Everyone Plays a Part in Keeping Health System Strong


I was on the phone recently with my 28 year-old daughter who lives in the Boston area. I asked her what she was feeling down there related to novel coronavirus or COVID-19.  She said she thought that it seemed like people were going “over the top” with responses. They had just closed the schools in her town after a single confirmed case.  “Isn’t this not much more than a bad flu?,” she asked.  But I realized that many people are thinking and feeling this way – especially younger, healthier people.  On the one hand we are hearing that the health risks to us and our families are low and not to panic.  On the other hand government driven public health actions seem very at odds with that idea. How to explain this seeming contradiction? The answer comes down to the difference between Individual Risk and Systemic Risk. Let’s make up some numbers to explain.

Individual risk is the risk that something bad will happen to an individual.  Imagine a person who has an individual risk of becoming very seriously ill over the next year of 1 in 10,000 (0.01%)  That is a small number and not one that most people would worry about. Now imagine that coronavirus doubles that individual risk.  Now that risk is 2 in 10,000 or 0.02%. When you double a small number, it is still a small number and still doesn’t sound very scary.

Systemic risk: Systemic risk is the risk that a system will fail due to some major event of catastrophe. In healthcare, one systemic risk is that our population needs more care than we can provide, in this case due to the demands of coronavirus. Our healthcare system is generally prepared to meet the total of everyone’s individual risk – but what happens to the system when everyone’s individual risk increases?

When we put in place public health measures like canceling big events, closing schools, limiting travel etc., the goal is to reduce systemic risk. If we can reduce the number of people that see their individual risk increase, we reduce the systemic risk. 

Over the next weeks and months, we may experience a variety of public health measures designed to protect our systems. We may see school closures, we may see event cancellations, we may see travel plans interrupted and we may see March Madness games played with no fans. We may be tempted to ignore or pooh pooh those measures because we are not worried about ourselves and our healthy families. We may be tempted to take individual risks because those risks don’t seem that big to us. We might say something like “I don’t care if I get this, I’m young and I’m healthy.” 

I am no longer young, but I am healthy. I tell myself I am less likely to get seriously ill than many my age or even younger.  But if thinking that way leads me to take risks, it is not only me that suffers. I need to remember that I am a critical part of our public health efforts. If I can minimize my risk, I can reduce our systemic risk. 

What can you do? Use the good resources out there like the CDC, New York Department of Health or the UVMHN website to stay informed. Do what you can to avoid this virus. Ask yourself a few questions. Do I really need to fly? Do I really need to go to that conference? Do I really need to go to that party? Do I really need to work even if I just feel a little sick?  Protect yourself, protect your family and protect our health care system.