I flew out to CA for a gig this weekend, and two of my kids came along. We got into SFO late Thursday night, drove to San Jose to sleep, and got to the gig on Friday. We took rapid tests, all negative. A late night, and the kids fell asleep backstage in the keyboard case:

Saturday morning one was mostly fine, but the other was sleepy ("jet lag"). She stayed sleepy all day, napping more backstage, and she wasn't eating much ("different food than she usually eats"). After choosing what food we should get for dinner she wouldn't eat it and was cranky ("seems more 'sick' than 'jet lag'"). Another rapid test [1] immediate positive:

So I'm 3,000 miles from home with two kids, one of which has the contagious disease everyone's spent the last three years avoiding. We're scheduled to check out by noon tomorrow, drive back to SFO, and take a red-eye home. What do I do?

Two options:

  • Isolate in place.
  • Fly home anyway.

Earlier in the pandemic this would have been a clear choice: isolate in place. It was required by public health order, and especially before vaccination traveling would have been too much risk to others and contribution to pandemic spread.

On the other hand, pre-covid I think almost everyone would have gone home. If you read advice it was mostly about how to decide whether to cancel a vacation or how to keep a sick kid comfortable on a plane. While there's some "if you're sick, don't fly", the examples were whether to begin a trip, not whether to return home. Discussion of "well enough to fly" was about whether you were up to it, not about risk to others. And of course there's no discussion of when you should wear a mask to protect others in the terminal or on the plane.

At this point, however, we are partway through a transition to treating covid as a normal disease. While the CDC recommendation is still not to fly, this was also what they recommended for people with similar illness pre-covid, and they recommend other things that most people aren't doing like masking when local covid levels are high. Airlines are back to charging change fees even with a positive test.

Isolating in place is at least four more days in CA, more if someone else gets sick (which did happen). Maybe six days in expectation? With flight change fees ($300), rental car extension ($400), and more days in the hotel ($600) this is $1,300+. Possibly we need a second room ($600) to separate the sick and well. Then there's dealing with food (probably delivery, more money) and work (with my wrist and neck issues this would need a more ergonomic setup than a laptop on a desk, so either more money or not working). It's possible, we could do it if we had to, but it's a lot.

I decided we'd fly home. We stayed as far away from others as possible in the terminals and kept our (K)N95s on the whole time—normally I let the kids take their masks off on the plane once the HEPA-filtered air is running and I've adjusted their blowers to 'full'. We got home Monday morning, and have been isolating since, including from each other.

Was this the right choice? I still don't know. I don't want to be a chump who expends inordinate effort to follow guidelines strictly when most of society has moved on, but there are also people still working very hard not to get covid who risk serious consequences if they were to get sick. [2] I'm not sure how to balance these, and the decision to come home rather than take on the logistics of isolating with kids in a far-off hotel was in part a selfish one. I'm writing this up not to encourage or discourage similar choices but to walk through how I was thinking about it and humanize a choice I expect some of you think was reckless and inconsiderate.


[1] There was nothing that required us to test here. If you'd told me in advance "if you get a positive you must isolate in place, but you can choose not to test" I likely would have chosen to wait to test until we were home, taking the same precautions described above until then.

[2] A rough calculation on the risk to others: imagine the person right in front of us on the plane is high risk, perhaps due to age, and really needs to not get sick. They're boosted and wearing an N95 to reduce their risk, but they're also three feet from someone with covid for five hours. How likely are we to get them sick? Using numbers from microcovid (which is generally much less useful than it was, but the best we have) I get that the risk of them catching covid is about 0.04% (390 microcovids).

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there are also people still working very hard not to get covid who risk serious consequences if they were to get sick

 

FWIW my partner is in this position, we have plans to fly for the first time since 2019 this March, and I am perfectly fine with your decision and decision-making process.

On [1], I'd say it's more prosocial to test as you did and travel anyway taking maximum precaution than to not test, because though you'd want to take maximum precaution it's harder without the clear confirm. 

