Personal responsibility

[liv]

TL;DR: I'm sick, and it might or might not be Covid, and I'm grumpy.

I'm very much susceptible to the notion that the key factor in the morality of society is personal responsibility. I'm white, I'm middle-class, specifically the kind of white middle-class background where my family dropped several notches on the social scale as immigrants, and through a combination of hard work and latent class privilege were able to climb back to comfortably middle class in a generation or two. Growing up, I often heard "you can have anything you want as long as you work for it", and the maxim seemed totally plausible until I met people from very different backgrounds to my own. I've been using 'individ-ewe-al' as an online handle for years. I'm by inclination capitalist and right-wing politically and I really really don't think the state should micromanage ordinary people's day-to-day lives.

But even with all those biases, I just don't see how personal responsibility is a viable strategy for dealing with infectious disease epidemics. Not that people aren't responsible. At least 80% of people are more responsible than Boris Johnson and his pro-disease cronies, and are basically willing to restrict their lives in order to keep other people safe, without needing legal compulsion. Part of the problem is that the remaining quintile are selfish jerks, but actually that's a very minor aspect. Much more serious is the issue that the virus doesn't care if you are an upright person with lots of personal responsibility; you can somewhat reduce your own personal risk by doing things like avoiding crowds, wearing good quality masks and so on, but that alone isn't enough to bring infection levels down and return to normality.

And more serious still is that you just can't exercise personal responsibility unless there's societal infrastructure to support you. On a basic level it's near-impossible to isolate when sick if testing isn't widely available; you are likely to miss asymptomatic cases and likely to over-compensate for minor symptoms like allergies. If there isn't coordinated surveillance, you can't know when cases are high and when extra precautions are needed, and indeed you can't know when it's time to relax. But it's more than that, you can't avoid spreading disease at work unless employers support working from home or taking time off from an in-person job when you might be infectious. If schools are actively prohibited from offering hybrid options and kids are written up for truancy any time they need to isolate, schools will be disease reservoirs no matter how much personal responsibility parents of schoolkids demonstrate. And there's a kind of knock-on effect; if everybody takes personal responsibility for deciding which events are safe, there's a baseline expectation that transport, retail, culture etc will be available for those who decide it is safe enough, which means that all the employees are forced to take additional risks that may be beyond their own thresholds.

Same goes for masking. I have no problem at all with wearing a good quality mask basically all the time I'm away from home, and I don't mind at all looking 'silly' if I'm the only person doing it. But one-way masking is not all that effective; to actually reduce transmission, it needs most people in most gatherings wearing masks (enough to compensate for people who are unable to wear masks.) And I can't take personal responsibility to ensure that all events and venues offer outdoor food options, let alone provide seats, tables and non-enclosed shelter to actually consume the food. I suppose I could take personal responsibility for bringing a portable HEPA filter with me wherever I go, but it would make a lot more sense for businesses to install filtering and air cleaning at an appropriate scale.

So here's my current situation: my friend invited me to a life even that's important to her, several hours travel away. If it were completely up to me I would have stayed home for two weeks before travelling to make sure I wasn't a potential disease vector. But I don't have that option; work insist that I attend in person 1-2 times a week, and this particular week there were multiple medium-sized in person indoor meetings where very few colleagues apart from me wore masks. It's even worse for people whose work makes them show up when they have known exposures or even confirmed infections. So failing that, I took repeated LFTs in the days leading up to the trip and they were all negative. I wore a FFP2 mask for the whole journey, which meant most of 7 hours with almost no opportunities to eat or drink. I had a few connections, but there wasn't time to buy food, leave the station to eat it, and return in time to catch the onward train. Bringing my own food with me might have been more responsible but I really wasn't sure I would get time to eat it and pretty certain I wouldn't be able to sit down to do so, and I didn't want to waste food by packing a lunch that I might not get to eat. Some of the trains had good aircon and I've heard that that can be pretty good protection, but some really didn't (which also made the two hour stretch in 30+ temperatures on a train with about twice as many passengers as seats really unpleasant). If we had a societal level approach to ventilation, I would know whether it was safe to take my mask off on the train in order to eat some sandwiches and take a drink.

The event itself was mostly outdoors, and I wore a mask for the part that was indoors. The celebratory food and drinks afterwards were indoors, but the venue did have a balcony and were willing to bring my food out to me. That meant I ate on my own and not with my friend and the party, but that's ok, that's a level of personal responsibility that's ok for me. The day after the event, I started getting symptoms, mostly a really really painful sore throat, and feeling slightly shivery and achey.

