COVID-19 is confusing: UAB psychologist Josh Klapow discusses our individual assessments of risk

To say that the COVID-19 pandemic has left people confused is an understatement. One area of confusion: wearing masks.

The fact is that COVID cases are dropping everywhere. A Tweet from the Centers for Disease Control on April 21 pointed out that more than 98 percent of the U.S. population lives in a location with a low or medium COVID-19 Community Level.

And mask mandates are falling, too, with no requirements for people to wear masks on public transportation.

So, it’s crazy to keep wearing a mask in public, right?

Not so fast, said Dr. Josh Klapow, a clinical psychologist and adjunct at UAB.

Klapow said whether to wear a mask should not be based on what most people are doing — but on personal, individual circumstances.

Based on age and preexisting conditions, the actual risk of exposure varies from person to person, he said.

“It’s risk mitigation,” Klapow said, adding that “Risk is not subjective. Perception of risk or judgment of your risk is subjective. .. We all have different risks given who we are, where we are and what the situation is. … What’s subjective is my perception about my relative risk.”

To his point, the risk, even in Alabama, is not high, but the picture is complicated.

The Alabama Department of Public Health listed the statewide risk level as of April 25 — and the risk levels in Jefferson and Shelby Counties — as moderate, meaning that between 10 and 50 people out of 100,000 were positive for coronavirus. In Jefferson County, for instance, there were about 400 known cases in the period between April 11 and April 24 — about 34 new cases reported daily on average, according to the New York Times COVID tracker for the county.

The CDC listed the Jefferson and Shelby County Community levels as low as of April 25.

That doesn’t sound like many cases, considering previous high numbers. And COVID hospitalization and death rates are considerably lower.

However, the NYT shows those 34 cases to be a 49% increase over the last 14 day period. Even with the hospitalization rate down by 20%, and the death rate remaining flat, NYT describes the local rate of cases as “high.”

And aside from any confusion about what the numbers really mean, the risk for infection and complication remains different for different people.

“If somebody’s wearing a mask in a public setting — first of all, we don’t know what their health situation is,” Klapow said.

On the other hand, last year, CDC says, COVID was the third leading cause of death in the U.S. behind heart disease and cancer. And according to the CDC, older adults — people over 65 in particular, people with a variety of serious medical conditions, people who are pregnant or recently pregnant, and racial and ethnic minorities are at higher risk of becoming severely ill from COVID 19. “If you or your family member are at high risk for severe illness, wear a mask or respirator with greater protection in public indoor spaces if you are in an area with a high COVID-19 Community Level. Talk with your healthcare provider about wearing a mask in a medium COVID-19 Community Level,” the CDC says on its website.

Mental impact

Regardless of current community levels, Klapow noted that two years of the pandemic has had a definite impact on how people think. Klapow calls COVID “the crisis that keeps rolling on and on, or the crisis that keeps giving.”

“The reason I think that’s important is psychologically, we always want bad things to be over,” he said. “ We want an end to things that we don’t like… So I think one of the challenges with COVID is, its impact has not only been like the last two years. But it's still having an impact on our day-to-day lives. Supply chain issues. Hybrid working environments. Backlog of healthcare procedures and tests, etc. Inflation rates… It's not just what has it done to us. It's still doing it to us.

“Even if the infection rates and the death rates are going down, it’s still impacting us today,” Klapow said. ”While we are emerging, part of the challenge we have is that our lives are still functionally altered and so that adds to the cumulative psychological impact.”

That said, the psychological impact of the continuation of the pandemic is also different for different people and one of the ways that shows up is in mask wearing.

“People judge or value risk differently,” Klapow said.

Some are risk averse. “I don’t want to get COVID, period. So I’m going to be much more risk averse than you. You’re saying, ‘I don’t want COVID either but… I’m not willing to wear a mask in a public setting where no one else is wearing a mask.’ That’s you saying, ‘I should be OK,’ and me saying ‘I don’t think I’m going to be OK.’... To say one is right and one is wrong — it is what it is. It’s our decision to make to evaluate that.”

Another factor to consider, even if most people are choosing to go without masks, is that some authorities are still encouraging their use.

For instance, the NYT quotes Dr. Asaf Bitton, a primary care doctor and Harvard public health expert who suggests that masks may even make sense if you’re outdoors in certain situations. “If you can’t feel wind on your cheeks, you’re probably not in an area of great outdoor ventilation,” Bitton said. “If you’re really shoulder-to-shoulder with people, that might be a case of outdoor mask wearing, at least for now.”

Klapow himself said he still wears masks in some meetings. “It's risk mitigation.”