seven months ago.
Double-masking is now the rule when he goes to the grocery store, and he no longer eats indoors at restaurants. "The right way to approach this is as if it were a new virus and question all your assumptions," he says.
The rapid rise of the Delta variant of the virus that causes Covid-19 has caused many people to reassess the risks of going about their lives. The highly contagious variant infects people more easily than earlier strains, and infected people carry higher levels of virus, research indicates.
Vaccines still provide strong protection against severe illness and death; unvaccinated people account for the overwhelming majority of hospitalizations and deaths. Yet the possibility of a breakthrough infection -- and potentially transmitting it onward -- is stirring apprehension among many who are vaccinated.
Part of the trepidation is the uncertainty: Scientists are still learning about Delta, including how much of a threat it poses to vaccinated adults as well as young children not yet eligible for shots. So we asked a group of doctors -- all vaccinated -- how they are recalculating risk in their own families and daily activities.
All said they are wearing masks again in crowded indoor public places. They mostly wear N95s in higher-risk settings, like with patients or on planes, and doubleup with cloth and surgical masks in less risky situations. Most have stopped dining indoors. They are still largely comfortable taking off masks in groups of friends and family when they are sure everyone present is vaccinated, depending on the size of the group.
Most said they are limiting or curtailing travel. Dr. Wachter won't take "elective" trips, but he will go see his parents in Florida next month; his father is in hospice care. Once on the airplane, he will remove his N95 mask only long enough "to gobble down" some food, and only then if all passengers around him have their masks on, he says.
Trey Dunbar, president of Our Lady of the Lake Children's Health in Baton Rouge, La., visited his son in Atlanta before Delta cases surged. Those cases now fill his emergency room, which is seeing a five- to sixfold increase in children with respiratory viruses, about one-third to half of which are Covid, he says.
He has postponed plans to visit his parents and adult daughter in North Carolina. He acknowledges that he's being conservative, given that all are vaccinated. Even a mild bout of the illness would keep him off the front lines in treating the surge, he says. "What I do is important to me," Dr. Dunbar says. "Everybody has a threshold, and I fall on the cautious side."
Megan Ranney, an emergency doctor and associate dean of the Brown University School of Public Health, has a fully vaccinated 12-year-old daughter and a 9-year-old son who isn't yet eligible. Since the Delta surge, she now runs through a checklist of questions to assess risk for daily activities.
First, she says, she asks herself, "What's the chance of there being someone sick in this place?" -- reasoning that the chances are greater in communities with higher case rates, at hospitals and when around children too young to be vaccinated. Then: Is the activity indoors or outdoors? How good is the ventilation and how long will we spend here? Are we engaging in a high-risk activity like exercise or singing, or something lower-risk like sitting and listening?
Then she layers on another set of questions: How well are we protected? Can we open the windows? How many people will we be with and are they wearing masks? What are the chances any of us will get seriously sick?
For now, she has decided to let her children be together with her older parents, who are both vaccinated and take precautions in their own activities.
Less clear to her is back-to-school. She's not confident that most of the children in her daughter's class will be fully vaccinated when school starts in a month, and says the school hasn't said yet whether masks will be required. She's watching the data from Southern states where cases are surging. So far the data she has seen doesn't indicate to her that children are more susceptible to severe illness than from prior strains, but "the jury is still out," she says. For now she plans to send her children to school with high-quality masks.
John Volckens, professor of environmental health and an aerosol scientist at Colorado State University in Fort Collins, Colo., has two children ages 4 and 8. He will send them back to school in masks even though the school district doesn't require them, he says. "It may be difficult from a social perspective, but that's OK," he says.
Doctors are also adjusting the risk calculus for family members they consider more vulnerable. Monica Gandhi, an infectious-disease doctor and professor of medicine at UCSF, says she is still eating at restaurants and plans to fly with her children because of her confidence in the vaccines and high vaccination rates in San Francisco. On the plane, she'll make sure her unvaccinated young son is well-masked, has the ventilation on above him and is seated between her and another vaccinated family member.
She is also concerned about her parents, both vaccinated and in their 80s. She has asked them to mask indoors, avoid indoor dining and stay off planes until this surge abates.
She is less worried about the risks at school, which will require students including her two boys, ages 11 and 13, to wear masks. She's also asked school officials to improve ventilation by opening windows and doors, and suggested having the children eat lunches outside." [1]

1. Doctors Share Their Own Risk Strategies --- As Covid cases rise, daily routines are changing
Morris, Betsy.  Wall Street Journal, Eastern edition; New York, N.Y. [New York, N.Y]. 09 Aug 2021: A.9.