So what's the responsible thing to do? I started looking for places to isolate but there is almost nothing available at short notice in high season. Even if I was prepared to drop most of a month's salary on a short term let, there really weren't a lot of options for somewhere to stay where I could be sure I wasn't exposing other people, such as hotel staff. Would I have a means to get food and clean clothes without risking infecting others? A society-wide response would provide at least financial support for isolation, and ideally designated safe, well-ventilated venues for people who needed to isolate. Just as an individual person, even a relatively rich one who could just about afford four figures to book somewhere to stay in this sort of situation, I was really limited. In the end I decided to take an LFT, and when that was negative, travelled home. This time I really really didn't take my mask off, even briefly, for the full 6 hour trip, even when I was outdoors, and I was really scared I was putting other people at risk.

So I made it home. I had a kind of bad night, and I've taken today off work because I'm not really well enough to work from home. Still testing negative. Theoretically, as a vaccinated person even if I test positive I'm advised to take precautions, but there is no legal obligation on me or my employer to actually isolate properly. Given the timing, I was potentially exposed Wednesday at work, Thursday while travelling long distance and maybe Friday at the event, and symptomatic by Saturday, so I think it's most likely that I caught this (whether Covid or some other upper respiratory thing) at work.

Another aspect of why personal responsibility doesn't work is that we never really had an effective track and trace system, and what little we did have has been abandoned. So if I do test positive, I don't really have a good way of informing the people who might have been exposed to me, fellow passengers on the train, fellow attendees at the celebration (which was in a pub so it was kind of semi-public, not just members of our group whom I will be able to contact). And even then, I'm relying on LFTs, which I'm taking personal responsibility for purchasing, but obviously not personally responsible for making sure LFTs are manufactured and quality checked and distributed. I should possibly pay for a PCR which are in theory more sensitive but again, they're only as good as the quality control systems which are... non-existent, basically, I can take some amount of personal responsibility for researching a provider I believe to be reputable, but that only goes so far.

At the same time, the personal responsibility rhetoric means that I keep running across vulnerable, disabled and shielding people who argue that anyone who does any travel or socializing at all is an evil eugenicist who wants disabled people to die. I really don't know how to deal with that. Possibly it was ableist of me to even contemplate taking a long train journey to a celebratory event when some people can't do that. But the problem with that line of reasoning is that me not taking the train for an event that wasn't strictly necessary for my life just wouldn't go very far in making the world safe for vulnerable and immune-compromised people. What if "what I want" is a world with lots of remote and hybrid options, where in-person events have really high standards of ventilation and everybody knows whether they are currently infectious or not so they can act accordingly? I can agitate for that, but I need organizations and ideally public bodies on my side to achieve anything.

I've been personally called a bad person both for saying that we need to move on from santizing hands and touchpoints to taking actually airborne precautions based on what we now know about the science, and for saying that sometimes people leave the house and mix socially while infections are high for reasons other than just being 'dicks'. And I can see the temptation, I feel myself getting irritated with people who take risks that look unnecessary to me (but I don't know their lives and I don't know what they've compromised on to be able to do that one thing I might not approve of). I confess I do also get irritated with people who say things like, Omicron has an R₀ of over 18 and anyone who ever leaves their house is recklessly spreading microscopic murder machines!!! But really, there's no point getting irritated with people who are exercising personal responsibility in the wrong ways, I should remind myself that the problem is that infectious disease can't be solved by personal responsibility alone.

Comments

[seekingferret]

Sorry you're sick, hope you feel better soon, COVID or not.

I empathize with a lot of this, particularly the last paragraph. And I find I'm particularly struggling when people say things like the "Omicron has an R0 of over 18 and..." because I am very much struggling to keep up with the science and the facts but a lot of the time either their facts about the dangers of COVID are wrong or my facts about the dangers of COVID are wrong and I don't know how to evaluate whether or not I'm recklessly spreading microscopic murder machines because I don't know whose facts are right. I'm finding it very hard to make probabilistic calculations about my personal risk and the risk I pose to others, and especially because I am very aware that whatever facts I do have about the reality are lagging behind the reality by months or years.

My mother got COVID two weeks ago and went to see a doctor who prescribed Paxlovid and she refused to take it, partially because of fearmongering on the news about its side effects but I think in large part because it would have meant admitted that at 66 she is old enough to be considered high risk, and that was scary to her and also I suspect a blow to her vanity. Thankfully she's fine and recovered well, but it was still frustrating to me, not to mention terrifying, that she wasn't following easy and straightforward medical guidelines with a lot of evidence behind them. So I am skeptical of personal responsibility, I know that people are not rational and that no matter how much I try to calculate the odds I am not rational. But I'm also skeptical that large government agencies are rational so I'm not sure I believe in any workable alternative to personal responsibility either.

