It Hardly Ever Happens But Sometimes It Does

Last spring, about three months after my breast-cancer diagnosis and six weeks after my mastectomy, I received my “oncotype report,” the document that calculated my mortality risk. The report would give me the odds of being healthy for the next decade and help my doctors advise me on what to do next: would I need chemotherapy? Obviously, I waited for this report on tenterhooks.

The results, when I got them, made me jubilant. According to the oncotype report, I could escape the horrors of chemo. And the news got better from there. If I took the two types of hormone-suppressing medicine my doctor prescribed, my risk of distant recurrence within nine years was a minuscule and life-affirming 3 percent. This meant that I had a 97 percent chance of being totally fine, odds I would take to the bank any day of the week. I wrote in an essay for this magazine of my confidence that I would die of something else.

So you can imagine, perhaps, how strange it feels to have been sitting inside for the better part of ten weeks to shield myself from COVID-19 that carries a mortality risk that is either “considerably less than one percent,” as Dr. Anthony Fauci put it in March, or 1.3 percent, as a new study from the University of Washington found, or somewhere in between. Until March 16
I walked around with a 3 percent chance that my cancer will recur somewhere awful — in my liver or my bones or my brain — feeling bright and cocky about my future, and now I’m sitting indoors, gaining weight and losing track of the date and occasionally finding myself on my knees in the kitchen based on a far smaller risk whose precise parameters we do not know.

It’s hard to use risk data as a guide to life, especially when a new killer virus is on the loose. And I’m not saying I’ve got this nailed, this business of living with a number in my head: It took a long time, and a lot of long sessions with an invisible entity (let’s call it Fate) and middle-of-night accountings of expectations and hopes, not to mention a couple surgeries and countless visits with countless doctors — an ongoing fact of my life now — to get to this place, but honestly (and this is the truth), I was hardly thinking about my mortality anymore until the coronavirus came to town. And now this process, this normalization of relative risk, has become our national pastime as we face reopening and calibrate and recalibrate daily, hourly, how much risk we can tolerate — on behalf of ourselves and the people we love, yes, but also how comfortable we feel presenting ourselves as a possible risk to someone else. What’s okay, today, this minute? And with whom? A walk, a run, a picnic outside? A camping trip? A kids’ sleepover? A trip to the takeout window at the bar?

This risk fog is made denser and harder to see through by a science-denying federal government that minimizes the dangers of COVID-19 while encouraging (on the one hand) sham cures and (on the other) local contagion, thus increasing the odds of more needless death both from the virus and from untreated other illnesses and poverty. And this magical thinking is amplified by a population that demonstrates a growing willingness (on the right and on the left) to follow “personal beliefs” and intuitions about risk rather than to try to understand it in an empirical way. (Is anyone as worried as I am about the outsize influence of the vaccine deniers in the event that a working vaccine is developed?) And then there is the matter of how you look at it, at the individual risk level or the population level, assessing danger to yourself or the danger you represent to others. A smaller-than-one-percent fatality risk may feel like a shrug, but 100,000 needless and contemporaneous deaths in the U.S. feels like war. And even when focused narrowly on oneself and one’s family, it’s hard to assess a low-risk probability because the risk isn’t distributed evenly. Death rates among kids are vanishingly small, yet a small number of kids have died in terrifying ways. Older people are most at risk — a third of U.S. deaths have been in nursing homes — but many seniors also do fine, while some young athletes with no underlying conditions have died on ventilators in hospitals alone. Talk about odds to the family of the person who was hit by a bus or struck by lightning or felled by a rare and fatal cancer: It hardly ever happens, but sometimes it does. And at the same time, we have to work, and meet up, and have sex, and raise our children. Those children have to go to school. We have to work with the numbers and live.

And yet it’s so tempting to look away from them. Look no further than the current presidential race. At 77, Joe Biden has a more than 4 percent probability of dying within a year, according to the Social Security Administration’s actuarial tables. At 73, Donald Trump has a 3 percent chance — but at 243 pounds (if his doctor is telling the truth), he also falls into the medical category “obese,” a condition that increases his vulnerability to “all causes of death,” according to the CDC. In other words, the likelihood of either one of these men dying before next Father’s Day is far, far higher than that of the average American dying of COVID-19. And yet here we all are sheltering in place while these mortals lead us into a terrifying future. (Is it too much to raise Bernie Sanders’s inexplicable ambition here, when, at 78 and having survived a heart attack, his chance of dying within a year is one in four?)

It’s normal for young people to be blind to risk — in hipster Brooklyn on beautiful weekends, young people defy quarantine and throng the streets — as was I long before I ever got cancer. In my youth, I took stupid risks, starting with the sex and drinking kind (I was lucky to have escaped mostly unmolested: Nearly one in five American women are survivors of rape, and most rapes happen before age 25), but also drunk driving, both as the driver and the passenger (28 percent of all traffic deaths involve alcohol); night swimming (drowning is the seventh leading cause of death for people between 15 and 24 years old); failure to wear sunscreen (even though regular use of SPF 15 or higher reduces the risk of squamous-cell cancer by 40 percent), and hitchhiking (though according to this article, falling carries a greater fatality risk). In those years, I had friends who loved skydiving (one in about 100,000 fatality risk), bungee jumping (one in 500,000), and rock climbing (one in 1,750), but these were not my cup of tea. My preference was for slower-speed adventures — some far more dangerous than I knew. My friends and I took backpacking vacations, clueless that one in 15,700 people die in the backcountry every year. My brother and I took a memorable canoeing trip in the Boundary Waters, encountering loon and moose and bald eagles. We ate fish we caught in clear cold lakes. It never occurred to me that I was risking my life, though the probability of death from canoeing is surprisingly high: one in 10,000. But despite all this risk-taking and all the fear and the horror, it’s also true that young people feel immortal because, in a way, they are. The chance of a 25-year-old woman dying within a year, according to those same actuarial tables, is so small you need a microscope to see it: .06 percent.

