How Do You Even Calculate COVID-19 Risk Anymore?

9 minute read

This month, I did something both mundane and momentous: I went to a fitness class, in an actual gym, alongside other humans. In the Before Times, this was something I did multiple times a week. But—you know the rest.

It felt good to be back for the first time in more than a year, until I walked home afterward and began to spiral. Was that safe? Did I just get COVID? Did I just spread COVID? Am I part of the problem?

Some facts helped me feel better: I knew everyone in the studio was vaccinated, thanks to New York City’s requirements for businesses like gyms and restaurants. The class was small and fairly spaced out. And I liked to think that no one would have attended while knowingly ill. But thousands of New Yorkers still test positive for the virus every day, and the new and largely unknown Omicron variant threatens to undo our tenuous return to “normal,” given early reports of its extra transmissibility and potential to cause breakthrough infections in people who are vaccinated.

In many ways, decision making is even more complicated now than it was last year.

I would never wish for a return to 2020, but “stay outside or stay home” were, at least, clear marching orders. Now, I’m often at a loss. As a young, healthy, vaccinated and boosted adult, I’m at low personal risk and eager to embrace life circa 2019. But I also care about curbing the spread of COVID-19 and protecting those more vulnerable than I am, particularly with Omicron on the scene and other variants likely to follow it. And I’d still rather not get sick or infect my loved ones if I can help it.

Now that vaccines and boosters are available to most people in the U.S., plenty are stuck in similar dilemmas. How do you behave when life is creeping toward normal, but more than 1,000 Americans, and even more people worldwide, still die from this virus every day?

The new normal?

Most experts agree that we’ll eventually live with COVID-19, as we do the flu and common cold. That doesn’t mean it will be harmless; inevitably, some people will get seriously ill, develop long-term symptoms or die, as they do with influenza. But at a population level, widespread vaccination and immunity from prior infections will help downgrade the virus into something that mostly causes mild disease, freeing us from factoring COVID-19 into every decision.

With about 60% of Americans fully vaccinated, largely protecting them from the most dire outcomes, are we there yet? If you’re vaccinated, can you safely gather with family or eat inside at a restaurant, even though the virus continues to circulate widely?

The unsatisfying answer, of course, is it depends. If you are immunocompromised, elderly or have an underlying medical condition (or live with anyone who fits into these categories), you’re working with a different set of variables than someone who is younger and healthier. Families with children younger than 5, who cannot yet be vaccinated, may also choose to be more cautious, even though most young children do not get seriously ill. It’s also worth considering whether the people you’re around are vaccinated and boosted, since unvaccinated, partially vaccinated and even fully vaccinated but unboosted people are at much greater risk of infection than those with the full suite of shots.

Dr. Neha Nanda, medical director of infection protection at the University of Southern California’s Keck School of Medicine, recommends keeping an eye on both case-count and hospitalization trends in your area. There’s no exact threshold at which you should or should not do certain activities, but she says the U.S. Centers for Disease Control and Prevention’s map of community spread can be helpful. If your area meets the definition of “high” transmission—at least 100 new cases per 100,000 people over the past week, and/or at least 10% of COVID-19 tests are coming back positive—you may choose to scale back some of your activities, particularly as we learn more about Omicron and the severity of disease it may cause.

Hospitalization rates can also be useful, says Dr. Kelly Michelson, a pediatrician and bioethicist at the Northwestern University Feinberg School of Medicine. Case counts give a snapshot of COVID-19’s prevalence, which is particularly important information for unvaccinated or high-risk people for whom any exposure could be serious.

Meanwhile, if hospitalizations are so high that ICU beds are filling up in your area, you may decide to be more careful than normal—both to lessen burdens on the health care system and to avoid a worst-case scenario if you were unlucky enough to get seriously sick. But “if you’re a [vaccinated] person who’s healthier and you’re in an area where cases are going up but hospitals are fairly open, that’s a different calculus into what is reasonable to do,” Michelson says.