[redbird]

Another piece of the problem is that the "screw you, I've got mine" contingent are doing their best to obscure the differences between, for example, needing to go to work in order to pay your bills; going to an event like the one you traveled for and isolating beforehand to the extent possible; and multiple unmasked visits per week to crowded bars.

One online argument I walked away from, a few months ago, was with someone who said that if she wasn't already prepared [in spring 2022] to go out dancing to live music, unmasked, she might as well never leave her house again.

It's hard enough to figure out what is safe enough -- for me, for my household, given what I know this month and what medical treatment is available to me -- without people being upset by questions like "what are your covid protocols?" As you say, we don't know what other compromises people are making, in terms of total risk: in infectious disease terms, it may matter whether you make that railroad journey once in six months or every week, but it doesn't matter whether you were traveling for social reasons, medical ones, or because you really like train trips.

[ambyr]

My kingdom for it to become standard, as it apparently is in some parts of Asia, for buildings to have clearly displayed air quality monitors in public places. I am willing to take the personal responsibility of deciding what buildings to enter; I don’t want the personal responsibility of sourcing a portable CO2 monitor produced somewhere with reasonable quality control and carrying it everywhere I go.

[anais_pf]

I hope you feel better soon, and that this turns out not to be Covid.

[seekingferret]

You don't worry that if we had systems like that we'd just end up drowning in information we don't know what to do with? Because I worry about that a lot, and I'm an engineer who spends a lot of time designing systems for telling people when something is unsafe. It's one thing for me to put a Hydrogen Fluoride sensor in a tool and set an alarm to trigger if we're at 25% TLV, we have lots of data and know what will happen if someone faces an exposure at that level. And on the other hand, we designed a system that channels high powered microwave radiation and I set out to design sensors and shielding based on maintaining safe limits of exposure and... I learned that the literature is confusing and uncertain and there is no federal guideline other than "Not enough to do immediate physical tissue damage" and... it was really challenging to know how to approach the design.

CO2 level is a proxy for a proxy for a proxy, a high level doesn't mean that you will get COVID and a low number doesn't mean that you won't, and as you say, what that number does is foist the personal responsibility for deciding what to do with that number onto every individual, no matter how mathematically and scientifically literate they may be. I'm not always sure that more data is better data.

[liv]

Yeah, part of why personal responsibility is hopeless is that it's so impossible to keep up with the science and facts, let alone feed that data into personal decisions. You're absolutely right about lagged information too, even if an individual is capable of filtering good quality evidence from misinformation, a lot of the studies are based on older variants and contexts with less vaccination and more restrictions, all of which make it hard to extrapolate anything. The R0 of 18 thing is ridiculous on its face, it comes from adding up numbers that are not at all additive and it's absolutely implausible in the real world, but there are plenty of other claimed risks that I'm far less sure of. And there's a layer beyond just probabilistic; there are plenty of risks that would be negligible if one person did them once but cumulatively disastrous if everybody did them every day and I don't really know how to take that into account.

I'm glad to hear that your mother recovered, but oof, that is really hard about the drug decision. You're entirely right that people aren't rational and government agencies aren't rational and organizations in general aren't rational, but I still think we could be doing a lot better than leaving everything up to individuals. Like, for example, it's possible to have some sort of functional occupational health and safety system whereby businesses are liable if they expose employees (and customers) to dangers. It doesn't have to be perfectly rational or even perfectly enforced, but it's not completely unthinkable.

[lovingboth]

Yep, the recent peak is down to the current variant not caring much if you have had Covid-19 before or if you have been vaccinated..

.. and the government going "It's all over! Do what like! If anything happens, it's down to you!"

At least this time, fewer people have died.

[oracne]

This.

[oracne]

I hope you feel better soon, and that it's not covid.

[liv]

Yes, the (likely intentional) obscuring differences really bothers me too. Both treating all possible risky behaviours as basically the same, and the other side, treating all possible health measures as equivalent to full trapped in your home lockdown. Forgoing unmasked dancing absolutely is hard but it's definitely very different from never leaving the house!

I am mostly, but not completely, trying to stick to events where I can ask the other participants about their covid protocols. But train journeys clearly aren't in that category, and synagogue services are pretty borderline. I haven't had a lot of problems with people being upset about being asked, but having basically helpful acquaintances doesn't go as far as I would like.

