A Christmas Day Dispatch From The Airport.
How this doctor thinks about risk, and how that has changed over time.
Dear Inside Medicine readers,
Just a quick dispatch from San Francisco International Airport on this Christmas Day. Wishing you a wonderful holiday season, whatever you celebrate!
I’m sitting here in the terminal and I’m thinking about how my own understanding of risk has changed over the last few years. I thought I’d share that with you—letting you know how this doctor thinks about these issues, as we head into 2023.
Before the pandemic, I used to travel a fair amount. But I didn’t think much about infection prevention for myself, even during cold and flu season. When my spouse entered the scene, it was she who would bring HandiWipes to clean off the admittedly disgusting surfaces on planes. (I was surprised to learn—from the internet—that the tray tables are dirtier than the restroom flush buttons, by the way.) I used to give her a judgmental glance when she would do her little pre-flight clean-up routine, a routine which got a little more intense in 2018 after we had our first daughter.
Okay, she was right. And I should have seen it. I had an undeniable track record of arriving to vacations and promptly developing a fever or mild gastrointestinal illness for 24-48 hours, before bouncing back and being just fine. It was probably a combination of inadequate attention to these sanitation issues related to travel, and also that I always seemed to arrive to the airport exceedingly behind on sleep. Not a great combo.
What I do. Since Covid, I obviously wear an N95 mask in the airport and on the plane (and the car to and from the airpot, etc). I wipe down the surfaces on the planes. And in some cases, I even show up having slept a bit more than I used to before our trips. My track record on arrival has improved dramatically! I have not been sick on a trip in a long time—and we do in fact travel more than most. (This is the one area where we have been a little more risk tolerant since 2020.)
What has changed since last year. But even with respect to Covid-19 risk, I am now less worried about the airport itself than I once was. I’ve learned from my colleague Dr. Joseph Allen, that large spaces with good air circulation—even ones with a larger number of people—are probably less risky than small enclosed ones where just a few people who might be infected are exhaling particles of Stuff-I-Don’t-Want™ with every breath, filling the room up with risk, as time goes on.
So, yes, I’ll drop my mask for 5 minutes to grab a bite to eat or sip a coffee during the 120 minutes I’m in this airport. Because the risk of infection is correlated to intensity of exposure and time of exposure, I’m still decreasing my odds of picking anything up—via droplet or air—substantially (possibly by 95% or more) compared to if I did not wear a mask here, and still carry hand sanitizer.
Of course, there’s a lot of chance involved with this and I accept some level of risk. (We do test ourselves for Covid before we see anyone who we are worried could be at-risk). That’s also I appreciate that at least a few people at this airport are still wearing masks. Together, we lower or raise the odds of spreading pathogens of all kinds by our behavioral choices. Let’s be good to each other!
As you gather for the holiday, remember that “harm reduction” is better than not trying at all. Harm reduction basically means “doing something less dangerous, rather than giving up altogether” on trying because it’s not possible or practical to avoid all danger. If you drive at 100mph for two minutes on a highway, the risk of a fatal crash is far lower than driving at that speed for two hours would be. The same principle applies in many areas of life. Harm reduction is an essential framework for keeping people safe. It’s a concept that is widely applicable to more situations than I can even begin to name here, but it is one that we will keep coming back to in this newsletter.
With that in mind, keep each other safe and—therefore—enjoy your holidays!
Like your wife, I have always carried antibacterial wipes too when flying and wipe my space down as far back as I can remember. I still have yet to fly anywhere since the covid-19 outbreak. But pre-covid19 I flew frequently. Sometimes monthly. I am planning to fly to Washington DC in February if I am recalling correctly. Like you, my thoughts on risk have also changed since the covid-19 outbreak. Overall, 2022 was probably the worst year ever for me since the covid-19 outbreak! Why was it the worst? One word, “work!” Non-medical management (educators) did not make it any easier dealing with covid-19. Because they were tired of “it” they decided it was over. No need for anyone to wear masks or receive any covid-19 education for that matter and crazily looked upon their school nurses as the “enemy!” NO joke!! Ugh... Way too many vested school nurses, one over 25 years of service to the district. She was also one of our practicing FNP’s. Several nurses quit! We even had a few brand new school nurses quit and went back to the hospital setting because they could not believe the complete madness of how the district not only treated their school nurses so poorly but how they played down covid-19. I for one am looking forward to 2023! I feel it will be a better year, even if we must still continue to fight for what’s right and continue to give covid-19 education!
Happy holidays and safe travels :)
I also used to get sick after most flights, and unnecessarily lost the first couple days of vacation to sniffles and sinuses, sometimes worse.
I had actually decided to start wearing a surgical mask on the next flight I took, stubbornly, and with determination not to feel like a freak, and then the pandemic hit, normalizing it! Now I wouldn’t dream of travel without an n95.