On the general subject, I'll say that at this point I also prefer living in your world, traveling in a plane of people following your decision process. Most people have been vaccinated, most people have already had Covid, and afaik there are no particular strains on the medical system right now ? I don't particular fear being slightly exposed to Covid again. 

Thanks for this.  I don't think there's any way to make the decision and then call attention to it without encouraging others to do the same (unless you're pretty strongly regretful and/or condemned for it), but I also think that this kind of decision is a critical part of world-modeling, and having very specific examples and reasoning is important in understanding the opposing forces rather than having un-workable far-mode absolutes.

I'm fairly surprised to read this, as I continue to be surprised by the number of my friends and acquaintances who have flown home with COVID despite having the means not to. Every flight I've taken since the pandemic started, I've taken the time to game plan what would happen if I or someone in my party were to test positive during the trip. Did you not do this? On the scale of the incomes you have posted on your blog previously, $2000 or so is not very much.

And from the JetBlue policy you linked to, I guess you bought Basic Blue fares?

It seems like you chose to be your own insurance policy and then decided not to pay out.

Several airlines, at least as of a few months ago, required me to check a box confirming that I had not tested positive for COVID in some recent amount of time, or had a fever. Is this no longer the case, or did you choose to check that box?

Maybe the risk numbers make sense here, but planes/airports are one of the hardest places to avoid to be able to participate in society normally and I am surprised by your choice given all the other posts in which you seem exceedingly concerned about not spreading COVID.

Every flight I've taken since the pandemic started, I've taken the time to game plan what would happen if I or someone in my party were to test positive during the trip. Did you not do this?

I didn't, though I knew it was a possibility. I also didn't make game plans for "get in a car accident", "miss our flight", or "they lose our luggage".

On the scale of the incomes you have posted on your blog previously, $2000 or so is not very much.

I don't think of the money I earn as entirely mine, and my income has also recently dropped by about 4x due to switching careers.

But even then, it can't just be "if it would cost $X to reduce transmission by Y%, you should do it if you have $X" -- it matters how much X and Y are.

Several airlines, at least as of a few months ago, required me to check a box confirming that I had not tested positive for COVID in some recent amount of time, or had a fever. Is this no longer the case, or did you choose to check that box?

The airlines aren't asking this anymore. If they were I would have answered truthfully.

That they've stopped asking this is more information about how they view covid.

I am surprised by your choice given all the other posts in which you seem exceedingly concerned about not spreading COVID.

I was very concerned in 2020 about spreading covid: I thought it posed a high risk for some people and we needed to work together as a society to make sure they didn't get it. Changes since then include (a) vaccination, (b) availability of high quality masks, and (c) society mostly giving up on reducing spread. And so for the last year or so I've thought the amount of sacrifice people should make to reduce spread is much lower now.

I'm fully vaccinated and to my knowledge have never had covid. When flying, I would rather sit next to someone covid-positive who wears a well-fitted mask the entire trip than sit next to someone with some random non-covid cold or flu who's wearing no mask. Thank you for keeping your droplets to yourselves.

Correctly fitted masks have been state of the art for preventing respiratory infections since long before 2020, and it's been emergency response protocol to wear them around suspected contagious patients for a long time. Sadly, I can't take self-reported mask usage vs sickness data too seriously these days, because I see so many people wearing masks so ineffectively. Even now that they've become completely optional, I'm always amazed when I notice somebody walking around with a mask hanging under their nose or gapping several centimeters from their face.

As someone about to embark on a compulsory cross-country flight for work, I empathize with your decision process. Thanks for taking the time to write it out.

In your shoes, I would do as you've done. People who choose to travel implicitly accept risk, including the risk of exposure to people who choose not to protect themselves and those around them.

I was feeling the beginning of sickness (slight fever, runny nose, scratchy throat) while at the airport around a year ago when returning from a trip. I made the same decision you did: prioritized masking, distance where feasible, and getting home as quickly as possible instead of taking on ~$1k of hotels/food to wait until I was healthy. I think I made the right decision and agree with yours here.