Really good point that infection risk doesn't depend on whether you do things for "good" reasons or not! On a personal level, if I evaluate the reasons for taking a calculated risk that averages out at taking risks less often, which does matter. But on a societal level, selfish acts aren't particularly more risky than virtuous ones because the virus isn't a moral agent. That's related, I think, to the inadequacy of personal responsibility. A person who sends their kids to school because they need an education, or visits many vulnerable people to provide care, is behaving very responsibly, but is also a big potential vector of disease.

[nameandnature]

Can you explain why I should avoid catching and passing on COVID more than I would, say, flu? For flu, I wouldn't go to work if I had it, and I'd avoid vulnerable people, but wouldn't expect others to be masked indoors to avoid me (or anyone else) getting it, or for the government to enforce masking, say, and certainly wouldn't berate people in general for going to pubs or going to weddings in case they passed on the flu.

I say this because COVID is less deadly than flu because of vaccination and the reduced virulence of omicron. I'm someone who largely supported lockdown before the vaccines were available, but I'd say the only justification for such authoritarian restrictions on personal freedoms is that a lot of people might well have died without them.

There are still people who are especially vulnerable, but again, pre-COVID we didn't impose (or feel guilty about not self-imposing) mass restrictions to stop the masses giving them flu. Perhaps we should have?

[finding_helena]

This is really well said. You encapsulated my concerns with a lot of the rhetoric I hear from both camps. It's a Covid world now, and precautions overall are so relaxed now as to be nonexistent. We're trying to live in it and it is not going to change any time soon. Trying to reconcile all that is hard. I don't feel like there is a black and white solution here, not that we as individuals can implement.

[wildeabandon]

I think the main reasons is that whilst Covid is less deadly than flu, it's considerably more likely to lead to long term, possibly permanent disability.

As a relatively minor additional factor, I think the much higher infectiousness of Covid also means that there's more chance of it mutating into something considerably more deadly, and reducing transmission reduces that risk.

[(Anonymous)]

Omicron is less dangerous than delta, but delta was more dangerous than the initial Wuhan strain. I hope that the next variant doesn't turn out to be more dangerous than delta, or even as infectious as omicron but more dangerous.

[lilacsigil]

Yes, I think one of the reasons I haven't yet have COVID despite working in healthcare in person throughout is that I live in a very rural area. There's no public transport, most gatherings are outside, there's pretty much no restaurants to eat out in, I'm entirely able to wear a mask everywhere out of my home with no problems. Also, I don't have school-age kids. Precautions are pretty much completely out the window and it's incredibly frustrating.

[lnr]

There's an awful lot of space for precautions in between the two extremes of Lockdowns and Nothing - and I think we should be being more cautious than we are. For one thing it's now well over 6 months since many vulnerable people had a booster - unless you're over 75 or immunosuppressed you're mostly not eligible. My son hasn't even had his second dose yet, as he caught covid just before the first dose for under 11s and had to wait 12 weeks. (He gave it to both of us, Mike was more ill than he's even been with flu - I was lucky and only experienced it as a very heavy cold). I have friends on their third round and still struggling with long covid symptoms from the first, and scared this is going to make it worse.

I've already booked my flu jab for September and I still don't know if I'll get another covid one, or when, despite having been one of the people on the CVE list!

Wearing masks in enclosed indoor spaces, testing, and providing people with *proper* sick leave so they can isolate if they have it all seem like sensible precautions to me, but like Liv says, relying on people to choose to do those things from a sense of personal responsibility isn't enough.

Also I would try and avoid catching and passing on flu too!

[(Anonymous)]

I'm not sure the evidence is there for the claim that COVID is much more likely to lead to long term disability. I'm not denying that some people are affected by it for long after they've had it, but this is also true of flu and other viruses. Possibly I'm missing some research into this, though.

[(Anonymous)]

Wearing masks in enclosed indoor spaces, testing, and providing people with *proper* sick leave so they can isolate if they have it all seem like sensible precautions to me, but like Liv says, relying on people to choose to do those things from a sense of personal responsibility isn't enough.

Why not enough/more cautious, though? I don't think there's justification for legal mask mandates, for example, on the basis that we never did this for flu or other viruses, and COVID is currently less deadly than those. (Again, I complied with the mandates and tried to buy the best masks I could, so I'm not an "anti-masker" in that sense). Long COVID is a worry but I'm not aware of decent research on how bad it is, so that could still tip the balance in my mind.

I do worry that there's a subset of people who had the fear of God put into them during the pre-vax period and are naturally more scrupulous than others, who're now missing out on life for no reason. (I know some personally. They got it despite their precautions and are now on the mend, so might hopefully come out of their caves again.) It's not as bad as America where mask wearing (or not) has become tied to a political identity so is a form of signalling.

