A patient once asked me what I had done on a recent vacation. I told her I had gone scuba diving. She said she would never do that, it was too risky. I asked her what she did on her vacations. “Hang-gliding,” she replied. Well, to each their own.
Perception of risk has been the subject of many studies and analyses. It’s important from a public health standpoint to understand how people will make decisions regarding health threats, preventive measures, and treatment options. The COVID-19 pandemic was and still is a study in behaviors based on risk perception.
We generally believe as individuals that we don’t take unreasonable risks. We balance our expectation of benefit or reward against the degree of harm if we fail and the likelihood that we won’t. Professional stunt performers will do the math and adjust conditions to minimize their risk, but most of us just “guesstimate” our chances.
Regarding health-related decisions, we may know there’s a future risk of a choice we make today. But if it offers immediate reward, we may underestimate the risk, a tendency called optimistic bias.
We think differently when the issue involves two choices neither of which we want. For instance, no one wants to have cancer, but we sometimes put off cancer screening because it is unpleasant, or because we don’t want to risk learning we may have it. We may do this even knowing that cancers are more successfully treated when found early.
Our attitudes toward COVID-19 and the vaccines have been more complex. The disease in its original form was often deadly to older people while kids and young adults usually survived with relatively mild symptoms. However, some young people did die, and many others continue to live with persistent fatigue, respiratory difficulty, or neurologic symptoms. This range of variable consequences led to a range of risk perceptions and behaviors, from sheltering at home to “COVID parties” where groups of people deliberately exposed themselves to an infected person.
Public health measures, including universal masking and lockdowns, were a response to officials’ risk assessment, but they also influenced the risk perception of individuals. For some they were a comforting preventive measure. For others they were unnecessary and a flagrant violation of rights. Our divided political preferences muddied whatever degree of objectivity people were trying to apply to their decisions.
As vaccines became available in December 2020, people had to balance the risk of becoming infected with COVID-19 against their concern about the risk of the new vaccines. As deaths continued to rise, their rapid development was an answered prayer. The vaccines had the potential to save millions of lives. But all vaccines have some risks, and many people mistrusted these because they were developed rapidly. Rumors were circulated, anti-vaccine proponents campaigned against them, and a rare but fatal blood clotting disorder was found associated with one vaccine. So, many people chose not to be vaccinated. Sadly, some went on to die from COVID-19.
We now have COVID-19 variants that can infect us even after vaccinations, though we are much less likely to die from them. We have boosters because vaccination effectiveness fades. The risk equation keeps changing and we have to keep reassessing our decisions. How can our experience help us?
Our best decisions will be based on data, not on who said it.
We may not have as much data as we want but we need to decide anyway.
Not deciding is still a decision.
Politics and social media are not helpful in risk assessment.
About Dr. Joseph Moser
Dr. Moser is the Chief Medical Officer at University of Maryland Charles Regional Medical Center. He has over 40 years of experience in the health care field and now oversees all of UM Charles Regional medical Center’s doctors on staff.
