It’s been two weeks since I wrote about COVID-19, and in that time the virus has extended from a handful of countries to over one hundred, from two cases in two states to over 400 cases in 35. And though those numbers still sound low, I urge you to calculate how many degrees of separation you are, RIGHT NOW, from someone who is quarantined (or should be). Here in Boston, most of us are at one or two.

Still, there’s a whole lotta this being shared:

The FLU kills thousands and so does heart disease and the whole country isn’t losing weight and buying Pelotons and most people will be fine or don’t even know they have it so why is THE MEDIA making everyone freak out and buy toilet paper to last until Christmas?

These arguments from exasperated acquaintances on social media are troubling me. The state of Costco shelves and price gouging of Purell tells us that a LOT of people are heeding warnings and preparing to hunker down. A candid picture from Teddy’s glee club performance (which should have been canceled, but we’ll get to that) caught a kid coughing into the crook of his arm. So maybe a little bit of hysteria is a good thing? I mean, for the first time in history, men are washing their hands after peeing? But there are plenty of articles, cable news talking heads, a sizable fraction of your Facebook friends (and occasionally our own political leaders) who insist this “hype” is overblown nonsense.

They’re wrong.

First, all of us should unearth our binders from favorite college professors and revisit the definition of false equivalence. Arguments comparing COVID-19 with other diseases—diseases that have vaccines and medicines and data and more history on the planet than a handful of months—are not valid. If we shouldn’t be overly concerned with COVID-19 because the flu also kills lots of people, does it follow that we can quit reminding women to get mammograms all of October because heart disease is actually more common? That’s how false equivalence arguments fail. Further, calling fear of a probable pandemic “hypocritical” when a person’s daily life does not already include safeguards against more common ailments is just unhelpful when it isn’t unkind. Finally, insisting this virus with a “low” mortality rate is not worthy of travel bans, event cancelations, and school closures entirely ignores a really enormous and valuable and loved set of people at real risk of dying.

The CDC put together this comparison to staunch flu-is-like-COVID-19 arguments… and why I’m worried about veteran teachers, grandparents, and most people in our church pews.

Since I wrote the last essay, my phone has been binging regularly with requests for advice. Bernie saw patients well beyond his office hours on Friday because everyone wanted his medical opinion on their travel plans and to discuss their relative risk. Should my parents come to the kids’ piano recitals? Should we go to Europe for Spring Break? Can I take the boys to the YMCA pool? Are you going to the PTA meeting? Can we go to the basketball game? Can we fly to Colorado to go skiing? The answer to all of these is no.

No no no no no.

COVID-19 isn’t a snowstorm. A rapidly spreading virus cannot be approached with the same sliced bread and bottled water hoarding preparation. We should not be trying to fit all of the activities in before it “really hits.” It’s here, people. Our churches, classrooms, stadiums, yoga studios, airplanes, and grocery stores are black ice. We’re already at risk because we failed to heed the warnings from Wuhan to be vigilant. I find this quote from Mike Leavitt, former Health and Human Services Secretary particularly poignant:

“Everything we do before a pandemic will seem alarmist. Everything we do after will seem inadequate.”

The only way to protect yourself and your family is with good hygiene, by limiting your errands to those where you can stay 6 feet away from people, or by just staying home. Is this impractical? Yes, for a lot of people. Yes, but it is also all we have. And kind of guessing that everything will be ok and this will just die out as the weather gets warmer isn’t really how viruses work. Behavior modification is the only way to prevent widespread dissemination of a disease that could kill a significant number of our cancer patients, grandparents, disabled friends, and asthmatics. If you can afford to miss things—especially if you are over 60 and/or have other health issues—please do that. Stay home. Your pets will love you even more, and you’ll stay healthy.

It should be telling that medical professionals are canceling meetings daily. Residency interviews are being held via Skype. Morbidity and mortality conferences are on hold. Faculty dinners are being rescheduled. As a division chief, every day Bernie has another cancellation to consider, and continually chooses to limit exposure. He passed on the Celtics game last night because he has cancer patients who are relying on him. We’re canceling our trip to London because those same patients will need to reschedule their operations (and caregiver and child care plans) should he get quarantined. It seems reasonable for an otherwise healthy person to risk COVID-19 exposure because for 80% of patients the course will be mild. But what if your exposure risk leaves you quarantined for two weeks? How many other people and their livelihood will be affected by your forced absence? And should you become infected, how many of your close contacts are people in the very high risk category? In that light, is the glee club choir assembly really worth it?

We should all be weighing what is “worth” the risk right now very heavily, especially if you have the luxury of opting out of things that, let’s face it, really aren’t all that critical. In lieu of any “herd immunity” to protect us (since none of us is immune), the best we can do for those of us who cannot afford to miss work or take public transportation right now is to reduce their exposure. Drive to Vermont to ski instead of flying to the Rockies. Videotape the piano recital. Watch the Celtics on TV. Not forever… just for now. We cannot discount the potential spread of COVID-19 as we would an exuberant StormWatch meteorologist tracking a Nor’Easter that could easily be just a dusting. COVID-19 is here, it’s spreading, and it only looks like a few scattered flurries now because we have yet to do any sort of adequate testing or data acquisition.

But there’s black ice out there, people. The WHO has listed its first objective to “interrupt human to human transmission…” so let’s help them do that when we can.