[nameandnature]

Argh, that was me, DW not good at remembering I'm a user, it seems.

[sfred]

I find it all very frustrating too. I hope you feel better soon.

[ewt]

I hope you're on the mend soon!

I think if it were normal for most people to wear masks at indoor gatherings, and normal to have excellent ventilation (or filtering/UV-C/whatever air treatment), there would still be some airborne illness. But there would be less of it, and it would likely be less severe (in cases where viral exposure levels at infection influence disease severity). In such a context I would be willing to do things like remove my mask to eat and drink.

This wouldn't only affect catching Covid, of course. It would mean less 'flu, less measles in areas with low vaccine uptake, less chickenpox (insert rant here about chickenpox vaccination not being routinely offered on the NHS), less of that horrible cold that does the rounds most winters. It's not just about Covid, it's about airborne transmission of loads of things after a century of not taking that possibility seriously and blaming poor hand hygiene instead. (Good hand hygiene is still good, of course.)

I am very, very frustrated that we aren't there yet. In this less supportive context, for me 'personal responsibility' combined with my household's risk tolerance means wearing an elastomeric respirator at any indoor gathering or in sufficiently crowded outdoor spaces, which is a lot more uncomfortable and inconvenient than an N95, and really difficult to sing in (an N95 isn't wonderful, but when I was in Canada in May I attended two choral concerts where the entire choir were wearing masks). And yes, we are hugely privileged in that all of us can work from home; "not everyone can do this, so we should, in order to prevent infecting others" is part of our calculations. Whereas 'personal responsibility' for my 92-year-old father-in-law who lives alone is rather different.

[ewt]

I think one issue is that we used to be told that 'flubwas mostly transmitted by fomites and droplets, not aerosols. So we didn't take mitigations against airborne transmission of 'flu because we didn't think that was relevant.

It turns out it is relevant.

[jack]

That's a good question, I agree that often publishing values is often a compromise that doesn't help anyone, if people end up with meaningless choices because there's too much information for them to choose, or because no-one produces anything with the value they'd like to have. I think there's a lot of cases like that (some where it's a problem, some we've solved by converging conventionally or legally on a required acceptable value)

But I think there's two points here. One is, if it's a choice people don't care about much, then information doesn't help much, but if it's a choice people care about a lot, then it's much more likely that they'll make a choice that matters.

And the other is, the alternatives to making the current situation more transparent might be either "do nothing" or "someone with some expertise decides what's safe and we do that." I think most people who would like information about ventilation would *like* it if places took effective anti-covid measures as best as could be determined, but are complaining and asking for information when they live in places where they think places AREN'T taking effective measures, and think that publishing information which is comparatively easy to do would be better for them than nothing.

[jack]

I'm not sure the evidence is there for the claim that COVID is much more likely to lead to long term disability.

This is what I would like to see something more conclusive about. My thinking was roughly, "Long term or permanent impairment used to be a significant risk with covid. There's some indications it's less of a risk now but I haven't heard anything conclusive, and whatever the risk is the risk could easily be a 0.X% chance *ever* or a 0.X% chance every 4 months forever. If we go longer we go without any evidence that it IS still a big risk then it becomes less likely eventually."

I feel silly I haven't seen any actual research (even just imprecise research like "how many people in the UK still suffering from long covid four months after getting infected in the spring covid wave") I think those statistics are there I just don't have a good overview and I don't know if someone does or not.

For completeness I did a quick google to find out any obvious sources I was missing.

https://health-study.joinzoe.com/blog/covid-long-covid-risk estimates 4.5% of uk omicron cases as long covid (using a cut-off of "still have symptoms, usually fatigue or similar, after 4 weeks"). That sounds worryingly high to me, but I don't know how many of them are unvaccinated, or how many are getting better after 4 weeks vs being still the same after 4 weeks. (https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/articles/coronaviruscovid19latestinsights/infections has some other recent numbers for the UK total, broadly compatible I think)

For completeness, my informal sample of "having heard of people I know getting long covid", I think had one person get "never getting better" long covid from an early wave :( And approximately one person getting "weak for several weeks but then seeming to recover" long covid from the recent wave. But I don't know how many people I know well enough to know I would have heard if they had a lingering but not permanent covid case. Maybe 50?

[seekingferret]

I feel like the methodology that would work best for me would be something like the Energy Star or LEED Rating systems where experts came up with some standards for building ventilation that could be reduced down to two or three levels from worst to best and I could make 'personal responsibility' choices about whether I want to spend time in a Gold Ventilated Building or a Bronze Ventilated Building.