Know your own mind

However, there’s a limit to how far logical considerations like these go, says Petko Kusev, a professor of behavioral science at the U.K.’s University of Huddersfield who studies risk-taking and decision-making. While some people generally have higher risk tolerances than others, it’s not a fixed measure for anyone; your mood, surroundings, company and even hormones all influence your perception of risk and benefit from one moment to the next. So even if you think you’re making calculated decisions about what’s safe to do, you may be swayed by these factors more than you realize. “People are not really good computational creatures,” he says.

Humans also tend to “focus very little on the probability [of something actually happening] and much more on the [potential] negative outcome” of a decision, says Robyn Wilson, a professor of risk analysis and decision science at the Ohio State University. For example, plane crashes are extremely rare, but many people are terrified of flying because of how grisly occasional crashes are. Threats that are new or unknown also tend to make people avoid risk—highly relevant during the pandemic, when scary new developments are constant.

It is possible to be excessively risk averse, Wilson says. “You have to ask the question of, ‘What other harm is coming from that decision?’” she says. There aren’t many downsides to, say, getting takeout instead of dining inside a restaurant. But for bigger issues, like whether to stay isolated from loved ones or keep kids out of school, there are consequences worth considering, Wilson says.

To help with these difficult decisions, public health authorities should consistently issue clear, visual reminders about risk levels, what’s safe to do and how to protect others, Kusev says. Humans reach for “accessible” information when faced with difficult decisions, he explains. When it’s impossible to know everything—as it is when making almost any pandemic-related decision—we tend to latch onto the first compelling source of information we find, whether that’s the advice of experts or misinformation circulating on social media. For that reason, it’s crucial that science-based, credible information is easy to find and understand.

We’re not operating alone

For Elizabeth Lanphier, a medical ethicist at Cincinnati Children’s Hospital Medical Center, it all comes down to what feels like it’s worth the risk. Maybe a good friend’s wedding is, but a night out at a bar isn’t. “We’re all going to have different answers as to what is worth it,” she says. “As long as those don’t knowingly put other people at harm,” they can be helpful frameworks for hard decisions.

The tricky part is, even carefully made decisions can unknowingly put people at harm. The virus can spread asymptomatically, making it difficult to ever say with total confidence that we’re not contagious. Full vaccination, masking indoors and regular testing all reduce the chances of transmitting the disease, but there’s no such thing as a guarantee when the virus is still infecting more than 100,000 people in the U.S. every day and when Omicron seems particularly adept at outsmarting vaccines.

“We have obligations to participate in [a society] and think about others with whom we are interconnected,” Lanphier says. In other words, your own safety shouldn’t be the only measure of what to do right now. You should also consider burdens on local health care networks and the safety of people around you, particularly those who may not have a choice about how much they expose themselves to the virus, like frontline workers.

“It’s perfectly reasonable to go to the grocery store,” Lanphier says. “But we might say that there’s some obligation to wear a mask while you do so,” in the name of protecting other people in the store.

Getting vaccinated is the clearest way to help protect your community, Michelson says. In doing so, you lessen your chances of getting infected, which lowers the odds that you pass on the virus to someone near you.

So where does that leave those of us who have been vaccinated and are ready to get out into the world, but who still want to be good COVID citizens? “Live your life in a way that encompasses all the ammunition that we’ve gathered,” like masking, regular testing, monitoring community transmission and getting booster shots, Nanda says.

Personally, I’m committed to wearing masks in most public indoor spaces, taking regular tests and monitoring any potential symptoms to avoid infecting anyone else. Beyond that, I make decisions by weighing what is worth a risk.

Right now, fitness classes and dinners with friends feel worth it after missing these activities for so long. Weddings, holidays and family gatherings do, too. But for activities I don’t miss as much, like going to movie theaters and concerts, I feel fine sticking with Netflix and Spotify a bit longer.

It’s possible that Omicron will make me reevaluate my decision-making process in the weeks to come. Even now, I don’t know if these are the “right” decisions, or if anything can be reduced to a simple right-or-wrong anymore. We’re all doing the best we can with the information we have, filling in the gaps as we go.

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