Parenthood cured me of my disinterest in risk, probably because my fear of death became real. Having fulfilled my evolutionary destiny, mortality came unmistakably into view, both inevitable and — it was obvious to me now — a thing to prevent or delay for as long as possible. I began working to reduce my chances of death in small, meaningful ways: buckling my seat belt in taxi cabs (in New York City, on a typical winter afternoon, there are about 200 accidents involving taxis), crossing at crosswalks after looking both ways (pedestrian deaths nationwide have risen 50 percent in the past decade), and holding myself to a relatively strict two-drink maximum (liver damage, heart disease, brain damage, and certain cancers are linked to excessive drinking in women).

Mostly these adjustments were sensible responses to actual risks, though I confess to retaining a germ of irrational death panic. Until I became a parent, I loved airplane travel. I flew whenever I could — for work, for fun — relishing that feeling of being untethered and soaring, of starting here and landing there simply because I wanted to and could. But I had air tickets to fly on 9/11, our daughter was born two years later, and now, even though I know in my mind that the chances of dying in a commercial airliner are so small they’re impossible to calculate, going to the airport, especially when separated from my family, fills me with dread. And even though I am well into my 50s, I never swim in the ocean without imagining a shark attack. I once knew a man who was actually attacked by a shark, seized in the big fish’s jaws and shaken around — this was how he told the story — like a rag in the mouth of a dog, until he lay unconscious on the beach waiting for a helicopter evacuation. So even though the chance of being killed by a shark is one in 264 million, the fact that it almost happened to someone I knew makes the possibility more real. The doctors I know who have seen COVID-19 deaths up close are the most cautious among my acquaintances about reopening. Not only are they better at interpreting data than most — they’ve seen the horror-movie versions of this disease up close, and they know how little they can do.

I never, ever, worried about germs or infectious disease — even though before the pandemic, more than 55,000 people would die from flu and pneumonia in the U.S. each year. Possibly this was because my scientist father is a virologist. From a very young age, I knew that “coronavirus” meant a family of illnesses that included the common cold and that getting sick is how your body learns to get better: in my childhood home, we talked about “healthy dirt”; for the common colds and flus of childhood, my father would prescribe aspirin, TLC, and “plenty of fluids.” We received our vaccinations in full and on schedule, a rite that was treated with the same proud and patriotic reverence as a visit to the voting booth. And so I never went in for unproven cures — the supplements, the diet regimens, the homeopathy and body-work fads that have appealed to so many of my friends. I exercised regularly and ate my veggies (heart disease kills nearly 650,000 people each year), put my faith in science — in evidence — and forged ahead.

Even though I’m of Ashkenazi Jewish descent (one in 40 of us carry a dangerous mutation that increases our risk of breast cancer), breast cancer wasn’t even on my radar. I worried about colon cancer because that’s what my mother died of. (A first-degree relative with colon cancer doubles your risk.) The women in my family were afflicted with Alzheimer’s and osteoporosis, not breast cancer, and these risks I felt I could kick down the road. So I went to my mammograms in the same mood, approximately, that I visited the tax accountant: an annual necessity that caused temporary apprehension that was readily forgotten about until the next year. As it turned out, I didn’t have the Jewish breast-cancer gene, but I got the breast cancer anyway.

A recent prepublication study from Stanford University called the mortality risk from COVID-19 for a person younger than 65 with no underlying conditions “remarkably uncommon” and compared the risk to a long commute. Now, as a city dweller who hasn’t owned a car in more than 30 years, I am terrified of driving, but most people are not. Most Americans get in their cars and drive on average 30 miles a day without thinking much about risk to life. We eat and sleep in our cars; we take other people’s children into our cars and allow our children to ride in theirs. And yet — very much like COVID-19 — I put my life in the hands of strangers (who are drunk, distracted, speeding, fighting with their spouse, looking for an earbud between the seats) every time I get into a vehicle. Car accidents are a leading cause of death in America, killing about 36,000 people a year. Every person in the country has about a one-in-100 lifetime risk of dying in an encounter with a car. Pedestrian deaths are on the rise — 124 pedestrians (and 28 cyclists) were killed by automobiles in New York City last year owing to inattention, failing to yield, and speeding.

My teenager is staying mostly indoors these days. But before the global pandemic, the thing I worried about more than anything else is that she would step off a curb while looking at her phone on her way home from school while a driver entered the crosswalk while looking at his phone. Part of my job as her parent was to remind her incessantly about this risk and to inform her to the point where she was sick of hearing my voice that she has to be responsible for her own health and safety, because the truth is you never know what stupid thing another person might do. This is a good metaphor for where we are now, as a country, facing the invisible contagious threat of COVID-19. What I wish for more than anything else is for her to be commuting to school again and for me to be learning the lesson that all parents must learn: that you have to teach kids how to educate and inform themselves. In order to keep them safe and be responsible to others, you have to do everything in your power to impress upon them the importance of this. And then you have to hope for the best.