To Go or Not to Go

How Not To Hurt My In-laws This Thanksgiving

Lately, as I walk around New York City, I feel as though I am embodying a walking contradiction.

On one hand, by day, I work for the largest health and healthcare foundation in the country. I know the unequivocal personal and public health benefits of wearing marks, practicing physical distancing and avoiding crowds — particularly as weather changes and flu season rolls in.

On the other hand, I’m a person who craves community and diversity of opinions and experiences. I’m a mother, wife, sister, daughter, and friend. I long to be out and part of their lives and the world.

So, like all of us, I’ve had to try to resolve these contradictions — not at the abstract level — but in everyday concrete decisions. Do I send my kids to school in person or choose the remote option? Do I let my kids play soccer? Do I spend an extra hour in the car picking my husband up from work or do I let him take the subway? Do I have dinner with friends? Do I visit my father? Do I let my children trick-or-treat? And most recently, do I go to my in-laws’ home for Thanksgiving?

Each of these decisions is an exercise in risk assessment. A subconscious mental calculation where I have to process a myriad of inputs to inform a binary decision — do I or don’t I?

As I said, I crave a diversity of opinions and, in addition to reading, listening and wearing out my friends and colleagues in endless discussions, I reached out to an expert on decision making. Brie Linkenhoker, founder of Worldview Studio. She is a behavioral scientist whose work is rooted in how we think about and manage uncertainty in our lives and work. Below are highlights from our conversation that may help as you look to mitigate risks during these challenging situations.

The Context:

Brie first reminded me that even people who respect science don’t make decisions based on science alone. We all have competing values and priorities that we weigh as we make decisions. A simple example of this. A few weeks ago, I was chaperoning the scooter carpool to soccer practice. When I hit the street, I realized I had forgotten to grab my mask as I left my apartment. I realized it because it felt weird because I always wear a mask outside of my apartment. I proceeded without a mask because, I reasoned, “I’ll be scootering outside and not within six feet of people.” What I neglected to consider was the value I place on conformity and my identity as someone who wears a mask. I felt judged by my fellow mask wearing New Yorkers during the entirety of the 20 minute round trip — causing me to regret my decision.

In our wide ranging conversation, Brie also explained that others may disregard or minimize anticipated risk for different reasons beyond contradicting values. For example, fatalism (e.g. whether I get this is beyond my control) may limit precaution efforts. The concept of scarcity (reduced mental bandwidth to process risk of infection vs. other concerns — like economic ones) may cause us to lower our guard. Recency bias (you know someone who was very sick with COVID-19 or worse yet died from it) may heighten perceived risk. And, of course, social norms, which vary from place to place, impact how we behave out in public (i.e. if everyone arounds you wears a mask, you do as well. Conversely, if everyone around you is getting together for not- so-physically-distanced drinks, you may be more tempted to accept an invitation to do the same.) It is also worth noting that there is variation in people’s ability to control their decisions. There are those who would make a decision to stay home in the interests of promoting health who find themselves powerless to make the choice not to go to work.

In short, these complicated calculations of the human mind are not simple, or even just complicated. They are complex. Instead of adding numbers we must subtract our biases. A 2x2 matrix doesn’t work here and Pros and Cons lists are less helpful when we are dealing with imperfect information and uncertain probabilities. And that uncertainty makes the complex decisions even harder.

Also, everyone has different parameters. Rather than assuming that there is one answer, we must appreciate that everyone’s calculations are different.

The Tools:

Fortunately there are tools that can help us better understand our risks and inform our calculations.

One simple example that Brie pointed to was the presence of a common explanatory metaphor. Early in the pandemic we rallied behind the idea of “flattening the curve.” It gave us a shared purpose by which we could frame our individual choices. As we move forward, is there a new metaphor that can capture your approach to risk as an individual, a family, or even as a country?

Lacking an overarching metaphor, pre-commitments are also helpful. Rather than having to make constant individual calculations, you instead assert very specific rules that govern your decisions (e.g. we do not do eat inside restaurants.) These firm rules simplify your calculations because you’ve created a constant, uncompromising position.