It turned out I had the ordinary flu, not covid. I don't think the prosocial decision making is substantially different between the flu & covid at this point in time.

Were you at least able to able to avoid the medical-legal system's toll collecting/time wasting bullshit by going to a "test to treat" center and getting antivirals for everyone?  

Or at least the current sick?  The internet says you can just go to one of those "test to treat" centers, show that positive covid test, and boom, antivirals that will reduce your odds of all the negative events that covid can cause.  (even in young children)

I have heard differently, stories of someone showing up to the center and getting the usual runaround.  "well we don't have a pharmacist here right now so uh go away..."

We haven't done paxlovid; it's only approved for age 12+: https://www.yalemedicine.org/news/13-things-to-know-paxlovid-covid-19

I'm writing this up not to encourage or discourage similar choices but to walk through how I was thinking about it and humanize a choice I expect some of you think was reckless and inconsiderate.

I've never seen this phrase "humanize a choice" before. Nor has Google apparently, which returns only 1 prior instance across the entire internet.

What's the intended meaning?

This meaning is something like "showing the human factors behind a decision". It's generally used in cases where a choice might initially be hard to sympathize with until you understand how a person ended up in the situation and how they thought about it.

Searching [humanize the choice] and [humanize the decision] turn up a few more examples -- does that help?

After including all variants you listed plus a few others, there are still less than 100 total instances across the internet. So it seems very rarely used.

Possibly because it could get confused with 'humanize' as 'human-ize', which wouldn't make sense.  As choices, decisions, etc., don't have an independent existence. 

 "humane-ize" would be the more sensible reading:

humane
: marked by compassion, sympathy, or consideration for humans or animals

humane prison guards

a more humane way of treating farm animals

: characterized by or tending to broad humanistic culture : HUMANISTIC

humane studies

i.e. 'making a choice with/having compassion, sympathy, or consideration for humans or animals'

Yet the implications still differ somewhat from "showing the human factors behind a decision". Considering your intended meaning I think this is one of those cases where shortening a phrase increases ambiguity too much.

I think he was asking the reader to empathize with his choice in life. Life is about survival. Survival is about coping. There are a lot of different ways people cope with existence, striving for good career, high status and money, having children to make life seem less lonely, go find people to socialize and people who can empathize with you when you are depressed. Because of COVID, a lot of people have to cope harder now. Having to cope harder makes coping not as effective as they used to be. "Humanize a choice" means "Please be empathetic with my choice during this dire times."

If respirators are widely available (even in the absence of vaccines), the responsibility for protection (especially for voluntary activities) falls on the person that doesn't want to get infected.

If someone wants to protect others, they should wear ventless (or vented-but-filtered) respirators. Non-respirator masks provide little to no protection.

Hmm.  If we’re in a world of completely individualized responsibility for avoiding illness by masking (or not, and dealing with the consequences), then it’s completely unacceptable for society at large to ever force an individual to mask or not (e.g. TSA checkpoints are an obviously relevant sticking point for flying).  Can’t have it both ways.

If there were no reasonable ways (e.g., lack of respirators and/or vaccines) for an individual to protect themselves against covid, society could force everyone to protect individuals. The only reason why mask mandates (and associated NPIs) were ever a thing was that there were no other reasonable ways of protecting against covid. Now, there are other reasonable ways of protecting against covid, and that's why mask mandates aren't a thing anymore.

I don’t see how that’s particularly responsive to anything that I said in my comment?

You seemed to be talking about mask mandates versus individual responsibility, and that's what I replied about. If you think my reply didn't address your comment, can you rephrase it or point out why you think my comment wasn't responsive?

I didn’t say anything about ever requiring anyone to wear a mask, and yet that’s the only topic that you addressed in your reply.

I think there are a lot more options than a simplistic binary between collectively forcing people to wear masks and individually forcing people to accept all responsibility for their own infection outcomes.  Those two positions aren’t even really points on a single dimension, because not all responsibility is enforced responsibility.  Indeed, the OP spends a fair number of words trying to discern their current unenforced responsibilities to others.

