“Should I go or should I stay?”
Although this sounds like the lyrics from a country song, this question opens the perilous issue of confirmation bias or cognitive bias — the phenomenon recently described among individuals who were weighing the option of not receiving the COVID-19 vaccine, which we know is overwhelmingly safe and effective.
We are now learning from cognitive experts that individuals often decide about X, Y, or Z based upon intuition, a gut feeling, and then they seek out, tease out, and distill the data to support that decision. Belief comes first and data come second.
If I believe upfront that the vaccine is safe and effective, for example, I will marshal the data to support that decision. On the other hand, if I do not believe and trust in the vaccine, I will find data out there to support that decision as well.
Let’s agree to agree on that point. But let us raise the stakes to real life.
· Should you stay home or should you go to a family reunion in another state, take an airplane flight, and be with people who have not been in your bubble thus far?
· Should you go to a big box store to shop?
· Should you attend an outdoor family picnic in a park on a nice sunny day?
· Should you stay home or should you go to your grandchild’s soccer game at the outdoor field?
· Should you go back to your workplace to mingle indoors with coworkers who have also been working from home?
· Should you return to your gym for a treadmill workout and then use the weight machines?
· Should you stay or should you go . . .
With new CDC guidelines about where you should wear a mask depending on your vaccination status, these decisions are a little easier. The fallback is always WEAR A MASK — or don’t go.
A complicating factor with mutants
As a backdrop at the same time, halfway around the world, the Indian subcontinent is disintegrating from COVID-19. Three hundred thousand new cases a day and approximately 3,000 deaths a day with no end in sight from this apocalyptic cataclysm. It is a matter of time before a vicious mutation from the subcontinent spreads beyond the confines of that geographic region. It is just a question of time and a plane trip.
In a sense, life is a roll of the dice, it is based on odds, probabilities, and percentages — just like the racetrack where I spent my formative years. Despite voluminous data available to bettors at racetracks primarily through the Daily Racing Form, the experts select the winner in only 30 percent of races.
So, at the end of the day, with COVID there is no algorithm whether you should stay or go. There is no artificial intelligence or machine learning that can definitively provide guidance. We make the best decision that we can under the circumstances with the information available to us. And we recognize and accept that intuition, judgment, and that gut feeling should not be ignored during these uncertain decisions.
The light at the end of tunnel is still dim
Just when we believed that, yes, there was a light at the end of the COVID tunnel because of safe and effective vaccines, there has been the vocal emergence of anti-vaccine voices and pushback about lockdowns setting the stage for another surge, which is especially lethal for young individuals, many of whom are not vaccinated.
No one could have anticipated the searing COVID crisis, but the investment in vaccine development has been too great to totally unravel the program because of misguided and misinformed people with cognitive bias (they want to believe the virus is a hoax and the vaccine a sham). Everyone agrees that we must move forward.
The freight train is heading down the track out of control, and this group ought to be nimble and agile or they will get run over and imperil the rest of us.
Let me stick with the train analogy for a moment. There is a classic psychological dilemma that Psych 101 students are always asked to examine.
You are the student, and here is your moral dilemma: A runaway train is barreling down the tracks heading for five people who are tied up on the tracks (cue the ominous music). You are the train router some distance away. You can slip a switch to route the train to another track. But wait, on that track is another person tied to the tracks.
What do you do? If you do nothing, you allow the train to kill five people. If you flip the lever, the train is rerouted and kills one person.
Happily, the train problem is theoretical and the fodder for many discussions of ethics. Sadly, if you are unvaccinated, you have these two choices. Which track will you take? What if the people tied up on the track are your parents, coworkers, and children? Does it matter if they are random strangers?
Think about it.
Hope for a better day
With the emergence of these remarkably safe and effective vaccines, the tide of the pandemic is subtly improving. However, it seems highly unlikely that we will ever get back to what we all recalled as normal. Herd immunity requires about an 80 percent vaccination rate, and it seems unlikely that we will reach that number because of individuals avoiding the vaccine. The relaxation of social distancing and congregate gatherings clearly will fuel another pandemic in conjunction with the emergence of mutations.
So whether we are a surgeon, a retail clerk, or somebody’s mom or dad or grandparent, with a word of encouragement, a thank-you, a recognition of each other and why we vaccinate because it helps us all, we can hope for a better day.
Dr. Edward T. Creagan, professor emeritus at the Mayo Clinic Medical School, blogs at www.AskDoctorEd.com and is the author of award-winning books on end of life and patient empowerment.
