Corona #37: COVID C.A.R.E.

How should we interact with other people during Corona Time, and especially now, as restrictions are loosening and we may be coming to a “new normal?”

Evelin Dacker,  MD is a physician in Salem Oregon who promotes a way to handle this problem.  She calls it COVID C.A.R.E.  C.A.R.E. is an acronym for Container, Agreements, Risk Tolerance and Etiquette.

Here are the nuts and bolts of her approach.

Container:  All of us live in a container.  Some live in more than one.  Those in our household would be one container.  Those in our work group would be another.  Those we socialize with would be another. 

Your container(s) can have people at different social distances and include people who are also in multiple containers. It probably includes the people who you directly intersect with: anyone who comes within 6 feet of you for more than 10 minutes. As time goes on, these containers may change, with people moving away or closer. 

Dr. Dacker chose the word CONTAINER, specifically because we are trying to “contain” the rate of infection.

Think about who may be in your container(s).  What are their risks? How does our choice to engage with others affect them? Where does our container exist? A person living in New York City may feel very differently than someone living in rural Oregon. 

Agreements:  We often take people that we live with for granted.  And the same goes for people that we work or socialize with. 

Have we sat down and spoken our boundaries and risk reduction etiquette out loud?  Do we have a common understanding of each other’s boundaries and risk tolerances?  As we move towards broadening our containers (loosening restrictions), we need to create agreements with each other to help navigate these changes. 

Everyone needs to understand and be clear about their needs and risks with everyone else within their container. Usually the highest risk person or the person with the lowest risk tolerance will set the standards of acceptable behavior for the container.

In some containers, it is difficult to have perfect risk reduction behaviors, such as maintaining 6 foot distance from strangers, wearing masks, or staying at home. For example families with essential/ frontline workers, teenage children, or special needs people may require disclosure about the additional risks to others as the social network broadens. 

Risk Tolerance:  What is your risk tolerance and what are you putting onto others?  Do you always (or never) maintain a six foot distance from others, and expect them to do the same?

This is the most controversial and difficult place to navigate as we reduce social distancing and open society back up. We each have our own personal tolerance for illness, disease and death. It is imperative that we understand this in order to take into account everyone else in our container and community at large.

Risk tolerance can dictate the behaviors we impart unconsciously to others.  We assume that everyone is on the same page (ours) or should be.  That is most likely not the case.

The more someone is at risk of disease and death due to where they live, their health, pre-existing conditions, economic status, race, or age, the lower their risk tolerance. Others feel that they have less to lose if they get sick, and are willing to take on more risks. One cannot know everyone’s level of vulnerability.  Essential workers and those they care for have died due to others’ inadvertent exposure. 

Your personal risk tolerance is yours alone and cannot be imposed on anyone else without their clear verbal understanding and agreement. As risk tolerance increases, so does the potential harm to others. You are responsible for protecting others from yourself.  Not to do this is a violation of  consent and boundary. 

Understanding risk tolerance and being responsible for your choices is critical to our ability to open up our society as safely as possible. 

 The person with the lowest risk tolerance and highest risk, must set the bar, without guilt or manipulation. If there are inconsistencies with this, then etiquette needs to be discussed and agreements made. 

Etiquette: Etiquette is something we do for each other and for the benefit of society as a whole. There are expectations that we behave in a way that reduces our risk of contracting COVID-19 and also  the risk to those that do not have a choice in their interactions with us. We are not only taking on reducing risks for ourselves, but on how we are imposing ourselves on others. 

Two additional notes:

Gloves — Are not well recommended since some people use the wearing of gloves to touch anything. Gloves can give a false sense of protection.  If you are going to wear gloves, they must be put on after a 20 second hand wash or use of alcohol sanitizer. Do not touch your face with your gloved hand or you will self contaminate. Take off the gloves as soon as they are no longer needed. Pull one off first, then use the clean hand to go under the glove to pull the other one off.  Do not reuse them.  Dispose of them in a closed container. 

Shaming and Judgment  –  These are trying times. We are scared. Some of us are facing death and illness like never before in our lives. Shame is a powerful tool used to maintain conformity to a social standard. It works. It also causes death, depression, isolation, and deep suffering far greater than any virus ever could. Being judgmental about others’ choices shuts people down from being honest. Not knowing what someone is doing during the age of Coronavirus is potentially deadly. It is far better to know if someone is not following measures to reduce viral transmission, so that you can protect yourself, than to shame and judge them to where they don’t disclose that to anyone else (while not changing their behavior). Listening to their reasons and having an open discussion is far more effective to have them care about their choices. 

If you want to the complete version of Dr. Dacker’s program click on this link:

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Many thanks to Rose O’Keefe for alerting me to Dr. Dacker’s Covid C.A.R.E. plan.

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