Sometimes, though, asking ourselves to always follow the rules is unrealistic. Conditions can often be a more realistic intervention than absolute and inflexible guidance (i.e. sex education and birth control have proven more effective in decreasing unwanted pregnancy than abstinence education.) Inspired by geometric proofs, the “If/Then” statement allows us to consider the different ways that the risk in a situation can be reduced by certain conditions. For example, “If I am going to meet a friend for coffee, then we are going to do it outside and we will be walking.” These conditions provide us with contingencies and a more flexible framework for decision making, while also increasing our individual agency.

Another form of risk mitigation comes from the attestations that are asked of us or that we ask of others. I’m sure many of you, like me, have had to fill out daily forms confirming that you or your child is free from symptoms before going to school or soccer practice. Attestations can add confidence to our decision making process when we know that others are abiding by the same rules, and counting on us to be honest.

And speaking of honesty, perhaps the most powerful tool is acknowledgment. Our decisions are not made in isolation. If we’ve learned anything from COVID-19, it is that we are all intricately connected. Our decisions impact other people. If we don’t wear masks, we put others in physical danger. If we decide not to hang out with someone who is lonely, then do we cause unintended emotional harm. We need to acknowledge both the health risks of our behaviors and the emotional difficulty of our decisions when trying to minimize those risks.

The Decision:

So how does this all add up when it comes to us making everyday decisions and risks related to COVID-19?

Rather than answering this in the abstract, let me share the concrete example as it relates to my Thanksgiving dilemma. Now you may be wondering why am I even asking this question. Dr. Anthony Fauci and other public health officials have repeatedly asked us to be extra careful during the holidays. Yet here I am still trying to process conflicting values and information — much like so many other people.

You see, Thanksgiving is my husband’s favorite holiday. It is close to Diwali, an important religious holiday for our family, and in years past, we have celebrated both holidays together. It’s not just a holiday weekend for our family, it’s the holiday weekend. So I have conflicted values over a desire to follow rules (don’t gather) and to please my family (go to my in-laws).

I also have a job at a health foundation, that means that my decisions may be judged by my colleagues, and friends and relatives may look to what I do for Thanksgiving as a potential signal for what they can do also.

Here are the tools I’m using to help inform my decision.

• Pre-commitments. We don’t gather inside. We don’t take overnight trips. We don’t touch/share things with our hands. We don’t get together with groups of ten or more people. We don’t hug. We wear masks when we aren’t eating. If these pre-commitments aren’t met, then Turkey Day at the in-laws is not possible.
• Attestations. We all confirm that we don’t have any symptoms. We all take a PCR test before coming. We all confirm that we’ve self-isolated before and after waiting for results. This increases the likelihood that we might attend as it creates shared confidence in the safety of the gathering.
• Conditions. If we go, then we must sit on opposite ends of the table. If we go, then there is only one person serving food. If we go, we will use disposable plates and utensils. If the weather prohibits us from eating outside, then we can’t go. If infection rates rise to unacceptable levels in either of our counties, then we stay home. These conditions set clear boundaries that increase safety and understanding.
• Acknowledgements. The most important thing I can do is to have a direct conversation with everyone involved — my husband, my kids, my in-laws. We are all trying to make our own calculations with different inputs and formulas. Collectively, it’s important to acknowledge that our various values, biases and risk calculations may be different from each other. And that’s ok. Hopefully we’re able to make a decision that everyone can live with. If not, at least we better understand where everyone is coming from.

Ultimately, I don’t want to hurt my family’s feelings regarding whether we do or do not get together on Thanksgiving. But more importantly I don’t want to HURT my family. Stories of unintended COVID-19 deaths related to weddings and family gatherings should give us all pause. `

Our holidays should not be super spreaders of disease but super spreaders of compassion and understanding.

Which brings me back to the appeal of a common explanatory metaphor. As someone steeped in health and health care, perhaps I wish I could treat Thanksgiving (and similar decisions) the way a doctor may treat her patient. Beginning with the original Hippocratic principle of “do no harm.”

I wrote most of this post a few days ago. Today, I write a different ending than I would have if I had finished this yesterday. It turns out that the do no harm metaphor works for my family! Taking into consideration the current conditions, and after a meaningful exchange of opinions, we’ve ultimately decided to celebrate together but at three different tables — one in New York City, one in Glen Rock, New Jersey and one in Mahwah, New Jersey. As one family member summed up our final calculation, “It should be grand. Most importantly all should be safe, comfortable and not worried at all.”

May you and your family’s calculations yield equally grand results.