My comment was, loosely speaking, simply an informal proof by contradiction demonstrating that our society is not in fact currently and effectively aligned with your asserted state of the world.  I started by granting your comment’s argument that making appropriate respirators available for sale in appropriate quantities means that individuals are expected to manage their risk of COVID infection without supporting interventions from the rest of society.  I then pointed out that there’s at least one clear-cut way that society currently falls short of this premise — people are not always free to choose whether they will wear or not wear a mask, and by definition one cannot be the sole responsible party for a decision they cannot decide.  Because something needs to change in order to enact your asserted state of the world, we know that this world state hasn’t been fully implemented yet — both sides of a contradiction can’t be simultaneously true.

I suspect we mostly agree about this, and the apparent disagreement was caused by a misunderstanding.

So, let me clarify: what I tried to say is that as long as individuals can protect themselves, there is no compelling reason for society to force others to protect individuals or for others to voluntarily protect individuals in those situations in which individuals can protect themselves (I probably should have been more explicit about this to avoid any confusion). For instance, if you need a root canal, you obviously can't protect yourself by wearing a respirator (and assuming that vaccines weren't effective), and dental staff should wear respirators and perhaps also increase ventilation. In the case of flying, individuals can protect themselves by using a respirator, and there would be no point in having anyone else mask up. Earlier in the pandemic, having everyone mask in most situations was a good policy at the societal and individual level, but now it's not for the reasons I've already mentioned.

It seems like you're treating "protect yourself" as binary, when it's not? If I wear a snug N95 I might lower my risk by ~6x. If I swap the N95 for a P100, maybe ~12x. If I also shaved, maybe ~32x. But 32x is still not ∞x, and if the people around me also mask then risk is lower than if only I mask.

Which is not to say that everyone should mask all the time. But I think your view of responsibility is too simple: it has to depend at least in part on the level of risk remaining after taking reasonable efforts to protect oneself.

In most situations (with some exceptions like going to the dentist) and for nearly everyone (with some exceptions like people living in a nursing home), the level of risk remaining after taking reasonable efforts to protect oneself seems miniscule.

We wore ventless N95s / KN95s

The masks in your photo don't look like respirators.

Also, KN95s aren't respirators.

The masks in the photo are KN95s. N95s aren't manufactured in child sizes.

I wore an N95, one kid wore a KN95, and the other switched to an N95 partway through the trip after we realized they fit her.

What's the idea behind KN95s not being respirators? Would you say an N95 isn't a respirator? A KF94?

Anything that has earloops (this includes most of the KN95s that I've seen and all KF94s) can't be a respirator, because it's nearly impossible to form a seal between the filter material and the face with the low amount of tension that earloops provide. There will be massive air leakage and the filtration efficiency will be much less than 95% (the minimum standard for most respirators), regardless of the filtration efficiency of the filter material itself.

For kids, options exist that are likely to be lot better than anything with earloops. Some KN95s do have head straps like N95s (but I've heard that a good seal is not easy to get around the nose due to the lack of a piece of foam which N95s often have). Kid-sized elastomeric respirator-like facepieces (like the Flo Mask and Aria 19) exist and some have been "tested to" N95 or higher standards (but not officially approved by any standards body, AFAIK). A PAPR that can fit anyone can be DIYed. Although it isn't officially approved by any standards body either AFAIK, the seals and filtering material can be verified by the person that's DIYing it.

What you say makes sense, but it isn't how other people use the term. For example, the CDC says:

The information on this page is about N95 respirators but also applies to international respirators, like KN95 respirators.

https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/types-of-masks.html#respirators

The CDC also says:

Most of these products have an ear loop design. NIOSH-approved N95s typically have head bands. Furthermore, limited assessment of ear loop designs, indicate difficulty achieving a proper fit. While filter efficiency shows how well the filter media performs, users must ensure a proper fit is achieved.

https://www.cdc.gov/niosh/npptl/respirators/testing/NonNIOSHresults.html

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