The risks of masks are being uncomfortable and less connected...

The risks of masks are being uncomfortable and less connected to one another but the benefits for public safety are substantial. Credit: AFP via Getty Images/Kena Betancur

I got pregnant in March 2020. Before I'd even had my first ultrasound, I got COVID-19 when the fetus inside me was around six weeks old. After two weeks of pounding headaches and sleeping 14 hours a day, I got out of bed and found I could taste my food again. I felt lucky. At my first obstetrics appointment, I asked my doctor whether clearing the virus after a minor illness meant the baby was okay, too. She paused and said: "We don't know. The babies in Wuhan who may have been exposed during the first trimester haven't been born yet."

When scientists in southern Africa detected the omicron variant a few weeks ago, I was reminded of this anxious exchange, the pensive helplessness it inspired. The variant is still a finding of unclear but ominous significance, like a worrisome growth detected on a surveillance CT scan. There is good reason to believe it is very contagious and may evade parts of the immune response elicited by vaccines, but it is not yet clear whether it will make many people, and vaccinated people specifically, seriously ill; in fact it may not. The situation is still unfolding, however, and my phone has been buzzing since Thanksgiving with questions from concerned friends, hoping that I, as a doctor, could lend some insight or reassurance.

"It all feels so familiar — and so horribly wearisome," Anne Helen Petersen wrote in The Washington Post, describing "pandemic burnout" amid the emergence of the delta variant. Those words could also apply to the uneasiness we feel now, as we sort out the meaning of omicron. What Peterson calls "burnout" is also familiar to me from my experience as a palliative care doctor and geriatrician. It feels like when a patient has a relapse of disease.

When I have had to inform a patient about a new, upsetting diagnosis, it has been hard. A serious illness is devastating, terrifying — but initially, it can be met with energy for a fight. Newly diagnosed patients often believe that chemotherapy, or surgery, or medicine, can help, maybe cure. Their anger and anxiety are accompanied by determination. They have hope.

When I have had to tell someone that an illness has returned or progressed despite treatment, however — a cancer recurrence, for example — it has been, on average, much harder. With a relapse, everything is different. The return of an illness is a tacit confirmation that previous efforts to vanquish it were unsuccessful. People feel misled, betrayed, heartbroken, depleted. Their bodies have already been through a lot. Just staying alert to all the things that illness demands of you, within the constraints it imposes on your life, is profoundly exhausting. Expert opinions about what to do next diverge as you get further from first-line, algorithmic treatment protocols. Goals shift, from eradicating disease to learning to live with it.

Throughout the pandemic, the advice from elected officials has often been vague and confusing, and the discourse about what our collective goals are and how to achieve them has only gotten more fractious. As a result, it's often felt like we've been left to navigate this thing on our own — as caregivers, as workers, as parents and children and partners. Two years in, "just getting through it" no longer feels like a viable option. It makes sense for us to look for more sustainable ways of living in this reality, as people learn to do when a new diagnosis becomes a chronic disease.

Helping patients and their loved ones navigate illness has taught me that immersing ourselves in a stream of new, evolving, conflicting information isn't helpful. In the first weeks of the omicron era, this has come in the form of legitimate experts and pseudo-experts on Twitter posting graphs I can't enhance clearly enough to read, walking me through viral transmission math I barely understand, reporting gravely that they don't want to say, "I told you so," but they did. In the space of a single article, one expert says boosters will protect us from omicron, another speculates that they won't. The very same information can be shared with alarm or as a reassurance that we have strategies that work.

Fighting to keep up with it all isn't productive for most of us; it is overwhelming. We need a manageable framework to help us cope with the unknown and make decisions in a way that is consistent, logical and pragmatic. This is what I try to help my patients do when they're facing hard choices, and these are the things I try to remember, both at work and with my family.

