How We Made Our COVID-19 “Know Your Risk” Guide
Where Did This Idea Come From?
What Is This Not?
Exactly What Was Asked?
Who Are These Experts?
How Did You Gather the Physicians’ Opinions?
How Did You Analyze the Data?
Did the Experts Agree on their Rankings?
How Accurate Are These Numbers?
Why Didn’t You Rate ...?
More than 1 million people around the globe saw the Texas Medical Association’s “Know Your Risk During COVID-19” chart the past few days. The chart is intended as a guide, prepared by physician experts, to help people make smart and educated choices of activities to pursue amid the COVID-19 pandemic.
Over the holiday weekend, the chart appeared in media outlets from Ireland to India, from Ecuador to the Philippines. It has been unofficially translated into Arabic, Spanish, and Italian.
On Facebook, Twitter, Instagram, and via email, many people wrote TMA asking for specifics on how the guide was constructed. This document, undertaken with full transparency, is an attempt to answer those questions.
Where Did This Idea Come From?
During the June 26 meeting of the TMA COVID-19 Task Force one of the members shared a risk chart she had seen online. A Michigan news outlet created it sometime in May by asking four public health experts to rate 36 different activities from 1 (least risky) to 10 (riskiest). The Task Force (and later, the TMA Committee on Infectious Diseases) was tasked with providing their expert opinions to create a similar chart to guide Texans on how to assess their potential risk during daily activities.
The selected list of activities to rate was derived initially from the Michigan list, with modifications based on common summertime activities for Texans.
What Is This Not?
The chart is based on the expert opinions of 14 Texas physicians (more details below) of the relative risk of contracting COVID-19 from participating in various common activities.
This is not a study of the actual risk from participating in these activities based on data collected from individuals and their exposure to COVID-19. While such a study would prove extremely useful moving forward, that was not the intent of this project. TMA asked the physician experts to apply the current scientific understanding of how COVID-19 spreads to common activities Texans undertake every day. The association wanted something that could help Texans make informed choices now, when many parts of the state are seeing huge increases in confirmed COVID-19 cases and hospitalizations.
Exactly What Was Asked?
Below is the language in the email sent to the physician participants:
As per the discussions in the TMA COVID-19 Task Force and Committee on Infectious Diseases this week, I am asking you to help TMA create a “risk index” document for the general public.
To help Texans make informed choices of activities to undertake amid the COVID-19 pandemic, TMA is asking members of the task force and the committee – our infectious disease experts -- to rank the "riskiness" of a number of activities.
Please assign a risk of 1 (least risk) to 10 (riskiest) to each of these activities using the following criteria: Whether it’s inside or outside; proximity to others; exposure time; likelihood of compliance; and personal risk level. Please assume that participants in these activities are following currently recommended safety protocols when possible.
For any of these activities, if you have some insight about what would make it less risky or more risky, please leave it in the comments box.
(The underlined paragraph contains the specific directions the physicians were asked to follow in rating each of the 38 activities under consideration.)
Here is a screen shot of the beginning of the evaluation tool:
Who Are These Experts?
Members of the TMA COVID-19 Task Force and the TMA Committee on Infectious Diseases were invited to rate the activities. These are some of Texas’ leading experts in epidemiology, public health, and infectious diseases.
The Task Force members were appointed in March by the TMA Board of Trustees to “help Texas physicians prepare their practices to protect and treat their patients in the event of a community outbreak of the 2019 novel coronavirus.” The Task Force chair, Wendy Chung, MD, is chief epidemiologist at Dallas County Health and Human Services. The group includes a former commissioner of the Texas Department of State Health Services (Dr. Lakey), and a former medical director at the Dallas County Health Department and current member of the American Medical Association Council on Science and Public Health (Dr. Carlo).
The TMA Committee on Infectious Diseases is a 12-member group whose mission is to “educate the profession and public on the prevalence, detection, diagnosis, and treatment of infectious diseases, including HIV, tuberculosis, and sexually transmitted diseases, [and] monitor legislation regarding infectious diseases.” The committee chair is Thomas Kaspar, MD, a board-certified infectious disease specialist practicing in Victoria, Texas, who is also a member of the TMA COVID-19 Task Force. The committee members all have extensive training and experience in infectious diseases.
How Did You Gather the Physicians’ Opinions?
Using the Qualtrics survey platform, each of the activities was listed following the format shown in the screen shot above. The presentation of the activities was randomized to cancel out any effect order might have. The email shown above was sent to the 23 unique members of the TMA COVID-19 Task Force and the Committee on Infectious Diseases. Responses were collected from June 25-29, 2020. A total of 14 replies were received.
How Did You Analyze the Data?
Using Excel, the average rating was computed for each of the activities listed. The averages were rounded to the nearest whole number and sorted from lowest to highest.
Did the Experts Agree on their Rankings?
Although respondents were asked to assume participants were following all recommended precautions, the physician experts were clear that many factors influence the risk of each activity. While the average ranking is a helpful starting place to understand risk, as always, the reality is “it depends.”
On most activities, the experts’ rankings clustered together. More divergent rankings stemmed from varying assumptions made about the activity, which are reflected in the comments the participants made concerning those activities. For example:
• Visiting an elderly friend or relative in their home:
o The risk all depends on where they have been.
o You may be more risk to them than they to you.
o Wear a mask and maintain social distance.
• Spending an hour at a playground:
o If others are there, this is risky.
o 3 if masked and distanced; otherwise 8.
How Accurate Are These Numbers?
This is not a scientific study and the rankings should not be interpreted as absolute risk of participating in an activity. More weight should be put on the groupings and an activity’s relative position on the chart than on the numbers. The closer together two activities are, the more similar their risk is; the further apart, the more different.
This chart shows that certain activities are different in risk, but it does not tell us precisely how much. Something rated a “5” – like having dinner at someone else’s house – is not necessarily five times as risky as the lone item rated a “1” – opening the mail but it is a riskier activity in general.
Why Didn’t You Rate ...?
TMA received many such questions on social media. Some were driven by current events (riots and protests), some by mere curiosity or profession (massages), and some by geography (cricket).
In general, TMA selected activities that many Texans might commonly be engaged in during the summer. To approximate the relative risk of an activity that is not on the list, one could select a rated activity that is similar in terms of the criteria the physician experts used:
• Whether it’s inside or outside;
• Proximity to others;
• Exposure time;
• Likelihood of compliance with public health recommendations; and
• Personal risk level.
Also, please assume that participants in these activities are following currently recommended safety protocols such as wearing a face covering and social distancing at least six feet when appropriate.
= new reply since forum marked as read