First: The pandemic, like a cancer recurrence, is a situation fundamentally characterized by uncertainty, ambiguity and loss of control. We usually can't anticipate exactly how things will change, because complex problems yield complex possibilities — and we have very little individual influence over many of the relevant variables. Might we sort it out with omicron, only for another variant of concern to pop up somewhere else? Yes, if we don't vaccinate more of the world quickly, it's likely. But that is a concern that requires global interventions — interventions that relate only tangentially to our personal decision-making about, say, whether to visit this relative or attend that friend's wedding.

Tolerating uncertainty is perhaps the hardest thing about being sick or being scared. But acknowledging uncertainty also allows us to focus on what is truly within the narrow bounds of our influence. We can hope for a lot, but we determine very little. Explicitly acknowledging that tension can create space for us to do our best, even though no one can promise our best will be enough.

Second, I try to remember that no intervention is risk-free. This is true of something as simple as taking an aspirin for a headache, but also of social hardships, such as wearing masks in crowded places. The risks of masks are being uncomfortable and less connected to one another; the benefits for public safety are substantial. Here, choosing the intervention is clearly the right thing to do.

Not every such assessment, however, has such a straightforward answer — say, when weighing whether an 85-year-old should undergo elective heart surgery. How well is this particular patient expected to get through a big procedure and a hospital stay? How much is the problem you're operating on actually bothering her? What is her likely life expectancy, and how does she hope to spend the time she has left? In these cases, rather than ask, "Is this the right thing to do?" — a question so stark that it can feel impossible to answer — it is more useful to approach it in more human terms: "Do the benefits of this action outweigh the risks, for me, the people I care about and my community at large?"

Useful risk assessments take into account what we know, what we don't know, a personal evaluation of our values and priorities and an honest accounting of how our choices might impact others. Part of the way we will survive this without losing our minds is by recognizing that we generally make the choices that make sense for us, not choices that are universally correct.

The third difficult reality is that we can be guided and advised in good faith to believe many different things. (We can also be advised, in bad faith, to make devastating mistakes.) "Trust science" has been repeated frequently throughout the pandemic, as a mantra and a cudgel. But trusting science isn't about ceding all authority to experts who are themselves human beings, working through problems in real time. Rather, it's about believing in the scientific method, a process of challenging our hypotheses until we feel relatively sure. Waiting for that to unfold is excruciating — but rushing to judgment, being overly reactive, can leave us flailing counterproductively.

Though we've learned a lot about this virus, we know only a few basic principles with absolute confidence. The things that fall into that category — for example the utility of vaccines, ventilation, masking and testing — should be emphasized over and over. From what we know so far about omicron, the news suggests at least some measures to take: You should get a booster, you should vaccinate your kids, you should keep masking for protection in a crowd. So much else — especially emerging data from ongoing laboratory studies — is static. This is the case with the majority of what is being shared about omicron right now: It's a lot of noise, and we, the general public, can't yet recognize the song.

This advice may feel frustratingly vague; it lacks the reassuring concreteness of being told to take some decisive action. But acknowledging these realities can help de-escalate some of the worst feelings that come with a recurrence of disease. It helps me and my patients when we reframe decisions around articulating what we care about. Instead of trying to master a problem, we talk about maximizing benefits, minimizing risks, stating what we really know for sure, and tolerating change and uncertainty. It is a relief to absolve ourselves of acing a test that cannot be aced. It allows us to feel tenderness for ourselves and each other. In the tensest moments of my career, I have found that it is important to find opportunities to be gentle: to acknowledge how emotional this is, to wonder about how your experience may overlap with or diverge from mine, to empathize.

I was very lucky. My baby was born after an uncomplicated pregnancy and delivery; next week we are celebrating his first birthday. I don't know what the world will be like on his second. But I can hold the hope that it will be better than this moment of omicron-inspired anxiety, and sit with the possibility that it may not — and within those constraints, make the best decisions I can.

The uncertainties of living with an existential threat are impossible to face, and yet we have to face them anyway. We ought to do so with some accrued wisdom from all we've already been through together.

Rachael Bedard is a geriatrician and palliative care physician working in the New York City jail system.

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